Search results for: emergency response training simulator
Commenced in January 2007
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Edition: International
Paper Count: 9743

Search results for: emergency response training simulator

1913 Language Choice and Language Maintenance of Northeastern Thai Staff in Suan Sunandha Rajabhat University

Authors: Napasri Suwanajote

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The purposes of this research were to analyze and evaluate successful factors in OTOP production process for the developing of learning center on OTOP production process based on Sufficiency Economic Philosophy for sustainable life quality. The research has been designed as a qualitative study to gather information from 30 OTOP producers in Bangkontee District, Samudsongkram Province. They were all interviewed on 3 main parts. Part 1 was about the production process including 1) production, 2) product development, 3) the community strength, 4) marketing possibility, and 5) product quality. Part 2 evaluated appropriate successful factors including 1) the analysis of the successful factors, 2) evaluate the strategy based on Sufficiency Economic Philosophy, and 3) the model of learning center on OTOP production process based on Sufficiency Economic Philosophy for sustainable life quality. The results showed that the production did not affect the environment with potential in continuing standard quality production. They used the raw materials in the country. On the aspect of product and community strength in the past 1 year, it was found that there was no appropriate packaging showing product identity according to global market standard. They needed the training on packaging especially for food and drink products. On the aspect of product quality and product specification, it was found that the products were certified by the local OTOP standard. There should be a responsible organization to help the uncertified producers pass the standard. However, there was a problem on food contamination which was hazardous to the consumers. The producers should cooperate with the government sector or educational institutes involving with food processing to reach FDA standard. The results from small group discussion showed that the community expected high education and better standard living. Some problems reported by the community included informal debt and drugs in the community. There were 8 steps in developing the model of learning center on OTOP production process based on Sufficiency Economic Philosophy for sustainable life quality.

Keywords: production process, OTOP, sufficiency economic philosophy, language choice

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1912 Didactic Suitability and Mathematics Through Robotics and 3D Printing

Authors: Blanco T. F., Fernández-López A.

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Nowadays, education, motivated by the new demands of the 21st century, acquires a dimension that converts the skills that new generations may need into a huge and uncertain set of knowledge too broad to be entirety covered. Within this set, and as tools to reach them, we find Learning and Knowledge Technologies (LKT). Thus, in order to prepare students for an everchanging society in which the technological boom involves everything, it is essential to develop digital competence. Nevertheless LKT seems not to have found their place in the educational system. This work is aimed to go a step further in the research of the most appropriate procedures and resources for technological integration in the classroom. The main objective of this exploratory study is to analyze the didactic suitability (epistemic, cognitive, affective, interactional, mediational and ecological) for teaching and learning processes of mathematics with robotics and 3D printing. The analysis carried out is drawn from a STEAM (Science, Technology, Engineering, Art and Mathematics) project that has the Pilgrimage way to Santiago de Compostela as a common thread. The sample is made up of 25 Primary Education students (10 and 11 years old). A qualitative design research methodology has been followed, the sessions have been distributed according to the type of technology applied. Robotics has been focused towards learning two-dimensional mathematical notions while 3D design and printing have been oriented towards three-dimensional concepts. The data collection instruments used are evaluation rubrics, recordings, field notebooks and participant observation. Indicators of didactic suitability proposed by Godino (2013) have been used for the analysis of the data. In general, the results show a medium-high level of didactic suitability. Above these, a high mediational and cognitive suitability stands out, which led to a better understanding of the positions and relationships of three-dimensional bodies in space and the concept of angle. With regard to the other indicators of the didactic suitability, it should be noted that the interactional suitability would require more attention and the affective suitability a deeper study. In conclusion, the research has revealed great expectations around the combination of teaching-learning processes of mathematics and LKT. Although there is still a long way to go in terms of the provision of means and teacher training.

Keywords: 3D printing, didactic suitability, educational design, robotics

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1911 Exploring Social Emotional Learning in Diverse Academic Settings

Authors: Regina Rahimi, Delores Liston

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The advent of COVID-19 has heightened awareness of the need for social emotional learning (SEL) throughout all educational contexts. Given this, schools (most often p12 settings) have begun to embrace practices for addressing social-emotional learning. While there is a growing body of research and literature on common practices of SEL, there is no ‘standard’ for its implementation. Our work proposed here recognizes there is no universal approach for addressing SEL and rather, seeks to explore how SEL can be approached in and through diverse contexts. We assert that left unrecognized and unaddressed by teachers, issues with social and emotional well-being profoundly negatively affect students’ academic performance and exacerbate teacher stress. They contribute to negative student-teacher relationships, poor classroom management outcomes, and compromised academic outcomes. Therefore, teachers and administrators have increasingly turned to developing pedagogical and classroom practices that support the social and emotional dimensions of students. Substantive quantitative evidence indicates professional development training to improve awareness and foster positive teacher-student relationships can provide a protective function for psycho-social outcomes and a promotive factor for improved learning outcomes for students. Our work aims to add to the growing body of literature on improving student well-being by providing a unique examination of SEL through a lens of diverse contexts. Methodology: This presentation hopes to present findings from an edited volume that will seek to highlight works that examine SEL practices in a variety of academic settings. The studies contained within the work represent varied forms of qualitative research. Conclusion: This work provides examples of SEL in higher education/postsecondary settings, a variety of P12 academic settings (public; private; rural, urban; charter, etc.), and international contexts. This work demonstrates the variety of ways educational institutions and educators have used SEL to address the needs of students, providing examples for others to adapt to their own diverse contexts. This presentation will bring together exemplar models of SEL in diverse practice settings.

Keywords: social emotional learning, teachers, classrooms, diversity

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1910 The Communicational Behaviors of the Nurses Towards 'Crying Patient'

Authors: Hacer Kobya Bulut, Kıymet Yeşilçiçek Çalık, Birsel Canan Demirbağ, Hacer Erdöl, Songül Aktaş

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Introduction: As an expression of an emotion which always exists in life, crying is regarded as one of the problematic behaviors of patients by nurses. Towards such patients, nurses may exhibit emotional and behavioral reactions such as feeling helpless, anger, indifferent, defense, and opposition. However crying either meets a need, reduces the tension to cope with problems or helps patient to gain strength. Therefore, nurses must accept that crying is a normal mechanism that reduces emotional tension and should approach a crying patient accordingly. Objective: This study was carried out to evaluate the communicational behaviors of the nurses towards ‘crying patient’. Methods: This descriptive study was conducted with the nurses working at a university hospital in a city in the Eastern Black Sea in June-September 2015. The entire universe was tried to be reached without sampling. 90% of the population was reached and the study was completed with 309 nurses who volunteered to participate in the study. Data were collected through a questionnaire which was prepared reviewing the literature by researchers. Data were evaluated in SPSS analysis program using percentages, numbers and chi-square test with the 95% confidence interval and p <0.05significance level. Findings: The findings showed that the average age of nurses was 31.52 ± 7.96, work experience was 10:09 ± 7.69 and only 22.7% had training about ‘approach to crying patient’ during their education. 97.1% of the nurses often faced with crying patients in their professional lives, 62.8% stated that they faced crying women patients. When they see crying patients, 84.8% of the nurses ‘do not want the patient to cry’, 80.9% wonder ‘why they are crying’, % 79.6 ‘feel uneasiness’,% 79.3 ‘feel sorry’ and 41.4% ‘ feel helpless’. The question ‘Why do you think the patient is crying?’ was answered by 93.5% nurses as ‘they are suffering’, by 86.1% ‘they are helpless’, 80.9% ‘they are sad’, 79.6% ‘they need help’, 54.4% ‘because they feel inadequate,’ and 44.7% ‘they fail to control their crying behavior. ‘How do you approach to your patient when she/he is crying?’ question was answered by 82.5% of nurses as ‘I would console’, 77.3% as ‘I would ask the reason’, 63.1% as ‘I would try to stop her from crying’ all of which are actually inappropriate nursing approaches. However, 92.2% of the nurses stated that ‘I do not judge the crying patient’, ‘87.1% said ‘I allocate time to crying patients’ and 85.8% said ‘ I ask patient whether they want to cry alone’. The study showed that educational background and work experience of the nurses affected the appropriate approach to crying patients (P <0.05). Conclusion: As a result of the study, it was found out that nurses do not want patients to cry, so they exhibit inappropriate approach such as consoling the patients and they have difficulty in approaching crying patients.

Keywords: approach to patient, communication, crying patient, nurse, Turkey

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1909 Humoral and Cellular Immune Responses to Major Human Cytomegalovirus Antigens in Mice Model

Authors: S. Essa, H. Safar, R. Raghupathy

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Human cytomegalovirus (CMV) continues to be a source of severe complications to immunologically immature and immune-compromised hosts. Effective CMV vaccine that diminishes CMV disease in transplant patients and avoids congenital infection remains of high importance as no approved vaccines exist. Though the exact links of defense mechanisms are unidentified, viral-specific antibodies and Th1/Th2 cytokine responses have been involved in controlling viral infections. CMV envelope glycoprotein B (UL55/gB), the matrix proteins (UL83/pp65, UL99/pp28, UL32/pp150), and the assembly protein UL80a/pp38 are known to be targets of antiviral immune responses. In this study, mice were immunized with five HCMV antigens (UL32/pp150, UL80a/pp38, UL99/pp28, and UL83/pp65), and serum samples were collected and evaluated for eliciting viral-specific antibody responses. Moreover, Splenocytes were collected, stimulated, and assessed for cytokine responses. The results demonstrated a CMV-antigen-specific antibody response to pp38 and pp65 (E/C >2.0). The highest titers were detected with pp38 (average E/C 16.275) followed by pp65 (average E/C 7.72). Compared to control cells, splenocytes from PP38 antigen immunized mice gave a significantly higher concentration of GM-CSF, IFN-γ, IL-2 IL-4, IL-5, and IL-17A (P<0.05). Also, splenocytes from pp65 antigen immunized mice resulted in a significantly higher concentration of GM-CSF, IFN-γ, IL-2 IL-4, IL-10, IL-12, IL-17A, and TNF- α. The designation of target CMV peptides by identifying viral-specific antibodies and cytokine responses is vital for understanding the protective immune mechanisms during CMV infection and identifying appropriate viral antigens to develop novel vaccines.

Keywords: hepatitis C virus, peripheral blood mononuclear cells, neutrophils, cytokines

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1908 Sensing of Cancer DNA Using Resonance Frequency

Authors: Sungsoo Na, Chanho Park

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Lung cancer is one of the most common severe diseases driving to the death of a human. Lung cancer can be divided into two cases of small-cell lung cancer (SCLC) and non-SCLC (NSCLC), and about 80% of lung cancers belong to the case of NSCLC. From several studies, the correlation between epidermal growth factor receptor (EGFR) and NSCLCs has been investigated. Therefore, EGFR inhibitor drugs such as gefitinib and erlotinib have been used as lung cancer treatments. However, the treatments result showed low response (10~20%) in clinical trials due to EGFR mutations that cause the drug resistance. Patients with resistance to EGFR inhibitor drugs usually are positive to KRAS mutation. Therefore, assessment of EGFR and KRAS mutation is essential for target therapies of NSCLC patient. In order to overcome the limitation of conventional therapies, overall EGFR and KRAS mutations have to be monitored. In this work, the only detection of EGFR will be presented. A variety of techniques has been presented for the detection of EGFR mutations. The standard detection method of EGFR mutation in ctDNA relies on real-time polymerase chain reaction (PCR). Real-time PCR method provides high sensitive detection performance. However, as the amplification step increases cost effect and complexity increase as well. Other types of technology such as BEAMing, next generation sequencing (NGS), an electrochemical sensor and silicon nanowire field-effect transistor have been presented. However, those technologies have limitations of low sensitivity, high cost and complexity of data analyzation. In this report, we propose a label-free and high-sensitive detection method of lung cancer using quartz crystal microbalance based platform. The proposed platform is able to sense lung cancer mutant DNA with a limit of detection of 1nM.

Keywords: cancer DNA, resonance frequency, quartz crystal microbalance, lung cancer

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1907 Professionals’ Learning from Casework in Child Protection: The View from Within

Authors: Jude Harrison

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Child protection is a complex and sensitive practice. The core responsibility is the care and protection of children and young people who have been subject to or who are at risk from abuse and neglect. The work involves investigating allegations of harm, preparing for and making representations to the legal system, and case planning and management across a continuum of complicated care interventions. Professionals’ learning for child protection practice is evident in a range of literature investigating multiple learning processes such as university preparation, student placements, professional supervision, training, and other post-qualifying professional development experiences at work. There is, however, very limited research into how caseworkers learn in and through their daily practice. Little is known, therefore, about how learning at work unfolds for caseworkers, the dimensions in which it can be understood or the ways in which it can be best facilitated and supported. Compounding this, much of the current child protection learning literature reflects an orthodox conception of learning as mentalistic and individualised, in which knowledge is typically understood as abstract theory or as technical skill or competency. This presentation outlines key findings from a PhD research study that explored learning at work for statutory child protection caseworkers from an alternative interpretation of learning using a practice theory approach. Practice theory offers an interpretation of learning as performative and grounded in situated experience. The findings of the study show that casework practice is both a mode and site of learning. The study was ethnographic in design based and followed 17 child protection caseworkers via in-depth interviews, observations and participant reflective journaling. Inductive and abductive analysis was used to organise and interpret the data and expand analysis, leading to themes. Key findings show learning to be a sociomaterial property of doing; the social ontological character of learning; and teleoaffectivity as a feature of learning. The findings contribute to theoretical and practical understandings of learning and practice in child protection, child welfare and the professional learning literature more broadly. The findings have potential to contribute to policy directions at state, territory and national levels to enhance child protection practice and systems.

Keywords: adiult learning, workplace learning, child welfare, sociomaterial, practice theory

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1906 Evaluating the Water Balance of Sokoto Basement Complex to Address Water Security Challenges

Authors: Murtala Gada Abubakar, Aliyu T. Umar

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A substantial part of Nigeria is part of semi-arid areas of the world, underlain by basement complex (hard) rocks which are very poor in both transmission and storage of appreciable quantity of water. Recently, a growing attention is being paid on the need to develop water resources in these areas largely due to concerns about increasing droughts and the need to maintain water security challenges. While there is ample body of knowledge that captures the hydrological behaviours of the sedimentary part, reported research which unambiguously illustrates water distribution in the basement complex of the Sokoto basin remains sparse. Considering the growing need to meet the water requirements of those living in this region necessitated the call for accurate water balance estimations that can inform a sustainable planning and development to address water security challenges for the area. To meet this task, a one-dimensional soil water balance model was developed and utilised to assess the state of water distribution within the Sokoto basin basement complex using measured meteorological variables and information about different landscapes within the complex. The model simulated the soil water storage and rates of input and output of water in response to climate and irrigation where applicable using data from 2001 to 2010 inclusive. The results revealed areas within the Sokoto basin basement complex that are rich and deficient in groundwater resource. The high potential areas identified includes the fadama, the fractured rocks and the cultivated lands, while the low potential areas are the sealed surfaces and non-fractured rocks. This study concludes that the modelling approach is a useful tool for assessing the hydrological behaviour and for better understanding the water resource availability within a basement complex.

Keywords: basement complex, hydrological processes, Sokoto Basin, water security

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1905 Local Directional Encoded Derivative Binary Pattern Based Coral Image Classification Using Weighted Distance Gray Wolf Optimization Algorithm

Authors: Annalakshmi G., Sakthivel Murugan S.

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This paper presents a local directional encoded derivative binary pattern (LDEDBP) feature extraction method that can be applied for the classification of submarine coral reef images. The classification of coral reef images using texture features is difficult due to the dissimilarities in class samples. In coral reef image classification, texture features are extracted using the proposed method called local directional encoded derivative binary pattern (LDEDBP). The proposed approach extracts the complete structural arrangement of the local region using local binary batten (LBP) and also extracts the edge information using local directional pattern (LDP) from the edge response available in a particular region, thereby achieving extra discriminative feature value. Typically the LDP extracts the edge details in all eight directions. The process of integrating edge responses along with the local binary pattern achieves a more robust texture descriptor than the other descriptors used in texture feature extraction methods. Finally, the proposed technique is applied to an extreme learning machine (ELM) method with a meta-heuristic algorithm known as weighted distance grey wolf optimizer (GWO) to optimize the input weight and biases of single-hidden-layer feed-forward neural networks (SLFN). In the empirical results, ELM-WDGWO demonstrated their better performance in terms of accuracy on all coral datasets, namely RSMAS, EILAT, EILAT2, and MLC, compared with other state-of-the-art algorithms. The proposed method achieves the highest overall classification accuracy of 94% compared to the other state of art methods.

Keywords: feature extraction, local directional pattern, ELM classifier, GWO optimization

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1904 Passive Vibration Isolation Analysis and Optimization for Mechanical Systems

Authors: Ozan Yavuz Baytemir, Ender Cigeroglu, Gokhan Osman Ozgen

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Vibration is an important issue in the design of various components of aerospace, marine and vehicular applications. In order not to lose the components’ function and operational performance, vibration isolation design involving the optimum isolator properties selection and isolator positioning processes appear to be a critical study. Knowing the growing need for the vibration isolation system design, this paper aims to present two types of software capable of implementing modal analysis, response analysis for both random and harmonic types of excitations, static deflection analysis, Monte Carlo simulations in addition to study of parameter and location optimization for different types of isolation problem scenarios. Investigating the literature, there is no such study developing a software-based tool that is capable of implementing all those analysis, simulation and optimization studies in one platform simultaneously. In this paper, the theoretical system model is generated for a 6-DOF rigid body. The vibration isolation system of any mechanical structure is able to be optimized using hybrid method involving both global search and gradient-based methods. Defining the optimization design variables, different types of optimization scenarios are listed in detail. Being aware of the need for a user friendly vibration isolation problem solver, two types of graphical user interfaces (GUIs) are prepared and verified using a commercial finite element analysis program, Ansys Workbench 14.0. Using the analysis and optimization capabilities of those GUIs, a real application used in an air-platform is also presented as a case study at the end of the paper.

Keywords: hybrid optimization, Monte Carlo simulation, multi-degree-of-freedom system, parameter optimization, location optimization, passive vibration isolation analysis

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1903 Thermoluminescence Study of Cu Doped Lithium Tetra Borate Samples Synthesized by Water/Solution Assisted Method

Authors: Swarnapriya Thiyagarajan, Modesto Antonio Sosa Aquino, Miguel Vallejo Hernandez, Senthilkumar Kalaiselvan Dhivyaraj, Jayaramakrishnan Velusamy

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In this paper the lithium tetra borate (Li2B4O7) was prepared by used water/solution assisted synthesis method. Once finished the synthesization, Copper (Cu) were used to doping material with Li2B4O7 in order to enhance its thermo luminescent properties. The heating temperature parameters were 750°C for 2 hr and 150°C for 2hr. The samples produced by water assisted method were doped at different doping percentage (0.02%, 0.04%, 0.06%, 0.08%, 0.12%, 0.5%, 0.1%, and 1%) of Cu.The characteristics and identification of Li2B4O7 (undoped and doped) were determined in four tests. They are X-ray diffraction (XRD), Scanning electron microscope (SEM), Photoluminescence (PL), Ultra violet visible spectroscopy (UV Vis). As it is evidence from the XRD and SEM results the obtained Li2B4O7 and Li2B4O7 doping with Cu was confirmed and also confirmed the chemical compositition and their morphologies. The obtained lithium tetraborate XRD pattern result was verified with the reference data of lithium tetraborate with tetragonal structure from JCPDS. The glow curves of Li2B4O7 and Li2B4O7 : Cu were obtained by thermo luminescence (TLD) reader (Harshaw 3500). The pellets were irradiated with different kind of dose (58mGy, 100mGy, 500mGy, and 945mGy) by using an X-ray source. Finally this energy response was also compared with TLD100. The order of kinetics (b), frequency factor (S) and activation energy (E) or the trapping parameters were calculated using peak shape method. Especially Li2B4O7: Cu (0.1%) presents good glow curve in all kind of doses. The experimental results showed that this Li2B4O7: Cu could have good potential applications in radiation dosimetry. The main purpose of this paper is to determine the effect of synthesis on the TL properties of doped lithium tetra borate Li2B4O7.

Keywords: dosimetry, irradiation, lithium tetraborate, thermoluminescence

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1902 The Spatial Potential of the Croatian Adriatic Area for the Development of an Indigenous Form of Cruising Tourism - Mini Croatian Cruiser

Authors: Srećko Favro, Dora Mužinić

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The eastern coast of the Adriatic Sea has been a significant part of the most important traffic corridors since Antiquity due to its position as the deepest indented bay of the Mediterranean and numerous bays on the coast and is-lands. The central place throughout history was occupied by the central part - Split-Dalmatia County, with its center in Antica in Salona and later in Split. Nowadays, in addition to its traffic and economic importance, this area is also important for tourism, an area where Croatia develops its economy and realizing its economic growth. Nautical tourism is the most important form of the tourist economic sector that uses the geographical features of the Croatian Adriatic water area and achieves the greatest growth based on tour-ist trends in the world (coronavirus - separation from the masses, adventure tourism - own arrangements) and thus opens up the possibility of develop-ment for other parts of the tourist economy. This will be described in the ex-ample of the business of the Split-Dalmatia County shipping company from Krilo Jesenice, which operates as a mini-cruising service provider, the lead-ing form of cruising in Croatia. The advantages that this type of tourism provides to travelers in terms of customized itineraries, high-quality services, an intimate atmosphere, and a unique experience through familiarization with local culture and tradition will be considered. Through direct primary research and analysis of available secondary research data, an attempt will be made to show how traditional Croatian mini cruisers manage to stand out in a competitive tourist environment. Their impact on the local economy, sus-tainability, and environmental protection will be considered, as well as how they are integrated into the tourist offer of other destinations in Croatia. In addition, the challenges and opportunities that arise in the maintenance and development of traditional Croatian mini cruisers will be discussed, includ-ing issues such as infrastructure, staff training, and market trends.

Keywords: croatia, adriatic, cruising, nautical tourism, mini cruise

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1901 The Influence of Neighborhood Centers of Tehran Municipality in Living Style of the Residents of Each Neighborhood

Authors: Fahimeh Rafiezade, Fatemeh Kakoyi Dinaki, Maryam Soufi

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This research studies and identifies the important elements of the living style of the residents of one of the neighborhoods of Tehran. The study will also study the role, the degree, and extent of the influence of neighborhood trainings in the lives of these people. Saraymahaleh is one of the centers established by Tehran municipality in various neighborhoods of Tehran in order to provide educational, cultural, etc. services. We carried out our study according to demography, field study, observation, 30 interviews, and 2 focus group discussions (FGD) at Sahebalzaman neighborhood in district 18 of Tehran municipality. We interpreted our observations and interviews with the neighborhoods’ supervisors and city council assistants (Shorayar), supervisor of Saraymahaleh and people who refer to them. We used this information to study the citizens’ lifestyle, values, behavioral, motivational, and attitude preferences in their religious and environmental orientations, cultural consumptions, and spare times, and the influence of Saraymahaleh on these aspects according to specific economic, cultural, and ethnic characteristics. Sahebalzaman neighborhood is considered an underprivileged district in terms of economy, high illiteracy, and low but structured migration of young people. The interviews we made helped us classify the people referring to Saraymahaleh based on their demographic attributes and attitudes and the reason of referring and finally the influence of the rendered services on their lifestyles. The studies indicate that women made the most part of people referring to Saraymahaleh Sahebalzaman. They were mostly young, in their midlives, and generally unemployed without a specialized skill. People referred to Saraymahaleh Sahebalzaman mostly to receive services or for entertainment and recreation purposes, i.e. they did not take part actively. In addition to creating welfare and cultural facilities, Saraymahaleh increases the level of skill training, empowerment, innovation and creativity, and issues skill certificates and documents that helps to increase job and income producing opportunities for the neighborhood residents, improve the quality of their live, and increase their hope for life.

Keywords: lifestyle, living in neighborhood, Saraymahaleh, Tehran municipality, urban life, demography

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1900 A Conceptual Model of Preparing School Counseling Students as Related Service Providers in the Transition Process

Authors: LaRon A. Scott, Donna M. Gibson

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Data indicate that counselor education programs in the United States do not prepare their students adequately to serve students with disabilities nor provide counseling as a related service. There is a need to train more school counselors to provide related services to students with disabilities, for many reasons, but specifically, school counselors are participating in Individualized Education Programs (IEP) and transition planning meetings for students with disabilities where important academic, mental health and post-secondary education decisions are made. While school counselors input is perceived very important to the process, they may not have the knowledge or training in this area to feel confident in offering required input in these meetings. Using a conceptual research design, a model that can be used to prepare school counseling students as related service providers and effective supports to address transition for students with disabilities was developed as a component of this research. The authors developed the Collaborative Model of Preparing School Counseling Students as Related Service Providers to Students with Disabilities, based on a conceptual framework that involves an integration of Social Cognitive Career Theory (SCCT) and evidenced-based practices based on Self-Determination Theory (SDT) to provide related and transition services and planning with students with disabilities. The authors’ conclude that with five overarching competencies, (1) knowledge and understanding of disabilities, (2) knowledge and expertise in group counseling to students with disabilities, (3), knowledge and experience in specific related service components, (4) knowledge and experience in evidence-based counseling interventions, (5) knowledge and experiencing in evidenced-based transition and career planning services, that school counselors can enter the field with the necessary expertise to adequately serve all students. Other examples and strategies are suggested, and recommendations for preparation programs seeking to integrate a model to prepare school counselors to implement evidenced-based transition strategies in supporting students with disabilities are included

Keywords: transition education, social cognitive career theory, self-determination, counseling

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1899 The Impact of Nonverbal Communication Between Restaurant Staff and Customers on Customer Attraction in Restaurants: A Case Study of Food Courts in Tehran City

Authors: Mahshid Asadollahi, Mohammad Akbari Asl

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The restaurant industry is highly competitive, and restaurants are constantly looking for ways to attract new customers and retain their existing ones. Nonverbal communication is an important factor in creating a positive customer experience and can play a significant role in attracting customers to restaurants. Nonverbal communication can include body language, facial expressions, tone of voice, and physical proximity, among other things. The present study aimed to investigate the impact of nonverbal communication between restaurant employees and customers on attracting customers in food courts in Tehran. The research method was descriptive-correlational, and the statistical population of this study included all customers of food court restaurants in Tehran, which was about 30 restaurants. The research sample was selected through probability sampling, and 440 customers completed emotional response, customer satisfaction, and nonverbal communication questionnaires in person. The data obtained were analyzed using multiple regression analysis. The results showed that vocal language, employee proximity, physical appearance, and speech movements, as components of nonverbal communication of restaurant employees, had an impact on attracting customers. Additionally, positive and negative emotions of customers have a significant relationship with customer attraction in Food Court restaurants. The study shows that various nonverbal communication factors can play a significant role in attracting customers, and that positive and negative customer emotions can affect customer satisfaction. Therefore, restaurant owners and managers should pay attention to nonverbal communication and train their employees accordingly to create a positive and welcoming atmosphere for customers.

Keywords: verbal language, proximity of employees, physical appearance, speech gestures, nonverbal communication, customer emotions, customer attraction

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1898 Induction of Cellular and Humoral Immune Responses in BALB/c Mice Immunized With rB2L and rF1L Proteins of Orf Virus Adjuvanted With Alumina Nanoparticles

Authors: Alhaji Modu Bukar, Faez Firdaus Abdullah Jesse, Che Azurahanim Che Abdullah, Mustapha M. Noordin, Mohd-Lila Mohd Azmia

Abstract:

Orf virus (ORFV) is the causative agent of a proliferative skin lesion known as contagious ecthyma in sheep and goats. Currently used live attenuated vaccines against ORFV infection have been reported to cause severe outbreaks in vaccinated animals. In this study, we investigated the immunogenicity of the B2L and F1L proteins of the virus, which are thought to elicit a protective immune response The 6-week-old 50 female mice were divided into 8 groups: seven experimental groups and one control group. Each animal in the experimental group received an initial immunisation with the nanoparticles or proteins coated with the nanoparticles, followed by two booster immunizations with the same products 14 days apart. Ten days after the last booster inoculation, the mice were either humanely killed or lethally challenged with UPM /HSN-2-ORFV at a dose of 106 TCID50/mL in a volume of 50 μl. The spleen was examined for histopathological changes and quantification of T cells by flow cytometry. On the other hand, the degree of protection of mice from the lethal virus was evaluated by lesion size, weight loss, and histopathological examination of skin and liver. The results showed that mice immunised with rB2L alone, rB2L-Al₂O₃-NPs, rB2L/rF1L, and rB2L/rF1L-Al₂O₃-NPs elicited statistically higher levels of anti-rB2L and/or rF1L-specific IgA/IgG and CD4/CD8 cell immune responses than mice in the control groups (p < 0.01). The vaccine candidate did not exhibit severe skin damage after monitoring histopathology, morbidity, and mortality. Overall, the results suggest that recombinant rB2L and rF1L antigens may be useful universal vaccine candidates against ORFV infections.

Keywords: orf virus, antigen nanoparticles, virus, nanoparticles

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1897 Navigating Life Transitions for Young People with Vision Impairment: A Community-Based Participatory Research Approach to Accessibility and Diversity

Authors: Aikaterini Tavoulari, Michael Proulx, Karin Petrini

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Objective: This study aims to explore the unique challenges faced by young individuals with vision impairment (VI) during key life transitions, utilizing a community-based participatory research (CBPR) approach to identify limitations and positive aspects of existing support systems, with a focus on accessibility and diversity. Design: The study employs a qualitative CBPR design, engaging young participants with VI through online and in-person working groups over six months, prioritizing their active involvement and diverse perspectives. Methods: Twenty-one young individuals with VI from across the UK and with different VI conditions were recruited to participate in the study via a climbing and virtual reality event and stakeholders’ support. Data collection methods included open discussions, forum exchanges, and qualitative questionnaires. The data were analyzed with NVivo using inductive thematic analysis to identify key themes and patterns related to the challenges and experiences of life transitions for this diverse population. Results: The analysis revealed barriers to accessibility, such as assumptions about what a person with VI can do, inaccessibility to material, noisy environments, and insufficient training with assistive technologies. Enablers included guidance from diverse professionals and peers, multisensory approaches (beyond tactile), and peer collaborations. This study underscores the need for developing accessible and tailored strategies together with these young people to address the specific needs of this diverse population during critical life transitions (e.g., to independent living, employment and higher education). Conclusion: Engaging and co-designing effective approaches and tools with young people with VI is key to tackling the specific accessibility barriers they encounter. These approaches should be targeted at different transitional periods of their life journey, promoting diversity and inclusion.

Keywords: vision impairement, life transitions, qualitative research, community-based participatory design, accessibility

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1896 Subsurface Exploration for Soil Geotechnical Properties and its Implications for Infrastructure Design and Construction in Victoria Island, Lagos, Nigeria

Authors: Sunday Oladele, Joseph Oluwagbeja Simeon

Abstract:

Subsurface exploration, integrating methods of geotechnics and geophysics, of a planned construction site in the coastal city of Lagos, Nigeria has been carried out with the aim of characterizing the soil properties and their implication for the proposed infrastructural development. Six Standard Penetration Tests (SPT), fourteen Dutch Cone Penetrometer Tests (DCPT) and 2D Electrical Resistivity Imaging employing Dipole-dipole and Pole-dipole arrays were implemented on the site. The topsoil (0 - 4m) consists of highly compacted sandy lateritic clay(10 to 5595Ωm) to 1.25m in some parts and dense sand in other parts to 5.50m depth. This topsoil was characterized as a material of very high shear strength (≤ 150kg/m2) and allowable bearing pressure value of 54kN/m2 to 85kN/m2 and a safety factor of 2.5. Soft amorphous peat/peaty clay (0.1 to 11.4Ωm), 3-6m thick, underlays the lateritic clay to about 18m depth. Grey, medium dense to very dense sand (0.37 to 2387Ωm) with occasional gravels underlies the peaty clay down to 30m depth. Within this layer, the freshwater bearing zones are characterized by high resistivity response (83 to 2387Ωm), while the clayey sand/saline water intruded sand produced subdued resistivity output (0.37 to 40Ωm). The overall ground-bearing pressure for the proposed structure would be 225kN/m2. Bored/cast-in-place pile at 18.00m depth with any of these diameters and respective safe working loads 600mm/1,140KN, 800mm/2,010KN and 1000mm/3,150KN is recommended for the proposed multi-story structure.

Keywords: subsurface exploration, Geotechnical properties, resistivity imaging, pile

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1895 Effective Strategies Migrants Adopted to Improve Food Security in a Regional Area of Australia

Authors: Joanne Sin Wei Yeoh, Quynh Lê, Daniel R. Terry, Rosa Mc Manamey

Abstract:

Food security is a global issue and one of the concerns in Australia, particularly in regional and rural areas. Despite Australia’s current ability to produce enough food to feed more than its current population, evidence has been accumulating over the last decade to demonstrate many Australians struggle to feed themselves, including immigrants from cultural and linguistically diverse (CALD) backgrounds. This study aims to identify the acculturation strategies used by migrants to enhance their approach to food security in Tasmania. The study employed a mixed methods approach that used both questionnaires and semi-structured interviews with migrants living in Tasmania. Descriptive and inferential statistics was used to analyse data collected from questionnaire, whereas, thematic analysis was employed to analyse the interview data. Migrants (n=301) completed the questionnaire with a response rate of 50.2% and 33 follow-up interviews were conducted. We found that majority of the migrants (70.0%) replaced food ingredients and went without the food they could not buy from shops with similar ingredients. Support and advice from friends were effective ways to improve their food access. Additionally, length of stays in Tasmania and region of origin were significantly associated with the ways migrants dealing with food security. The interview results revealed that migrants managed to adapt to the new food culture by using different acculturation strategies, including access food ingredients from other country; adjusting or adapting; home gardening and access to technology. In addition, social and cultural capitals were also treated as vital roles in improving migrants’ food security. To summarize, migrants employed different strategies for food security while acculturating into the new environment. Our findings could become the guidelines for migrants and relevant government or private sectors that address food security.

Keywords: food security, migrants, strategies, inferential statistics

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1894 Using Problem-Based Learning on Teaching Early Intervention for College Students

Authors: Chen-Ya Juan

Abstract:

In recent years, the increasing number of children with special needs has brought a lot of attention by many scholars and experts in education, which enforced the preschool teachers face the harsh challenge in the classroom. To protect the right of equal education for all children, enhance the quality of children learning, and take care of the needs of children with special needs, the special education paraprofessional becomes one of the future employment trends for students of the department of the early childhood care and education. Problem-based learning is a problem-oriented instruction, which is different from traditional instruction. The instructor first designed an ambiguous problem direction, following the basic knowledge of early intervention, students had to find clues to solve the problem defined by themselves. In the class, the total instruction included 20 hours, two hours per week. The primary purpose of this paper is to investigate the relationship of student academic scores, self-awareness, learning motivation, learning attitudes, and early intervention knowledge. A total of 105 college students participated in this study and 97 questionnaires were effective. The effective response rate was 90%. The student participants included 95 females and two males. The average age of the participants was 19 years old. The questionnaires included 125 questions divided into four major dimensions: (1) Self-awareness, (2) learning motivation, (3) learning attitudes, and (4) early intervention knowledge. The results indicated (1) the scores of self-awareness were 58%; the scores of the learning motivations was 64.9%; the scores of the learning attitudes was 55.3%. (2) After the instruction, the early intervention knowledge has been increased to 64.2% from 38.4%. (3) Student’s academic performance has positive relationship with self-awareness (p < 0.05; R = 0.506), learning motivation (p < 0.05; R = 0.487), learning attitudes (p < 0.05; R = 0.527). The results implied that although students had gained early intervention knowledge by using PBL instruction, students had medium scores on self-awareness and learning attitudes, medium high in learning motivations.

Keywords: college students, children with special needs, problem-based learning, learning motivation

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1893 Approaches to Integrating Entrepreneurial Education in School Curriculum

Authors: Kofi Nkonkonya Mpuangnan, Samantha Govender, Hlengiwe Romualda Mhlongo

Abstract:

In recent years, a noticeable and worrisome pattern has emerged in numerous developing nations which is a steady and persistent rise in unemployment rates. This escalation of economic struggles has become a cause of great concern for parents who, having invested significant resources in their children's education, harboured hopes of achieving economic prosperity and stability for their families through secure employment. To effectively tackle this pressing unemployment issue, it is imperative to adopt a holistic approach, and a pivotal aspect of this approach involves incorporating entrepreneurial education seamlessly into the entire educational system. In this light, the authors explored approaches to integrating entrepreneurial education into school curriculum focusing on the following questions. How can an entrepreneurial mindset among learners be promoted in school? And how far have pedagogical approaches improved entrepreneurship in schools? To find answers to these questions, a systematic literature review underpinned by Human Capital Theory was adopted. This method was supported by the three stages of guidelines like planning, conducting, and reporting. The data were specifically sought from publishers with expansive coverage of scholarly literature like Sage, Taylor & Francis, Emirate, and Springer, covering publications from 1965 to 2023. The search was supported by two broad terms such as promoting entrepreneurial mindset in learners and pedagogical strategies for enhancing entrepreneurship. It was found that acquiring an entrepreneurial mindset through an innovative classroom environment, resilience, and guest speakers and industry experts. Also, teachers can promote entrepreneurial education through the adoption of pedagogical approaches such as hands-on learning and experiential activities, role-playing, business simulation games and creative and innovative teaching. It was recommended that the Ministry of Education should develop tailored training programs and workshops aimed at empowering educators with the essential competencies and insights to deliver impactful entrepreneurial education.

Keywords: education, entrepreneurship, school curriculum, pedagogical approaches, integration

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1892 Dosimetry in Interventional Radiology Examinations for Occupational Exposure Monitoring

Authors: Ava Zarif Sanayei, Sedigheh Sina

Abstract:

Interventional radiology (IR) uses imaging guidance, including X-rays and CT scans, to deliver therapy precisely. Most IR procedures are performed under local anesthesia and start with a small needle being inserted through the skin, which may be called pinhole surgery or image-guided surgery. There is increasing concern about radiation exposure during interventional radiology procedures due to procedure complexity. The basic aim of optimizing radiation protection as outlined in ICRP 139, is to strike a balance between image quality and radiation dose while maximizing benefits, ensuring that diagnostic interpretation is satisfactory. This study aims to estimate the equivalent doses to the main trunk of the body for the Interventional radiologist and Superintendent using LiF: Mg, Ti (TLD-100) chips at the IR department of a hospital in Shiraz, Iran. In the initial stage, the dosimeters were calibrated with the use of various phantoms. Afterward, a group of dosimeters was prepared, following which they were used for three months. To measure the personal equivalent dose to the body, three TLD chips were put in a tissue-equivalent batch and used under a protective lead apron. After the completion of the duration, TLDs were read out by a TLD reader. The results revealed that these individuals received equivalent doses of 387.39 and 145.11 µSv, respectively. The findings of this investigation revealed that the total radiation exposure to the staff was less than the annual limit of occupational exposure. However, it's imperative to implement appropriate radiation protection measures. Although the dose received by the interventional radiologist is a bit noticeable, it may be due to the reason for using conventional equipment with over-couch x-ray tubes for interventional procedures. It is therefore important to use dedicated equipment and protective means such as glasses and screens whenever compatible with the intervention when they are available or have them fitted to equipment if they are not present. Based on the results, the placement of staff in an appropriate location led to increasing the dose to the radiologist. Manufacturing and installation of moveable lead curtains with a thickness of 0.25 millimeters can effectively minimize the radiation dose to the body. Providing adequate training on radiation safety principles, particularly for technologists, can be an optimal approach to further decreasing exposure.

Keywords: interventional radiology, personal monitoring, radiation protection, thermoluminescence dosimetry

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1891 Liminal Disabled Tweens’ Identification with Disney Animations in Algeria

Authors: Selma Aitsaid

Abstract:

Disney canon texts, mainly animations, are believed to have authority over children’s identities. However, most research on Disney tends to focus either on textual analysis, or Western and non-western adult audiences. In fact, there is a lack of scholarship on Disney child audiences from non-western countries though children are believed to be Disney‘s main target audience, and Disney is a global corporation that appeals to audiences from all over the world as well. Therefore, qualitative research was conducted by interviewing around twenty five Algerian disabled tweens between the age 11 to 14 on their familiarity and identification with Disney animations. The reason behind choosing disabled children is because minority groups have not been interviewed on their possible interpretations of Disney animations despite the fact that these texts have been interpreted by some scholars as being inclusive of minority groups such as queer and disabled people. To that end, this project aims to decolonize disability and Global Southern Academia by three ways. The first way is to uncover inequalities of the metropolitan thought enshrined in the global power of the metropole vis a vis the subaltern. This approach was called postcolonialism. The second way is to value non-western academic and non-academic resources. This is the project of ‘indigenous knowledge. The third way is to analyse the forms of knowledge that were produced by intellectuals in colonized countries as a response to Western Academic hegemony. Consequently, this research endeavored to unravel the inequality, the dynamics of neocolonialism and subordination to colonial discourses within the Algerian discourse on disability and other knowledge such as tweenhood, childhood and non-western viewership, which are mainly defined through Western lenses. Algerian resources were included with the aim of enhancing an academic collaboration between the North and South as well. The findings showed that the postcolonial context had an impact on how children perceive Disney animations. They also demonstrated that children are able to negotiate the meaning of Disney texts within their own context.

Keywords: child audiences, Algeria, childhood, disability, Disney animations, global South, postcolonialism, tweens, Western hegemony

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1890 A Case of Severe Iatrogenic Cushing’s Syndrome Followed by Adrenal Crisis, Multifocal Pneumonia, Sepsis, Pulmonary Embolism and Prolonged Adrenal Insufficiency

Authors: Jelena Maletkovic

Abstract:

Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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1889 A Damage Level Assessment Model for Extra High Voltage Transmission Towers

Authors: Huan-Chieh Chiu, Hung-Shuo Wu, Chien-Hao Wang, Yu-Cheng Yang, Ching-Ya Tseng, Joe-Air Jiang

Abstract:

Power failure resulting from tower collapse due to violent seismic events might bring enormous and inestimable losses. The Chi-Chi earthquake, for example, strongly struck Taiwan and caused huge damage to the power system on September 21, 1999. Nearly 10% of extra high voltage (EHV) transmission towers were damaged in the earthquake. Therefore, seismic hazards of EHV transmission towers should be monitored and evaluated. The ultimate goal of this study is to establish a damage level assessment model for EHV transmission towers. The data of earthquakes provided by Taiwan Central Weather Bureau serve as a reference and then lay the foundation for earthquake simulations and analyses afterward. Some parameters related to the damage level of each point of an EHV tower are simulated and analyzed by the data from monitoring stations once an earthquake occurs. Through the Fourier transform, the seismic wave is then analyzed and transformed into different wave frequencies, and the data would be shown through a response spectrum. With this method, the seismic frequency which damages EHV towers the most is clearly identified. An estimation model is built to determine the damage level caused by a future seismic event. Finally, instead of relying on visual observation done by inspectors, the proposed model can provide a power company with the damage information of a transmission tower. Using the model, manpower required by visual observation can be reduced, and the accuracy of the damage level estimation can be substantially improved. Such a model is greatly useful for health and construction monitoring because of the advantages of long-term evaluation of structural characteristics and long-term damage detection.

Keywords: damage level monitoring, drift ratio, fragility curve, smart grid, transmission tower

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1888 Development of Immuno-Modulators: Application of Molecular Dynamics Simulation

Authors: Ruqaiya Khalil, Saman Usmani, Zaheer Ul-Haq

Abstract:

The accurate characterization of ligand binding affinity is indispensable for designing molecules with optimized binding affinity. Computational tools help in many directions to predict quantitative correlations between protein-ligand structure and their binding affinities. Molecular dynamics (MD) simulation is a modern state-of-the-art technique to evaluate the underlying basis of ligand-protein interactions by characterizing dynamic and energetic properties during the event. Autoimmune diseases arise from an abnormal immune response of the body against own tissues. The current regimen for the described condition is limited to immune-modulators having compromised pharmacodynamics and pharmacokinetics profiles. One of the key player mediating immunity and tolerance, thus invoking autoimmunity is Interleukin-2; a cytokine influencing the growth of T cells. Molecular dynamics simulation techniques are applied to seek insight into the inhibitory mechanisms of newly synthesized compounds that manifested immunosuppressant potentials during in silico pipeline. In addition to estimation of free energies associated with ligand binding, MD simulation yielded us a great deal of information about ligand-macromolecule interactions to evaluate the pattern of interactions and the molecular basis of inhibition. The present study is a continuum of our efforts to identify interleukin-2 inhibitors of both natural and synthetic origin. Herein, we report molecular dynamics simulation studies of Interluekin-2 complexed with different antagonists previously reported by our group. The study of protein-ligand dynamics enabled us to gain a better understanding of the contribution of different active site residues in ligand binding. The results of the study will be used as the guide to rationalize the fragment based synthesis of drug-like interleukin-2 inhibitors as immune-modulators.

Keywords: immuno-modulators, MD simulation, protein-ligand interaction, structure-based drug design

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1887 Incorporation of Growth Factors onto Hydrogels via Peptide Mediated Binding for Development of Vascular Networks

Authors: Katie Kilgour, Brendan Turner, Carly Catella, Michael Daniele, Stefano Menegatti

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In vivo, the extracellular matrix (ECM) provides biochemical and mechanical properties that are instructional to resident cells to form complex tissues with characteristics to develop and support vascular networks. In vitro, the development of vascular networks can be guided by biochemical patterning of substrates via spatial distribution and display of peptides and growth factors to prompt cell adhesion, differentiation, and proliferation. We have developed a technique utilizing peptide ligands that specifically bind vascular endothelial growth factor (VEGF), erythropoietin (EPO), or angiopoietin-1 (ANG1) to spatiotemporally distribute growth factors to cells. This allows for the controlled release of each growth factor, ultimately enhancing the formation of a vascular network. Our engineered tissue constructs (ETCs) are fabricated out of gelatin methacryloyl (GelMA), which is an ideal substrate for tailored stiffness and bio-functionality, and covalently patterned with growth factor specific peptides. These peptides mimic growth factor receptors, facilitating the non-covalent binding of the growth factors to the ETC, allowing for facile uptake by the cells. We have demonstrated in the absence of cells the binding affinity of VEGF, EPO, and ANG1 to their respective peptides and the ability for each to be patterned onto a GelMA substrate. The ability to organize growth factors on an ETC provides different functionality to develop organized vascular networks. Our results demonstrated a method to incorporate biochemical cues into ETCs that enable spatial and temporal control of growth factors. Future efforts will investigate the cellular response by evaluating gene expression, quantifying angiogenic activity, and measuring the speed of growth factor consumption.

Keywords: growth factor, hydrogel, peptide, angiogenesis, vascular, patterning

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1886 The Healthcare Costs of BMI-Defined Obesity among Adults Who Have Undergone a Medical Procedure in Alberta, Canada

Authors: Sonia Butalia, Huong Luu, Alexis Guigue, Karen J. B. Martins, Khanh Vu, Scott W. Klarenbach

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Obesity is associated with significant personal impacts on health and has a substantial economic burden on payers due to increased healthcare use. A contemporary estimate of the healthcare costs associated with obesity at the population level are lacking. This evidence may provide further rationale for weight management strategies. Methods: Adults who underwent a medical procedure between 2012 and 2019 in Alberta, Canada were categorized into the investigational cohort (had body mass index [BMI]-defined class 2 or 3 obesity based on a procedure-associated code) and the control cohort (did not have the BMI procedure-associated code); those who had bariatric surgery were excluded. Characteristics were presented and healthcare costs ($CDN) determined over a 1-year observation period (2019/2020). Logistic regression and a generalized linear model with log link and gamma distribution were used to assess total healthcare costs (comprised of hospitalizations, emergency department visits, ambulatory care visits, physician visits, and outpatient prescription drugs); potential confounders included age, sex, region of residence, and whether the medical procedure was performed within 6-months before the observation period in the partial adjustment, and also the type of procedure performed, socioeconomic status, Charlson Comorbidity Index (CCI), and seven obesity-related health conditions in the full adjustment. Cost ratios and estimated cost differences with 95% confidence intervals (CI) were reported; incremental cost differences within the adjusted models represent referent cases. Results: The investigational cohort (n=220,190) was older (mean age: 53 standard deviation [SD]±17 vs 50 SD±17 years), had more females (71% vs 57%), lived in rural areas to a greater extent (20% vs 14%), experienced a higher overall burden of disease (CCI: 0.6 SD±1.3 vs 0.3 SD±0.9), and were less socioeconomically well-off (material/social deprivation was lower [14%/14%] in the most well-off quintile vs 20%/19%) compared with controls (n=1,955,548). Unadjusted total healthcare costs were estimated to be 1.77-times (95% CI: 1.76, 1.78) higher in the investigational versus control cohort; each healthcare resource contributed to the higher cost ratio. After adjusting for potential confounders, the total healthcare cost ratio decreased, but remained higher in the investigational versus control cohort (partial adjustment: 1.57 [95% CI: 1.57, 1.58]; full adjustment: 1.21 [95% CI: 1.20, 1.21]); each healthcare resource contributed to the higher cost ratio. Among urban-dwelling 50-year old females who previously had non-operative procedures, no procedures performed within 6-months before the observation period, a social deprivation index score of 3, a CCI score of 0.32, and no history of select obesity-related health conditions, the predicted cost difference between those living with and without obesity was $386 (95% CI: $376, $397). Conclusions: If these findings hold for the Canadian population, one would expect an estimated additional $3.0 billion per year in healthcare costs nationally related to BMI-defined obesity (based on an adult obesity rate of 26% and an estimated annual incremental cost of $386 [21%]); incremental costs are higher when obesity-related health conditions are not adjusted for. Results of this study provide additional rationale for investment in interventions that are effective in preventing and treating obesity and its complications.

Keywords: administrative data, body mass index-defined obesity, healthcare cost, real world evidence

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1885 Beta-Carotene Attenuates Cognitive and Hepatic Impairment in Thioacetamide-Induced Rat Model of Hepatic Encephalopathy via Mitigation of MAPK/NF-κB Signaling Pathway

Authors: Marawan Abd Elbaset Mohamed, Hanan A. Ogaly, Rehab F. Abdel-Rahman, Ahmed-Farid O.A., Marwa S. Khattab, Reham M. Abd-Elsalam

Abstract:

Liver fibrosis is a severe worldwide health concern due to various chronic liver disorders. Hepatic encephalopathy (HE) is one of its most common complications affecting liver and brain cognitive function. Beta-Carotene (B-Car) is an organic, strongly colored red-orange pigment abundant in fungi, plants, and fruits. The study attempted to know B-Car neuroprotective potential against thioacetamide (TAA)-induced neurotoxicity and cognitive decline in HE in rats. Hepatic encephalopathy was induced by TAA (100 mg/kg, i.p.) three times per week for two weeks. B-Car was given orally (10 or 20 mg/kg) daily for two weeks after TAA injections. Organ body weight ratio, Serum transaminase activities, liver’s antioxidant parameters, ammonia, and liver histopathology were assessed. Also, the brain’s mitogen-activated protein kinase (MAPK), nuclear factor kappa B (NF-κB), antioxidant parameters, adenosine triphosphate (ATP), adenosine monophosphate (AMP), norepinephrine (NE), dopamine (DA), serotonin (5-HT), 5-hydroxyindoleacetic acid (5-HIAA) cAMP response element-binding protein (CREB) expression and B-cell lymphoma 2 (Bcl-2) expression were measured. The brain’s cognitive functions (Spontaneous locomotor activity, Rotarod performance test, Object recognition test) were assessed. B-Car prevented alteration of the brain’s cognitive function in a dose-dependent manner. The histopathological outcomes supported these biochemical evidences. Based on these results, it could be established that B-Car could be assigned to treat the brain’s neurotoxicity consequences of HE via downregualtion of MAPK/NF-κB signaling pathways.

Keywords: beta-carotene, liver injury, MAPK, NF-κB, rat, thioacetamide

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1884 A Resource-Based Understanding of Health and Social Care Regulation

Authors: David P. Horton, Gary Lynch-Wood

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Western populations are aging, prone to various lifestyle health problems, and increasing their demand for health and social care services. This demand has created enormous fiscal and regulatory challenges. In response, government institutions have deployed strategies of behavior modification to encourage people to exercise greater personal responsibility over their health and care needs (i.e., welfare responsibilisation). Policy strategies are underpinned by the assumption that people if properly supported, will make better health and lifestyle selections. Not only does this absolve governments of the responsibility for meeting all health and care needs, but it also enables government institutions to assert fiscal control over welfare spending. Looking at the regulation of health and social care in the UK, the authors identify and outline a suite of regulatory tools that are designed to extract and manage the resources of health and social care services users and to encourage them to make (‘better’) use of these resources. This is important for our understanding of how health and social care regulation is responding to ongoing social and economic challenges. It is also important because there has been a failure to systematically examine the relevance of resources for regulation, which is surprising given that resources are crucial to how and whether regulation succeeds or fails. In particular, drawing from the regulatory welfare state concept, the authors analyse the key legal and regulatory changes and mechanisms that have been introduced since the 2008 financial crisis, focusing on critical measures such as the Health and Social Care Act and regulations introduced under the National Health Service Act. The authors show how three types of user resources (i.e., tangible, labor, and data) are being used to assert fiscal control and increase welfare responsibilisation. Amongst other things, the paper concludes that service users have become more than rule followers and targets of behavioral modification; rather, they are producers of resources that regulatory systems have come to rely on.

Keywords: health care, regulation, resources, social care

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