Search results for: antenatal care services

Authors: Ekeh Greg

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Learning has been part of human existence from time immemorial. The aim of every learning is to know the truth. In education, it is desirable that true knowledge is imparted and imbibed. For this to be achieved, there is need for honesty, in this context, academic honesty among students, especially in e-learning. This is an ethical issue since honesty bothers on human conduct. However, research findings have shown that academic honesty has remained a big challenge to online learners, especially among the university students. This is worrisome since the university education is the final education system and a gateway to life in the wider society after schooling. If they are practicing honesty in their academic life, it is likely that they will practice honesty in the in the society, thereby bringing positive contributions to the society wherever they find themselves. With this in mind, the significance of this study becomes obvious. On grounds of this significance, this paper focuses on strategies that are adjudged certain to enhance the practice of honesty in e-learning so as to enable learners to be well equipped to contribute to the society through honest ways. The aim of the paper is to contribute to the efforts of instilling the consciousness and practice of honesty in the minds and hearts of learners. This will, in turn, promote effective teaching and learning, academic high standard, competence and self-confidence in university education. Philosophical methods of conceptual analysis, clarification, description and prescription are adopted for the study. Philosophical perspective is chosen so as to ground the paper on the basis of rationality rather than emotional sentiments and biases emanating from cultural, religious and ethnic differences and orientations. Such sentiments and biases can becloud objective reasoning and sound judgment. A review of related literature is also carried out. The findings show that academic honesty in e-learning is a cherished value, but it is bedeviled by some challenges, such as care-free attitude on the part of students and absence of monitoring. The findings also show that despite the challenges facing academic honesty, strategies such as self-discipline, determination, hard work, imbibing ethical and philosophical principles, among others, can certainly enhance the practice of honesty in e-learning among university students. The paper, therefore, concludes that these constitute strategies for enhancing academic honesty among students. Consequently, it is suggested that instructors, school counsellors and other stakeholders should endeavour to see that students are helped to imbibe these strategies and put them into practice. Students themselves are enjoined to cherish honesty in their academic pursuit and avoid short-cuts. Short-cuts can only lead to mediocrity and incompetence on the part of the learners, which may have long adverse consequences, both on themselves and others.

Keywords: academic, ethical, philosophical, strategies

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Authors: Athena Pedro, Zandile Batweni, Laura Bradfield, Michael Dare, Ashley Nyman

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The rapid growth and development of an infant in the first 1000 days of life means that this time period provides the greatest opportunity for a positive developmental impact on a child’s life socially, emotionally, cognitively and physically. Current research is being focused on children in the first 1000 days, but there is a lack of research and understanding of mothers and their experiences during this crucial time period. Thus, it is imperative that more research is done to help better understand the experiences of mothers during the first 1000 days of their child’s life, as well as gain more insight into mothers’ knowledge regarding this time period. The first 1000 days of life, from conception to two years, is a critical period, and the child’s attachment to his or her mother or primary caregiver during this period is crucial for a multitude of future outcomes. The aim of this study was to explore mothers’ understanding and experience of the first 1000 days of their child’s life, specifically looking at attachment in the context of Bowlby and Ainsworths’ attachment theory. Using a qualitative methodological framework, data were collected through semi-structured individual interviews with 12 first-time mothers from low-income communities in Cape Town. Thematic analysis of the data revealed that mothers articulated the importance of attachment within the first 1000 days of life and shared experiences of how they bond and form attachment with their babies. Furthermore, these mothers expressed their belief in the long-term effects of early attachment of responsive positive parenting as well as the lasting effects of poor attachment and non-responsive parenting. This study has implications for new mothers and healthcare staff working with mothers of new-born babies, as well as for future contextual research. By gaining insight into the mothers’ experiences, policies and intervention efforts can be formulated in order to assist mothers during this time, which ultimately promote the healthy development of the nation’s children and future adult generation. If researchers are also able to understand the extent of mothers’ general knowledge regarding the first 1000 days and attachment, then there will be a better understanding of where there may be gaps in knowledge and thus, recommendations for effective and relevant intervention efforts may be provided. These interventions may increase knowledge and awareness of new mothers and health care workers at clinics and other service providers, creating a high impact on positive outcome. Thus, improving the developmental trajectory for many young babies allows them the opportunity to pursue optimal development by reaching their full potential.

Keywords: attachment, experience, first 1000 days, knowledge, mothers

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Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

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Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

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Authors: Gabrielle Brand, Christopher Etherton-Beer

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The learning landscape of higher education environment is changing, with an increased focus over the past decade on how educators might begin to cultivate reflective skills in health professions students. In addition, changing professional requirements demand that health professionals are adequately prepared to practice in today’s complex Australian health care systems, including responding to changing demographics of population ageing. To counteract a widespread perception of health professions students’ disinterest in caring for older persons, the authors will report on an exploratory, mixed method research study that used photographs, narrative and small group work to enhance medical and nursing students’ reflective learning experience. An innovative photo-elicitation technique and reflective questioning prompts were used to increase engagement, and challenge students to consider new perspectives (around ageing) by constructing shared storylines in small groups. The qualitative themes revealed how photographs, narratives and small group work created learning spaces for reflection whereby students could safely explore their own personal and professional values, beliefs and perspectives around ageing. By providing the space for reflection, the students reported how they found connection and meaning in their own learning through a process of self-exploration that often challenged their assumptions of both older people and themselves as future health professionals. By integrating cognitive and affective elements into the learning process, this research demonstrates the importance of embedding visual methodologies that enhance reflection and transformative learning. The findings highlight the importance of integrating the arts into predominantly empirically driven health professional curricula and can be used as a catalyst for individual and/or collective reflection which can potentially enhance empathy, insight and understanding of the lived experiences of older patients. Based on these findings, the authors have developed ‘Depth of Field: Exploring Ageing’ an innovative, interprofessional, digital reflective learning resource that uses Prezi Inc. software (storytelling tool that presents ideas on a virtual canvas) to enhance students’ reflective capacity in the higher education environment.

Keywords: narrative, photo-elicitation, reflective learning, qualitative research

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Authors: Comsun Thongchai, Vorapoj Promasatayaprot

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Background: Child development center is a day care center that gathers large numbers of children in the same areas. As a result, it provides high opportunity for infection, especially gastrointestinal and respiratory infections. Ubon Ratchathani has been a province with an increasing number of cases of Hand foot and mouth disease each year reported between 2014 and 2016. Accorded to a recent investigation reported, HFMD occurred in the Child Development Center and kindergartens, this was a place where HFMD spreads. This research was aimed to investigate the knowledge, attitude and behavior about hand foot and mouth disease preventing of child caregivers in child development centers, Ubon Ratchathani Province. Method: Descriptive study was conducted between April and July, 2017. The study instruments used questionnaires and in-depth interviews on their practices of prevention and environment management of HFMD. The samples of survey questionnaires were caregivers who are working in 160 child development centers of the 160 parishes in Ubon Ratchathani province. The data was analyzed by percentages, means and standard deviations and Pearson Product Moment Correlation Coefficient. Result: The results showed that the majority were female (96.3%), average age 41 years (68.3%), marital status were couples (85.7%) and studied in undergraduate (75.2%). with a period of performance as teachers in child development centers range from 10 to 14 years were percentage 58.7 and 71.8 percent of them had been trained by health worker about the control HFMD. The knowledge for preventive in hand foot mouth disease on child caregivers was at high level. The mean score was 2.76 (S.D. = 0.114). The attitude of child caregivers was at a moderate level. Its mean score was 2.28 (S.D. = 0.247). On the other hand, the level of environmental management to prevent HFMD was low. The mean score was 1.34 (S.D. = 0.215). The factor of personal characteristics as gender, age, educational level, duration at work, knowledge and attitude of preventive HFMD was associated with Preventive of Behaviors to a statistically significant level (p<0.05 respectively). Conclusion: These results should be concerned to develop knowledge and improving practice for preventive hand foot mouth disease of child caregivers in child development centers by training. Preparation of media education, Surveillance of hand foot mouth disease and health behaviors promotion with community participation need to be supported continuously.

Keywords: preventive behavior, child development center, hand foot mouth disease, Thailand

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Authors: Zhaoxu Lu, Yufeng Ma, Linying Gao, Li Wang, Mei Qiang

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Mercury (Hg) is a well-recognized environmental pollutant known by its toxicity of development and neurotoxicity, which may result in adverse health outcomes. However, the mechanisms underlying the teratogenic effects of Hg are not well understood. Imprinting genes are emerging regulators for fetal development subject to environmental pollutants impacts. In this study, we examined the association between paternal preconception Hg exposures and the alteration of DNA methylation of imprinting genes in human sperm DNA. A total of 618 men aged from 22 to 59 was recruited from the Reproductive Medicine Clinic of Maternal and Child Care Service Center and the Urologic Surgery Clinic of Shanxi Academy of Medical Sciences during April 2015 and March 2016. Demographic information was collected using questionnaires. Urinary Hg concentrations were measured using a fully-automatic double-channel hydride generation atomic fluorescence spectrometer. And methylation status in the DMRs of imprinting genes H19, Meg3 and Peg3 of sperm DNA were examined by bisulfite pyrosequencing in 243 participants. Spearman’s rank and multivariate regression analysis were used for correlation analysis between sperm DNA methylation status of imprinting genes and urinary Hg levels. The median concentration of Hg for participants overall was 9.09μg/l (IQR: 5.54 - 12.52μg/l; range = 0 - 71.35μg/l); no significant difference was found in median concentrations of Hg among various demographic groups (p > 0.05). The proportion of samples that a beyond intoxication criterion (10μg/l) for urinary Hg was 42.6%. Spearman’s rank correlation analysis indicates a negative correlation between urinary Hg concentrations and average DNA methylation levels in the DMRs of imprinted genes H19 (rs=﹣0.330, p = 0.000). However, there was no such a correlation found in genes of Peg3 and Meg3. Further, we analyzed of correlation between methylation level at each CpG site of H19 and Hg level, the results showed that three out of 7 CpG sites on H19 DMR, namely CpG2 (rs =﹣0.138, p = 0.031), CpG4 (rs =﹣0.369, p = 0.000) and CpG6 (rs=﹣0.228, p = 0.000), demonstrated a significant negative correlation between methylation levels and the levels of urinary Hg. After adjusting age, smoking, drinking, intake of aquatic products and education by multivariate regression analysis, the results have shown a similar correlation. In summary, mercury nonoccupational environmental exposure in reproductive-aged men associated with altered DNA methylation outcomes at DMR of imprinting gene H19 in sperm, implicating the susceptibility of the developing sperm for environmental insults.

Keywords: epigenetics, genomic imprinting gene, DNA methylation, mercury, transgenerational effects, sperm

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Authors: Keneilwe Matlhaku

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Crosslinguistic studies (theoretical and clinical) have shown delays and significant misarticulation in the acquisition of the rhotics. This article provides a detailed analysis of the early development of the rhotic phoneme, an apical trill /r/, by monolingual Setswana (Tswana S30) children of age ranges between 1 and 4 years. The data display the following trends: (1) late acquisition of /r/; (2) a wide range of substitution patterns involving this phoneme (i.e., gliding, coronal stopping, affrication, deletion, lateralization, as well as, substitution to a dental and uvular fricative). The primary focus of the article is on the potential origins of these variations of /r/, even within the same language. Our data comprises naturalistic longitudinal audio recordings of 6 children (2 males and 4 females) whose speech was recorded in their homes over a period of 4 months with no or only minimal disruptions in their daily environments. Phon software (Rose et al. 2013; Rose & MacWhinney 2014) was used to carry out the orthographic and phonetic transcriptions of the children’s data. Phon also enabled the generation of the children’s phonological inventories for comparison with adult target IPA forms. We explain the children’s patterns through current models of phonological emergence (MacWhinney 2015) as well as McAllister Byun, Inkelas & Rose (2016); Rose et al., (2022), which highlight the perceptual and articulatory factors influencing the development of sounds and sound classes. We highlight how the substitution patterns observed in the data can be captured through a consideration of the auditory properties of the target speech sounds, combined with an understanding of the types of articulatory gestures involved in the production of these sounds. These considerations, in turn, highlight some of the most central aspects of the challenges faced by the child toward learning these auditory-articulatory mappings. We provide a cross-linguistic survey of the acquisition of rhotic consonants in a sample of related and unrelated languages in which we show that the variability and volatility in the substitution patterns of /r/ is also brought about by the properties of the children’s ambient languages. Beyond theoretical issues, this article sets an initial foundation for developing speech-language pathology materials and services for Setswana learning children, an emerging area of public service in Botswana.

Keywords: rhotic, apical trill, Phon, phonological emergence, auditory, articulatory, mapping

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Authors: Madeline Tagg, Choihoong Mui, Elizabeth Lek, Jide Menakaya

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Introduction: Simulation technology is used by neonatal teams to learn and refresh skills and gain the knowledge and confidence to care for sick neonates. In-situ simulation is considered superior to laboratory-based programmes as it closely mirrors real life situations. This study reports our experience of running regular laboratory-based simulation sessions for senior clinicians and nurses and its impact on their knowledge, skills and confidence. Methods: A before and after questionnaire survey was carried out on senior clinicians and nurses that attended a scheduled laboratory-based simulation session. Participants were asked to document their expectations before a 3-hour monthly laboratory programme started and invited to feedback their reflections at the end of the session. The session included discussion of relevant clinical guidelines, immersion in a scenario and video led debrief. The results of the survey were analysed in three skills based categories - improved, no change or a worsened experience. Results: 45 questionnaires were completed and analysed. Of these 25 (55%) were completed by consultants seven and six by nurses and trainee doctors respectively, and seven respondents were unknown. 40 (88%) rated the session overall and guideline review as good/excellent, 39 respondents (86%) rated the scenario session good/excellent and 40/45 fed back a good/excellent debrief session. 33 (73%) respondents completed the before and after questionnaire. 21/33 (63%) reflected an improved knowledge, skill or confidence in caring for sick new-bon babies, eight respondents reported no change and four fed back a worse experience after the session. Discussion: Most respondents found the laboratory based structured simulation session beneficial for their professional development. They valued equally the whole content of the programme such as guideline review and equipment training as well as the simulation and debrief sessions. Two out three participants stated their knowledge of caring for sick new-born babies had been transformed positively by the session. Sessions where simulation equipment failed or relevant staff were absent contributed to a poor educational experience. Summary: A regular structured laboratory-based simulation programme with a rich content is a credible educational resource for improving the knowledge, skills and confidence of senior clinicians caring for sick new born babies.

Keywords: knowledge, laboratory based, neonates, simulation

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Authors: Giovanni Duran Polo

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Demonstrate the importance of the stages such as Information, Diagnosis, Management, and Intervention is fundamental to have a historical, live, and quality inhabited center. One of the major actions to take is to promote the concept of the management of a historic center with harmonious development. For that, concerned actors should strengthen the concept that said historic center may be the neighborhood of all and for all. The centers of historical cities, presented as any other urban area, social, environmental issues etc; yet they get added value that have no other city neighborhoods. The equity component, either by the urban plan, or environmental quality offered properties of architectural, landscape or some land uses are the differentiating element, while the tool that makes them attractive face pressure exerted by new housing developments or shopping centers. That's why through the experience of working in historical centers, they are declared the actions in heritage areas. This paper will show how the encounter with each of these places are trying to take the phases of information, to gather all the data needed to be closer to the territory with specific data, diagnosis; which allowed the actors to see what state they were, felt how the heart is related to the rest of the city, show what problems affected the situation and what potential it had to compete in a global market. Also, to discuss the importance of the organization, as it is legal and normative basis for it have an order and a concept, when you know what can and what cannot, in an area where the citizen has many myth or history, when he wanted to intervene in protected buildings. It is also appropriate to show how it could develop the intervention phase, where the shares on the tangible elements and intervention for the protection of the heritage property are executed. The management is the final phase which will carry out all that was raised on paper, it's time to orient, explain, persuade, promote, and encourage citizens to take care of the heritage. It is profitable and also an obligation and it is not an insurmountable burden. It has to be said this is the time to pull all the cards to make the historical center and heritage becoming more alive today. It is the moment to make it more inhabited and to transformer it into a quality place, so citizens will cherish and understand the importance of such a place. Inhabited historical centers, endowments and equipment required, with trade quality, with constant cultural offer, with well-preserved buildings and tidy, modern and safe public spaces are always attractive for tourism, but first of all, the place should be conceived for citizens, otherwise everything will be doomed to failure.

Keywords: development, diagnosis, heritage historic center, intervention, management, patrimony

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Authors: Jamie Sundvall, Lisa Jennings

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Site based field internship learning (SBL) is an educational approach within a Master’s of Social Work (MSW) university field placement department that promotes a more streamlined approach to the integration of theory and evidence based practices for social work students. The SBL model is founded on research in the field, consideration of current work force needs, United States national trends of MSW graduate skill and knowledge deficits, educational trends in students pursing a master’s degree in social work, and current social problems that require unique problem solving skills. This study explores the use of site-based learning in a hybrid social work program. In this setting, site based learning pairs online education courses and social work field education to create training opportunities for social work students within their own community and cultural context. Students engage in coursework in an online setting with both synchronous and asynchronous features that facilitate development of core competencies for MSW students. Through the SBL model, students are then partnered with faculty in a virtual course room and a university vetted site within their community. The study explores how this model of learning creates community partnerships, through which students engage in a learning loop to develop social work skills, while preparing students to address current community, social, and global issues with the engagement of technology. The goal of SBL is to more effectively equip social work students for practice according to current workforce demands, provide access to education and care to populations who have limited access, and create self-sustainable partnerships. Further, the model helps students learn integration of evidence based practices and helps instructors more effectively teach integration of ethics into practice. The study found that the SBL model increases the influence and professional relevance of the social work profession, and ultimately facilitates stronger approaches to integrating theory into practice. Current implementation of the practice in the United States will be presented in the study. dditionally, future research conceptualization of SBL models will be presented, in order to collaborate on advancing best approaches of translating theory into practice, according to the current needs of the profession and needs of social work students.

Keywords: collaboration, fieldwork, research, site-based learning, technology

Procedia PDF Downloads 125

Authors: Lisa Bennett, Cynthia Walters, Cynthia Argani, Andy Satin, Geeta Sood, Kerri Huber, Lisa Grubb, Woodrow Noble, Melissa Eichelberger, Darlene Zinalabedini, Eric Ausby, Jeffrey Snyder, Kevin Kirchoff

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Background: Surgical site infections (SSIs) within the obstetric population pose a variety of complications, creating clinical and personal challenges for the new mother and her neonate during the postpartum period. Our journey to achieve compliance with the SSI core measure for cesarean sections revealed many opportunities to improve these outcomes. Objective: Achieve and sustain core measure compliance keeping surgical site infection rates below the national benchmark pooled mean of 1.8% in post-operative patients, who delivered via cesarean section at the Johns Hopkins Bayview Medical Center. Methods: A root cause analysis was performed and revealed several environmental, pharmacologic, and clinical practice opportunities for improvement. A multidisciplinary approach led by the OB Safety Nurse, OB Medical Director, and Infectious Disease Department resulted in the implementation of fourteen interventions over a twenty-month period. Interventions included: post-operative dressing changes, standardizing operating room attire, broadening pre-operative antibiotics, initiating vaginal preps, improving operating room terminal cleaning, testing air quality, and re-educating scrub technicians on technique. Results: Prior to the implementation of our interventions, the SSI quarterly rate in Obstetrics peaked at 6.10%. Although no single intervention resulted in dramatic improvement, after implementation of all fourteen interventions, the quarterly SSI rate has subsequently ranged from to 0.0% to 2.70%. Significance: Taking an introspective look at current practices can reveal opportunities for improvement which previously were not considered. Collectively the benefit of these interventions has shown a significant decrease in surgical site infection rates. The impact of this quality improvement project highlights the synergy created when members of the multidisciplinary team work in collaboration to improve patient safety, and achieve a high quality of care.

Keywords: cesarean section, surgical site infection, collaboration and teamwork, patient safety, quality improvement

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Authors: Ozcan Yavas, Berrak Erol Nalbur, Sermin Gunarslan

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A materiality matrix is a tool that organizations use to prioritize their activities and adapt to the increasing sustainability requirements in recent years. For the materiality index to move from business models to the sustainability business model stage, it must be done with all partners in the raw material, supply, production, product, and end-of-life product stages. Within the scope of this study, the Materiality Matrix was used to transform the business model into a sustainability business model and to create a sustainability roadmap in a factory producing electric buses. This matrix determines the necessary roadmap for all stakeholders to participate in the process, especially in sectors that produce sustainable products, such as the electric vehicle sector, and to act together with the cradle-to-cradle approach of sustainability roadmaps. Global Reporting Initiative analysis was used in the study conducted with 1150 stakeholders within the scope of the study, and 43 questions were asked to the stakeholders under the main headings of 'Legal Compliance Level,' 'Environmental Strategies,' 'Risk Management Activities,' 'Impact of Sustainability Activities on Products and Services,' 'Corporate Culture,' 'Responsible and Profitable Business Model Practices' and 'Achievements in Leading the Sector' and Economic, Governance, Environment, Social and Other. The results of the study aimed to include five 1st priority issues and four 2nd priority issues in the sustainability strategies of the organization in the short and medium term. When the studies carried out in the short term are evaluated in terms of Sustainability and Environmental Risk Management, it is seen that the studies are still limited to the level of legal legislation (60%) and individual studies in line with the strategies (20%). At the same time, the stakeholders expect the company to integrate sustainability activities into its business model within five years (35%) and to carry out projects to become the first company that comes to mind with its success leading the sector (20%). Another result obtained within the study's scope is identifying barriers to implementation. It is seen that the most critical obstacles identified by stakeholders with climate change and environmental impacts are financial deficiency and lack of infrastructure in the dissemination of sustainable products. These studies are critical for transitioning to sustainable business models for the electric vehicle sector to achieve the EU Green Deal and CBAM targets.

Keywords: sustainability business model, materiality matrix, electricity bus, carbon neutrality, sustainability management

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Authors: A. Olivi, P. Reyes Cabrera

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Ageing and urbanization are two of the main trends that characterize the twenty-first century. Its trending is especially accelerated in the emerging countries of Asia and Latin America. Chile is one of the countries in the Latin American region, where the demographic transition to ageing is becoming increasingly visible. The challenges that the new demographic scenario poses to urban administrators call for searching innovative solutions to maximize the functional and psycho-social benefits derived from the relationship between older people and the environment in which they live. Although mobility is central to people's everyday practices and social relationships, it is not distributed equitably. On the contrary, it can be considered another factor of inequality in our cities. Older people are a particularly sensitive and vulnerable group to mobility. In this context, based on the ageing in place strategy and following the social innovation approach within a spatial context, the "Community Observatory of Territorial Information Control and Management" project aims at the collective search and validation of solutions for the satisfaction of mobility and accessibility specific needs of urban aged people. Specifically, the Observatory intends to: i) promote the direct participation of the aged population in order to generate relevant information on the territorial situation and the satisfaction of the mobility needs of this group; ii) co-create dynamic and efficient mechanisms for the reporting and updating of territorial information; iii) increase the capacity of the local administration to plan and manage solutions to environmental problems at the neighborhood scale. Based on a participatory mapping methodology and on the application of digital technology, the Observatory designed and developed, together with aged people, a crowdsourcing platform for smartphones, called DIMEapp, for reporting environmental problems affecting mobility and accessibility. DIMEapp has been tested at a prototype level in two neighborhoods of the city of Valparaiso. The results achieved in the testing phase have shown high potential in order to i) contribute to establishing coordination mechanisms with the local government and the local community; ii) improve a local governance system that guides and regulates the allocation of goods and services destined to solve those problems.

Keywords: accessibility, ageing, city, digital technology, local governance

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Authors: Mikhail V. Khachaturyan, Inga A. Koryagina, Eugenia V. Klicheva

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In modern conditions, scientific judgment of problems in developing mechanisms of value creation and risk management acquires special relevance. Formation of economic knowledge has resulted in the constant analysis of consumer behavior for all players from national and world markets. Effective mechanisms development of the demand analysis, crucial for consumer's characteristics of future production, and the risks connected with the development of this production are the main objectives of control systems in modern conditions. The modern period of economic development is characterized by a high level of globalization of business and rigidity of competition. At the same time, the considerable share of new products and services costs has a non-material intellectual nature. The most successful in Russia is the contemporary development of small innovative firms. Such firms, through their unique technologies and new approaches to process management, which form the basis of their intellectual capital, can show flexibility and succeed in the market. As a rule, such enterprises should have very variable structure excluding the tough scheme of submission and demanding essentially new incentives for inclusion of personnel in innovative activity. Realization of similar structures, as well as a new approach to management, can be constructed based on value-oriented management which is directed to gradual change of consciousness of personnel and formation from groups of adherents included in the solution of the general innovative tasks. At the same time, valuable changes can gradually capture not only innovative firm staff, but also the structure of its corporate partners. Introduction of new technologies is the significant factor contributing to the development of new valuable imperatives and acceleration of the changing values systems of the organization. It relates to the fact that new technologies change the internal environment of the organization in a way that the old system of values becomes inefficient in new conditions. Introduction of new technologies often demands change in the structure of employee’s interaction and training in their new principles of work. During the introduction of new technologies and the accompanying change in the value system, the structure of the management of the values of the organization is changing. This is due to the need to attract more staff to justify and consolidate the new value system and bring their view into the motivational potential of the new value system of the organization.

Keywords: value, risk, creation, problems, organization

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Authors: Cleto J. Sauer Jr., Rita C. Sauer, Chaider G. Andrade, Doris F. Rabelo

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Introduction: Endotracheal Intubation (ETI) is a procedure for clinical management of patients with severe clinical presentation of COVID-19 disease. Realistic simulation (RS) is an active learning methodology utilized for clinical skill's improvement. To improve ETI skills of public health network's physicians from Recôncavo da Bahia region in Brazil, during COVID-19 outbreak, RS training was planned and carried out. Training scenario included the Nasco Lifeform realistic simulator, and three actions were simulated: ETI procedure, sedative drugs management, and bougie guide utilization. Training intervention occurred between May and June 2020, as an interinstitutional cooperation between the Health's Department of Bahia State and the Federal University from Recôncavo da Bahia. Objective: The main objective is to report the effects on participants' self-confidence perception for ETI procedure after RS based training. Methods: This is a descriptive study, with secondary data extracted from questionnaires applied throughout RS training. Priority workplace, time from last intubation, and knowledge about bougie were reported on a preparticipation questionnaire. Additionally, participants completed pre- and post-training qualitative self-assessment (10-point Likert scale) regarding self-confidence perception in performing each of simulated actions. Distribution analysis for qualitative data was performed with Wilcoxon Signed Rank Test, and self-confidence increase analysis in frequency contingency tables with Fisher's Exact Test. Results: 36 physicians participated of training, 25 (69%) from primary care setting, 25 (69%) performed ETI over a year ago, and only 4 (11%) had previous knowledge about the bougie guide utilization. There was an increase in self-confidence medians for all three simulated actions. Medians (variation) for self-confidence before and after training, for each simulated action were as follows: ETI [5 (1-9) vs. 8 (6-10) (p < 0.0001)]; Sedative drug management [5 (1-9) vs. 8 (4-10) (p < 0.0001)]; Bougie guide utilization [2.5 (1-7) vs. 8 (4-10) (p < 0.0001)]. Among those who performed ETI over a year ago (n = 25), an increase in self-confidence greater than 3 points for ETI was reported by 23 vs. 2 physicians (p = 0.0002), and by 21 vs. 4 (p = 0.03) for sedative drugs management. Conclusions: RS training contributed to self-confidence increase in performing ETI. Among participants who performed ETI over a year, there was a significant association between RS training and increase of more than 3 points in self-confidence, both for ETI and sedative drug management. Training with RS methodology is suitable for ETI confidence enhancement during COVID-19 outbreak.

Keywords: confidence, COVID-19, endotracheal intubation, realistic simulation

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Authors: Samuel Owoade, Zainab Idowu, Idris Ajibade, Abel Uzoka

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Cloud computing adoption continues to soar, with 83% of enterprise workloads estimated to be in the cloud by 2022. However, this rapid migration raises security concerns, needing strong security management solutions to safeguard sensitive data and essential applications. This paper investigates the critical role of technical project managers in orchestrating security management initiatives for cloud environments, evaluating their responsibilities, challenges, and best practices for assuring the resilience and integrity of cloud infrastructures. Drawing from a comprehensive review of industry reports and interviews with cloud security experts, this research highlights the multifaceted landscape of security management in cloud environments. Despite the rapid adoption of cloud services, only 25% of organizations have matured their cloud security practices, indicating a pressing need for effective management strategies. This paper proposes a strategy framework adapted to the demands of technical project managers, outlining the important components of effective cloud security management. Notably, 76% of firms identify misconfiguration as a major source of cloud security incidents, underlining the significance of proactive risk assessment and constant monitoring. Furthermore, the study emphasizes the importance of technical project managers in facilitating cross-functional collaboration, bridging the gap between cybersecurity professionals, cloud architects, compliance officers, and IT operations teams. With 68% of firms seeing difficulties integrating security policies into their cloud systems, effective communication and collaboration are critical to success. Case studies from industry leaders illustrate the practical use of security management projects in cloud settings. These examples demonstrate the importance of technical project managers in using their expertise to address obstacles and generate meaningful outcomes, with 92% of firms reporting improved security practices after implementing proactive security management tactics. In conclusion, this research underscores the critical role of technical project managers in safeguarding cloud environments against evolving threats. By embracing their role as guardians of the cloud realm, project managers can mitigate risks, optimize resource utilization, and uphold the trust and integrity of cloud infrastructures in an era of digital transformation.

Keywords: cloud security, security management, technical project management, cybersecurity, cloud infrastructure, risk management, compliance

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Authors: Friday I. Joseph

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Background: Nigeria has an under-five mortality rate that is 128 per 1000 live birth which is higher than the rate for the African region. Optimal breastfeeding practice has the potential to reduce under-five mortality by 13% in developing countries. However, documented exclusive breastfeeding rate in Nigeria from birth to six months is just 17%. Aim: To explore perceptions of the sociocultural factors that influence exclusive breastfeeding for six months among rural mothers in Bindawa and Baure Local Government Area (LGA), Katsina state, North West Nigeria, to inform policies, intervention or strategies to improve exclusive breastfeeding practice in Nigeria. Methods: The social constructionism-interpretivist epistemological approach informed the use of an exploratory study to understand mothers’ experiences and views. Twenty mothers, all from rural areas between 19-35 years old were conveniently sampled from two LGA in Katsina state, north –west Nigeria for semi-structured interviews. Sample size had representation of both Hausa and Fulani ethnic group. Thematic content analysis was utilized for analysis. Results: Three major themes emerged from the study: (1) Breastfeeding initiation - Immediate traditional newborn care practices, birth attendant, place of delivery, the perception of about colostrum determines how soon a mother initiate breastfeeding. (2) Exclusive breastfeeding and introduction of food-Motivation to sustain exclusive breastfeeding relies on the interplay between the obligation to perform traditional rites; mother’s awareness and family support. (3) Decision making about infant feeding – It is not independent of the influence of key social figures like the father, mother-in-law, traditional birth attendant and the health workers. Overall, in spite of awareness of exclusive breastfeeding benefits, mothers expressed concerns that they may not win their family support if they shared contrary views. Conclusions: Health promotion intervention should be tailored, taking cognizant and addressing the sociocultural barriers to the practice of optimal breastfeeding by a focused community and family-based participatory approach. Implementers of interventions should employ culture-sensitive approaches in community-based intervention.

Keywords: exclusive breastfeeding, perception, qualitative, sociocultural determinants

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Authors: Ram Sharan Mehta, Sanjeev Sharma

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Introduction: Haemodialysis (HD) is a mechanical process of removing waste products from the blood and replacing essential substances in patients with renal failure. First artificial kidney developed in Netherlands in 1943 AD First successful treatment of CRF reported in 1960AD, life-saving treatment begins for CRF in 1972 AD. In 1973 AD Medicare took over financial responsibility for many clients and after that method become popular. BP Koirala institute of health science is the only center outside the Kathmandu, where HD service is available. In BPKIHS PD started in Jan.1998, HD started in August 2002 till September 2003 about 278 patients received HD. Day by day the number of HD patients is increasing in BPKIHS as with institutional growth. No such type of study was conducted in past hence there is lack of valid & reliable baseline data. Hence, the investigators were interested to conduct the study on " Profile of the Renal Failure patients under Haemodialysis at B.P. Koirala Institute of Health Sciences Nepal". Objectives: The objectives of the study were: to find out the Socio-demographic characteristics of the patients, to explore the knowledge of the patients regarding disease process and Haemodialysis and to identify the problems encountered by the patients. Methods: It is a hospital-based exploratory study. The population of the study was the clients under HD and the sampling method was purposive. Fifty-four patients undergone HD during the period of 17 July 2012 to 16 July 2013 of complete one year were included in the study. Structured interview schedule was used for collect data after obtaining validity and reliability. Results: Total 54 subjects had undergone for HD, having age range of 5-75 years and majority of them were male (74%) and Hindu (93 %). Thirty-one percent illiterate, 28% had agriculture their occupation, 80% of them were from very poor community, and about 30% subjects were unaware about the disease they suffering. Majority of subjects reported that they had no complications during dialysis (61%), where as 20% reported nausea and vomiting, 9% Hypotension, 4% headache and 2%chest pain during dialysis. Conclusions: CRF leading to HD is a long battle for patients, required to make major and continuous adjustment, both physiologically and psychologically. The study suggests that non-compliance with HD regimen were common. The socio-demographic and knowledge profile will help in the management and early prevention of disease and evaluate aspects that will influence care and patients can select mode of treatment themselves properly.

Keywords: profile, haemodialysis, Nepal, patients, treatment

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Authors: Pin Yu Chen, Puay Chuan Lee, Yu Jen Loo, Ju Xia Zhang, Deborah Teo, Jack Wei Chieh Tan, Biauw Chi Ong

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Background: Synchronous communication, such as telephone calls, remains the standard communication method between nurses and other healthcare professionals in Singapore public hospitals despite advances in asynchronous technological platforms, such as instant messaging. Although miscommunication is one of the most common causes of lapses in patient care, there is a scarcity of research characterizing baseline inter-professional healthcare communications in a hospital setting due to logistic difficulties. Objective: This study aims to characterize the frequency and patterns of communication behaviours among healthcare professionals. Methods: The one-week observational study was conducted on Monday through Sunday at the nursing station of a cardiovascular medicine and cardiothoracic surgery inpatient ward at the National Heart Centre Singapore. Subjects were shadowed by two physicians for sixteen hours or consecutive morning and afternoon nursing shifts. Communications were logged and characterized by type, duration, caller, and recipient. Results: A total of 1,023 communication events involving the attempted use of the common telephones at the nursing station were logged over a period of one week, corresponding to a frequency of one event every 5.45 minutes (SD 6.98, range 0-56 minutes). Nurses initiated the highest proportion of outbound calls (38.7%) via the nursing station common phone. A total of 179 face-to-face communications (17.5%), 362 inbound calls (35.39%), 481 outbound calls (47.02%), and 1 emergency alert (0.10%) were captured. Average response time for task-oriented communications was 159 minutes (SD 387.6, range 86-231). Approximately 1 in 3 communications captured aimed to clarify patient-related information. The total duration of time spent on synchronous communication events over one week, calculated from total inbound and outbound calls, was estimated to be a total of 7 hours. Conclusion: The results of our study showed that there is a significant amount of time spent on inter-professional healthcare communications via synchronous channels. Integration of patient-related information and use of asynchronous communication channels may help to reduce the redundancy of communications and clarifications. Future studies should explore the use of asynchronous mobile platforms to address the inefficiencies observed in healthcare communications.

Keywords: healthcare communication, healthcare management, nursing, qualitative observational study

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Authors: Seemabahen Dave, Maria Varua, Basant Maheshwari, Roger Packham

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The declining groundwater levels and quality are acknowledged to be affecting the well-being of farmers especially those located in the semi-arid regions where groundwater is the only source of water for domestic and agricultural use. Further, previous studies have identified the need to examine the quality of life of farmers beyond economic parameters and for a shift in setting rural development policy goals to the perspective of beneficiaries. To address these gaps, this paper attempts to ascertain the subjective wellbeing of farmers from two semi-arid regions of India. The study employs the integrated conceptual framework for the assessment of individual and regional subjective wellbeing developed by Larson in 2009 at Australia. The method integrates three domains i.e. society, natural environment and economic services consisting of 37 wellbeing factors. The original set of 27 revised wellbeing factors identified by John Ward is further revised in current study to make it more region specific. Generally, researchers in past studies select factors of wellbeing based on literature and assign the weights arbitrary. In contrast, the present methodology employs a unique approach by asking respondents to identify the factors most important to their wellbeing and assign weights of importance based on their responses. This method minimises the selection bias and assesses the wellbeing from farmers’ perspectives. The primary objectives of this study are to identify key wellbeing attributes and to assess the influence of groundwater on subjective wellbeing of farmers. Findings from 507 farmers from 11 villages of two watershed areas of Rajasthan and Gujarat, India chosen randomly and were surveyed using a structured face-to-face questionnaire are presented in this paper. The results indicate that significant differences exist in the ranking of wellbeing factors at individual, village and regional levels. The top five most important factors in the study areas include electricity, irrigation infrastructure, housing, land ownership, and income. However, respondents are also most dissatisfied with these factors and correspondingly perceive a high influence of groundwater on them. The results thus indicate that intervention related to improvement of groundwater availability and quality will greatly improve the satisfaction level of well-being factors identified by the farmers.

Keywords: groundwater, farmers, semi-arid regions, subjective wellbeing

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Authors: Ahlyum Mun, Ji-Young Moon, Moon-Seok Yoon, Dong-Jin Baek, Doo-Seok Seo, Oun-Kyong Moon

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There is a growing public concern over the standards of farm animal welfare, with higher standards of food safety. In addition, the recent low incidence of Avian Influenza in laying hens among certificated farms is receiving attention. In this study, we introduce animal welfare systems covering the rearing, transport and slaughter of farm animals in South Korea. The concepts of animal welfare farm certification are based on ensuring the five freedoms of animal. The animal welfare is also achieved by observing the condition of environment including shelter and resting area, feeding and water and the care for the animal health. The certification of farm animal welfare is handled by the Animal Protection & Welfare Division of Animal and Plant Quarantine Agency (APQA). Following the full amendment of Animal Protection Law in 2011, animal welfare farm certification program has been implemented since 2012. The certification system has expanded to cover laying hen, swine, broiler, beef cattle and dairy cow, goat and duck farms. Livestock farmers who want to be certified must apply for certification at the APQA. Upon receipt of the application, the APQA notifies the applicant of the detailed schedule of the on-site examination after reviewing the document and conducts the on-site inspection according to the evaluation criteria of the welfare standard. If the on-site audit results meet the certification criteria, APQA issues a certificate. The production process of certified farms is inspected at least once a year for follow-up management. As of 2017, a total of 145 farms have been certified (95 laying hen farms, 12 swine farms, 30 broiler farms and 8 dairy cow farms). In addition, animal welfare transportation vehicles and slaughterhouses have been designated since 2013 and currently 6 slaughterhouses have been certified. Animal Protection Law has been amended so that animal welfare certification marks can be affixed only to livestock products produced by animal welfare farms, transported through animal welfare vehicles and slaughtered at animal welfare slaughterhouses. The whole process including rearing–transportation- slaughtering completes the farm animal welfare system. APQA established its second 5-year animal welfare plan (2014-2019) that includes setting a minimum standard of animal welfare applicable to all livestock farms, transportation vehicles and slaughterhouses. In accordance with this plan, we will promote the farm animal welfare policy in order to truly advance the Korean livestock industry.

Keywords: animal welfare, farm animal, certification system, South Korea

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Authors: Timothy Antoniuk

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This paper will demonstrate why the most successful and livable cities in the future will require multi-disciplinary designers to develop a deep understanding of peoples’ changing lifestyles, and why new generations of deeply integrated products, services and experiences need to be created. Disseminating research from the UNEP Creative Economy Reports and through a variety of other consumption and economic-based statistics, a compelling argument will be made that it is peoples’ living spaces that offer the easiest and most significant affordances for inducing positive changes to their wellbeing, and to a city’s economic and environmental prosperity. This idea, that leveraging happiness, wellbeing and prosperity through creating new concepts and typologies of ‘home’, puts people and their needs, wants, desires, aspirations and lifestyles at the beginning of the design process, not at the end, as so often occurs with current-day multi-unit housing construction. As an important part of the creative-reflective and statistical comparisons that are necessary for this on-going body of research and practice, Professor Antoniuk created the Micro Habitation Lab (mHabLab) in 2016. By focusing on testing the functional and economic feasibility of activating small spaces with different types of architectural robotics, a variety of movable, expandable and interactive objects have been hybridized and integrated into the architectural structure of the Lab. Allowing the team to test new ideas continually and accumulate thousands of points of feedback from everyday consumers, a series of on-going open houses is allowing the public-at-large to see, physically engage with, and give feedback on the items they find most and least valuable. This iterative approach of testing has exposed two key findings: Firstly, that there is a clear opportunity to improve the macro and micro functionality of small living spaces; and secondly, that allowing people to physically alter smaller elements of their living space lessens feelings of frustration and enhances feelings of pride and a deeper perception of “home”. Equally interesting to these findings is a grouping of new research questions that are being exposed which relate to: The duality of space; how people can be in two living spaces at one time; and how small living spaces is moving the Extended Home into the public realm.

Keywords: architectural robotics, extended home, interactivity, micro living spaces

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Authors: Martyn Queen, Diane Crone, Andrew Parker, Saul Bloxham

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Rationale: There is a growing body of evidence that supports the use of physical activity during and after cancer treatment. However, activity levels for patients remain low. As more cancer patients are treated successfully, and treatment costs continue to escalate, physical activity may be a promising adjunct to a person-centred healthcare approach to recovery. Aim: The aim was to further understand how physical activity may enhance the recovery process for a group of mixed-site cancer patients. Objectives: The research investigated longitudinal changes in physical activity and perceived the quality of life between two and six month’s post-exercise interventions. It also investigated support systems that enabled patients to sustain these perceived changes. Method: The respondent cohort comprised 14 mixed-site cancer patients aged 43-70 (11 women, 3 men), who participated in a two-phase physical activity intervention that took place at a university in the South West of England. Phase 1 consisted of an eight-week structured physical activity programme; Phase 2 consisted of four months of non-supervised physical activity. Semi-structured interviews took place three times over six months with each participant. Grounded theory informed the data collection and analysis which, in turn, facilitated theoretical development. Findings: Our findings propose three theories on the impact of physical activity for recovering cancer patients: 1) Knowledge gained through a structured exercise programme can enable recovering cancer patients to independently sustain physical activity to four-month follow-up. 2) Sustaining physical activity for six months promotes positive changes in the quality of life indicators of chronic fatigue, self-efficacy, the ability to self-manage and energy levels. 3) Peer support from patients facilitates adherence to a structured exercise programme and support from a spouse, or life partner facilitates independently sustained physical activity to four-month follow-up. Conclusions: This study demonstrates that qualitative research can provide an evidence base that could be used to support future care plans for cancer patients. Findings also demonstrate that a physical activity intervention can be effective at helping cancer patients recover from the side effects of their treatment, and recommends that physical activity should become an adjunct therapy alongside traditional cancer treatments.

Keywords: physical activity, health, cancer recovery, quality of life, support systems, qualitative, grounded theory, person-centred healthcare

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Authors: Ilaria Barletta, Mahesh Mani, Björn Johansson

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The concept of sustainability encompasses economic, environmental, social and institutional considerations. Sustainable manufacturing (SM) is, therefore, a multi-faceted concept. It broadly implies the development and implementation of technologies, projects and initiatives that are concerned with the life cycle of products and services, and are able to bring positive impacts to the environment, company stakeholders and profitability. Because of this, achieving SM-related goals requires a holistic, life-cycle-thinking approach from manufacturing companies. Further, such an approach must rely on a logic of continuous improvement and ease of implementation in order to be effective. Currently, there exists in the academic literature no comprehensively structured frameworks that support manufacturing companies in the identification of the issues and the capabilities that can either hinder or foster sustainability. This scarcity of support extends to difficulties in obtaining quantifiable measurements in order to objectively evaluate solutions and programs and identify improvement areas within SM for standards conformance. To bridge this gap, this paper proposes the concept of a framework for assessing and continuously improving the sustainability of manufacturing companies. The framework addresses strategies and projects for SM and operates in three sequential phases: analysis of the issues, design of solutions and continuous improvement. A set of interviews, observations and questionnaires are the research methods to be used for the implementation of the framework. Different decision-support methods - either already-existing or novel ones - can be 'plugged into' each of the phases. These methods can assess anything from business capabilities to process maturity. In particular, the authors are working on the development of a sustainable manufacturing maturity model (SMMM) as decision support within the phase of 'continuous improvement'. The SMMM, inspired by previous maturity models, is made up of four maturity levels stemming from 'non-existing' to 'thriving'. Aggregate findings from the use of the framework should ultimately reveal to managers and CEOs the roadmap for achieving SM goals and identify the maturity of their companies’ processes and capabilities. Two cases from two manufacturing companies in Australia are currently being employed to develop and test the framework. The use of this framework will bring two main benefits: enable visual, intuitive internal sustainability benchmarking and raise awareness of improvement areas that lead companies towards an increasingly developed SM.

Keywords: life cycle management, continuous improvement, maturity model, sustainable manufacturing

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Authors: M. Moso-Diez, J. L. Moragues-Oregi, K. Simon-Elorz

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Innovation procurement is designed to steer the development of solutions towards concrete public sector needs as a driver for innovation from the demand side (in public services as well as in market opportunities for companies), is horizontally emerging as a new policy instrument. In 2014 the new EU public procurement directives 2014/24/EC and 2014/25/EC reinforced the support for Public Procurement for Innovation, dedicating funding instruments that can be used across all areas supported by Horizon 2020, and targeting potential buyers of innovative solutions: groups of public procurers with similar needs. Under this programme, new policy adapters and networks emerge, aiming to embed innovation criteria into new procurement processes. As these initiatives are in process, research related to is scarce. We argue that Innovation Public Procurement can arise as an innovative policy instrument to public procurement in different policy domains, in spite of existing institutional and cultural barriers (legal guarantee versus innovation). The presentation combines insights from public procurement to supply management chain management in a sustainability and innovation policy arena, as a means of providing understanding of: (1) the circumstances that emerge; (2) the relationship between public and private actors; and (3) the emerging capacities in the definition of the agenda. The policy adopters are the contracting authorities that mainly are at municipal level where they interact with the supply management chain, interconnecting sustainability and climate measures with other policy priorities such as innovation and urban planning; and through the Competitive Dialogue procedure. We found that geography and territory affect both the level of municipal budget (due to municipal income per capita) and its institutional competencies (due to demographic reasons). In spite of the relevance of institutional determinants for public procurement, other factors play an important role such as human factors as well as both public policy and private intervention. The experience is a ‘city project’ (Bilbao) in the field of brownfield decontamination. Brownfield sites typically refer to abandoned or underused industrial and commercial properties—such as old process plants, mining sites, and landfills—that are available but contain low levels of environmental contaminants that may complicate reuse or redevelopment of the land. This article concludes that Innovation Public Procurement in sustainability and climate issues should be further developed both as a policy instrument and as a policy research line that could enable further relevant changes in public procurement as well as in climate innovation.

Keywords: innovation, city projects, public policy, public procurement

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Authors: Mohammad Khatib, Salam Hadid

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Introduction: Developing nurses' cultural competence begins in their basic training and requires them to participate in an array of activities which raise their awareness and stimulate their interest, desire and curiosity about different cultures, by creating opportunities for intercultural meetings promoting the concept of 'culture' and its components, including recognition of cultural diversity and the legitimacy of the other. Importantly, professionals need to acquire specific cultural knowledge and thorough understanding of the values, norms, customs, beliefs and symbols of different cultures. Similarly, they need to be given opportunities to practice the verbal and non-verbal communication skills of other cultures according to their cultural codes. Such a system is being implemented as part of nursing studies at Zefat Academic College in two study frameworks; firstly, a course integrating nursing theory and practice in multicultural nursing; secondly, a course in learning the languages spoken in Israel focusing on medical and nursing terminology. Methods: Students participating in the 'Transcultural Nursing' course come from a variety of backgrounds: Jews, or Arabs, religious, or secular; Muslim, Christian, new immigrants, Ethiopians or from other cultural affiliations. They are required to present and discuss cultural practices that affect health. In addition, as part of the language course, students learn and teach their friends 5 spoken languages (Arabic, Russian, Amharian, Yidish, and Sign language) focusing on therapeutic interaction and communication using the vocabulary and concepts necessary for the therapeutic encounter. An evaluation of the process and the results was done using a structured questionnaire which includes series of questions relating to the contributions of the courses to their cultural knowledge, awareness and skills. 155 students completed the questionnaire. Results: A preliminary assessment of this educational system points an increase in cultural awareness and knowledge among the students as well as in their willingness to recognize the other's difference. A positive atmosphere of multiculturalism is reflected in students' mutual interest and respect was created. Students showed a deep understanding of cultural issues relating to health and care (consanguinity and genetics, food customs; cultural events, reincarnation, traditional treatments etc.). Most of the students were willing to recommend the courses to others and suggest some changes relating learning methods (more simulations, role playing and activities).

Keywords: cultural competence, nursing education, culture, language

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Authors: Gyorgy Folk

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A finite set of cardinal needs define the human core of living well shaped on the evolutionary time scale as attested by social and life sciences of the last decades. Well-being is the purported state of living well. Living of humans akin any other living beings involves the exchange of vital substance with nature, maintaining a supportive symbiosis with an array of other living beings, living up to bonds to kin and exerting efforts to sustain living. A supportive natural environment, access to material resources, the nearness to fellow beings, and life sustaining activity are prerequisites of well-being. Well-living is prone to misinterpretation as an individual achievement, one lives well only and only if bonded to human relationships, related to a place, incorporated in nature. Akin all other forms of it, human life is a self-sustaining arrangement. One may say that the substance of life is life, and not materials, products, and services converted into life. The human being remains shaped on an evolutionary time scale and is enabled within the non-altering core of human being, invariant of cultural differences in earthly space and time. Present paper proposes the introduction of weal, the missing link in the causal chain of societal performance and the goodness of life. Interpreted differently over the ages, cultures and disciplines, instead of well-being, the construct in general use, weal is proposed as the underlying foundation of well-being. Weal stands for the totality of socialised reality as framing well-being for the individual beyond the possibility of deliberate choice. The descriptive approach to weal, mapping it under the guidance of discrete scientific disciplines reveals a limited set of cardinal aspects, labeled here the cardinal needs. Cardinal expresses the fundamental reorientation weal can bring about, needs deliver the sense of sine qua non. Weal is conceived as a oneness mapped along eight cardinal needs. The needs, approached as aspects instead of analytically isolated factors do not require mutually exclusive definitions. To serve the purpose of reorientation, weal is operationalised as a domain in multidimensional space, each dimension encompassing an optimal level of availability of the fundamental satisfiers between the extremes of drastic insufficiency and harmful excess, ensured by actual human effort. Weal seeks balance among the material and social aspects of human being while allows for cultural and individual uniqueness in attaining human flourishing.

Keywords: human well-being, development, economic theory, human needs

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Authors: Sagwata A. Manyike, Hulisani Magada

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The South African National Biodiversity Institute is in the process of developing a guideline which sets out how biodiversity can be incorporated into land use (zoning) schemes. South Africa promulgated its Spatial Planning and Land Use Management Act in 2015 and the act seeks, amongst other things, to bridge the gap between spatial planning and land use management within the country. In addition, the act requires local governments to develop wall-to-wall land use schemes for their entire jurisdictions as they had previously only developed them for their urban areas. At the same time, South Africa has a rich history of systematic conservation planning whereby Critical Biodiversity Areas and Ecological Support Areas have been spatially delineated at a scale appropriate for spatial planning and land use management at the scale of local government. South Africa is also in the process of spatially delineating ecological infrastructure which is defined as naturally occurring ecosystems which provide valuable services to people such as water and climate regulation, soil formation, disaster risk reduction, etc. The Biodiversity and Land Use Project, which is funded by the Global Environmental Facility through the United Nations Development Programme is seeking to explore ways in which biodiversity information and ecological infrastructure can be incorporated into the spatial planning and land use management systems of local governments. Towards this end, the Biodiversity and Land Use Project have developed a guideline which sets out how local governments can integrate biodiversity into their land-use schemes as a way of not only ensuring sustainable development but also as a way helping them prepare for climate change. In addition, by incorporating biodiversity into land-use schemes, the project is exploring new ways of protecting biodiversity through land use schemes. The Guideline for Incorporating Biodiversity into Land Use Schemes was developed as a response to the fact that the National Land Use Scheme Guidelines only indicates that local governments needed to incorporate biodiversity without explaining how this could be achieved. The Natioanl Guideline also failed to specify which biodiversity-related layers are compatible with which land uses or what the benefits of incorporating biodiversity into the schemes will be for that local government. The guideline, therefore, sets out an argument for why biodiversity is important in land management processes and proceeds to provide a step by step guideline for how schemes can integrate priority biodiversity layers. This guideline will further be added as an addendum to the National Land Use Guidelines. Although the planning act calls for local government to have wall to wall schemes within 5 years of its enactment, many municipalities will not meet this deadline and so this guideline will support them in the development of their new schemes.

Keywords: biodiversity, climate change, land use schemes, local government

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Authors: Maysoon Nasser Samhan, Somaya Alkiswani, Abdullah Alzibdeh

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Background: Routine lumbar MRIs for back pain may yield normal results despite persistent symptoms, which means the possibility of other causes for this pain, which was not shown on the routine images. Research suggests including coronal STIR imaging to detect additional pathologies like sacroiliitis. Objectives: This study aims to enhance diagnostic accuracy and aid in determining treatment processes for patients with persistent back pain who have normal routine lumbar MRI (T1 and T2 images) by incorporating coronal STIR into the examination. Methods: A prospectively conducted study involving 274 patients, 115 males and 159 females, with an age range of 6–92 years, reviewed their medical records and imaging data following a lumbar spine MRI. This study included patients with back pain and sciatica as their primary complaints, all of whom underwent lumbar spine MRIs at our hospital to identify potential pathologies. Using a GE Signa HD 1.5T MRI System, each patient received a standard MRI protocol that included T1 and T2 sagittal and axial sequences, as well as a coronal STIR sequence. We collected relevant MRI findings, including abnormalities and structural variations, from radiology reports. We classified these findings into tables and documented them as counts and percentages, using Fisher’s exact test to assess differences between categorical variables. We conducted a statistical analysis using Prism GraphPad software version 10.1.2. The study adhered to ethical guidelines, institutional review board approvals, and patient confidentiality regulations. Results: Exclusion of the coronal STIR sequence led to 83 subjects (30.29%) being classified as within normal limits on MRI examination. 36 patients without abnormalities on T1 and T2 sequences showed abnormalities on the coronal STIR sequence, with 26 cases attributed to spinal pathologies and 10 to non-spinal pathologies. In addition to that, Fisher's exact test demonstrated a significant association between sacroiliitis diagnosis and abnormalities identified solely through the coronal STIR sequence (P < 0.0001). Conclusion: Implementing coronal STIR imaging as part of routine lumbar MRI protocols has the potential to improve patient care by facilitating a more comprehensive evaluation and management of persistent back pain.

Keywords: magnetic resonance imaging, lumber MRI, radiology, neurology

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Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

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Transient ischaemic attacks (TIAs) are warning signs for future strokes. TIA patients are at increased risk of stroke and cardio-vascular events after a first episode. A majority of studies on TIA focused on the occurrence of these ancillary events after a TIA. Long-term mortality after TIA received only limited attention. We undertook this study to determine the long-term hazards of all-cause mortality following a first episode of a TIA using anonymised electronic health records (EHRs). We used a retrospective case-control study using electronic primary health care records from The Health Improvement Network (THIN) database. Patients born prior to or in year 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general medical practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Weibull-Cox survival model which included both scale and shape effects and a random frailty effect of GP practice. 20,633 cases and 58,634 controls were included. Cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to matched controls (HR = 3.04, 95% CI (2.91 - 3.18)). The HRs for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to matched controls. Aspirin provided long-term survival benefits to cases. Cases aged 39-60 years on aspirin had HR of 0.93 (0.84 - 1.00), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5 years, 10 years and 15 years, respectively, compared to cases in the same age group who were not on antiplatelets. Similar beneficial effects of aspirin were observed in other age groups. There were no significant survival benefits with other antiplatelet options. No survival benefits of antiplatelet drugs were observed in controls. Our study highlights the excess long-term risk of death of TIA patients and cautions that TIA should not be treated as a benign condition. The study further recommends aspirin as the better option for secondary prevention for TIA patients compared to clopidogrel recommended by NICE guidelines. Management of risk factors and treatment strategies should be important challenges to reduce the burden of disease.

Keywords: dual antiplatelet therapy (DAPT), General Practice, Multiple Imputation, The Health Improvement Network(THIN), hazard ratio (HR), Weibull-Cox model

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