Search results for: atypical axillary involvement
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1251

Search results for: atypical axillary involvement

471 Development, Testing, and Application of a Low-Cost Technology Sulphur Dioxide Monitor as a Tool for use in a Volcanic Emissions Monitoring Network

Authors: Viveka Jackson, Erouscilla Joseph, Denise Beckles, Thomas Christopher

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Sulphur Dioxide (SO2) has been defined as a non-flammable, non-explosive, colourless gas, having a pungent, irritating odour, and is one of the main gases emitted from volcanoes. Sulphur dioxide has been recorded in concentrations hazardous to humans (0.25 – 0.5 ppm (~650 – 1300 μg/m3), downwind of many volcanoes and hence warrants constant air-quality monitoring around these sites. It has been linked to an increase in chronic respiratory disease attributed to long-term exposures and alteration in lung and other physiological functions attributed to short-term exposures. Sulphur Springs in Saint Lucia is a highly active geothermal area, located within the Soufrière Volcanic Centre, and is a park widely visited by tourists and locals. It is also a current source of continuous volcanic emissions via its many fumaroles and bubbling pools, warranting concern by residents and visitors to the park regarding the effects of exposure to these gases. In this study, we introduce a novel SO2 measurement system for the monitoring and quantification of ambient levels of airborne volcanic SO2 using low-cost technology. This work involves the extensive production of low-cost SO2 monitors/samplers, as well as field examination in tandem with standard commercial samplers (SO2 diffusion tubes). It also incorporates community involvement in the volcanic monitoring process as non-professional users of the instrument. We intend to present the preliminary monitoring results obtained from the low-cost samplers, to identify the areas in the Park exposed to high concentrations of ambient SO2, and to assess the feasibility of the instrument for non-professional use and application in volcanic settings

Keywords: ambient SO2, community-based monitoring, risk-reduction, sulphur springs, low-cost

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470 Knowledge and Practice of Family Planning among Rural Women in Ogun State, South West Nigeria

Authors: Tope Olubodun

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Background: Family planning practices help individuals and couples avoid unwanted pregnancies, regulate intervals between pregnancies, and determine the number of children in the family. Family planning is an effective intervention for promoting maternal health, but its acceptability and utilization are impeded by many factors in Southwest Nigeria. Aim: This study was conducted to assess women’s knowledge and practice of family planning in two rural communities in Ogun State, Southwest Nigeria, and to determine factors associated with the utilization of family planning among these women. Methods: This was a cross-sectional study conducted among 561 women of reproductive age selected by multistage sampling. The data collection was done using interviewer-administered questionnaires. Data obtained were analyzed using IBM SPSS Statistics version 20. Frequencies were generated, and chi-square test was used to explore associations. The level of significance was set at 0.05. Result: The majority of the respondents were aware of family planning 410 (73.1%). The method most commonly known was male condom 348 (62.0%), then pills 276 (49.2%) and injectables 231(41.3%). The commonest sources of information on family planning were health workers 158 (26.8%), outreaches 162 (27.5%) and TV/radio 136 (23.1%). Respondents that had used family planning, however, only constituted forty–five percent. The methods commonly used were injectables 104 (39.2%) and pills 85 (32.1%). Reasons for choosing not to use family planning include the desire for more children 78 (26.3%), because spouse does not support family planning 56 (18.9%), fear of unbearable side effects 44 (14.9%), and poor knowledge of the methods of family planning as well as where the services can be obtained 39 (13.2%). There is a statistically significant association between age, ethnicity, education, occupation, average monthly income, and use of family planning. Conclusion: Campaigns that promote male involvement in family planning, use of family planning for child spacing, and dispelling of fears is recommended to improve the practice of family planning among such a group of women.

Keywords: family planning, rural, knowledge, practice

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469 Potentials and Challenges of Implementing Participatory Irrigation Management, Tanzania

Authors: Pilly Joseph Kagosi

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The study aims at assessing challenges observed during implementation of participatory irrigation management (PIM) approach for food security in semi-arid areas of Tanzania. Data were collected through questionnaire, PRA tools, key informants discussion, Focus Group Discussion (FGD), participant observation and literature review. Data collected from questionnaire was analyzed using SPSS while PRA data was analyzed with the help of local communities during PRA exercise. Data from other methods were analyzed using content analysis. The study revealed that PIM approach has contribution in improved food security at household level due to involvement of communities in water management activities and decision making which enhanced availability of water for irrigation and increased crop production. However there were challenges observed during implementation of the approach including; minimum participation of beneficiaries in decision making during planning and designing stages, meaning inadequate devolution of power among scheme owners; Inadequate and lack of transparency on income expenditure in Water Utilization Associations’ (WUAs), water conflict among WUAs members, conflict between farmers and livestock keepers and conflict between WUAs leaders and village government regarding training opportunities and status; WUAs rules and regulation are not legally recognized by the National court and few farmers involved in planting trees around water sources. However it was realized that some of the mentioned challenges were rectified by farmers themselves facilitated by government officials. The study recommends that, the identified challenges need to be rectified for farmers to realize impotence of PIM approach as it was realized by other Asian countries.

Keywords: potentials of implementing participatory approach, challenges of participatory approach, irrigation management, Tanzania

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468 Autoimmune Diseases Associated with Primary Biliary Cirrhosis: A Retrospective Study of 51 Patients

Authors: Soumaya Mrabet, Imen Akkari, Amira Atig, Elhem Ben Jazia

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Introduction: Primary biliary cirrhosis (PBC) is a cholestatic cholangitis of unknown etiology. It is frequently associated with autoimmune diseases, which explains their systematic screening. The aim of our study was to determine the prevalence and the type of autoimmune disorders associated with PBC and to assess their impact on the prognosis of the disease. Material and methods: It is a retrospective study over a period of 16 years (2000-2015) including all patients followed for PBC. In all these patients we have systematically researched: dysthyroidism (thyroid balance, antithyroid autoantibodies), type 1 diabetes, dry syndrome (ophthalmologic examination, Schirmer test and lip biopsy in case of Presence of suggestive clinical signs), celiac disease(celiac disease serology and duodenal biopsies) and dermatological involvement (clinical examination). Results: Fifty-one patients (50 women and one men) followed for PBC were collected. The Mean age was 54 years (37-77 years). Among these patients, 30 patients(58.8%) had at least one autoimmune disease associated with PBC. The discovery of these autoimmune diseases preceded the diagnosis of PBC in 8 cases (26.6%) and was concomitant, through systematic screening, in the remaining cases. Autoimmune hepatitis was found in 12 patients (40%), defining thus an overlap syndrome. Other diseases were Hashimoto's thyroiditis (n = 10), dry syndrome (n = 7), Gougerot Sjogren syndrome (n=6), celiac disease (n = 3), insulin-dependent diabetes (n = 1), scleroderma (n = 1), rheumatoid arthritis (n = 1), Biermer Anemia (n=1) and Systemic erythematosus lupus (n=1). The two groups of patients with PBC with or without associated autoimmune disorders were comparable for bilirubin levels, Child-Pugh score, and response to treatment. Conclusion: In our series, the prevalence of autoimmune diseases in PBC was 58.8%. These diseases were dominated by autoimmune hepatitis and Hashimoto's thyroiditis. Even if their association does not seem to alter the prognosis, screening should be systematic in order to institute an early and adequate management.

Keywords: autoimmune diseases, autoimmune hepatitis, primary biliary cirrhosis, prognosis

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467 Intercultural Education and Changing Paradigms of Education: A Research Survey

Authors: Shalini Misra

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The means and methods of education have been changing fast since the invention of internet. Both, ancient and modern education emphasized on the holistic development of students. But, a significant change has been observed in the 21st century learners. Online classes, intercultural and interdisciplinary education which were exceptions in the past, are setting new trends in the field of education. In the modern era, intercultural and interpersonal skills are of immense importance, not only for students but for everyone. It sets a platform for better understanding and deeper learning by ensuring the active participation and involvement of students belonging to different social and cultural backgrounds in various academic and non-academic pursuits. On October 31, 2015, on the occasion of 140th birth anniversary of Sardar Vallabhbhai Patel, Hon’ble Prime Minister of India, Narendra Modi announced a wonderful initiative, ‘Ek Bharat Shreshtha Bharat’ i.e. ‘One India Best India’ commonly known as ‘EBSB’. The program highlighted India’s rich culture and traditions. The objective of the program was to foster a better understanding and healthy relationship among Indian States. Under this program, a variety of subjects were covered like ‘Arts, Culture and Language’ .It was claimed to be a successful cultural exchange where students from diverse communities shared their thoughts and experiences with one another. Under this online cultural exchange program, the state of Uttarakhand was paired with the state of Karnataka in the year 2022. The present paper proposes to undertake a survey of a total of thirty secondary level students of Uttarakhand and the partner state Karnataka, who participated in this program with a purpose of learning and embracing new ideas and culture thus promoting intercultural education. It aims to study and examine the role of intercultural education in shifting and establishing new paradigms of education.

Keywords: education, intercultural, interpersonal, traditions, understanding

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466 Study of the Genotoxic Potential of Plant Growth Regulator Ethephon

Authors: Mahshid Hodjat, Maryam Baeeri, Mohammad Amin Rezvanfar, Mohammad Abdollahi

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Ethephon is one of the most widely used plant growth regulator in agriculture that its application has been increased in recent years. The toxicity of organophosphate compounds is mostly attributed to their potent inhibition of acetylcholinesterase and their involvement in neurodegenerative disease. Although there are few reports on butyrylcholinesterase inhibitory role of ethephon, still there is no evidence on neurotoxicity and genotoxicity of this compound. The aim of the current study is to assess the potential genotoxic effect of ethephon using two genotoxic endpoints; γH2AX expression and comet assay on embryonic murine fibroblast. γH2AX serves as an early and sensitive biomarker for evaluating the genotoxic effects of chemicals. Oxidative stress biomarkers, including intracellular reactive oxygen species, lipid peroxidation and antioxidant capacity were also examined. The results showed a significant increase in cell proliferation 24h post-treatment with 10, 40,160µg/ml ethephon. The γH2AX expression and γH2AX foci count per cell were increased at low concentration of ethephon that was concomitant with increased DNA damage break at 40 and 160 µg/ml as illustrated by increased comet tail moment. A significant increase in lipid peroxidation and ROS formation were observed at 160 µg/ml and higher doses. The results showed that low-dose of ethephon promoted cell proliferation while induce DNA damage, raising the possibility of ethephon mutagenicity. Ethephon-induced genotoxic effect of low dose might not related to oxidative damage. However, ethephon was found to increase oxidative stress at higher doses, lead to cellular cytotoxicity. Taken together, all data indicated that ethylene, deserves more attention as a plant regulator with potential genotoxicity for which appropriate control is needed to reduce its usage.

Keywords: ethephon, DNA damage, γH2AX, oxidative stress

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465 Conceptual Understanding for the Adoption of Energy Assessment Methods in the United Arab Emirates Built Environment

Authors: Amna I. Shibeika, Batoul Y. Hittini, Tasneem B. Abd Bakri

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Regulation and integration of public policy, economy, insurance industry, education, and construction stakeholders are the main contributors to achieve sustainable development. Building environmental assessment methods were introduced in the field to address issues such as global warming and conservation of natural resources. In the UAE, Estidama framework with its associated Pearl Building Rating System (PBRS) has been introduced in 2010 to address and spread sustainability practices within the country’s fast-growing built environment. Based on literature review of relevant studies investigating different project characteristics that influence sustainability outcomes, this paper presents a conceptual framework for understanding the adoption of PBRS in UAE projects. The framework also draws on Diffusion of Innovations theory to address the questions of how the assessment method is chosen in the first place and what is the impact of PBRS on the multi-disciplinary design and construction processes. The study highlights the mandatory nature of the adoption of PBRS for government buildings as well as imbedding Estidama principles within Abu Dhabi building codes as key factors for raising awareness about sustainable practices. Moreover, several project-related elements are addressed to understand their relationship with the adoption process, including project team collaboration; communication and coordination; levels of commitment and engagement; and the involvement of key actors as sustainability champions. This conceptualization of the adoption of PBRS in UAE projects contributes to the growing literature on the adoption of energy assessment tools and addresses the UAE vision is to be at the forefront of innovative sustainable development by 2021.

Keywords: adoption, building assessment, design management, innovation, sustainability

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464 The Implementation of Incineration for Waste Reduction

Authors: Kong Wing Man

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The purpose of this paper is to review the waste generation and management in different parts of the world. It is undeniable that waste generation and management has become an alarming environmental issue. Solid waste generation links inextricably to the degree of industrialization and economic development. Urbanization increases with the economic wealth of the countries. As the income of people and standard of living enhances, so does their consumption of goods and services, leading to a corresponding increase in waste generation. Based on the latest statistics from What A Waste Report published by World Bank (2012), it is estimated that the current global Municipal Solid Waste (MSW) generation levels are about 1.3 billion tonnes per year (1.2 kg per capita per day). By 2050, it is projected that the waste generation will be doubled. Although many waste collection practices have been implemented in various countries, the amount of waste generation keeps increasing. An integrated solid waste management is needed in order to reduce the continuous significant increase in waste generation rates. Although many countries have introduced and implemented the 3Rs strategy and landfill, however, these are only the ways to diverse waste, but cannot reduce the volume. Instead, the advanced thermal treatment technology, incineration, can reduce up to 90% volume of disposed waste prior to dispose at landfills is discussed. Sweden and Tokyo were chosen as case studies, which provide an overview of the municipal solid waste management system. With the condition of escalating amount of wastes generated, it is crucial to build incinerators to relief pressing needs of landfill. Two solutions are proposed to minimize waste generation, including one incineration in one city and several small incinerators in different cities. While taking into consideration of a sustainable model and the perspectives of all stakeholders, building several incinerators at different cities and different sizes would be the best option to reduce waste. Overall, the solution to the global solid waste management should be a holistic approach with the involvement of both government and citizens.

Keywords: Incineration, Municipal Solid Waste, Thermal Treatment, Waste generation

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463 Implementation of Gender Policy in the Georgian National Defence: Key Issues and Challenges

Authors: Vephkhvia Grigalashvili

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The defense of Georgia is every citizen’s duty. The present article reviews the principles and standards of gender policy in the Georgian national defense sector. In addition, it looks at mechanisms for ensuring gender equality, going through the relevant Georgian legislation. Furthermore, this work aims to conduct a comparative analysis of defense models of Georgia, Finland, and the Baltic States in order to identify core institutional challenges. The study produced the following findings:(a) The national defense planning is based on the Total Defense approach, which implies a wide involvement of the country`s population in state defense. (b) This political act does not specify gender equality aspects of the Total Defense strategy; (c) According to the Constitution of Georgia, irrespective of gender factors, every citizen of Georgia is legally obliged to participate in state security activities. However, the state has an authority (power of choice) to decide which gender group (male or/and female citizen) must fulfill above mentioned their constitutional commitment. For instance, completion of compulsory military and reserve military services is a male citizen’s duty, whereas professional military service is equally accessible to both genders. The study concludes that effective implementation of the Total Defense concept largely depends on how Georgia uses its capabilities and human resources. Based on the statistical fact that more than 50% of the country’s population are women, Georgia has to elaborate on relevant institutional mechanisms for implementation of gender equality in the national defense organization. In this regard, it would be advisable: (i) to give the legal opportunity to women to serve in compulsory military service, and (ii) to develop labor reserve service as a part of the anti-crisis management system of Georgia.

Keywords: gender in defense organisation, gender mechanisms, gender in defense policy, gender policy

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462 Promoting Personhood and Citizenship Amongst Individuals with Learning Disabilities: An Occupational Therapy Approach

Authors: Rebecca Haythorne

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Background: Agendas continuously emphasise the need to increase work based training and opportunities for individuals with learning disabilities. However research and statistics suggest that there is still significant stigma and stereotypes as to what they can contribute, or gain from being part of the working environment. Method: To tackles some of these prejudices an Occupational Therapy based intervention was developed for learning disability service users working at a social enterprise farm. The intervention aimed to increase positive public perception around individual capabilities and encourage individuals with learning disabilities to take ownership and be proud of their individual personhood and citizenship. This was achieved by using components of the Model of Human Occupation to tailor the intervention to individual values, skills and working contributions. The final project involved making creative wall art for public viewing, focusing on 'who works there and what they do'. This was accompanied by a visitor information guide, allowing individuals to tell visitors about themselves, the work they do and why it is meaningful to them. Outcomes: The intervention has helped to increased metal well-being and confidence of learning disability service users “people will know I work here now” and “I now have something to show my family about the work I do at the farm”. The intervention has also increased positive public perception and community awareness “you can really see the effort that’s gone into doing this” and “it’s a really visual experience to see people you don’t expect to see doing this type of work”. Resources left behind have further supported individuals to take ownership in creating more wall art to be sold at the farm shop. Conclusion: the intervention developed has helped to improve mental well-being of both service users and staff and improve community awareness. Due to this, the farm has decided to roll out the intervention to other areas of the social enterprise and is considering having more Occupational Therapy involvement in the future.

Keywords: citizenship, intervention, occupational therapy, personhood

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461 Punishment on top of Punishment - Impact of Inmate Misconduct

Authors: Nazirah Hassan, Andrew Kendrick

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Punishment inside the penal institution has always been practiced in order to maintain discipline and keep order. Nonetheless, criminologists have long debated that the enforcement of discipline by punishing inmates is often ineffective and has a detrimental impact on inmates’ conduct. This paper uses data from a sample of 289 incarcerated young offenders to investigate the prevalence of institutional misconduct. It explores punitive cultural practices inside institutions and how this culture affects the inmates’ conduct during confinement. The project focused on male and female young offenders aged 12 to 21 years old, in eight juvenile justice institutions. The research collected quantitative and qualitative data using a mixed-method approach. All participants completed the Direct and Indirect Prisoner behavior Checklist-Scaled Version Revised (DIPC-SCALED-R). In addition, exploratory interviews were carried out with sixteen inmates and eight institutional staff. Results of the questionnaire survey show that almost half of the inmates reported a higher level of involvement in perpetration. It demonstrates a remarkable convergence of direct, rather than indirect, perpetration. Also, inmates reported a higher level of tobacco used and behavior associated with negative attitudes towards staff and institutional rules. In addition to this, the qualitative data suggests that the punitive culture encourages the onset of misconduct by increasing the stressful and oppressive conditions within the institution. In general, physical exercise and locking up inmates are two forms of punishment that were ubiquitous throughout the institutions. Interestingly, physical exercise is not only enforced by institutional staff but also inmates. These findings are discussed in terms of existing literature and their practical implications are considered.

Keywords: institutional punishment, incarcerated young offenders, punitive culture, institutional misconduct

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460 Empowering Children through Co-creation: Writing a Book with and for Children about Their First Steps Towards Urban Independence

Authors: Beata Patuszynska

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Children are largely absent from Polish social discourse, a fact which is mirrored in urban planning processes. Their absence creates a vicious circle – an unfriendly urban space discourages children from going outside on their own, meaning adults do not see a need to make spaces more friendly for a group, not present. The pandemic and lockdown, with their closed schools and temporary ban on unaccompanied minors on the streets, have only reinforced this. The project – co-writing with children a book concerning their first steps into urban independence - aims at empowering children, enabling them to find their voice when it comes to urban space. The foundation for the book was data collected during research and workshops with children from Warsaw primary schools, aged 7-10 - the age they begin independent travel in the city. The project was carried out with the participation and involvement of children at each creative step. Children were (1) models: the narrator is an 7-year-old boy getting ready for urban independence. He shares his experience as well as the experience of his school friends and his 10-year-old sister, who already travels on her own. Children were (2) teachers: the book is based on authentic children’s stories and experience, along with the author’s findings from research undertaken with children. The material was extended by observations and conclusions made during the pandemic. Children were (3) reviewers: a series of draft chapters from the book underwent review by children during workshops performed in a school. The process demonstrated that all children experience similar pleasures and worries when it comes to interaction with urban space. Furthermore, they also have similar needs that need satisfying. In my article, I will discuss; (1) the advantages of creating together with children; (2) my conclusions on how to work with children in participatory processes; (3) research results: perceptions of urban space by children age 7-10, when they begin their independent travel in the city; the barriers to and pleasures derived from independent urban travel; the influence of the pandemic on children’s feelings and their behaviour in urban spaces.

Keywords: children, urban space, co-creation, participation, human rights

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459 Confidence Levels among UK Emergency Medicine Doctors in Performing Emergency Lateral Canthotomy: Should it be a Key Skill in the ED

Authors: Mohanad Moustafa, Julia Sieberer, Rhys Davies

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Background: Orbital compartment syndrome (OCS) is a sight-threatening Ophthalmologic emergency caused by rapidly increasing intraorbital pressure. It is usually caused by a retrobulbar hemorrhage as a result of trauma. If not treated in a timely manner, permanent vision loss can occur. Lateral canthotomy and cantholysis are minor procedures that can be performed bedside with equipment available in the emergency department. The aim of the procedure is to release the attachments between the suspensory ligaments of the eye and the bony orbital wall, leading to a decrease in intraorbital pressure and preventing irreversible loss of vision. As most Ophthalmologists across the UK provide non-resident on-call service, this may lead to a delay in the treatment of OCS and stresses the need for Emergency medical staff to be able to provide this sight-saving procedure independently. Aim: To survey current training, experience, and confidence levels among Emergency Medicine doctors in performing emergency lateral canthotomy and to establish whether these variables change the following teaching from experienced ophthalmologists. RESULTS: Most EM registrars had little to no experience in performing lateral canthotomy and cantholysis. The majority of them showed a significant increase in their confidence to perform the procedure following ophthalmic-led teaching. The survey also showed that the registrars felt such training should be added to/part of the EM curriculum. Conclusion: The involvement of Ophthalmologists in the teaching of EM doctors to recognise and treat OCS independently may prevent delays in treatment and reduce the risk of permanent sight loss. This project showed potential in improving patient care and will lead to a National Survey of EM doctors across the UK.

Keywords: lateral canthotomy, retrobulbar hemorrhage, Ophthalmology, orbital compartment syndrome, sight loss, blindness

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458 Narrative Constructs and Environmental Engagement: A Textual Analysis of Climate Fiction’s Role in Shaping Sustainability Consciousness

Authors: Dean J. Hill

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This paper undertakes the task of conducting an in-depth textual analysis of the cli-fi genre. It examines how writing in the genre contributes to expressing and facilitating the articulation of environmental consciousness through the form of narrative. The paper begins by situating cli-fi within the literary continuum of ecological narratives and identifying the unique textual characteristics and thematic preoccupations of this area. The paper unfolds how cli-fi transforms the esoteric nature of climate science into credible narrative forms by drawing on language use, metaphorical constructs, and narrative framing. It also involves how descriptive and figurative language in the description of nature and disaster makes climate change so vivid and emotionally resonant. The work also points out the dialogic nature of cli-fi, whereby the characters and the narrators experience inner disputes in the novel regarding the ethical dilemma of environmental destruction, thus demanding the readers challenge and re-evaluate their standpoints on sustainability and ecological responsibilities. The paper proceeds with analysing the feature of narrative voice and its role in eliciting empathy, as well as reader involvement with the ecological material. In looking at how different narratorial perspectives contribute to the emotional and cognitive reaction of the reader to text, this study demonstrates the profound power of perspective in developing intimacy with the dominating concerns. Finally, the emotional arc of cli-fi narratives, running its course over themes of loss, hope, and resilience, is analysed in relation to how these elements function to marshal public feeling and discourse into action around climate change. Therefore, we can say that the complexity of the text in the cli-fi not only shows the hard edge of the reality of climate change but also influences public perception and behaviour toward a more sustainable future.

Keywords: cli-fi genre, ecological narratives, emotional arc, narrative voice, public perception

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457 Patient Perspectives on the Role of Orthopedic Nurse Practitioners: A Cross-Sectional Study

Authors: Merav Ben Natan, May Revach, Or Sade, Yaniv Yonay, Yaron Berkovich

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Background: The inclusion of nurse practitioners (NPs) specializing in orthopedics holds promise for enhancing the quality of care for orthopedic patients. Understanding patients’ perspectives on this role is crucial for evaluating the feasibility and acceptance of integrating NPs into orthopedic settings. This study aims to explore the receptiveness of orthopedic patients to treatment by orthopedic NPs and examines potential associations between patients’ willingness to engage with NPs, their familiarity with the NP role, perceptions of nursing, and satisfaction with orthopedic nursing care. Methods: This cross-sectional study involved patients admitted to an orthopedic department at a central Israeli hospital between January and February 2023. Data was collected using a validated questionnaire consisting of five sections, reviewed by content experts. Statistical analyses were conducted using SPSS and included descriptive statistics, independent samples t-tests, Pearson correlations, and linear regression. Results: Participants in the study showed a moderate willingness to receive treatment from orthopedic NPs, with more than two-thirds expressing strong openness. Patients were generally receptive to NPs performing various clinical tasks, though there was less enthusiasm for NPs’ involvement in medication management and preoperative evaluations. Positive attitudes towards nurses and familiarity with the NP role were significant predictors of patient receptiveness to NP treatment. Conclusion: Patient acceptance of orthopedic NPs varies across different aspects of care. While there is a general willingness to receive care from NPs, these nuanced preferences must be considered when implementing NPs in orthopedic settings. Awareness and positive perceptions of the NP role play crucial roles in shaping patients’ willingness to engage with NPs.

Keywords: orthopedic nurse practitioners, patient receptiveness, perceptions of nursing, clinical tasks

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456 The Nexus between Child Marriage and Women Empowerment with Physical Violence in Two Culturally Distinct States of India

Authors: Jayakant Singh, Enu Anand

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Background: Child marriage is widely prevalent in India. It is a form of gross human right violation that succumbs a child bride to be subservient to her husband within a marital relation. We investigated the relationship between age at marriage of women and her level of empowerment with physical violence experienced 12 months preceding the survey among young women aged 20-24 in two culturally distinct states- Bihar and Tamil Nadu of India. Methods: We used the information collected from 10514 young married women (20-24 years) at all India level, 373 in Bihar and 523 in Tamil Nadu from the third round of National Family Health Survey. Empowerment index was calculated using different parameters such as mobility, economic independence and decision making power of women using Principal Component Analysis method. Bivariate analysis was performed primarily using chi square for the test of significance. Logistic regression was carried out to assess the effect of age at marriage and empowerment on physical violence. Results: Lower level of women empowerment was significantly associated with physical violence in Tamil Nadu (OR=2.38, p<0.01) whereas child marriage (marriage before age 15) was associated with physical violence in Bihar (OR=3.27, p<0.001). The mean difference in age at marriage between those who experienced physical violence and those who did not experience varied by 7 months in Bihar and 10 months in Tamil Nadu. Conclusion: Culture specific intervention may be a key to reduction of violence against women as the results showed association of different factors contributing to physical violence in Bihar and Tamil Nadu. Marrying at an appropriate age perhaps is protective of abuse because it equips a woman to assert her rights effectively. It calls for an urgent consideration to curb both violence and child marriage with stricter involvement of family, civil society and the government. In the meanwhile physical violence may be recognized as a public health problem and integrate appropriate treatment to the victims within the health care institution.

Keywords: child marriage, empowerment, India, physical violence

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455 NLRP3-Inflammassome Participates in the Inflammatory Response Induced by Paracoccidioides brasiliensis

Authors: Eduardo Kanagushiku Pereira, Frank Gregory Cavalcante da Silva, Barbara Soares Gonçalves, Ana Lúcia Bergamasco Galastri, Ronei Luciano Mamoni

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The inflammatory response initiates after the recognition of pathogens by receptors expressed by innate immune cells. Among these receptors, the NLRP3 was associated with the recognition of pathogenic fungi in experimental models. NLRP3 operates forming a multiproteic complex called inflammasome, which actives caspase-1, responsible for the production of the inflammatory cytokines IL-1beta and IL-18. In this study, we aimed to investigate the involvement of NLRP3 in the inflammatory response elicited in macrophages against Paracoccidioides brasiliensis (Pb), the etiologic agent of PCM. Macrophages were differentiated from THP-1 cells by treatment with phorbol-myristate-acetate. Following differentiation, macrophages were stimulated by Pb yeast cells for 24 hours, after previous treatment with specific NLRP3 (3,4-methylenedioxy-beta-nitrostyrene) and/or caspase-1 (VX-765) inhibitors, or specific inhibitors of pathways involved in NLRP3 activation such as: Reactive Oxigen Species (ROS) production (N-Acetyl-L-cysteine), K+ efflux (Glibenclamide) or phagossome acidification (Bafilomycin). Quantification of IL-1beta and IL-18 in supernatants was performed by ELISA. Our results showed that the production of IL-1beta and IL-18 by THP-1-derived-macrophages stimulated with Pb yeast cells was dependent on NLRP3 and caspase-1 activation, once the presence of their specific inhibitors diminished the production of these cytokines. Furthermore, we found that the major pathways involved in NLRP3 activation, after Pb recognition, were dependent on ROS production and K+ efflux. In conclusion, our results showed that NLRP3 participates in the recognition of Pb yeast cells by macrophages, leading to the activation of the NLRP3-inflammasome and production of IL-1beta and IL-18. Together, these cytokines can induce an inflammatory response against P. brasiliensis, essential for the establishment of the initial inflammatory response and for the development of the subsequent acquired immune response.

Keywords: inflammation, IL-1beta, IL-18, NLRP3, Paracoccidioidomycosis

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454 Insights into Insect Vectors: Liberibacter Interactions

Authors: Murad Ghanim

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The citrus greening disease, also known as Huanglongbing, caused by the phloem-limited bacterium Candidatus Liberibacter asiaticus (CLas) has resulted in tremendous losses and the death of millions of citrus trees worldwide. CLas is transmitted by the Asian citrus psyllid (ACP) Diaphorina citri. The closely-related bacterium Candidatus Liberibacter solanacearum (CLso), which is associated with vegetative disorders in carrots and the zebra chips disease in potatoes, is transmitted by other psyllid species including Bactericera trigonica in carrots and B. ckockerelli in potatoes. Chemical sprays are currently the prevailing method for managing these diseases for limiting psyllid populations; however, they are limited in their effectiveness. A promising approach to prevent the transmission of these pathogens is to interfere with the vector-pathogen interactions, but our understanding of these processes is very limited. CLas induces changes in the nuclear architecture in the midgut of ACP and activates programmed cell death (apoptosis) in this organ. Strikingly, CLso displayed an opposite effect in the gut of B. trigonica, showing limited apoptosis, but widespread necrosis. Electron and fluorescent microscopy further showed that CLas induced the formation of Endoplasmic reticulum (ER) inclusion- and replication-like bodies, in which it increases and multiplies. ER involvement in bacterial replication is hypothesized to be the first stage of an immune response leading to the apoptotic and necrotic responses. ER exploitation and the subsequent events that lead to these cellular and stress responses might activate a cascade of molecular responses ending up with apoptosis and necrosis. Understanding the molecular interactions that underlay the necrotic/apoptotic responses to the bacteria will increase our knowledge of ACP-CLas, and BT-CLso interactions, and will set the foundation for developing novel, and efficient strategies to disturb these interactions and inhibit the transmission.

Keywords: Liberibacter, psyllid, transmission, apoptosis, necrosis

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453 How Message Framing and Temporal Distance Affect Word of Mouth

Authors: Camille Lacan, Pierre Desmet

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In the crowdfunding model, a campaign succeeds by collecting the funds required over a predefined duration. The success of a CF campaign depends both on the capacity to attract members of the online communities concerned, and on the community members’ involvement in online word-of-mouth recommendations. To maximize the campaign's success probability, project creators (i.e., an organization appealing for financial resources) send messages to contributors to ask them to issue word of mouth. Internet users relay information about projects through Word of Mouth which is defined as “a critical tool for facilitating information diffusion throughout online communities”. The effectiveness of these messages depends on the message framing and the time at which they are sent to contributors (i.e., at the start of the campaign or close to the deadline). This article addresses the following question: What are the effect of message framing and temporal distance on the willingness to share word of mouth? Drawing on Perspectives Theory and Construal Level Theory, this study examines the interplay between message framing (Gains vs. Losses) and temporal distance (message while the deadline is coming vs. far) on intention to share word of mouth. A between-subject experimental design is conducted to test the research model. Results show significant differences between a loss-framed message (lack of benefits if the campaign fails) associated with a short deadline (ending tomorrow) compared to a gain-framed message (benefits if the campaign succeeds) associated with a distant deadline (ending in three months). However, this effect is moderated by the anticipated regret of a campaign failure and the temporal orientation. These moderating effects contribute to specifying the boundary condition of the framing effect. Handling the message framing and the temporal distance are thus the key decisions to influence the willingness to share word of mouth.

Keywords: construal levels, crowdfunding, message framing, word of mouth

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452 Class Control Management Issues and Solutions in Interactive Learning Theories’ Efficiency and the Application Case Study: 3rd Year Primary School

Authors: Mohammed Belalia Douma

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Interactive learning is considered as the most effective strategy of learning, it is an educational philosophy based on the learner's contribution and involvement mainly in classroom and how he interacts toward his small society “classroom”, and the level of his collaboration into challenge, discovering, games, participation, all these can be provided through the interactive learning, which aims to activate the learner's role in the operation of learning, which focuses on research and experimentation, and the learner's self-reliance in obtaining information, acquiring skills, and forming values and attitudes. Whereas not based on memorization only, but rather on developing thinking and the ability to solve problems, on teamwork and collaborative learning. With the exchange or roles - teacher to student- , when the student will be more active and performing operations more than the student under the interactive learning method; we might face a several issues dealing with class controlling management, noise, and stability of learning… etc. This research paper is observing the application of the interactive learning on reality “classroom” and answers several assumptions and analyzes the issues coming up of these strategies mainly: noise, class control…etc The research sample was about 150 student of the 3rd year primary school in “Chlef” district, Algeria, level: beginners in the range of age 08 to 10 years old . We provided a questionnaire of confidential fifteen questions and also analyzing the attitudes of learners during three months. it have witnessed as teachers a variety of strategies dealing with applying the interactive learning but with a different issues; time management, noise, uncontrolled classes, overcrowded classes. Finally, it summed up that although the active education is an inevitably effective method of teaching, however, there are drawbacks to this, in addition to the fact that not all theoretical strategies can be applied and we conclude with solutions of this case study.

Keywords: interactive learning, student, learners, strategies.

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451 High Temperature Tolerance of Chironomus Sulfurosus and Its Molecular Mechanisms

Authors: Tettey Afi Pamela, Sotaro Fujii, Hidetoshi Saito, Kawaii Koichiro

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Introduction: Organisms employ adaptive mechanisms when faced with any stressor or risk of being wiped out. This has made it possible for them to survive in harsh environmental conditions such as increasing temperature, low pH, and anoxia. Some of the mechanisms they utilize include the expression of heat shock proteins, synthesis of cryoprotectants, and anhydrobiosis. Heat shock proteins (HSPs) have been widely studied to determine their involvement in stress tolerance among various organism, of which chironomid species have been no exception. We examined the survival and expression of genes encoding five (5) heat shock proteins (HSP70, HSP67, HSP60, HSP27, and HSP23) from Chironomus sulfurosus larvae reared from 1st instar at 25°C, 30°C, 35°C, and 40°C. Results: The highest survival rate was recorded at 30°C, followed by 25°C, then 35°C. Only a small percentage of C. sulfurosus survived at 40°C (14.5%). With regards to HSPs expression, some HSPs responded to an increase in high temperature. The relative expression levels were lowest at 30°C for HSP70, HSP60, HSP27, and HSP23. At 25°C and 40°C, HSP70, HSP67, HSP60, HSP27, and HSP23 had the highest expression. At 35°C, all had the lowest expression. Discussion: The expression of heat shock proteins varies from one species to another. We designated the genes HSP 70, HSP 67, HSP 60, HSP 27, and HSP 23 genes based on transcriptome analysis of C. sulfurosus. Our study can be termed as a long-heat shock study as C. sulfurosus was reared from the first instar to the fourth instar, and this might have led to a continuous induction of HSPs at 25°C. 40°C had the lowest survival but highest HSPs expression as C. sulfurosus larvae had to utilize HSPs for sustenance. These results and future high-throughput studies at both the transcriptome and proteome level will improve the information needed to predict the future geographic distribution of these species within the context of global warming.

Keywords: chironomid, heat shock proteins, high temperature, heat shock protein expression

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450 Ulnar Nerve Changes Associated with Carpal Tunnel Syndrome and Effect on Median Ersus Ulnar Comparative Studies

Authors: Emmanuel K. Aziz Saba, Sarah S. El-Tawab

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Objectives: Carpal tunnel syndrome (CTS) was found to be associated with high pressure within the Guyon’s canal. The aim of this study was to assess the involvement of sensory and/or motor ulnar nerve fibers in patients with CTS and whether this affects the accuracy of the median versus ulnar sensory and motor comparative tests. Patients and methods: The present study included 145 CTS hands and 71 asymptomatic control hands. Clinical examination was done for all patients. The following tests were done for the patients and control: (1) Sensory conduction studies: median nerve, ulnar nerve, dorsal ulnar cutaneous nerve and median versus ulnar digit (D) four sensory comparative study; (2) Motor conduction studies: median nerve, ulnar nerve and median versus ulnar motor comparative study. Results: There were no statistically significant differences between patients and control group as regards parameters of ulnar motor study and dorsal ulnar cutaneous sensory conduction study. It was found that 17 CTS hands (11.7%) had ulnar sensory abnormalities in 17 different patients. The median versus ulnar sensory and motor comparative studies were abnormal among all these 17 CTS hands. There were statistically significant negative correlations between median motor latency and both ulnar sensory amplitudes recording D5 and D4. There were statistically significant positive correlations between median sensory conduction velocity and both ulnar sensory nerve action potential amplitude recording D5 and D4. Conclusions: There is ulnar sensory nerve abnormality among CTS patients. This abnormality affects the amplitude of ulnar sensory nerve action potential. The presence of abnormalities in ulnar nerve occurs in moderate and severe degrees of CTS. This does not affect the median versus ulnar sensory and motor comparative tests accuracy and validity for use in electrophysiological diagnosis of CTS.

Keywords: carpal tunnel syndrome, ulnar nerve, median nerve, median versus ulnar comparative study, dorsal ulnar cutaneous nerve

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449 Challenges of Implementing Participatory Irrigation Management for Food Security in Semi Arid Areas of Tanzania

Authors: Pilly Joseph Kagosi

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The study aims at assessing challenges observed during the implementation of participatory irrigation management (PIM) approach for food security in semi-arid areas of Tanzania. Data were collected through questionnaire, PRA tools, key informants discussion, Focus Group Discussion (FGD), participant observation, and literature review. Data collected from the questionnaire was analysed using SPSS while PRA data was analysed with the help of local communities during PRA exercise. Data from other methods were analysed using content analysis. The study revealed that PIM approach has a contribution in improved food security at household level due to the involvement of communities in water management activities and decision making which enhanced the availability of water for irrigation and increased crop production. However, there were challenges observed during the implementation of the approach including; minimum participation of beneficiaries in decision-making during planning and designing stages, meaning inadequate devolution of power among scheme owners. Inadequate and lack of transparency on income expenditure in Water Utilization Associations’ (WUAs), water conflict among WUAs members, conflict between farmers and livestock keepers and conflict between WUAs leaders and village government regarding training opportunities and status; WUAs rules and regulation are not legally recognized by the National court and few farmers involved in planting trees around water sources. However, it was realized that some of the mentioned challenges were rectified by farmers themselves facilitated by government officials. The study recommends that the identified challenges need to be rectified for farmers to realize impotence of PIM approach as it was realized by other Asian countries.

Keywords: challenges, participatory approach, irrigation management, food security, semi arid areas

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448 Teacher Knowledge: Unbridling Teacher Agency in the Context of Professional Development for Transformative Teaching and Learning

Authors: Bernice Badal

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This article addresses a persistent challenge related to teacher agency in knowledge acquisition in professional development (PD) workshops in contexts of educational change, given that scholarship identifies a need for more teacher involvement and amplification of teacher's voices. Theoretical concepts are drawn from Bandura’s Social cognitive theory, incorporating the triadic causation model of agency to examine the reciprocal nature of the context, teacher characteristics, and systemic influences that shape how knowledge is transmitted and acquired in PD workshops. This qualitative study, using a mix of classroom observations and interviews, explored the political, contextual, and personal characteristics of teacher agency in PD through an analysis of data extracted from a PhD study. The narratives of six teachers from three township schools are examined to show how PD efforts in South Africa have failed to take account of the holistic development of teacher agency in knowledge dissemination and how this shapes teacher self-efficacy beliefs about being able to masterfully apply the tenets of the reform. Agency, teacher voice, and contextual considerations were used as markers of the quality of the training provided to understand how knowledge is acquired and meaning is made. The findings suggest that systemic influences of institutionally imposed PD offer partial understandings of the reform, which is offered in traditional formats that do not consider teacher empowerment in knowledge production and the development of teacher agency. Common in all the participants’ responses is the need for more information and training on the prescribed approach for teaching English as a second language; however, this paper holds the view that more information may not solve teachers’ dilemmas. Accordingly, it recommends a restructuring of the programme with facilitators being more cognisant of teacher agency for the development of transformative teachers. The findings of the study contribute to the field of teacher knowledge, teacher training, and professional development in the context of educational reforms.

Keywords: teacher professional development, teacher voice, teacher agency, educational reforms, teacher knowledge

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447 Patriotic Education through Private/Everyday Narratives: What We Can Learn from Young People

Authors: Yijie Wang, Hanwei Cheng

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Under the Chinese educational context, the materials for patriotic education typically take the form of grand narratives. However, in post-modern times the younger members of society tend to welcome elements of more micro and personal nature. It is therefore important to explore how patriotism can be integrated into an ‘everyday’, private narrative that holds more attraction for the young. Based on semi-structured interviews of eight Chinese graduate students, this research examines how Chinese young people draw materials to establish national identity and develop love for the country from everyday-life details, as well as how they perceive, interpret and articulate their patriotism through private narratives. And implications for patriotic education are proposed accordingly. Several conclusions are drawn from the pre-interviews. Firstly, sensory experiences that remind people of their country—such as the taste of Chinese delicacies and the sound of a traditional instrument—are a major source of patriotic feelings. Secondly, the love for the country often stems from and is continued to be mediated by the emotional attachment with other people, typically significant others, and patriotism is articulated (or acknowledged) by the young as a kind of ‘sentiment’ rather than ‘faith’ or ‘belief’. Thirdly, for young people who are currently studying abroad, their birth country represents a kind of familiar, well-accustomed life or lifestyle, and any nostalgic realization of it leads to increased national belonging and sense of identity. Fourthly, the awareness of the country’s transformations—positive ones and neutral ones alike—triggers young people affections towards the country, and even negative transformations may result in promoted sense of self-involvement and therefore consolidate national identity. Implications for patriotic education can be drawn accordingly, and although the research is conducted under the Chinese context, it will hopefully contribute to the understanding of relevant fields.

Keywords: national identity, patriotic education, private narrative, young people

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446 Clinical Outcomes For Patients Diagnosed With DCIS Through The Breast Screening Programme

Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

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Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

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445 The Relationship Between Cyberbullying Victimization, Parent and Peer Attachment and Unconditional Self-Acceptance

Authors: Florina Magdalena Anichitoae, Anca Dobrean, Ionut Stelian Florean

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Due to the fact that cyberbullying victimization is an increasing problem nowadays, affecting more and more children and adolescents around the world, we wanted to take a step forward analyzing this phenomenon. So, we took a look at some variables which haven't been studied together before, trying to develop another way to view cyberbullying victimization. We wanted to test the effects of the mother, father, and peer attachment on adolescent involvement in cyberbullying as victims through unconditional self acceptance. Furthermore, we analyzed each subscale of the IPPA-R, the instrument we have used for parents and peer attachment measurement, in regards to cyberbullying victimization through unconditional self acceptance. We have also analyzed if gender and age could be taken into consideration as moderators in this model. The analysis has been performed on 653 adolescents aged 11-17 years old from Romania. We used structural equation modeling, working in R program. For the fidelity analysis of the IPPA-R subscales, USAQ, and Cyberbullying Test, we have calculated the internal consistency index, which varies between .68-.91. We have created 2 models: the first model including peer alienation, peer trust, peer communication, self acceptance and cyberbullying victimization, having CFI=0.97, RMSEA=0.02, 90%CI [0.02, 0.03] and SRMR=0.07, and the second model including parental alienation, parental trust, parental communication, self acceptance and cyberbullying victimization and had CFI=0.97, RMSEA=0.02, 90%CI [0.02, 0.03] and SRMR=0.07. Our results were interesting: on one hand, cyberbullying victimization is predicted by peer alienation and peer communication through unconditional self acceptance. Peer trust directly, significantly, and negatively predicted the implication in cyberbullying. In this regard, considering gender and age as moderators, we found that the relationship between unconditional self acceptance and cyberbullying victimization is stronger in girls, but age does not moderate the relationship between unconditional self acceptance and cyberbullying victimization. On the other hand, regarding the degree of cyberbullying victimization as being predicted through unconditional self acceptance by parental alienation, parental communication, and parental trust, this hypothesis was not supported. Still, we could identify a direct path to positively predict victimization through parental alienation and negatively through parental trust. There are also some limitations to this study, which we've discussed in the end.

Keywords: adolescent, attachment, cyberbullying victimization, parents, peers, unconditional self-acceptance

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444 The Role of Art and Music in Enriching Adult Learning in Maltese as a Second Language

Authors: Jacqueline Zammit

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Currently, a considerable number of individuals from different backgrounds are being drawn to Malta due to its favourable environment for business, investment, and employment. This influx has led to a growing interest among expats in learning Maltese as a second language (ML2) to enrich their experience of working and residing in Malta. However, the intricacies of Maltese grammar, particularly challenging for second language (L2) learners unfamiliar with Arabic, can pose difficulties in the learning process. Furthermore, it's worth noting that the teaching of ML2 is an emerging field with limited existing research on effective pedagogical strategies. The realm of second language acquisition (SLA) can be notably demanding for adults, requiring well-founded interventions to facilitate learning. Among these interventions, approaches grounded in empirical evidence have incorporated artistic and musical elements to augment SLA. Both art and music have proven roles in facilitating L2 communication, aiding vocabulary retention, and improving comprehension skills. This study aims to delve into the utilization of music and art as catalysts for enhancing the progress of adult learners in mastering ML2. The research employs a qualitative methodology, employing a sample selected through convenience sampling, which encompassed 37 adult learners of ML2. These participants engaged in individual interviews. The data derived from these interviews were subjected to thorough analysis. The outcomes of the study underscore the substantial positive influence exerted by art and music on the academic advancement of adult ML2 learners. Notably, it emerged from the participants' accounts that the current ML2 curricula lack the integration of art and music. Therefore, this study advocates for the incorporation of art and music components within both traditional classroom settings and online ML2 courses. The intention is to bolster the academic accomplishments of adult learners in the realm of Maltese as a second language, bridging the current gap between theory and practice.

Keywords: academic accomplishment, mature learners, visual art, learning Maltese as a second language, musical involvement, acquiring a second language

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443 Exploring the Effectiveness of End-Of-Life Patient Decision Add in the ICU

Authors: Ru-Yu Lien, Shih-Hsin Hung, Shu-Fen Lu, Ju-Jen Shie, Wen-Ju Yang, Yuann-Meei Tzeng, Chien-Ying Wang

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Background: The quality of care in intensive care units (ICUs) is crucial, especially for terminally ill patients. Shared decision-making (SDM) with families is essential to ensure appropriate care and reduce suffering. Aim: This study explores the effectiveness of an end-of-life decision support Patient Decision Aid (PDA) in an ICU setting. Methods: This study employed a cross-sectional research design conducted in an ICU from August 2020 to June 2023. Participants included family members of end-of-life patients aged 20 or older. A total of 319 participants. Family members of end-of-life patients received the PDA, and data were collected after they made medical decisions. Data collection involved providing family members with a PDA during family meetings. A post-PDA questionnaire with 17 questions assessed PDA effectiveness and anxiety levels. Statistical analysis was performed using SPSS 22.0. Results: The PDA significantly reduced anxiety levels among family members (p < 0.001). It helped them organize their thoughts, prepare for discussions with doctors, and understand critical decision factors. Most importantly, it influenced decision outcomes, with a shift towards palliative care and withdrawal of life-sustaining treatment. Conclusion: This study highlights the importance of family-centered end-of-life care in ICUs. PDAs promote informed decision-making, reduce conflicts, and enhance patient and family involvement. These tools align patient values and goals with medical recommendations, ultimately leading to decisions that prioritize comfort and quality of life. Implementing PDAs in healthcare systems can ensure that patients' care aligns with their values.

Keywords: shared decision-making, patient decision aid, end-of-life care, intensive care unit, family-centered care

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442 A Family Development Approach to Understanding the Transfer of Family Business Ownership

Authors: Susan Lanz, Gary T. Burke, Omid Omidvar

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The intention to transfer ownership control across family generations is acknowledged to be central to developing a theoretical understanding of how family businesses differ and are distinct as a business group. However, in practice, most business-owning families face challenges to transfer their business ownership from one family generation to the next. To date, researchers have paid little attention to how and when ownership is passed across family generations and what the dynamics of such transitions are. This is primarily due to the prevailing assumption that ownership transfer is an unimportant and legalistic issue that occurs within a wider family management succession process. Yet, the limited evidence available suggests that family ownership transfer occurs inside and outside of the management succession process and is a difficult process for business-owning families to navigate. As a result, many otherwise viable family businesses are closing, leading to unnecessary loss of jobs and knowledge. This qualitative paper examines how family members understand and navigate the ownership transfer process. This study uses an inductive qualitative research design, conducted through in-depth interviews within eight business-owning families. It draws on family development theory and shows how a wide range of family-related events and dynamics outside of family business involvement underlie and shape the ownership transfer process. The findings extend the theory on how these events trigger ownership transfer and how they shape the ownership meanings held within business-owning families. This study found that ownership transfer meanings extend beyond that of transferring the legal control and financial appropriation rights of shareholders. The study concludes there are three different stages in the process of ownership transfer -symbolic, re-balancing, and protectionist. Each stage creates distinct family social constructions of the rights of family members to hold business ownership, and each stage occurs within a specific family development phase.

Keywords: business-owning family, family development theory, ownership transfer, process

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