Search results for: primary school children

Authors: Lauren McGillivray, Michelle Torok, Alison Calear

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Suicide is the leading cause of death for Australians aged 15-24 years, with rates increasing over the past decade. As young people can be particularly vulnerable to mental health problems and suicidal behavior, they are an essential and obvious target for suicide prevention efforts. This study investigates the effectiveness of the universal mental health promotion and suicide prevention program, Youth Aware of Mental Health (YAM), to reduce suicidal ideation and attempts and increase help-seeking in young people. This trial took place in Australian schools across four regions in New South Wales that form part of LifeSpan, a larger multilevel suicide prevention research trial. The YAM program was delivered to Year 9 students in up to 78 schools over two years (from January 2017 to December 2019). All schools were invited to participate in YAM's evaluation, which included completing a student questionnaire at three time-points: baseline, 3-month post-intervention, and 6-month follow-up. The primary outcome is suicidal ideation severity. Secondary outcomes are new reports of suicide attempts, stigma towards suicide, knowledge about suicide, help-seeking intentions and behaviors, and depressive symptoms. Results from pre-post and follow-up data will be presented. These research findings are promising and will contribute to the evidence-based for YAM and suicide prevention programs in Australian schools. These findings are also expected to promote YAM's value and sustainability to be more widely delivered in Australian secondary schools.

Keywords: adolescent mental health, suicidal ideation, suicide prevention, universal program

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Authors: Byung Keun Yang, Jae Eun Ku, Young Seon Joo, Je Sung You, Sung Phil Chung, Hahn Shick Lee

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The purpose of this study is to review the evidence comparing the efficacy and safety between L-carnitine and extracorporeal elimination therapy in the management of acute valproic acid L-carnitine vs Extracorporeal Elimination for Acute Valproic acid Intoxication. PubMed, Embase, Cochrane library, Web of Science, KoreaMed, KMbase, and KISS were searched, using the terms carnitine and valproic acid. All studies, regardless of design, reporting efficacy or safety endpoints were included. Reference citations from identified publications were reviewed. Both English and Korean languages were included. Two authors extracted primary data elements including poisoning severity, presenting features, clinical management, and outcomes. Thirty two articles including 33 cases were identified. Poisoning severity was classified as 3 mild, 11 moderate, and 19 severe cases. Nine cases were treated with L-carnitine while 24 cases received extracorporeal therapy without L-carnitine. All patients except one expired patient treated with hemodialysis recovered clinically and no adverse effects were noted. A case report comparing two patients who ingested the same amount of valproic acid showed increased ICU stay (3 vs. 11 days) in case of delayed extracorporeal therapy. Published evidence comparing L-carnitine with extracorporeal therapy is limited. Based on the available evidence, it is reasonable to consider L-carnitine for patients with acute valproic acid overdose. In case of severe poisoning, extracorporeal therapy would also be considered in the early phase of treatment.

Keywords: carnitine, overdose, poisoning, renal dialysis, valproic acid

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Authors: Samir Malhotra, Rajan K. Khandotra, Rakesh K. Dhiman, Neelam Chadha

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There is paucity of data about safety and efficacy of probiotic treatment on patient outcomes in cirrhosis. Specifically, it is important to know whether probiotics can improve mortality, hepatic encephalopathy (HE), number of hospitalizations, ammonia levels, quality of life, and adverse events. Probiotics may improve outcomes in patients with acute or chronic HE. However, it is also important to know whether probiotics can prevent development of HE, even in situations where patients do not have acute HE at the time of administration. It is also important to know if probiotics are useful as primary prophylaxis of HE. We aimed to conduct an updated systematic review and meta-analysis to evaluate the safety and efficacy of probiotics in patients with cirrhosis. We searched PubMed, Cochrane library, Embase, Scopus, SCI, Google Scholar, conference proceedings, and references of included studies till June 2017 to identify randomised clinical trials comparing probiotics with other treatments in cirrhotics. Data was analyzed using MedCalc. Probiotics had no effect on mortality but significantly reduced HE (14 trials, 1073 patients, OR 0.371; 95% CI 0.282 to 0.489). There was not enough data to conduct a meta-analysis on outcomes like hospitalizations and quality of life. The effect on plasma ammonia levels was not significant (SMD -0.429; 95%CI -1.034 – 0.177). There was no difference in adverse events. To conclude, although the included studies had a high risk of bias, the available evidence does suggest a beneficial effect on HE. Larger studies with longer periods of follow-up are needed to determine if probiotics can reduce all-cause mortality.

Keywords: cirrhosis, hepatic encephalopathy, meta-analysis, probiotic

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Authors: Ghadeer M Alkusayer, Adelicia Yu, Pamela Orr

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Study objective: To report a case of postpartum pulmonary cryptococcal infection (CCI) in an otherwise healthy 35-year-old woman. Additionally, the cases of pulmonary cryptococcal infections either in the antepartum or the postpartum period with pregnancy outcomes, were systematically reviwed. Methods: A systematic search of Cochrane Library, MEDLINE, and EMBASE was conducted for peer-reviewed studies without date restrictions, published in English and relating to CCI during pregnancy or postpartum period. Conference press, editorials, opinion pieces and letters were excluded. Two authors independently screened citations and full-text articles, extracted data and assessed study quality. Given the heterogeneity of study designs, a narrative synthesis was conducted. Results: The search identified 128 references, of which 22 case reports and series met the inclusion criteria. This is a total of 29 women (including the current case) . The mean age of the women was 28.3 ± 12.3 years. Nine (31.03%) presented and were diagnosed in the postpartum period. Two (6.90%) of the patients were reported as immunocompromised with HIV. Four maternal deaths (13.79%) were found in this case series with one (4.3%) patient with severe neurological deficits. Four (17.4%) infant deaths were reported. Women primary presentation varied with chest pain 13 (44.82%), headache 10 (35.70%), dyspnea 19 (65.51%), or fever 12 (41.38%). Three studies reported placental pathology positive for C. neoformans. Conclusion: This case of pulmonary cryptococcal infection in the postpartum period is an important addition to the literature of this rare infection in pregnancy. The patient is not immunocompromised. The patient was successfully treated with 4 months of Fluconazole 400 mg and continued to breastfeed the healthy baby.

Keywords: pulmonary cryptococcus, pregnancy, cryptococci , postpartum

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Authors: Andrey Kupriyanov

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In recent years, much attention has been paid to the problems of ionospheric disturbances and their influence on the signals of global navigation satellite systems (GNSS) around the world. This is due to the increase in solar activity, the expansion of the scope of GNSS, the emergence of new satellite systems, the introduction of new frequencies and many others. The influence of the Earth's ionosphere on the propagation of radio signals is an important factor in many applied fields of science and technology. The paper considers the application of the method of transionospheric sounding using measurements from signals from Global Navigation Satellite Systems to determine the TEC distribution and scintillations of the ionospheric layers. To calculate these parameters, the International Reference Ionosphere (IRI) model of the ionosphere, refined in the local area, is used. The organization of operational monitoring of ionospheric parameters is analyzed using several NovAtel GPStation6 base stations. It allows performing primary processing of GNSS measurement data, calculating TEC and fixing scintillation moments, modeling the ionosphere using the obtained data, storing data and performing ionospheric correction in measurements. As a result of the study, it was proved that the use of the transionospheric sounding method for reconstructing the altitude distribution of electron concentration in different altitude range and would provide operational information about the ionosphere, which is necessary for solving a number of practical problems in the field of many applications. Also, the use of multi-frequency multisystem GNSS equipment and special software will allow achieving the specified accuracy and volume of measurements.

Keywords: global navigation satellite systems (GNSS), GPstation6, international reference ionosphere (IRI), ionosphere, scintillations, total electron content (TEC)

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Authors: Adèle Hotte-Meunier, Lisa Sarraf, Alan Bougeard, Félicia Bernier, Chloé Voyer, Jiaxuan Deng, Stéphanie El Asmar, Alina Stamate, Marc Corbière, Patrizia Villotti, Geneviève Sauvé

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Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with psychosocial, educational and occupational functioning. Although often conceptualized as a developmental disorder of childhood, 65% of children with ADHD continue to meet full or partial diagnostic criteria for ADHD in adulthood and an estimated 4% of the workforce has a diagnosis of ADHD. Methods: A systematic review was conducted to understand the experiences of people living with ADHD in the workplace. Articles reporting employment outcomes for people living with were identified by a search in eight databases on four separate occasions from June 27, 2022, to June 21, 2023. A risk of bias assessment for each study was performed using the Mixed Methods Appraisal Tool (MMAT). Results: A total of 79 studies were included in this systematic review (nADHD: 68, 216). Results were synthesized into three broad overarching categories: challenges, strengths and adaptations at work. Further, nine themes were included: ADHD symptoms at work, workplace performance, job satisfaction, interpersonal relationships at work, maladaptive work thoughts and behaviors, personal strengths, embracing ADHD, person-environment fit and accommodations and support. Sex differences were highlighted as a tenth subtheme. ADHD confers both strengths and limitations related to employment. Discussion: Workers with ADHD can not only adapt but thrive in employment with the right person-environment fit, accommodations and support. Many challenges related to ADHD can be managed or remodeled as assets in a workplace environment that fosters acceptance, flexible working practices and openness to neurodiversity.

Keywords: neurodivergence, occupation, workplace, person-environment fit

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Authors: Amber Elyse Corrigan, Alexander Smith, Anna Pennington, Ben Carter, Jonathan Hewitt

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Background and Purpose: Morbidity secondary to stroke is highly heterogeneous, but it is important to both patients and clinicians in post-stroke management and adjustment to life after stroke. The consideration of post-stroke morbidity clinically and from the patient perspective has been poorly measured. The patient-reported outcome measures (PROs) in morbidity assessment help improve this knowledge gap. The primary aim of this study was to consider the association between PRO outcomes and stroke predictors. Methods: A multicenter prospective cohort study assessed 549 stroke patients at 19 hospital sites across England and Wales during 2019. Following a stroke event, demographic, clinical, and PRO measures were collected. Prevalence of morbidity within PRO measures was calculated with associated 95% confidence intervals. Predictors of domain outcome were calculated using a multilevel generalized linear model. Associated P -values and 95% confidence intervals are reported. Results: Data were collected from 549 participants, 317 men (57.7%) and 232 women (42.3%) with ages ranging from 25 to 97 (mean 72.7). PRO morbidity was high post-stroke; 93.2% of the cohort report post-stroke PRO morbidity. Previous stroke, diabetes, and gender are associated with worse patient-reported outcomes across both the physical and cognitive domains. Conclusions: This large-scale multicenter cohort study illustrates the high proportion of morbidity in PRO measures. Further, we demonstrate key predictors of adverse outcomes (Diabetes, previous stroke, and gender) congruence with clinical predictors. The PRO has been demonstrated to be an informative and useful stroke when considering patient-reported outcomes and has wider implications for considerations of PROs in clinical management. Future longitudinal follow-up with PROs is needed to consider association of long-term morbidity.

Keywords: morbidity, patient-reported outcome, PRO, stroke

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Authors: Terentes Printzios Dimitrios, Loanna Gourgouli, Vlachopoulos Charalambos

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Aims: Atrial fibrillation (AF) remains one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity. Ablation techniques are becoming more appealing after the latest results of randomized trials showing the overall clinical benefit. On the other hand, imaging techniques and the frontier application of 3D printing are emerging as a valuable ally for cardiac procedures. However, no randomized trial has directly assessed the impact of preprocedural imaging and especially 3D printing guidance for AF ablation. The present study is designed to investigate for the first time the effect of 3D printing of the heart on the safety and effectiveness of the ablation procedure. Methods and design: The 3D-GALA trial is a randomized, open-label, controlled, multicentre clinical trial of 2 parallel groups designed to enroll a total of 100 patients undergoing ablation using cryo-balloon for paroxysmal and persistent AF. Patients will be randomized with a patient allocation ratio of 1: 1 to preprocedural MRI scan of the heart and 3D printing of left atrium and pulmonary veins and cryoablation versus standard cryoablation without imaging. Patients will be followed up to 6 months after the index procedure. The primary outcome measure is the reduction of radiation dose and contrast amount during pulmonary veins isolation. Secondary endpoints will include the percentage of atrial fibrillation relapse at 24h-Holter electrocardiogram monitoring at 6 months after initial treatment. Discussion: To our knowledge, the 3D-GALA trial will be the first study to provide evidence about the clinical impact of preprocedural imaging and 3D printing before cryoablation.

Keywords: atrial fibrillation, cardiac MRI, cryoablation, 3-d printing

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Authors: Felix Y. Mahenge, Abiud L. Kaswamila, Davis G. Mwamfupe

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Grapevine is a drought resistant crop, although in recent years it has been observed to be affect by climate change. This compelled investigation of grapevine farmers’ adaptation strategies to climate change in Dodoma, Tanzania. A mixed research approach was adopted. Likewise, purposive and random sampling techniques were used to select individuals for the study. About 248 grapevine farmers and 64 key informants and members of focus group discussions were involved. Primary data were collected through surveys, discussions, interviews, and observations, while secondary data were collected through documentary reviews. Quantitative data were analysed through descriptive statistics by means of IBM (SPSS) software while the qualitative data were analysed through content analysis. The findings indicate that climate change has adversely affected grapevine production leading to the occurrence of grapevine pests and diseases, drought which increases costs for irrigation and uncertainties which affect grapevine markets. For the purpose of lessening grapevine production constraints due to climate change, farmers have been using several adaptation strategies. Some of the strategies include application of pesticides, use of scarers to threaten birds, irrigation, timed pruning, manure fertilisers and diversification to other farm or non-farm activities. The use of pesticides and industrial fertilizers were regarded as increasing human health risks in the study area. The researchers recommend that the Tanzania government should strengthen the agricultural extension services in the study area so that the farmers undertake adaptation strategies with the consideration of human health safety.

Keywords: grapevine farmers, adaptation, climate change, human health

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Authors: Franklin Nantui Mabe, Samuel A. Donkoh, Seidu Al-Hassan

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Rice yields among agro-ecological zones are heterogeneous. Farmers, researchers and policy makers are making frantic efforts to bridge rice yield gaps between agro-ecological zones through the promotion of improved agricultural technologies (IATs). Farmers are also modifying these IATs and blending them with indigenous farming practices (IFPs) to form farmer innovation systems (FISs). Also, different metafrontier models have been used in estimating productivity performances and their drivers. This study used the two-step stochastic metafrontier model to estimate the productivity performances of rice farmers and their determining factors in GSZ, FSTZ and CSZ. The study used both primary and secondary data. Farmers in CSZ are the most technically efficient. Technical inefficiencies of farmers are negatively influenced by age, sex, household size, education years, extension visits, contract farming, access to improved seeds, access to irrigation, high rainfall amount, less lodging of rice, and well-coordinated and synergized adoption of technologies. Albeit farmers in CSZ are doing well in terms of rice yield, they still have the highest potential of increasing rice yield since they had the lowest TGR. It is recommended that government through the ministry of food and agriculture, development partners and individual private companies promote the adoption of IATs as well as educate farmers on how to coordinate and synergize the adoption of the whole package. Contract farming concept and agricultural extension intensification should be vigorously pursued to the latter.

Keywords: efficiency, farmer innovation systems, improved agricultural technologies, two-step stochastic metafrontier approach

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Authors: Liang-Jen Wang, Sung-Chou Li, Yuan-Ming Yeh, Sheng-Yu Lee, Ho-Chang Kuo, Chia-Yu Yang

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Background: Dysbiosis in the gut microbial community might be involved in the pathophysiology of attention deficit/hyperactivity disorder (ADHD). The fungal component of the gut microbiome, namely the mycobiota, is a hyperdiverse group of multicellular eukaryotes that can influence host intestinal permeability. This study therefore aimed to investigate the impact of fungal mycobiome dysbiosis and intestinal permeability on ADHD. Methods: Faecal samples were collected from 35 children with ADHD and from 35 healthy controls. Total DNA was extracted from the faecal samples, and the internal transcribed spacer (ITS) regions were sequenced using high-throughput next-generation sequencing (NGS). The fungal taxonomic classification was analysed using bioinformatics tools, and the differentially expressed fungal species between the ADHD and healthy control groups were identified. An in vitro permeability assay (Caco-2 cell layer) was used to evaluate the biological effects of fungal dysbiosis on intestinal epithelial barrier function. Results: The β-diversity (the species diversity between two communities), but not α-diversity (the species diversity within a community), reflected the differences in fungal community composition between ADHD and control groups. At the phylum level, the ADHD group displayed a significantly higher abundance of Ascomycota and significantly lower abundance of Basidiomycota than the healthy control group. At the genus level, the abundance of Candida (especially Candida albicans) was significantly increased in ADHD patients compared to the healthy controls. In addition, the in vitro cell assay revealed that C. albicans secretions significantly enhanced the permeability of Caco-2 cells. Conclusions: The current study is the first to explore altered gut mycobiome dysbiosis using the NGS platform in ADHD. The findings from this study indicated that dysbiosis of the fungal mycobiome and intestinal permeability might be associated with susceptibility to ADHD.

Keywords: ADHD, fungus, gut–brain axis, biomarker, child psychiatry

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Authors: Kushal Patel, Manasa Dittakavi, Cyrus Falsafi, Gretchen Lovett

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Rural America has seen a surge in opioid addiction rates and overdose deaths in recent years, becoming a significant public health crisis. This may be due to a variety of factors, such as lack of access to healthcare or other economic and social factors that can contribute to addiction such as poverty, unemployment, and social isolation. As the opioid epidemic has disproportionately affected rural communities, pregnant women in these areas may be highly susceptible and face additional difficulties in facing the appropriate care they need. Opioid use disorder has many negative effects on prenatal infants. These include changes in their microbiome, mental health, neurodevelopment and cognition. These can affect how the child performs in various activities in life and how they interact with others. It has been demonstrated that using cognitive behavioral therapy improves not just pain-related results but also mobility, quality of life, disability, and mood outcomes. This indicates that cognitive behavioral therapy (CBT) may be a useful therapeutic strategy for enhancing general health and wellbeing in people with opioid use problems. In terms of treating psychiatric diseases, CBT carries fewer dangers than opioids. One study that illustrates the potential for CBT to promote a reduction in opioid use disorder used self-reported drug use patterns 6 months prior to and during their pregnancy. At the beginning of the study, participants reported an average of 3.78 drug or alcohol use days in the previous 28 days, which decreased to 1.63 days after treatment. The study also found a decrease in depression scores, as measured by IDS scores, from 23.9 to 17.1 at the end of treatment. These and other results show that CBT can have meaningful impacts on pregnant women in Rural America who struggle with an opioid use disorder. This project has been approved by the West Virginia School of Osteopathic Medicine- Office of Research and Sponsored Programs and deemed non-research scholarly work.

Keywords: appalachia, CBT, opiods, pregnancy

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Authors: Camarena Rodriguez C. S., Portocarrero Bonifaz A., Palma Esparza R., Romero Carlos N. A.

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Adobe is a construction material that fulfills the same function as a conventional brick. Widely used since ancient times, it is present in an appreciable percentage of buildings in Latin America. Adobe is a mixture of clay and sand. The interest in the study of the properties of this material arises due to its presence in the infrastructure of hospital´s radiological services, located in places with low economic resources, for the attenuation of radiation. Some materials such as lead and concrete are the most used for shielding and are widely studied in the literature. The present study will determine the mass attenuation coefficient of Adobe. The minimum required thicknesses for the primary and secondary barriers will be estimated for the shielding of radiological facilities where conventional and dental X-rays are performed. For the experimental procedure, an X-ray source emitted direct radiation towards different thicknesses of an Adobe barrier, and a detector was placed on the other side. For this purpose, an UNFORS Xi solid state detector was used, which collected information on the difference of radiation intensity. The initial parameters of the exposure started at 45 kV; and then the tube tension was varied in increments of 5 kV, reaching a maximum of 125 kV. The X-Ray tube was positioned at a distance of 0.5 m from the surface of the Adobe bricks, and the collimation of the radiation beam was set for an area of 0.15 m x 0.15 m. Finally, mathematical methods were applied to determine the mass attenuation coefficient for different energy ranges. In conclusion, the mass attenuation coefficient for Adobe was determined and the approximate thicknesses of the most common Adobe barriers in the hospital buildings were calculated for their later application in the radiological protection.

Keywords: Adobe, attenuation coefficient, radiological protection, shielding, x-rays

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Authors: André Rui Coelho Fernandes, Mariana Rufino, Divakar Hamal, Amr Sousa, Emma Fossett, Kamalpreet Cheema

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Aim: A single patella tendon rupture is relatively uncommon, but a simultaneous bilateral event is a rare occurrence and has been scarcely reviewed in the literature. This review was carried out to analyse the existing literature on this event, with the aim of proposing a standardised approach to the diagnosis and management of this injury. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three independent reviewers conducted searches in PubMed, OvidSP for Medline and Embase, as well as Cochrane Library using the same search strategy. From a total of 183 studies, 45 were included, i.e. 90 patellas. Results: 46 patellas had a Type 1 Rupture equating to 51%, with Type 3 being the least common, with only 7 patellas sustaining this injury. The mean Insall-Salvio ratio for each knee was 1.62 (R) and 1.60 (L) Direct Primary Repair was the most common surgical technique compared to Tendon Reconstruction, with End to End and Transosseous techniques split almost equally. Brace immobilisation was preferred over cast, with a mean start to weight-bearing of 3.23 weeks post-op. Conclusions: Bilateral patellar tendon rupture is a rare injury that should be considered in patients with knee extensor mechanism disruption. The key limitation of this study was the low number of patients encompassed by the eligible literature. There is space for a higher level of evidence study, specifically regarding surgical treatment choice and methods, as well as post-operative management, which could potentially improve the outcomes in the management of this injury.

Keywords: trauma and orthopaedic surgery, bilateral patella, tendon rupture, trauma

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Authors: Adawati Suhaili, Kamisah Osman, Mohd Effendi, Ewan Mohd Matore

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The global education reform has prompted Malaysia to transform the education system in Malaysia through the Malaysian Education Blueprint (MEB) 2013-2025. This transformation is aimed to achieve the top one-third rank in international assessment. The low achievement of student scientific literacy in TIMMS (Trends in International Mathematics and Science Study ) and PISA (Programme for International Student Assessment) has caused concern to the Ministry Of Education (MOE) despite various reform efforts. Therefore, an alternative action by enhancing the role of the Head of Science Panels (HoSPs) as a key change agent in catalyzing the improvement of student performance should be considered. Highlights of previous studies have shown that subject leadership is able to enhance teacher teaching quality in order to increase student learning. To lead the Science department and guide Science teachers more effectively, HoSPs need to strengthen their leadership skills. However, the issue of weaknesses in the leadership competencies of HoSPs in Malaysia has caused them to lack confidence and ability in leading the Science Department. The main objective of this study is to explore the factors that contribute to the problems faced by HoSPs at Sarawak in their leadership roles. This study used a qualitative design framework and using a semi-structured interview method for data collection. There were six informants involved in the interview consisting of lecturers, Senior Administrative Assistant Teacher and HoSPs. The findings of the study had been identified four main factors that contribute to problems in the leadership competencies of HoSPs in Sarawak, namely leadership practices, leadership structure, academic subjects and school change. The results are significant to the MOE in strengthening the leadership competencies of HoSPs in a more focus for improving the achievement of scientific literacy of students in Malaysia. This study can help improve the Hosps' leadership competencies in Malaysia.

Keywords: issues, problems, Malaysia education blueprint, leadership competencies, head of science panels

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Authors: Bui Duc Sinh

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Ecotourism in national parks seemed to be one of the options in the conservation of the natural resources and to improve the living condition of local communities. However, ecotourism development will be useless if it lacks the perception and support of local communities and appropriate ecotourism strategies. The aims of this study were to measure residents’ perception and satisfaction towards ecotourism impacts and their attitudes for ecotourism development in Cuc Phuong National Park; to assess the current ecotourism strategies based on ecotourism criteria and then to provide recommendations on ecotourism development strategies. The primary data were collected through personal observations, in-depth interviews with residents and national park staffs, and from surveys on households in all of the five communes in the Cuc Phuong National Park. The results depicted that local communities were aware of ecotourism impacts and had positive attitudes toward ecotourism development, and were satisfied of ecotourism development. However, higher perception rate was found on specific groups such as the young, the high income and educated, and those with jobs related to ecotourism. The study revealed the issues of concerns about the current ecotourism development strategies in Cuc Phuong National Park. The major hindrances for ecotourism development were lack of local participation and unattractive ecotourism services. It was also suggested that Cuc Phuong National Park should use ecotourism criteria to implement ecotourism activities sustainably and to harmonize the sharing of benefits amongst the stakeholders. The approaches proposed were to: create local employment through reengineering, improve the ecotourism quality, appropriate tourism benefits to the stakeholders, and carry out education and training programs. Furthermore, the results of the study helped tour operators and tourism promoters aware the real concerns, issues on current ecotourism activities in Cuc Phuong National Park.

Keywords: ecotourism, ecotourism impact, local community, national park

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Authors: Aroma Elmina Martha

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Environment affects the continuity of life and human well-being and the bodies of other living. Environmental quality is very closely related to the quality of life. Sustainability must be protected from damage due to the use of natural resources, such as tin mining in Bangka island. This research is a descriptive study, which identifies the environmental damage caused by mining land and sea in Bangka district. The approach used is juridical, social and economic. The study uses primary legal materials, secondary, and tertiary, equipped with field research. The analysis technique used is qualitative analysis. The impacts of mining on land among other physical and chemical damage, erosion and widening the depth of the river, a pool of micro-climate, the quality and feasibility, vegetation, wildlife and biodiversity, land values, social and economic. This mining causes damage to the soil structure, and puddles in the former digs which were not backfilled again. The impact of mining on the ocean such as changes in current surge, erosion and abrasion basic coastal waters, shoreline change, marine water quality changes, and changes in marine communities. The findings of the research show that tin mining in the sea also potentially have a significant impact on the life of the reef, populations of marine organisms. However, mining on land needs to consider the impact of the damage, so that the damage can be minimized. In the recovery process needs to be pursued by exploiting the rest of the pile of tin. Thus, mining activities should take into account the distance of beach sediment size, wave height, wave length, wave period, and the acceleration of gravity. The process of the tin washing should be done in a fairly safe area, thus avoiding damage to the coral reefs that will eventually reduce the population of marine life.

Keywords: abration, environmental damage, mining, shoreline

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Authors: Monica Plechero

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Many firms belonging to Italian industrial districts faced a crisis starting from 2000 and upsurging during 2008-2014. To remain competitive in the global market, these firms and their local systems need to renovate their traditional competitive advantages, strengthen their link with global flows of knowledge. This may be particularly relevant in sectors such as the mechatronics, that combine traditional knowledge domain with new knowledge domains (e.g. mechanics, electronics, and informatics). This sector is nowadays one of the key sectors within the so-called ‘smart specialization strategy’ that can lead part of the Italian traditional industry towards new economic developmental opportunities. This paper, by investigating the mechatronics district of the Veneto region, wants to shed new light on how firms of a local system can gain from the globalization of innovation and innovation networks. Methodologically, the paper relies on primary data collected through a survey targeting firms of the local system, as well as on a number of qualitative case studies. The relevant role of medium size companies in the district emerges as evident, as they have wider opportunities to be involved in different processes of globalization of innovation. Indeed, with respect to small companies, the size of medium firms allows them to exploit strategically international markets and globally distributed knowledge. Supporting medium firms’ global innovation strategies, and incentivizing their role as district gatekeepers, may strengthen the competitive capability of the local system and provide new opportunities to positively face global competition.

Keywords: global innovation network, industrial district, internationalization, innovation, mechatronics, Veneto region

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Authors: Sadiah Baharom, Che Nidzam Che Ahmad, Saipol Barin Ramli, Asmayati Yahaya, Sopia Md Yassin

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The early childhood care and education (ECCE) in Malaysia aspire to develop children who are intellectually, emotionally, physically and spiritually balanced. This aspiration can only materialise if the early childhood program developed comprehensive and is of high quality comparable to international standards. As such, there is a pressing need to assess the quality of the program in an all-encompassing manner. The overall research project aims at developing a comprehensive and integrated model of high-quality Malaysian ECCE. One of the major objectives of this project is to assess and evaluate the scope and quality of the existing ECCE programs in Malaysia. To this end, a specific aspect of this objective is to develop and validate an instrument to assess and evaluate the ECCE curriculum of the country. Thus this paper describes the development and validation of an instrument to explore the quality of early childhood care and education curriculum currently implemented in the country’s ECCE centres. The generation of the constructs and items were based on a set of criteria mapped against existing ECCE practice, document analyses, expert interviews and panel discussions. The items went through expert validation and were field tested on 597 ECCE teachers. The data obtained went through an exploratory factor analysis to validate the constructs of the instrument followed by reliability studies on internal consistency based on the Cronbach Alpha values. The final set of items for the ECCE curriculum instrument, earmarked for the main study, consists of four constructs namely philosophy and core values, curriculum content, curriculum review and unique features. Each construct consists of between 21 to 3 items with a total of 36 items in all. The reliability coefficients for each construct range from 0.65 to 0.961. These values are within the acceptable limits for a reliable instrument to be used in the main study.

Keywords: early childhood and care education, instrument development, reliability studies, validity studies

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Authors: Gebrekiros Welegebriel Asfaw

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The management of the fragile, unique and irreplaceable cultural heritage from different perspectives is becoming a major challenge as important elements of culture are vanishing throughout the globe. The major purpose of this study is to assess how the cultural heritages of Aksum are managed for their future sustainability from heritage conservation and interpretation perspectives. Descriptive type of research design inculcating both quantitative and qualitative research methods is employed. Primary quantitative data was collected from 189 respondents (19 professionals, 88 tourism service providers and 82 tourists) and interview was conducted with 33 targeted informants from heritage and related professions, security employees, local community, service providers and church representatives by applying probability and non probability sampling methods. Findings of the study reveal that the overall sustainable management status of the cultural heritage of Aksum is below average. It is found that the sustainability of cultural heritage management in Aksum is facing a lot of unfavorable factors like lack of long term planning, incompatible system of heritage administration, limited capacity and number of professionals, scant attention to community based heritage and tourism development, dirtiness and drainage problems, problems with stakeholder involvement and cooperation, lack of organized interpretation and presentation systems and others. So, re-organization of the management system, creating platform for coordination among stakeholders and developing appropriate interpretation system can be good remedies. Introducing community based heritage and tourism development concept is also recommendable for a long term win-win success in Aksum.

Keywords: Aksum, conservation, interpretation, Sustainable Cultural Heritage Management

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Authors: Robin Ruowei Yang

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The Khitan-Liao dynasty (907-1125) was founded by the nomadic Khitan people and showed its peculiarities. This regime not only effectively ruled their own nomads, but also ruled the farming ethnic groups of the Han (漢) and others. It also controlled vast territories that included the northern border domains of China, East Asia, and even Central Asia. Different from the practice of other nomadic people, Khitan-Liao built settlement towns and cities on the Mongolia steppe from beginning of the dynasty, which made the politics, economy and culture of the steppe area develop significantly. In the process of cities’ construction, Khitan-Liao set up five capitals respectively. Except three of them were rebuilt or expanded based on existing cities in agricultural areas, two new capitals were built, namely up-capital (Shangjing) and middle-capital (Zhongjing) in the steppe area. This article takes the up-capital (Shangjing) as an example to investigate a special zone in the capital for settling movable tents which adapted Khitan nomads, especially its nomadic government officials to live in. By using primary Chinese historical records and newly archaeological excavations, this article examines how the special tent zone used by the Khitan rulers, discusses how the Khitan-Liao manifested its hybrid cultural characteristics in urban planning, and its implications in studying the history of Khitan-Liao. The information, discussion and argument presented in this article are also worth considering the influence of urbanization of Khitan-Liao’s urbaization on subsequent dynasties in pre-modern China and Inner Asia.

Keywords: cities on Steppe, special tent zone in cities, Khitan-Liao, hybrid culture

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Authors: Weishou Shen, Changxin Zou, Dong Liu

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High-mountain environments are experiencing more rapid warming than lowlands. The Tibetan (Qinghai-Xizang, TP) Plateau, known as the “Third Pole” of the Earth and the “Water Tower of Asia,” is the highest plateau in the world, however, ecological response to climate change has been hardly documented in high altitude regions. In this paper, we investigated climate warming induced ecological changes on the Tibetan Plateau over the past 50 years through combining remote sensing data with a large amount of in situ field observation. The results showed that climate warming up to 0.41 °C/10 a has greatly improved the heat conditions on the TP. Lake and river areas exhibit increased trend whereas swamp area decreased in the recent 35 years. The expansion in the area of the lake is directly related to the increase of precipitation as well as the climate warming up that makes the glacier shrink, the ice and snow melting water increase and the underground frozen soil melting water increase. Climate warming induced heat condition growth and reduced annual range of temperature, which will have a positive influence on vegetation, agriculture production and decreased freeze–thaw erosion on the TP. Terrestrial net primary production and farmland area on the TP have increased by 0.002 Pg C a⁻¹ and 46,000 ha, respectively. We also found that seasonal frozen soil depth decreased as the consequence of climate warming. In the long term, accelerated snow melting and thinned seasonal frozen soil induced by climate warming possibly will have a negative effect on alpine ecosystem stability and soil preservation.

Keywords: global warming, alpine ecosystem, ecological response, remote sensing

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Authors: Rajiv Ratan Singh, Sachin Kumar Tripathi, Pradeep Kumar Yadav

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The timely evaluation, diagnosis, and treatment of people who have been exposed to toxic chemicals is a crucial component of emergency poison management in the medical field. The various substances that can poison include chemicals, medications, and naturally occurring poisons. The toxicology of the particular drug involved, as well as the symptoms and indicators of poisoning, must be thoroughly understood to handle poisoning emergencies effectively. One of the most important aspects of emergency poison management in medicine is the prompt examination, diagnosis, and treatment of persons who have been exposed to dangerous substances. To properly manage poisoning crises, one must have a good understanding of the toxicology of the particular medication concerned, as well as the signs and indicators of poisoning. Emergency management of poisoning includes not only prompt medical attention but also patient education, follow-up care, and monitoring for any long-term consequences. To achieve the greatest results for patients, the management of poisoning is a complicated and dynamic process that calls for collaboration between medical professionals, first responders, and toxicologists. All poisoned patients who present to the emergency room are assessed and diagnosed based on a collection of symptoms and a biochemical diagnosis, and they are then provided targeted, specialized treatment for the toxin identified. This article focuses on the loxodromic strategy as the primary method of treatment for poisoned patients. The authors of this article conclude that mortality and morbidity can be reduced if patients visit the emergency room promptly and receive targeted treatment.

Keywords: antidotes, blood poisoning, emergency medicine, gastric lavage, medico-legal aspects, patient care

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Authors: Piyanee Khumpao

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Under the Thai Penal Code and Customs Act, sex toys are criminalized and completely prohibited through the legal interpretation as obscene objects by law enforcement, despite there is no explicit legal sanction against them. The purpose of preventing people from accessing sex toys is to preserve public morals. However, sex toys are still available, exposed, and sold publicly in main cities throughout Thailand. They are easily observed by people of any age. This paper argues that sexuality is human nature and human right. Human deserves sexual pleasure as long as getting sexual pleasure does not inflict any harm on others. Using sex toys in private (individually and/or as a couple with mutual consent) does not constitute any harm nor degrade public moral. Therefore, the complete ban of sex toys shall be lifted and decriminalized. Nevertheless, the economic analysis illustrates that criminalization and prohibition of sex toys would lead to its black market – higher price and lower quantity. Although it is socially desirable to have fewer sex toys in the market, there will usually be high demand for them because sexual pleasure is natural and, hence, people have a lower price elasticity of demand for such things, including pornography. Thus, its deterrent effect is not very effective. Moreover, sex toys vendors still always exist because higher price incentivizes them to act illegally and may gain benefits from selling low-quality sex toys. Consequently, consumers do not have a choice to select high-quality sex toys at a reasonable price. Then, they are forced to purchase low quality sex toys at a higher price. They also may suffer from health issues as well as other harms from its dangerous/toxic substances since lower quality products are manufactured poorly to save costs. A law and economics approach supports the decriminalization of sex toys in Thailand. Other measures to control its availability shall be adopted to protect the vulnerable, such as children. Options are i) zoning or regulation on-premises selling sex toys as in Singapore, Japan, and China, ii) regulations of sex toys as medical apparatus like in the state of Alabama, and iii) the prevention of sex toys exposure in the real (physical) appearance (i.e., allowing virtual exposure of sex toys) like in India.

Keywords: human nature, law and economics approach, sex toys, sexual pleasure

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Authors: Yi-Hsiang Pan, Chen-Hui Huang, Wei-Ting Hsu

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The purposes of the study were to understand these topics as follows: 1. To explore the effect of merging teaching personal and social responsibility (TPSR) with sports education model on students' game performance and responsibility. 2. To explore the effect of sports education model on students' game performance and responsibility. 3. To compare the difference between "merging TPSR with sports education model" and "sports education model" on students' game performance and responsibility. The participants include three high school physical education teachers and six physical education classes. Every teacher teaches an experimental group and a control group. The participants had 121 students, including 65 students in the experimental group and 56 students in the control group. The research methods had game performance assessment, questionnaire investigation, interview, focus group meeting. The research instruments include personal and social responsibility questionnaire and game performance assessment instrument. Paired t-test test and MANCOVA were used to test the difference between "merging TPSR with sports education model" and "sports education model" on students' learning performance. 1) "Merging TPSR with sports education model" showed significant improvements in students' game performance, and responsibilities with self-direction, helping others, cooperation. 2) "Sports education model" also had significant improvements in students' game performance, and responsibilities with effort, self-direction, helping others. 3.) There was no significant difference in game performance and responsibilities between "merging TPSR with sports education model" and "sports education model". 4)."Merging TPSR with sports education model" significantly improve learning atmosphere and peer relationships, it may be developed in the physical education curriculum. The conclusions were as follows: Both "Merging TPSR with sports education model" and "sports education model" can help improve students' responsibility and game performance. However, "Merging TPSR with sports education model" can reduce the competitive atmosphere in highly intensive games between students. The curricular projects of hybrid TPSR-Sport Education model is a good approach for moral character education.

Keywords: curriculum and teaching model, sports self-efficacy, sport enthusiastic, character education

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Authors: Anshu Gupta, Charu Gupta

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Background: Punjab, a border state in India has achieved notoriety world over for its drug abuse problem. People right from school kids to elderly are hooked to drugs. This pattern of substance abuse is prevalent in both cities and villages alike. Excess of younger population in India has further aggravated the situation. It is feared that the benefits of India’s economic growth may well be negated by the rising substance abuse especially in this part of the country. It is quite evident that the pattern of substance abuse tends to change over time which is an impediment in the formulation of effective strategies to tackle this issue. Aim: Purpose of the study was to ascertain the change in the pattern of drug abuse for two consecutive years in the out patient department (OPD) population. Method: The study population comprised of all the patients reporting for deaddiction to the psychiatry outpatient department over a period of twelve months for two consecutive years. All the patients were evaluated by the International Classification of Diseases; 10 criteria for substance abuse/dependence. Results: A considerably high prevalence of substance abuse was present in the Indian population. In general, there was an increase in prevalence from first to the second year, especially among the female population. Increase in prevalence of substance abuse appeared to be more prominent among the younger age group of both the sexes. A significant increase in intravenous drug abuse was observed. Peer pressure and parental imitation were the major factors fueling substance abuse. Precipitation or fear of withdrawal symptoms was the major factor preventing abstinence. Substance abuse had a significant effect on the health and interpersonal relations of these patients. Summary/Conclusion: Drug abuse and addiction are on the rise throughout India. Changing cultural values, increasing economic stress and dwindling supportive bonds appear to be leading to initiation of substance abuse. Need of the hour is to formulate a comprehensive strategy to bring about an overall reduction in the use of drugs.

Keywords: deaddiction, peer pressure, parental imitation, substance abuse/dependance

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Authors: Medagedara Kaushalya Sewwandi Supun Gunarathne

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This research explores the underlying motivations and consequences of individuals changing their sexual orientation as a response to sexual violence. The primary objective of the study is to unravel the psychological, emotional, and social factors that drive individuals, akin to Celie in Alice Walker’s ‘The Color Purple’, to contemplate and undergo changes in their sexual orientation following the trauma of sexual violence. Through an analytical and qualitative approach, the study employs in-depth textual and thematic analyses to scrutinize the complex interplay between sexual orientation and violence within the selected text. Through a close examination of Celie’s journey and experiences, the study reveals that her decision to switch sexual orientation arises from a desire for a more favorable and benevolent relationship driven by the absence of safety and refuge in her previous relationships. By establishing this bond between sexual orientation and violence, the research underscores how sexual violence can lead individuals to opt for a change in their sexual orientation. The findings highlight Celie’s transformation as a means to seek solace and security, thus concluding that sexual violence can prompt individuals to alter their sexual orientation. The ensuing discussion explores the implications of these findings, encompassing psychological, emotional, and social consequences, as well as the societal and cultural factors influencing the perception of sexual orientation. Additionally, it sheds light on the challenges and stigma faced by those who undergo such transformations. By comprehending the complex relationship between sexual violence and the decision to change sexual orientation, as exemplified by Celie in ‘The Color Purple’, a deeper understanding of the experiences of survivors who seek a safe haven through altering their sexual orientation can be attained.

Keywords: sexual violence, sexual orientation, refuge, transition

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Authors: S. Shafiee Ardestani, A. Najafi, N. Valizadeh, E. Payani, H. Karimian

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Objectives: Treatment of mild traumatic brain injury in emergency ward patients with any type of traumatic intracranial hemorrhage is flexible. The aim of this study is to assess the clinical outcomes of mild traumatic brain injury patients who had acute traumatic intracranial hemorrhage on initial emergency ward neuroimaging. Materials-Methods: From March 2011 to November 2012 in a retrospective cohort study we enrolled emergency ward patients with mild traumatic brain injury with Glasgow Coma Scale (GCS) scores of 14 or 15 and who had stable vital signs. Patients who had any type of intracranial hemorrhage on first head CT and repeat head CT within 24 hours were included. Patients with initial GCS < 14, injury > 24 hours old, pregnancy, concomitant non-minor injuries, and coagulopathy were excluded. Primary endpoints were neurosurgical procedures and/or death and for discharged patients, return to the emergency ward during one week. Results: Among 755 patients who were referred to the emergency ward and underwent two head CTs during first 24 hours, 302 (40%) were included. The median interval between CT scans was 6 hours (ranging 4 to 8 hours). Consequently, 135 (45%) patients had subarachnoid hemorrhage, 124 (41%) patients had subdural hemorrhage, 15 (5%) patients had epidural hemorrhage, 28 (9%) patients had cerebral contusions, and 54 (18%) patients had intra-parenchymal hemorrhage. Six of 302 patients died within 15 days of injury. 200 patients (66%) have been discharged from the emergency ward, 25 (12%) of whom returned to the emergency ward after one week. Conclusion: Discharge of the head trauma patients after a repeat head CT and brief period of observation in the emergency ward lead to early discharge of mild traumatic brain injury patients with traumatic ICH without adverse events.

Keywords: clinical outcomes, emergency ward, mild traumatic intracranial hemorrhage, Glasgow Coma Scale (GCS)

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Authors: Armando T. Zúñiga

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As the number of English Language Learners (ELLs) in public schools continues to grow, so does the achievement gap between ELLs and other student populations. In an effort to support classroom teachers with effective instructional strategies for this student population, many districts have created instructional coaching positions specifically to support classroom teachers of ELLs—ELL Teachers on Special Assignment (ELL TOSAs). This study employed a gap analysis framework to the ELL TOSA professional support program in one California school district to examine knowledge, motivation, and organizational influences (KMO) on the ELL TOSAs’ goal of supporting classroom teachers of ELLs. Three themes emerged as a result of data analysis. First, there was evidence to illustrate the interaction between knowledge and the organization. Data from ELL TOSAs indicated an understanding of the role that collaboration plays in coaching and how to operationalize it in their support of teachers. Further, all of the ELL TOSAs indicated they have received professional development on effective strategies for instructional coaching. Additionally, a large percentage of the ELL TOSAs indicated a knowledge of modeling as an effective coaching practice. Accordingly, all of the ELL TOSAs indicated that they had knowledge of feedback as an effective coaching strategy. However, there was not sufficient evidence to support that they learned the latter two strategies through professional development. A second theme surfaced as there was evidence to illustrate an interaction between motivation and the organization. Some ELL TOSAs indicated that their sense of self-efficacy was affected by conflicting roles and expectations for the job. Most of the ELL TOSAs indicated that their sense of self-efficacy was affected by an increased workload brought about by fiscal decision making. Finally, there was evidence illustrating the interaction between the organization and motivation. The majority of the of ELL TOSAs indicated that there is confusion about how their roles are perceived, leaving the ELL TOSAs to feel that their actions did not contribute to instructional change. In conclusion, five research-based recommendations to support ELL TOSA goal attainment and considerations for future research on instructional coaches for classroom teachers of ELLs are provided.

Keywords: English language development, English language acquisition, language and leadership, language coaching, English language learners, second language acquisition

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Authors: Sadeq Al Yaari, Muhammad Alkhunayn, Aayah Al Yaari, Ayman Al Yaari, Montaha Al Yaari, Sajedah Al Yaari, Fatehi Eissa

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The recent rise of smart educational aids and the move away from traditional listening aids are leading to a fundamental shift in the way in which individuals with attention and listening problems (ALP) manipulate listening inputs and/or act appropriately to the spoken information presented to them. A total sample of twenty-six ALP pupils (m=20 and f=6) between 7-12 years old was selected from different strata based on gender, region and school. In the sample size, thirteen (10 males and 3 females) received the treatment in terms of smart classes provided with smart educational aids in a listening course that lasted for four month-semester while others did not (they studied the same course by the same instructor but in ordinary class). A pretest was administered to assess participants’ levels, and a posttest was given to evaluate their attention and listening comprehension performance, namely in phonetic and phonological tests with sociolinguistic themes that have been designed for this purpose. Test results were analyzed both psychoneurolinguistically and statistically. Results reveal a remarkable change in pupils’ behavioral listening where scores witnessed a significant difference in the performance of the experimental ALP group in the pretest compared to the posttest (Pupils performed better at the pretest-posttest on phonetics than at the two tests on phonology). It is concluded that smart educational aids designed for listening skills help not only increase the listening command of pupils with ALP to understand what they listen to but also develop their interactive listening capability and, at the same rate, are responsible for increasing concentrated and in-depth listening capacity. Plus, ALP pupils become able to grasp the audio content of text recordings, including educational audio recordings, news, oral stories and tales, views, spiritual/religious text and general knowledge. However, the pupils have not experienced individual smart audio-visual aids that connect listening to other language receptive and productive skills, which could be the future area of research.

Keywords: language skills, implementing, listening skill, attention, smart aids

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