Search results for: maternal outcome

Authors: Sudha Bhutada, S. R. Nigam

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In this paper, a single-phase PV inverter applying a dual boost converter circuit inverter is proposed for photovoltaic (PV) generation system and PV grid connected system. This system is designed to improve integration of a Single phase inverter with Photovoltaic panel. The DC 24V is converted into to 86V DC and then 86V DC to 312V DC. The 312 V DC is then successfully inverted to AC 220V. Hence, solar energy is powerfully converted into electrical energy for fulfilling the necessities of the home load, or to link with the grid. Matlab Simulation software was used for simulation of the circuit and outcome are presented in this paper.

Keywords: H bridge inverter, dual boost converter, PWM, SPWM

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Authors: A. Gagat-Matuła

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The aim of this article is to present a relation between family relationships and styles of approach to coping with stress among young people from migrant families with cerebral palsy. The study involved 70 persons (with cerebral palsy in the standard intellectual capacity) from families, in which at least one of parents is a migrant. To measure the level of communication in the family, the Family Relationships Questionnaire (FRQ) was employed, while the styles of coping with stress was investigated with the CISS Questionnaire. The relation between family relationships and styles of coping with stressful situations of the respondents was investigated. It was shown that there is an affiliation between the emotion-oriented style of coping with the stress and the variable of “communication in my family”. Moreover, it was demonstrated that there is a linkage between the task-oriented style of coping with the stress and the variable of “maternal control in mother-child relationship”. Young people with CP subjected to overprotection and control from their mothers in problem situations tend to focus on their own emotions instead of trying to undertake constructive actions. Excessive control in daily life by mothers results in passivity and a lack of motivation to cope with difficult situations.

Keywords: young people with cerebral palsy, family relationships, styles of coping with stress, migration

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Authors: Sharvari Sane, Swati Sharma, Sanjay K. Prasad

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Local trains are the lifelines of Mumbai city. Earlier 1500 Volt D.C. supply, is now completely and successfully converted into 25 KV A.C. in central, western and harbour routes. This task is the outcome of the advancement in the area of power electronics. Author has already done the comparative study between D.C. and A.C. supply of traction and predicted the serious problem regarding the harmonics. In this paper, the simulation for 5 level as well as 7 level multilevel inverter has been done which is the substitute for the present cascade type inverter. This paper also showed the reduced level of Total Harmonic Distortion (THD) in the traction system.

Keywords: total harmonic distortion (THD), traction sub station (TSS), harmonics, multilevel inverter

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Authors: U. Chattaraj, K. Dhusiya, M. Raviteja

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Perception reaction time of drivers is an outcome of human thought process, which is vague and approximate in nature and also varies from driver to driver. So, in this study a fuzzy logic based model for prediction of the same has been presented, which seems suitable. The control factors, like, age, experience, intensity of driving of the driver, speed of the vehicle and distance of stimulus have been considered as premise variables in the model, in which the perception reaction time is the consequence variable. Results show that the model is able to explain the impacts of the control factors on perception reaction time properly.

Keywords: driver, fuzzy logic, perception reaction time, premise variable

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Authors: Santhita Tungkajiwangkoon, Yoshikazu Hoshi

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Three Japaneses Drosera species are the good model to study genome organization with highly specialized morphological group for insect trapping, and has revealed anti-inflammatory, and antibacterial effects, so there must be a reason for botanists are so appealing in these plants. Cytology and Flow cytometry were used to investigate the genetic stability and ploidy estimation in three related species. The cytological and Flow cytometry analysis were done in Drosera rotundifolia L., Drosera spatulata Labill and Drosera tokaiensis. The cytological studies by fluorescence staining (DAPI) showed that D. tokaiensis was an alloploid (2n=6x=60, hexaploid) which is a natural hybrid polyploids of D. rotundifolia and D. spatulata. D. rotundifolia was a diploid with the middle size of metaphase chromosomes (2n=2x=20) as a paternal origin and D. spatulata was a tetraploid with small size of metaphase chromosome (2n=4x=40) as a maternal origin. We confirmed by Flow cytometry analysis to determine the ploidy level and DNA content of the plants. The 2C-DNA values of D. rotundiflolia were 2.8 pg, D. spatulata was 1.6 pg and D. tokaiensis was 3.9 pg. However, 2C- DNA values of D. tokaiensis should be related from their parents but in the present study the 2C-DNA values of D. tokaiensis was no relation from the theoretical of hybrids representing additive parental. Possibility of D. tokaiensis is a natural hybrid, which is also hybridization in natural evolution can cause the genome reduction in plant.

Keywords: drosera, hybrid, cytology, flow cytometry

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Authors: Scott Cavinder

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Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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Authors: Rajasekhar Mamilla, G. Janardhana, G. Anjan Babu

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The present research studies analyses the students’ satisfaction with university performance regarding the reliability dimension, ability of professors and staff to perform the promised services with quality to students in the post-graduate courses offered by Sri Venkateswara University in India. The research is done with the notion that the student compares the perceived performance with prior expectations. Customer satisfaction is seen as the outcome of this comparison. The sample respondents were administered with the schedule based on the stratified random technique for this study. Statistical techniques such as factor analysis, t-test and correlation analysis were used to accomplish the respective objectives of the study.

Keywords: satisfaction, reliability, service quality, customer

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Authors: Myriam Rudaz, Thomas Ledermann, Frank D. Fincham

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We provide initial findings on the development and validation of the Genuine Happiness Scale (GHS). Based on the Buddhist view of happiness, genuine happiness can be described as an unlimited, everlasting inner joy and peace that gives a person the inner resources to deal with whatever comes his or her way in life. The sample consisted of 678 young adults, with 432 adults participating twice, approximately six weeks apart. Exploratory and confirmatory factor analysis supported a unidimensional factor structure of the GHS. Hierarchical regression analysis revealed that caring for bliss, mindfulness, and compassion predicted genuine happiness longitudinally above and beyond genuine happiness at baseline. We discuss the usefulness of the GHS as an outcome measure for evaluating mindfulness- and compassion-based intervention programs.

Keywords: happiness, bliss, well-being, caring for bliss, mindfulness, compassion

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Authors: Sharon Baoas, Toni Beninato, Michael Zenilman, Gokhan Ozuner

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Background An enhanced recovery after surgery (ERAS) protocol was implemented to improve quality and cost effectiveness of surgical care in elective colorectal procedures. Results A total of 109 patients, 55 (pre-ERAS) and 54 (post-ERAS) are included in the final analysis. There were no differences in complications were recorded (p = 0.37) and 30-day readmissions (p = 0.785). The mean hospital stay was 5.89 ± 2.62 days in pre-ERAS and 4.94 ± 2.27 days in post-ERAS group which was statistically significant (p = 0.047). Conclusions An ERAS protocol for colorectal surgery harmonised perioperative care and decreased length of stay.

Keywords: 30-day readmission, lenght of stay, Enhanced Recovery after surgery, Surgical site infection

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Authors: Erin Louise Robinson, Emily Elsa Freeman

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Rough-and-tumble play (RTP) is a physical and competitive type of play that parents engage in with their children. While past research has reported RTP to be the preferred play type for western fathers, the frequency of these interactions in Australian families have not been explored. With parental perceptions of play importance playing a major role in the frequency of activity engagement, the present study investigated how perceptions and parent gender impact on RTP play frequency. By utilising child gender in our approach, we also examined the historical trend of boys receiving more physical play interactions with their parents. Three hundred and seventy-nine respondents completed the study with their 0–10-year-old children. The results indicated that, in line with past research, parents engaged more frequently in RTP with their sons than their daughters. While, both mothers and fathers participated in RTP with their children, fathers perceived RTP to be of greater important to their child’s development than mothers did. Moreover, supporting previous findings, this more positive perception of the play was related to greater frequency of RTP in these father-child dyads. Although RTP literature remains heavily focussed on fathers, the fact that mothers are engaging in these interactions as well, establishes the need to explore maternal influences in future research.

Keywords: parenting, play, child development, family, Australia

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Authors: Malarvizhi Selvaraj, Paul Fergus, Andy Shaw

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Uterine contractions produced during labour have the potential to damage the foetus by diminishing the maternal blood flow to the placenta. In order to observe this phenomenon labour and delivery are routinely monitored using cardiotocography monitors. An obstetrician usually makes the diagnosis of foetus hypoxia by interpreting cardiotocography recordings. However, cardiotocography capture and interpretation is time-consuming and subjective, often lead to misclassification that causes damage to the foetus and unnecessary caesarean section. Both of these have a high impact on the foetus and the cost to the national healthcare services. Automatic detection of foetal heart rate may be an objective solution to help to reduce unnecessary medical interventions, as reported in several studies. This paper aim is to provide a system for better identification and interpretation of abnormalities of the fetal heart rate using RStudio. An open dataset of 552 Intrapartum recordings has been filtered with 0.034 Hz filters in an attempt to remove noise while keeping as much of the discriminative data as possible. Features were chosen following an extensive literature review, which concluded with FIGO features such as acceleration, deceleration, mean, variance and standard derivation. The five features were extracted from 552 recordings. Using these features, recordings will be classified either normal or abnormal. If the recording is abnormal, it has got more chances of hypoxia.

Keywords: cardiotocography, foetus, intrapartum, hypoxia

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Authors: Wid Kattan, Rahaf Albarraq

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Background: Tokophobia is a pathological fear of pregnancy that can lead to the avoidance of childbirth. It is classified as primary or secondary. This report describes a patient with tokophobia, as well as her presentation, risk factors, comorbidities, and treatment. Case Presentation: A 43-year-old Saudi woman experienced tokophobia upon becoming pregnant for the fifth time. She was assessed in two clinical interviews by a consultant psychiatrist specializing in women’s mental health. In addition, she completed several questionnaires for assessment of different aspects of her mental health: overall depression, perinatal depression, generalized anxiety, maternal functioning, and fear of childbirth (FOC). Several risk factors and comorbidities that may have contributed to the development of tokophobia in this patient were discussed, including traumatic experiences in previous deliveries, the unplanned nature of the pregnancy, perinatal depression, and pronounced symptoms of anxiety. A collaborative decision to perform a C-section was made, in line with obstetric guidelines and good mental health practice. Full symptomatic recovery was achieved immediately after delivery. Conclusions: We hope to increase clinical awareness of the assessment and management of tokophobia, which is a relatively new concept and, as yet, understudied.

Keywords: tokophobia, fear of childbirth, mental health, anxiety, case report, depression, fear of delivery, psychiatry, cesarean section, perinatal depression

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Authors: N. D'Amico, E. Grossi, B. Colombo, F. Rigiroli, M. Buscema, D. Fazzini, G. Cornalba, S. Papa

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Purpose: To characterize, through a radiomic approach, the nature of nodules considered non-specific by expert radiologists, recognized in magnetic resonance mammography (MRm) with T1-weighted (T1w) sequences with paramagnetic contrast. Material and Methods: 47 cases out of 1200 undergoing MRm, in which the MRm assessment gave uncertain classification (non-specific nodules), were admitted to the study. The clinical outcome of the non-specific nodules was later found through follow-up or further exams (biopsy), finding 35 benign and 12 malignant. All MR Images were acquired at 1.5T, a first basal T1w sequence and then four T1w acquisitions after the paramagnetic contrast injection. After a manual segmentation of the lesions, done by a radiologist, and the extraction of 150 radiomic features (30 features per 5 subsequent times) a machine learning (ML) approach was used. An evolutionary algorithm (TWIST system based on KNN algorithm) was used to subdivide the dataset into training and validation test and to select features yielding the maximal amount of information. After this pre-processing, different machine learning systems were applied to develop a predictive model based on a training-testing crossover procedure. 10 cases with a benign nodule (follow-up older than 5 years) and 18 with an evident malignant tumor (clear malignant histological exam) were added to the dataset in order to allow the ML system to better learn from data. Results: NaiveBayes algorithm working on 79 features selected by a TWIST system, resulted to be the best performing ML system with a sensitivity of 96% and a specificity of 78% and a global accuracy of 87% (average values of two training-testing procedures ab-ba). The results showed that in the subset of 47 non-specific nodules, the algorithm predicted the outcome of 45 nodules which an expert radiologist could not identify. Conclusion: In this pilot study we identified a radiomic approach allowing ML systems to perform well in the diagnosis of a non-specific nodule at MR mammography. This algorithm could be a great support for the early diagnosis of malignant breast tumor, in the event the radiologist is not able to identify the kind of lesion and reduces the necessity for long follow-up. Clinical Relevance: This machine learning algorithm could be essential to support the radiologist in early diagnosis of non-specific nodules, in order to avoid strenuous follow-up and painful biopsy for the patient.

Keywords: breast, machine learning, MRI, radiomics

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Authors: Rade M. Ciric

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The paper shows the development and implementation of the syllabus of the subject 'Distribution and Industrial Networks', attended by the vocational specialist Year 4 students of the Electric Power Engineering study programme at the Higher Education Technical School of Vocational Studies in Novi Sad. The aim of the subject is to equip students with the knowledge necessary for planning, exploitation and management of distributive and industrial electric power networks in an open electricity market environment. The results of the evaluation of educational outcomes on the subject are presented and discussed.

Keywords: engineering education, power distribution network, syllabus implementation, outcome evaluation

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Authors: M. Omer, D. Wilson

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Creating a database scheme is essentially a manual process. From a requirement specification, the information contained within has to be analyzed and reduced into a set of tables, attributes and relationships. This is a time-consuming process that has to go through several stages before an acceptable database schema is achieved. The purpose of this paper is to implement a Natural Language Processing (NLP) based tool to produce a from a requirement specification. The Stanford CoreNLP version 3.3.1 and the Java programming were used to implement the proposed model. The outcome of this study indicates that the first draft of a relational database schema can be extracted from a requirement specification by using NLP tools and techniques with minimum user intervention. Therefore, this method is a step forward in finding a solution that requires little or no user intervention.

Keywords: information extraction, natural language processing, relation extraction

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Authors: Juliet Sorensen, Anna Maitland

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Introduction: Characterized by lack of water and sanitation, food insecurity, and low access to hospitals and clinics, informal urban settlements in Lagos, Nigeria have very poor health outcomes. With little education and a general inability to demand basic rights, these communities are often disempowered and isolated from understanding, claiming, or owning their health needs. Utilizing community-based participatory research characterized by interdisciplinary, cross-cultural partnerships, evidence-based assessments, and both primary and secondary source research, a holistic health education and advocacy program was developed in Lagos to address health barriers for targeted communities. This includes a first of its kind guide formulated to teach community-based health educators how to transmit health information to low-literacy Nigerian audiences while supporting behavior change models and social support mechanisms. This paper discusses the interdisciplinary contributions to developing a health education program while also looking at the need for greater beneficiary ownership and implementation of health justice and access. Methods: In March 2016, an interdisciplinary group of medical, legal, and business graduate students and faculty from Northwestern University conduced a Health Needs Assessment (HNA) in Lagos with a partner and a local non-governmental organization. The HNA revealed that members of informal urban communities in Lagos were lacking basic health literacy, but desired to remedy this lacuna. Further, the HNA revealed that even where the government mandates specific services, many vulnerable populations are unable to access these services. The HNA concluded that a program focused on education, advocacy, and organizing around anatomy, maternal and sexual health, infectious disease and malaria, HIV/AIDS, emergency care, and water and sanitation would respond to stated needs while also building capacity in communities to address health barriers. Results: Based on the HNA, including both primary and secondary source research on integrated health education approaches and behavior change models and responsive, adaptive material development, a holistic program was developed for the Lagos partners and first implemented in November 2016. This program trained community-nominated health educators in adult, low-literacy, knowledge exchange approaches, utilizing information identified by communities as a priority. After a second training in March 2017, these educators will teach community-based groups and will support and facilitate behavior change models and peer-support methods around basic issues like hand washing and disease transmission. They will be supported by community paralegals who will help ensure that newly trained community groups can act on education around access, such as receiving free vaccinations, maternal health care, and HIV/AIDS medicines. Materials will continue to be updated as needs and issues arise, with a focus on identifying best practices around health improvements that can be shared across these partner communities. Conclusion: These materials are the first of their kind, and address a void of health information and understanding pervasive in informal-urban Lagos communities. Initial feedback indicates high levels of commitment and interest, as well as investment by communities in these materials, largely because they are responsive, targeted, and build community capacity. This methodology is an important step in dignity-based health justice solutions, albeit in the process of refinement.

Keywords: community health educators, interdisciplinary and cross cultural partnerships, health justice and access, Nigeria

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Authors: Tiffany Wicks

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Queer patients can face issues with self-advocating due to the factors of implicit provider bias, lack of tools and resources to self-advocate, and lack of comfortability in self-advocating based on prior experiences. In this study, five participants who identify as queer discussed their interactions with their healthcare providers. This exploratory study revealed that there is a need for healthcare provider education to reduce implicit bias and judgments about queer patients. There is also an important need for peer advocates in order to further inform healthcare promotion and decision-making before and during provider visits in an effort for a better outcome. Through this exploration, queer patients voiced their experiences and concerns to inform a need for change in healthcare collaboration between providers and patients in the queer community.

Keywords: queer, LGBT, patient, self-advocacy, healthcare

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Authors: Brooke Sweeney, David White, Felix Amparano, Nick A. Clark, Amy R. Beck, Mathew Lindquist, Lora Edwards, Julie Vandal, Jennifer Lisondra, Katie Cox, Renee Arensberg, Allen Cummins, Jazmine Cedeno, Jason D. Fraser, Kelsey Dean, Helena H. Laroche, Cristina Fernandez

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Background: National organizations call for standardized pre-surgical requirements and education to optimize postoperative outcomes. Since 2017 our surgery program has used defined protocols and educational curricula pre- and post-surgery. In response to patient outcomes, our educational content was refined to include quizzes to assess patient knowledge and surgical preparedness. We aim to optimize adolescent pre-bariatric surgery preparedness by improving overall aggregate pre-surgical assessment performance from 68% to 80% within 12 months. Methods: A multidisciplinary improvement team was developed within the weight management clinic (WMC) of our tertiary care, free-standing children’s hospital. A manual has been utilized since 2017, with limitations in consistent delivery and patient uptake of information. The curriculum has been improved to include quizzes administered during WMC visits prior to bariatric surgery. The initial outcome measure is the pre-surgical quiz score of adolescents preparing for bariatric surgery. Process measure was the number of questions answered correctly to test the questions. Baseline performance was determined by a patient assessment survey of pre-surgical preparedness at patient visits. Plan-Do-Study-Act cycles (PDSA) included: 1) creation and implementation of a refined curriculum, 2) development of 5 new quizzes based upon learning objectives, and 3) improving provider-lead teaching and quiz administration within clinic workflow. Run charts assessed impact over time. Results: A total of 346 quiz questions were administered to 34 adolescents. The outcome measure improved from a baseline mean of 68% to 86% following PDSA 2 cycles, and it was sustained. Conclusion/Implication: Patient/family comprehension of surgical preparedness improved with standardized education via team member-led teaching and assessment using quizzes during pre-surgical clinic visits. The next steps include launching redesigned teaching materials with modules correlated to quizzes and assessment of comprehension and outcomes post-surgically.

Keywords: bariatric surgery, adolescent, clinic, pre-bariatric training

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Authors: Juliana da Silva Cardoso, Cláudia Correia, Rita Gomes, Carolina Fraga, Inês Cascais, Sara Monteiro, Beatriz Teixeira, Sandra Ribeiro, Carolina Andrade, Cláudia Oliveira, Diana Gonzaga, Catarina Prior, Inês Vaz Matos

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The average daily screen time (ST) has been increasing in children, even at young ages. This seems to be associated with a higher incidence of neurodevelopmental disorders, and as the time of exposure increases, the greater is the functional impact. This study aims to compare the daily ST of toddlers and preschoolers previously and during the COVID-19 pandemic. A questionnaire was applied by telephone to parents/caregivers of children between 1 and 5 years old, followed up at 4 primary care units belonging to the Group of Primary Health Care Centers of Western Porto, Portugal. 520 children were included: 52.9% male, mean age 39.4 ± 13.9 months. The mean age of first exposure to screens was 13.9 ± 8.0 months, and most of the children were exposed to more than one screen daily. Considering the WHO recommendations, before the COVID-19 pandemic, 385 (74.0%) and 408 (78.5%) children had excessive ST during the week and the weekend, respectively; during the lockdown, these values increased to 495 (95.2%) and 482 (92.7%). Maternal education and both the child's median age and the median age of first exposure to screens had a statistically significant association with excessive ST, with OR 0.2 (p = 0.03, CI 95% 0.07-0.86), OR 1.1 (p = 0.01, 95% CI 1.05-1.14) and OR 0.9 (p = 0.05, 95% CI 0. 87-0.98), respectively. Most children in this sample had a higher than recommended ST, which increased with the onset of the COVID-19 pandemic. These results are worrisome and point to the need for urgent intervention.

Keywords: COVID-19 pandemic, preschoolers, screen time, toddlers

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Authors: Bashayer Alsana

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Emerging technologies present human interaction with new challenges. Individuals are required to interact and collaborate to achieve mutual gain. Accomplishing shared goals requires all parties involved to trust others commitment to fulfill their specified obligations. Trust is harder to establish when groups work virtually and members transcend time, space, and culture. This paper identifies the importance of trust in virtual groups of students at Cairo University by exposing them to electronic projects on which they collaborate.Students respond to a survey to assess their range of trust within their teams and how the outcome is affected. Gender differences and other demographic factors are analyzed to understand results and rates of trust. The paper concludes with summarizing factors influencing trust development and possible implications.

Keywords: students, teams, trust, virtual

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Authors: Hassan Sharafuddin, Chekra Allani

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Academicians at the Arab Open University have always voiced their concern about the efficacy of the blended learning process. Based on 75% independent study and 25% face-to-face tutorial, it poses the challenge of the predisposition to adjustment. Being used to the psychology of traditional educational systems, AOU students cannot be easily weaned from being spoon-fed. Hence they lack the motivation to plunge into self-study. For better involvement of AOU students into the learning practices, it is imperative to diagnose the factors that impede or increase their motivation. This is conducted through an empirical study grounded upon observations and tested hypothesis and aimed at monitoring and optimizing the students’ learning outcome. Recommendations of the research will follow the findings.

Keywords: academic performance, blended learning, educational psychology, independent study, pedagogy

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Authors: Oliver Chunho Ma, Tszying Chang

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Background: Traditional Chinese Medicine (TCM) has been widely used in the treatment of eczema. However, there is currently a lack of comprehensive research on the overall effectiveness of TCM in treating eczema, particularly using the Eczema Area and Severity Index (EASI) score as an evaluation tool. Meta-analysis can integrate the results of multiple studies to provide more convincing evidence. Objective: To conduct a systematic review and meta-analysis based on the EASI score to evaluate the overall effectiveness of TCM in the treatment of eczema. Specifically, the study will review and analyze published clinical studies that investigate TCM treatments for eczema and use the EASI score as an outcome measure, comparing the differences in improving the severity of eczema between TCM and other treatment modalities, such as conventional Western medicine treatments. Methods: Relevant studies, including randomized controlled trials (RCTs) and non-randomized controlled trials, that involve TCM treatment for eczema and use the EASI score as an outcome measure will be searched in medical literature databases such as PubMed, CNKI, etc. Relevant data will be extracted from the selected studies, including study design, sample size, treatment methods, improvement in EASI score, etc. The methodological quality and risk of bias of the included studies will be assessed using appropriate evaluation tools (such as the Cochrane Handbook). The results of the selected studies will be statistically analyzed, including pooling effect sizes (such as standardized mean differences, relative risks, etc.), subgroup analysis (e.g., different TCM syndromes, different treatment modalities), and sensitivity analysis (e.g., excluding low-quality studies). Based on the results of the statistical analysis and quality assessment, the overall effectiveness of TCM in improving the severity of eczema will be interpreted. Expected outcomes: By integrating the results of multiple studies, we expect to provide more convincing evidence regarding the specific effects of TCM in improving the severity of eczema. Additionally, subgroup analysis and sensitivity analysis can further elucidate whether the effectiveness of TCM treatment is influenced by different factors. Besides, we will compare the results of the meta-analysis with the clinical data from our clinic. For both the clinical data and the meta-analysis results, we will perform descriptive statistics such as means, standard deviations, percentages, etc. and compare the differences between the two using statistical tests such as independent samples t-test or non-parametric tests to assess the statistical differences between them.

Keywords: Eczema, traditional Chinese medicine, EASI, systematic review, meta-analysis

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Authors: Maria Angelica Trak-Fellermeier, Alison K. Macchi, Rodolfo Galvan, Yolangel Hernandez, Thresia Gambon, Rebeca Martinez, Cristina Palacios

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Poor lifestyle habits, vitamin D deficiency, and inadequate calcium intake, particularly during the COVID-19 pandemic, may contribute to severe osteopenia in childhood, increasing future fractures and osteoporosis risk. We here present a case of osteopenia in a 13-year-old white, Hispanic, premenarchal girl who completed the baseline visit of the MetA-Bone Trial during the COVID-19 pandemic. The premenarchal girl has a family history of osteoporosis (maternal grandfather) but no previous fractures; moderate outdoor activity was <1 hour/day 3 times/week with 8 hours/day of sleep. Consumption of dairy products and vegetables was <1 serving/day. Lab blood tests confirmed vitamin D deficiency (serum 25(OH)D: 9 ng/L) and hyperphosphatemia (5.2 mg/dL); other tests were normal. DXA scan Z‐score was ‐2.2 SD (indicative of osteopenia by age and sex). The premenarchal girl was referred to a pediatrician, who confirmed the results, and prescribed a daily supplement with 2000 IU of vitamin D and 1000 mg of calcium. Seclusion during the COVID-19 pandemic may have contributed to the severity of the findings. Therefore, we recommend screening children undergoing growth spurts for vitamin D, calcium, and poor lifestyle habits during and after the pandemic.

Keywords: bone mass, vitamin D, puberty, Hispanic

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Authors: Yadab Giri

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Confidence is considered a power of a good speaker, and it also can be taken as a tool for speaking. The paper entitled ‘Developing Speaking Confidence of Students through Communicative Activities’ has been written with the purpose of developing the speaking confidence of the students of the Seventh grade of our context in mind. The research is designed under the interpretive paradigm of action research. During my research, thirteen students from class seven were chosen for the study. It was seen a lot of improvement in their confidence while communicating with other speakers by the end of the eighth week. Though there is a positive result of the invention, some students still did not develop the level of confidence that they could have developed to get a satisfactory response. Therefore, the outcome of my action research is positive because students are eager and interested in speaking daily in the initiation of their English class, and they have improved in their speaking.

Keywords: confidence, speaking skills, action research, reflection with feedback and observation, finally endeavour

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Authors: Chechen Liao, Chin Yi Yang

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Although several factors that affect learning to program have been identified over the years, there continues to be no indication of any consensus in understanding why some students learn to program easily and quickly while others have difficulty. Seldom have researchers considered the problem of how to help the students enhance the programming learning outcome. The research had been conducted at a high school in Taiwan. Students participating in the study consist of 330 tenth grade students enrolled in the Basic Computer Concepts course with the same instructor. Two types of training methods-instruction-oriented and exploration-oriented were conducted. The result of this research shows that the instruction-oriented training method has better learning performance than exploration-oriented training method.

Keywords: learning performance, programming learning, TDD, training method

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Authors: T. Poppendieker

Abstract:

A new innovative tool for self-myofascial release is widely and increasingly used among athletes of various sports. The application of the foam roll is suggested to improve muscle performance and flexibility. Attempts to examine acute and somewhat long term effects of either have been conducted over the past ten years. However, the results of muscle performance have been inconsistent. It is suggested that regular use over a long period of time results in a different, muscle performance improving outcome. This study examines long-term effects of regular foam rolling combined with a short plyometric routine vs. solely the same plyometric routine on muscle performance and flexibility over a period of six weeks. Results of counter movement jump (CMJ), squat jump (SJ), and isometric maximal force (IMF) of a 90° horizontal squat in a leg-press will serve as parameters for muscle performance. Data on the range of motion (ROM) of the sit and reach test will be used as a parameter for the flexibility assessment. Muscle activation will be measured throughout all tests. Twenty male and twenty female members of a Frankfurt area fitness center chain (7.11) with an average age of 25 years will be recruited. Women and men will be randomly assigned to a foam roll (FR) and a control group. All participants will practice their assigned routine three times a week over the period of six weeks. Tests on CMJ, SJ, IMF, and ROM will be taken before and after the intervention period. The statistic software program SPSS 22 will be used to analyze the data of CMJ, SJ, IMF, and ROM under consideration of muscle activation by a 2 x 2 x 2 (time of measurement x gender x group) analysis of variance with repeated measures and dependent t-test analysis of pre- and post-test. The alpha level for statistic significance will be set at p ≤ 0.05. It is hypothesized that a significant difference in outcome based on gender differences in all four tests will be observed. It is further hypothesized that both groups may show significant improvements in their performance in the CMJ and SJ after the six-week period. However, the FR group is hypothesized to achieve a higher improvement in the two jump tests. Moreover, the FR group may increase IMF as well as flexibility, whereas the control group may not show likewise progress. The results of this study are crucial for the understanding of long-term effects of regular foam roll application. The collected information on the matter may help to motivate the incorporation of foam rolling into training routines, in order to improve athletic performances.

Keywords: counter movement jump, foam rolling, isometric maximal force, long term effects, self-myofascial release, squat jump

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Authors: Meera Tandan, Mohan Timilsina, Martin Cormican, Akke Vellinga

Abstract:

Background: In general practice, many infections are treated empirically without microbiological confirmation. Understanding susceptibility of antimicrobials during empirical prescribing can be helpful to reduce inappropriate prescribing. This study aims to apply a prediction model using a decision tree approach to predict the antimicrobial resistance (AMR) of urinary tract infections (UTI) based on non-clinical features of patients over 65 years. Decision tree models are a novel idea to predict the outcome of AMR at an initial stage. Method: Data was extracted from the database of the microbiological laboratory of the University Hospitals Galway on all antimicrobial susceptibility testing (AST) of urine specimens from patients over the age of 65 from January 2011 to December 2014. The primary endpoint was resistance to common antimicrobials (Nitrofurantoin, trimethoprim, ciprofloxacin, co-amoxiclav and amoxicillin) used to treat UTI. A classification and regression tree (CART) model was generated with the outcome ‘resistant infection’. The importance of each predictor (the number of previous samples, age, gender, location (nursing home, hospital, community) and causative agent) on antimicrobial resistance was estimated. Sensitivity, specificity, negative predictive (NPV) and positive predictive (PPV) values were used to evaluate the performance of the model. Seventy-five percent (75%) of the data were used as a training set and validation of the model was performed with the remaining 25% of the dataset. Results: A total of 9805 UTI patients over 65 years had their urine sample submitted for AST at least once over the four years. E.coli, Klebsiella, Proteus species were the most commonly identified pathogens among the UTI patients without catheter whereas Sertia, Staphylococcus aureus; Enterobacter was common with the catheter. The validated CART model shows slight differences in the sensitivity, specificity, PPV and NPV in between the models with and without the causative organisms. The sensitivity, specificity, PPV and NPV for the model with non-clinical predictors was between 74% and 88% depending on the antimicrobial. Conclusion: The CART models developed using non-clinical predictors have good performance when predicting antimicrobial resistance. These models predict which antimicrobial may be the most appropriate based on non-clinical factors. Other CART models, prospective data collection and validation and an increasing number of non-clinical factors will improve model performance. The presented model provides an alternative approach to decision making on antimicrobial prescribing for UTIs in older patients.

Keywords: antimicrobial resistance, urinary tract infection, prediction, decision tree

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Authors: Jane Ebele Iloanya

Abstract:

The introduction of the learning outcome approach in contemporary curriculum design and instruction, has brought student–centered education to the fore. In teacher –centered teaching and learning, the teacher transfers knowledge to the students, who are always at the receiving end. The teacher is assumed to know it all and hardly trusts the knowledge of the students. Teacher-centered education places emphasis on the supremacy of the teacher over the students who should ideally, be able to dialogue with the teacher. The paper seeks to examine the issue of democratisation of the teaching and learning process in Institutions of Higher Learning in Botswana. Botswana is a landlocked country in Southern Africa, with a total population of about two million people. In 1977, Botswana’s First National Policy on Education was unveiled. This came eleven years after the country gained independence from Great Britain. The philosophy which informed the 1977 Education Policy was “Social Harmony”. The philosophy of social harmony has four main principles: Unity, Development, Democracy and Self- Reliance. These principles were meant to permeate all aspects of lives of the people of Botswana, including, the issue of how teaching and learning is conducted in Botswana’s institutions of higher learning. This paper will examine the practicalisation of the principle of democracy in teaching and learning at higher education level in Botswana. It will in particular, discuss the issue of students’ participation and engagement in the teaching and learning process. The following questions will be addressed: 1.Are students involved in planning the curriculum? 2.How engaged are the students in the teaching and learning process? 3.How democratic are the teachers in terms of students’ rights and privileges? A mixed–method approach will be adopted in this study. Questionnaires will be distributed to the students to elicit their views on the practicalisation of the principle of democracy at the higher education level. Semi-structured interview questions will be administered in order to collect information from the lecturers on the issue of democratisation of teaching and learning at the higher education level in Botswana. In addition, relevant and related literature will be reviewed to augment collected data. The study will focus on three tertiary institutions in Gaborone, the capital city of Botswana. Currently, there are ten tertiary institutions in Gaborone; both privately and government owned. The outcome of this study will add to the existing body of knowledge on the issue of the practicalisation of democracy at the higher education level in Botswana. This research is therefore relevant in helping to find out if democratisation of teaching and learning has been realised in Botswana’s Institutions of higher learning. It is important to examine Botswana’s national policy on education in this way to ascertain if it has been effective in giving the country’s education system that democratic element, which is essential for a student-centered approach to the teaching and learning process.

Keywords: democratisation, higher education, learning, teaching

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Authors: Rabab Makki, Deputy Chief Dietitian

Abstract:

Malnutrition is commonly seen in Liver Disease patients. Prevalence of malnutrition in cirrhosis, is as high as 65-90%. Protein depletion and reduced muscle function are common. There are many mechanisms of malnutrition in liver cirrhosis e.g. insulin resistance, low respiratory quotient, increased glucogenesis etc. Nutrition support improves outcome in patients unable to maintain an intake of 35-40 Kcal/kg and 1.2-1.5 gm/kg/day. Simple methods of assessment such as subjective global assessment, calorie counting, MMC are useful. The value of BCAAs remains uncertain despite a considerable number of studies. Normal protein diets have been given safely to patients with hepatic encephalopathy. Restriction of protein not more than 48 hours pre- and pro-biotic, glutamine, fish oil etc are all part of the latest advanced techniques used.

Keywords: liver cirrhosis, omega 3 for liver disease, nutrition management, malnutrition

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Authors: Cesar Vazquez-Gonzalez, Sophie Avila-Foucat, Leonardo Ortiz-Lozano, Patricia Moreno-Casasola, Alejandro Granados-Barba

Abstract:

In the last twenty years, academic and scientific literature has been focused on understanding the processes and factors of coastal social-ecological systems vulnerability and resilience. Some scholars argue that resilience and vulnerability are isolated concepts due to their epistemological origin, while others note the existence of a strong resilience-vulnerability relationship. Here we present an ordinal logistic regression model based on the analytical framework about dynamic resilience-vulnerability interaction along adaptive cycle of complex systems and disasters process phases (during, recovery and learning). In this way, we demonstrate that 1) during the disturbance, absorptive capacity (resilience as a core of attributes) and external response capacity explain the probability of households capitals to diminish the damage, and exposure sets the thresholds about the amount of disturbance that households can absorb, 2) at recovery, absorptive capacity and external response capacity explain the probability of households capitals to recovery faster (resilience as an outcome) from damage, and 3) at learning, adaptive capacity (resilience as a core of attributes) explains the probability of households adaptation measures based on the enhancement of physical capital. As a result, during the disturbance phase, exposure has the greatest weight in the probability of capital’s damage, and households with absorptive and external response capacity elements absorbed the impact of floods in comparison with households without these elements. At the recovery phase, households with absorptive and external response capacity showed a faster recovery on their capital; however, the damage sets the thresholds of recovery time. More importantly, diversity in financial capital increases the probability of recovering other capital, but it becomes a liability so that the probability of recovering the household finances in a longer time increases. At learning-reorganizing phase, adaptation (modifications to the house) increases the probability of having less damage on physical capital; however, it is not very relevant. As conclusion, resilience is an outcome but also core of attributes that interacts with vulnerability along the adaptive cycle and disaster process phases. Absorptive capacity can diminish the damage experienced by floods; however, when exposure overcomes thresholds, both absorptive and external response capacity are not enough. In the same way, absorptive and external response capacity diminish the recovery time of capital, but the damage sets the thresholds in where households are not capable of recovering their capital.

Keywords: absorptive capacity, adaptive capacity, capital, floods, recovery-learning, social-ecological systems

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