Search results for: maternal voice

Authors: I. Stacher, B. Schrank, K. Stiehl, K. A. Woodcock

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Background: The need and desire for connectedness and belonging to a peer group is a major concern in middle childhood. This is particularly true for the period of school transition when making and maintaining friendships is put to the test. Social relations are important for enhancing self-esteem, confidence, and mental health. Conflicts with peers and victimization mark challenges in the complex social environment of early adolescents. Thus, the promotion of supportive peer relationships is an important social goal. The current literature lacks an in-depth analysis of young people’s experiences connected to making and maintaining friendships. Aim: This qualitative study aims to understand the factors that facilitate and hinder friendship and peer relations within the complex context of school transition. Methods: Youth engagement workshops at primary and secondary schools were conducted with 53 classes (N = 906 pupils; M age = 10.44; SD = .912) in 29 different schools across lower Austria. A big poster was created with the entire class, collecting early adolescents’ ideas on ways they can support each other in the school environment. Then, students were divided into smaller groups and encouraged to share their personal experiences of friendship. Verbatim quotes from students were collected on observation sheets and sticky notes during the activities. A thematic analysis was conducted. Results: Early adolescents describe facilitating factors that allow them to connect with peers. These descriptions are mainly on a behavioral level and are relevant for face-to-face and digital contact, e.g., practical and emotional support, spending time together, pleasure and fun. Specific challenges such as offensive actions, betrayal, and lack of emotion regulation exist and need to be addressed if aiming to reduce barriers between peers. Conclusion: Knowing first-hand experiences, desires, and barriers for making and maintaining friends at the time of school transition will help researchers to develop preventive health programs that adequately address the needs and preferences of today’s youth.

Keywords: youth voice, experts by experience, friendship, peer relations, primary-secondary school, transition

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Authors: Vivek Saxena, Shreshtha Saxena

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Background: Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance first recognized during pregnancy. Uncontrolled or untreated GDM is associated with various adverse outcomes to the maternal and fetal health. Overt diabetes mellitus may also develop in such patients. It is universally accepted fact that first and foremost management to treat GDM is dietary control and lifestyle modification even before starting any oral hypoglycemic agent (OHA) or insulin. So, proper dietary management and little changes in the patient’s lifestyle are very effective for reducing her plasma glucose level. Objectives: Proper counselling of the patients and flexibility in their lifestyle and diet can effectively control the plasma glucose level in GDM patients. Methods: Total 60 GDM patients of age > 18 years were taken. We had three counselling sessions with the patient and other members of the family like husband, parents, and in-laws at different intervals, discussed their lifestyle and diet pattern, helped them to eliminate the factors those had an adverse effect on plasma glucose level and promoted them to acquire a healthy lifestyle. We have counselled the patient and her family member separately and then together also. They have explained how increased plasma glucose level can be effectively controlled with the little modification in their diet and routine activities. They were also taught to remain stress-free during their rest of antenatal period. We have excluded the patients from our study who were diabetic before pregnancy and patients with other comorbid illnesses like hypothyroidism and valvular heart disease. Results and conclusions: Results were very rewarding as patients could acquire a lifestyle of their choice. They were happy because extra pill burden was not there. All the 60 patients were normoglycemic in remaining antenatal period, 48 patients were delivered normally and 12 patients underwent cesarean section due to various reasons.Regular counselling of the patients regarding their disease and little alterations in diet and lifestyle controlled the plasma glucose level much effectively. The things were more easier and effective when we included other family members during our counselling session because they play a major role in patient’s day to day activity and influence her life.

Keywords: dietary management, gestational diabetes mellitus, impaired glucose tolerance, oral hypoglycemic agent, pregnancy

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Authors: Mohd. Ashik Shahrier, Hiromi Wada

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Prenatal ethanol exposure has potential to induce difficulties in the social behavior of rats and can alter pup-dam communication suggesting that deficits in pups could result in altered dam behavior, which in turn could result in more aberrant behavior in the pup. Ultrasonic vocalization (USV) is a sensitive tool for investigating social behavior between rat pups and their dam. Rat pups produce USVs on separation from their dam. This signals the dam to locate her pups and retrieve them back to the nest. In this study, it was predicted that prenatal ethanol exposure cause alterations on the acoustic characteristics of USVs in rat pups. Thirteen pregnant rats were purchased and randomly assigned into three groups: high-ethanol (n = 4), low-ethanol (n = 5), and control (n = 4) groups. Laboratory ethanol (purity = 99.5%) was dissolved in tap water and administered to the high- and low-ethanol groups as drinking water from gestational days (GD) 8-20. Ethanol-containing water was administered to the animals in three stages by gradually increasing the concentration between GDs 8–20. From GDs 8–10, 10% and 5%, from GDs 11–13, 20% and 10%, and from GDs 14–20, 30% and 15% ethanol-containing water (v/v) was administered to the high- and low-ethanol groups, respectively. Tap water without ethanol was given to the control group throughout the experiment. The day of birth of the pups was designated as postnatal day (PND) 0. On PND 4, each litter was culled to four male and four female pups. For the present study, two male and two female pups were randomly sampled from each litter as subjects. Thus, eight male and eight female pups from the high-ethanol and control groups and another 10 male and 10 female pups from the low-ethanol group, were sampled. An ultrasonic microphone and the Sonotrack system version 2.4.0 (Metris, Hoofddorp, The Netherlands) were used to record and analyze USVs of the pups. On postnatal days 4, 8, 12 and 16, the resultant pups were individually isolated from their dams and littermates, and USVs were recorded for 5 min in a sound-proof box. Pups in the high-ethanol group produced greater number of USVs compared with that in both low-ethanol and control groups on PND 12. Rat pups in the high-ethanol group also produced higher mean, minimum, and maximum fundamental frequencies of USVs compared with that in both low-ethanol and control groups. Male pups in the high-ethanol group had higher USV amplitudes than in those in low-ethanol and control groups on PND 12. These results suggest that pups in the high-ethanol group relatively experienced more negative emotionality due to the ethanol-induced neuronal activation in the core limbic system and tegmental structures and accordingly, produced altered USVs as distress calls.

Keywords: emotionality, ethanol, maternal separation, ultrasonic vocalization

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Authors: Akiode Ayobami, Akiode Akinsewa, Odeku Mojisola, Salako Busola, Odutolu Omobola, Nuhu Khadija

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Purpose: Evidence exists that family planning use can contribute to reduction in infant and maternal mortality in any country. Despite these benefits, contraceptive use in Nigeria still remains very low, only 10% among married women. Understanding factors that predict contraceptive use is very important in order to improve the situation. In this paper, we analysed data from the 2013 Nigerian Demographic and Health Survey (NDHS) to better understand predictors of contraceptive use in Nigeria. The use of logistics regression and other traditional models in this type of situation is not appropriate as they do not account for social structure influence brought about by the hierarchical nature of the data on response variable. We therefore used multilevel modelling to explore the determinants of contraceptive use in order to account for the significant variation in modern contraceptive use by socio-demographic, and other proximate variables across the different Nigerian states. Method: This data has a two-level hierarchical structure. We considered the data of 26, 403 married women of reproductive age at level 1 and nested them within the 36 states and the Federal Capital Territory, Abuja at level 2. We modelled use of modern contraceptive against demographic variables, being told about FP at health facility, heard of FP on TV, Magazine or radio, husband desire for more children nested within the state. Results: Our results showed that the independent variables in the model were significant predictors of modern contraceptive use. The estimated variance component for the null model, random intercept, and random slope models were significant (p=0.00), indicating that the variation in contraceptive use across the Nigerian states is significant, and needs to be accounted for in order to accurately determine the predictors of contraceptive use, hence the data is best fitted by the multilevel model. Only being told about family planning at the health facility and religion have a significant random effect, implying that their predictability of contraceptive use varies across the states. Conclusion and Recommendation: Results showed that providing FP information at the health facility and religion needs to be considered when programming to improve contraceptive use at the state levels.

Keywords: multilevel modelling, family planning, predictors, Nigeria

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Authors: Lito M. Amit, Venecio U. Ultra, Young-Woong Song

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The business process outsourcing (BPO) in the Philippines is expanding rapidly attracting more than 2% of total employment. Currently, the BPO industry is confronted with several issues pertaining to sustainable productivity such as meeting the staffing gap, high rate of employees’ turnover and workforce retention, and the occupational health and safety (OHS) of call center agents. We conducted a survey of OHS programs and health concerns among call center agents in the Philippines and determined the sociocultural factors that affect the vulnerability of call center agents to occupational health risks and hazards. The majority of the agents affirmed that OHS are implemented and OHS orientation and emergency procedures were conducted at employment initiations, perceived favorable and convenient working environment except for occasional noise disturbances and acoustic shock, visual, and voice fatigues. Male agents can easily adjust to the demands and changes in their work environment and flexible work schedules than female agents. Female agents have a higher tendency to be pressured and humiliated by low work performance, experience a higher incidence of emotional abuse, psychological abuse, and experience more physical stress than male agents. The majority of the call center agents had a night-shift schedule and regardless of other factors, night shift work brings higher stress to agents. While working in a call center, higher incidence of headaches and insomnia, burnout, suppressed anger, anxiety, and depressions were experienced by female, younger (21-25 years old) and those at night shift than their counterpart. Most common musculoskeletal disorders include body pain in the neck, shoulders and back; and hand and wrist disorders and these are commonly experienced by female and younger workers. About 30% experienced symptoms of cardiovascular and gastrointestinal disorders and weakened immune systems. Overall, these findings have shown the variable vulnerability by a different subpopulation of call center agents and are important in the occupational health risk prevention and management towards a sustainable human resource for BPO industry in the Philippines.

Keywords: business process outsourcing industry, health risk of call center agents, socio-cultural determinants, Philippines

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Authors: Ntloyalefu Justinah, Fumane Khanare

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English learning has been found as one of the prevalent areas of difficulty for Deaf learners. However, studies conducted indicated that this challenge experienced by Deaf learners is an upsetting concern globally as is blamed and hampered by various reasons such as the way English is taught at schools, lack of teachers ' skills and knowledge, therefore, impact negatively on their academic performance. Despite any difficulty in English learning, this language is considered nowadays as the key tool to an educational and occupational career especially in Lesotho. This paper, therefore, intends to contribute to the existing literature by providing the views of Lesotho English teachers, which focuses on how effectively Universal design for learning can be implemented to enhance the academic performance of Deaf learners in context of the English language classroom. The purpose of this study sought to explore the use of universal design for learning (UDL) to support Deaf learners in Lesotho Secondary schools. The present study is informed by interpretative paradigm and situated within a qualitative research approach. Ten participating English teachers from two inclusive schools were purposefully selected and telephonically interviewed to generate data for this study. The data were thematically analysed. The findings indicated that even though UDL is identified as highly proficient and promotes flexibility in teaching methods teachers reflect limited knowledge of the UDL approach. The findings further showed that UDL ensures education for all learners, including marginalised groups, such as learners with disabilities through different teaching strategies. This means that the findings signify the effective use of UDL for the better performance of the English language by Deaf learners (DLs). This aligns with literature that shows mobilizing English teachers as assets help DLs to be engaged and have control in their communities by defining and solving problems using their resources and connections to other networks for asset and exchange. The study, therefore, concludes that teachers acknowledge that even though they assume to be knowledgeable about the definition of UDL, they have a limited practice of the approach, thus they need to be equipped with some techniques and skills to apply for supporting the performance of DLs by using UDL approach in their English teaching. The researchers recommend the awareness of UDL principles by the ministry of Education and Training and teachers training Universities, as well as teachers training colleges, for them to include it in their curricula so that teachers could be properly trained on how to apply it in their teaching effectively

Keywords: deaf learners, Lesotho, support learning, universal design for learning

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Authors: Muhammad Asim, Mehvish Amjad

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Background: Less than half of women in South Asia (SA) use any modern contraceptive method which leads to a huge burden of unintended pregnancies, unsafe abortions, maternal deaths, and socioeconomic loss. Women empowerment plays a pivotal role in improving various health seeking behaviours, including contraceptive use. The objective of this study to explore the association between women's empowerment and modern contraceptive, among rich and poor segment of population in SA. Methods: We used the most recent, large-scale, demographic health survey data of five South Asian countries, namely Afghanistan, Pakistan, Bangladesh, India, and Nepal. The outcome variable was the current use of modern contraceptive methods. The main exposure variable was a combination (interaction) of socio-economic status (SES) and women’s level of empowerment (low, medium, and high), where SES was bifurcated into poor and rich; and women empowerment was divided into three categories: decision making, attitude to violence and social independence. Moreover, overall women empowerment indicator was also created by using three dimensions of women empowerment. We applied both descriptive statistics and multivariable logistic regression techniques for data analyses. Results: Most of the women possessed ‘medium’ level of empowerment across South Asian Countries. The lowest attitude to violence empowerment was found in Afghanistan, and the lowest social independence empowerment was observed in Bangladesh across SA. However, Pakistani women have the lowest decision-making empowerment in the region. The lowest modern contraceptive use (22.1%) was found in Afghanistan and the highest (53.2%) in Bangladesh. The multivariate results depict that the overall measure of women empowerment does not affect modern contraceptive use among poor and rich women in most of South Asian countries. However, the decision-making empowerment plays a significant role among both poor and rich women to use modern contraceptive methods across South Asian countries. Conclusions: The effect of women’s empowerment on modern contraceptive use is not consistent across countries, and among poor and rich segment of population. Of the three dimensions of women’s empowerment, the autonomy of decision making in household affairs emerged as a stronger determinant of mCPR as compared with social independence and attitude towards violence against women.

Keywords: women empowerment, modern contraceptive use, South Asia, socio economic status

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Authors: Ruthanne Tobin

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As our data-driven, cloud-based, knowledge-centric lives become ever more global, mobile, and digital, educational systems everywhere are struggling to keep pace. Schools need to prepare students to become critical-thinking, tech-savvy, life-long learners who are engaged and adaptable enough to find their unique calling in a post-industrial world of work. Recognizing that no nation can afford poor achievement or high dropout rates without jeopardizing its social and economic future, the thirty-two nations of the OECD are launching initiatives to redesign schools, generally under the banner of Personalized Learning or 21st Century Learning. Their intention is to transform education by situating students as co-enquirers and co-contributors with their teachers of what, when, and how learning happens for each individual. In this focused review of the 2007-2017 literature on personalized learning, the author sought answers to two main questions: “What are the theoretical frameworks that guide personalized learning?” and “What is the conceptual understanding of the model?” Ultimately, the review reveals that, although the research area is overly theorized and under-substantiated, it does provide a significant body of knowledge about this potentially transformative educational restructuring. For example, it addresses the following questions: a) What components comprise a PL model? b) How are teachers facilitating agency (voice & choice) in their students? c) What kinds of systems, processes and procedures are being used to guide the innovation? d) How is learning organized, monitored and assessed? e) What role do inquiry based models play? f) How do teachers integrate the three types of knowledge: Content, pedagogical and technological? g) Which kinds of forces enable, and which impede, personalizing learning? h) What is the nature of the collaboration among teachers? i) How do teachers co-regulate differentiated tasks? One finding of the review shows that while technology can dramatically expand access to information, expectations of its impact on teaching and learning are often disappointing unless the technologies are paired with excellent pedagogies in order to address students’ needs, interests and aspirations. This literature review fills a significant gap in this emerging field of research, as it serves to increase conceptual clarity that has hampered both the theorizing and the classroom implementation of a personalized learning model.

Keywords: curriculum change, educational innovation, personalized learning, school reform

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Authors: Masuma Novak, Daniel Novak

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Background: Sweden along with other Nordic countries has the highest incidence of type 1 diabetes mellitus (T1DM) worldwide. The trend is increasing globally. The diagnosis is often given at the emergency clinic when children arrive with cardinal symptom of T1DM. Children with T1DM are known to have an increased risk of microvascular- and macrovascular complications. A family history of cardiovascular complications may further increase their risk. Clinically evident diabetes-related vascular complications are however rarely visible in childhood and adolescence, whereby an intensive diabetes treatment and normoglycemic control is a goal for every child. This study is a risk evaluation of children with T1DM based on their family’s cardiovascular history. Method: Since 2005 the Better Diabetes Diagnosis (BDD) study is a nationwide Swedish prospective cohort study that recruits new-onset T1DM who are less than 18 years old at time of diagnosis. For each newly diagnosed child, blood samples are collected for specific HLA genotyping and islet autoantibody assays and their family’s cardiovascular history is evaluated. As part of the BDD study, during the years 2010-2013 all children diagnosed with T1DM at the Queen Silvia’s Children’s Hospital in Sweden were asked about their family’s cardiovascular history. Questions regarded maternal and paternal high blood pressure, stroke, and myocardial infarction before the age of 55 years, and hyperlipidemia were answered. A maximum risk score of eight was possible. All children are clinically observed prospectively for early functional and structural abnormalities such as protein uremia, blood pressure, and retinopathy. Results: A total of 275 children aged 0 to 18 years were diagnosed with T1DM at the Queen Silvia’s Children’s Hospital emergency clinic during this four year period. The participation rate was 99.7%. 26.4% of the children had no hereditary cardiovascular risk factors. 22.7 % had one risk factor and 18.8% had two risk factors. 14.8% had three risk factors. 9.7% had four risk factors and 7.5% had five risk factors or more. Conclusion: Among children with T1DM in Sweden there is a difference in hereditary cardiovascular risk factors. These results indicate that children with T1DM who also have increased hereditary cardiovascular risk factors should be monitored closely with early screening for functional and structural cardiovascular abnormalities. This is a very preliminary and ongoing study which will be complemented with the cardiovascular risk analysis among children without T1DM.

Keywords: children, type I diabetes, emergency clinic, CVD risk

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Authors: Md. Khayrul Bashar, Md. Saiful Islam, Kimiko Yamashita, Yano Midori

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Despite having some progress in human authentication, conventional biometrics (e.g., facial features, fingerprints, retinal scans, gait, voice patterns) are not robust against falsification because they are neither confidential nor secret to an individual. As a non-invasive tool, electrocardiogram (ECG) has recently shown a great potential in human recognition due to its unique rhythms characterizing the variability of human heart structures (chest geometry, sizes, and positions). Moreover, ECG has a real-time vitality characteristic that signifies the live signs, which ensure legitimate individual to be identified. However, the detection accuracy of the current ECG-based methods is not sufficient due to a high variability of the individual’s heartbeats at a different instance of time. These variations may occur due to muscle flexure, the change of mental or emotional states, and the change of sensor positions or long-term baseline shift during the recording of ECG signal. In this study, a new method is proposed for human identification, which is based on the extraction of the local roughness of ECG heartbeat signals. First ECG signal is preprocessed using a second order band-pass Butterworth filter having cut-off frequencies of 0.00025 and 0.04. A number of local binary patterns are then extracted by applying a moving neighborhood window along the ECG signal. At each instant of the ECG signal, the pattern is formed by comparing the ECG intensities at neighboring time points with the central intensity in the moving window. Then, binary weights are multiplied with the pattern to come up with the local roughness description of the signal. Finally, histograms are constructed that describe the heartbeat signals of individual subjects in the database. One advantage of the proposed feature is that it does not depend on the accuracy of detecting QRS complex, unlike the conventional methods. Supervised recognition methods are then designed using minimum distance to mean and Bayesian classifiers to identify authentic human subjects. An experiment with sixty (60) ECG signals from sixty adult subjects from National Metrology Institute of Germany (NMIG) - PTB database, showed that the proposed new method is promising compared to a conventional interval and amplitude feature-based method.

Keywords: human identification, ECG biometrics, local roughness patterns, supervised classification

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Authors: Risheka Suthantirakumar, Eilish Pearson, Jacqueline Woodman

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Background: Previous research has found a variety of rates and reasons for choosing medically unindicated elective repeat cesarean section (ERCS). Understanding the frequency and reasoning of ERCS, especially when unwarranted, could help healthcare professionals better tailor their advice and service. Therefore, our study conducted meta-analyses and qualitative analyses to identify the reasons and rates worldwide for choosing this procedure over the trial of labor after cesarean (TOLAC), also referred to in published literature as vaginal birth after cesarean (VBAC). Methods: We conducted a systematic review of published literature available on PubMed, EMBASE, and science.gov and conducted a blinded peer review process to assess eligibility. Search terms were created in collaboration with experts in the field. An inclusion and exclusion criteria were established prior to reviewing the articles. Included studies were limited to those published in English due to author constraints, although no international boundaries were used in the search. No time limit for the search was used in order to portray changes over time. Results: Our qualitative analyses found five consistent themes across international studies, which were socioeconomic and cultural differences, previous cesarean experience, perceptions of risk with vaginal birth, patients’ perceptions of future benefits, and medical advice and information. Our meta-analyses found variable rates of ERCS across international borders and within national populations. The average rate across all studies was 44% (CI 95% 36-51). Discussion: The studies included in our qualitative analysis demonstrated similar repetitive themes, which give validity to the findings across the studies included. We consider the rate variation across and within national populations to be partially a result of differing inclusion and eligibility assessment between different studies and argue that a proforma be utilized for future research to be comparable.

Keywords: elective cesarean section, VBAC, TOLAC, maternal choice

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Authors: Inna Vinokurova, N. Savvina

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The goal of research: to study the organization of multi-field hospital’s work environment in the Republic of Sakha (Yakutia), Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine. Results: Autonomous public health care institution of Republic of Sakha (Yakutia) - Republican Hospital No. 1 - National Center of Medicine is a multidisciplinary, specialized hospital complex that provides specialized and high-tech medical care to children and adults in the Republic of Sakha (Yakutia) of the Russian Federation. There are 5 diagnostic and treatment centers (advisory and diagnostic, clinical, pediatric, perinatal, Republican cardiologic dispensary) with 45 clinical specialized departments with 727 cots, 5 resuscitation departments, 20 operating rooms and out-patient department with 905 visits in alternation in the National Center of Medicine. Annually more than 20,000 patients receive treatment in the hospital of the Republican Hospital of the Republic of Sakha (Yakutia), more than 70,000 patients visit out-patient sections, more than 2 million researches are done, more than 12,000 surgeries are performed, more than 2 thousand babies are delivered. National Center of Medicine has a great influence with such population’s health indicators as total mortality, birth rate, maternal, infant and perinatal mortality, circulatory system incidence. The work environment of the Republican Hospital of the Republic of Sakha (Yakutia) is represented by the following structural departments: pharmacy, blood transfusion department, sterilization department, laundry, dietetic department, infant-feeding centre, material and technical supply. More than 200 employees work in this service. The main function of these services is to provide on-time and fail-safe supply with all necessary: wear parts, medical supplies, donated blood and its components, foodstuffs, hospital linen , sterile instruments, etc. Thus, the activity of medical organization depends on the work environment, including quality health care, so it is a main part of multi-field hospital activity.

Keywords: organization of multi-field hospital’s, work environment, quality health care, pharmacy, blood transfusion department, sterilization department

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Authors: Amina El-Warari, Agata Vitale, Laura Caulfield, Jennifer Kinloch

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Background: Unemployment levels among refugees in the UK are much higher than voluntary migrants and UK-born citizens. The lack of employment and/or of suitable employment has detrimental consequences on refugees’ ability to integrate and become active citizens in the host country. Research indicates that, when individuals are forced to migrate, one of the most significant aspects to building their identity is their previous profession; this particularly applies to qualified refugees. Despite this, there is little support available to them. The current study is set in this context and aims to explore highly qualified refugees’ employment-related experiences in the UK as well as their suggestions on how to develop specific interventions that can support them in finding suitable employment. Methods: A qualitative study design was employed. Qualitative methods are in fact well suited to research with refugees, as they allow them to give their direct opinion, rather than this being filtered by stakeholders. Listening to ‘the refugee’s voice’ means developing ‘a refugee centered perspective’ where the diverse narratives told by participants are organized to tell their direct collective story. A total of 12 refugees, attending a non-profit refugee organization in the south-west of England, took part in the study. The selection criteria were being over 18, having a level of English that allows them to sustain a conversation, and having a University degree and/or professional qualification. All participants were interviewed individually; the data were transcribed and analyzed thematically. Findings: Participants had very little support in finding suitable employment; this often only consisted of a few sessions in their local job centers and English tutorials. They indicated that being unemployed/underemployed negatively affected their sense of identity, their acculturative stress, and their in-group/ out-group relations. They suggested that specific employment interventions for qualified refugees should be delivered to them individually in order to address their specific needs. Furthermore, most participants suggested that these interventions should support them in volunteering in organizations that match their skills/ qualifications. They also indicated that the employment interventions should support them in having their qualifications recognized in the UK as well as building links with universities/ centers where they can receive adequate training on how to understand and adapt to the employments needs in the UK. Conclusions: These findings will provide the basis for the second stage of the research where specific employment interventions will be designed and tested with highly qualified refugees. In addition, these findings shed light refugee integration policy.

Keywords: employment interventions, identity, integration, qualified refugees

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Authors: Emanuela Zilli, Antonella Ruffatto, Davide Bonaldo, Stefano Bevilacqua, Tommaso Caputo, Luisa Fontana, Carmelina Saraceno, Antonio Sturaroo, Teodoro Sava, Antonio Madia

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The new Hospital in Cittadella - ULSS 6 Euganea Health Trust, in the North-East of Italy (400 beds, project completion date in 2026), will partially take the place of the existing building. Interesting features have been suggested in order to project a modern, “environmental-friendly” and “people-friendly” building. Specific multidisciplinary meetings (involving stakeholders and professionals with different backgrounds) have been organized on a periodic basis in order to guarantee the appropriate implementation of logistic and organizational solutions related to eco-sustainability, integration with the context, and the concept of “design for all” and “humanization of care.” The resulting building will be composed of organic shapes determined by the external environment (sun movement, climate, landscape, pre-existing buildings, roads) and the needs of the internal environment (areas of care and diagnostic-treatment paths reorganized with experience gained during the pandemic), with extensive use of renewable energy, solar panels, a 4th-generation heating system, sanitised and maintainable surfaces. There is particular attention to the quality of the staff areas, which include areas dedicated to psycho-physical well-being (relax points, yoga gym), study rooms, and a centralized conference room. Outdoor recreational spaces and gardens for music and watercolour therapy will be included; atai-chi gym is dedicated to oncology patients. Integration in the urban and social context is emphasized through window placement toward the gardens (maternal-infant, mental health, and rehabilitation wards). Service areas such as dialysis, radiology, and labs have views of the medieval walls, the symbol of the city’s history. The new building has been designed to pursue the maximum level of eco-sustainability, harmony with the environment, and integration with the historical, urban, and social context; the concept of humanization of care has been considered in all the phases of the project management.

Keywords: environmental-friendly, humanization, eco-sustainability, new hospital

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Authors: S. Yeo, M. Mathur

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Introduction: Obesity, defined as a Body Mass Index (BMI) of more than or equal to 30kg/m, is associated with an increased risk of complications during pregnancy and delivery. During labour, obese mothers often require greater intervention and have higher rates of caesarean section. Despite a low overall rate of serious complications following caesarean section, a high BMI predisposes to a higher risk of postoperative complications. Our study, therefore, aimed to investigate the impact of antenatal obesity on adverse outcomes following caesarean section, particularly wound-related infections. Materials and Methods: A retrospective cohort study of all caesarean deliveries during the first quarter of a chosen year was undertaken in our hospital, which is a tertiary referral centre with > 12,000 deliveries per year. Patients’ health records and data from our hospital’s electronic labour and delivery database were reviewed. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS), and odds ratios plus adjusted odd ratios were calculated with 95% confidence intervals (CI). Results: A total of 1829 deliveries were reviewed during our study period. Of these, 180 (9.8%) patients were obese. The rate of caesarean delivery was 48.9% in obese patients versus 28.1% in non-obese patients. Post-operatively, 17% of obese patients experienced wound infection versus 0.2% of non-obese patients. Obese patients were also more likely to experience major postpartum haemorrhage (4.6% vs. 0.2%) and postpartum pyrexia (18.2% vs. 5.0%) in comparison to non-obese patients. Conclusions: Obesity is a significant risk factor in the development of postoperative complications following caesarean section. Wound infection remains a major concern for obese patients undergoing major surgery and results in extensive morbidity during the postnatal period. Postpartum infection can prolong recovery and affect maternal mental health, leading to reduced perinatal bonding with long-term implications on breastfeeding and parenting confidence. This study supports the need for the development of standardized protocols specifically for obese patients undergoing caesarean section. Multidisciplinary team care, in conjunction with anaesthesia, family physicians, and plastic surgery counterparts, early on in the antenatal journey, may be beneficial where wound complications are anticipated and to minimize the burden of postoperative infection in obese mothers.

Keywords: pregnancy, obesity, caesarean, infection

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Authors: Oluwaseun Adeleke, Samuel O. Ikani, Fidelis Edet, Anthony Nwala, Mopelola Raji, Simeon Christian Chukwu

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Introduction: Digital innovations have been useful in supporting a client’s contraceptive user journey from awareness to method initiation. The concept of contraceptive self-care is being promoted globally as a means for achieving universal access to quality contraceptive care; however, information about this approach is limited. An important determinant of the scale of awareness is the message construct, choice of information channel, and an understanding of the socio-epidemiological dynamics within the target audience. Significant gains have been made recently in expanding the awareness base of DMPA-SC -a relatively new entrant into the family planning method mix. The cornerstone of this success is a multichannel promotion campaign themed Discover your Power (DYP). The DYP campaign combines content marketing across select social media platforms, chatbots, Cyber-IPC, Interactive Voice Response (IVR), and radio campaigns. Methodology: During implementation, the project monitored predefined metrics of awareness and intent, such as the number of persons reached with the messages, the number of impressions, and meaningful engagement (link-clicks). Metrics/indicators are extracted through native insight/analytics tools across the various platforms. The project also enlists community mobilizers (CMs) who go door-to-door and engage WRA to advertise DISC’s online presence and support them to engage with IVR, digital companion (chatbot), Facebook page, and DiscoverYourPower website. Results: The result showed that the digital platforms recorded 242 million impressions and reached 82 million users with key DMPA-SC self-injection messaging in the three countries. As many as 3.4 million persons engaged (liked, clicked, shared, or reposted) digital posts -an indication of intention. Conclusion: Digital solutions and innovations are gradually becoming the archetype for the advancement of the self-care agenda. Digital innovations can also be used to increase awareness and normalize contraceptive self-care behavior amongst women of reproductive age if they are made an integral part of reproductive health programming.

Keywords: digital transformation, health systems, DMPA-SC, family planning, self-care

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Authors: Visvaganthie Moodley

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Language use and aesthetic appreciation are integral to meaning-making in prose, as they are in poetry. However, in comparison to poetic analysis, a literary analysis of prose that focuses on linguistics and stylistics is somewhat scarce as it generally requires the study of lengthy texts. Nevertheless, the effect of linguistic and stylistic features in prose as conscious design by authors for creating specific effects and conveying preconceived messages is drawing increasing attention of linguists and literary experts. A close examination of language use in prose can, among a host of literary purposes, convey emotive and cognitive values and contribute to making interpretations about how fictional characters are represented to the imaginative reader. This paper provides a literary analysis of Yann Martel’s narrative of a 14-year-old Indian boy, Pi, who had survived the wreck of a Japanese cargo ship, by focusing on his 227-day journey of tribulations, along with a Bengal tiger, on a lifeboat. The study favours a pluralistic approach blending literary criticism, linguistic analysis and stylistic description. It adopts Leech and Short’s (2007) broad framework of linguistic and stylistic categories (lexical categories, grammatical categories, figures of speech etc. [sic] and context and cohesion) as well as a range of other relevant linguistic phenomena to show how the narrator, Pi, and the author influence the reader’s interpretations of Pi’s character. Such interpretations are made using the lens of Freud’s psychoanalytical theory (which focuses on the interplay of the instinctual id, the ego and the moralistic superego) and Blake’s philosophy of innocence and experience (the two contrary states of the human soul). The paper traces Pi’s transformation from animal-loving, God-fearing vegetarian to brutal animal slayer and cannibal in his journey of survival. By a close examination of the linguistic and stylistic features of the narrative, it argues that, despite evidence of butchery and cannibalism, Pi’s gruesome behaviour is motivated by extreme physiological and psychological duress and not intentional malice. Finally, the paper concludes that the voice of the narrator, Pi, and that of the author, Martel, act as powerful persuasive agents in influencing the reader to respond with a sincere flow of sympathy for Pi and judge him as having retained his innocence in his instinctual need for survival.

Keywords: foregrounding, innocence and experience, lexis, literary analysis, psychoanalytical lens, style

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Authors: Pernille K. Christiansen, Mette Maria Skjøth, Line Lorenzen, Eva Draborg, Christina Anne Vinter, Trine Kjær, Mette Juel Rothmann

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Background and aims: Overweight and obesity are an increasing challenge on a global level. In Denmark, more than one-third of all pregnant women are overweight or obese, and many women exceed the gestational weight gain recommendations from the Institute of Medicine. Being overweight or obese, is associated with a higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Thus, it is important to focus on the women’s lifestyles between their pregnancies to lower the risk of gestational weight retention in the long run. The objective of this study was to explorer what barriers and challenges postpartum women experience with respect to healthy lifestyles during the postpartum period and to access whether an Information Technology based intervention might be a supportive tool to assist and motivate postpartum women to a healthy lifestyle. Materials and methods: The method is inspired by participatory design. A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. Results: From the women’s perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritise their own health-related risks, and to motivate them to plan and take care of their own health. As the women use Information Technology on a daily basis, the solution could be delivered through Information Technology. Finally, there is room for engaging the partner more in the communication related to the baby and family’s lifestyle. Conclusion: Postpartum women need tools that inform and motivate a healthy lifestyle postpartum. The tools should allow access to high-quality information from health care professionals, when the information is needed, and also allow engagement from the partner. Finally, Information Technology is a potential tool for delivering tools.

Keywords: information technology, lifestyle, overweight, postpartum

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Authors: Aljoša Šorgo

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Recent scholarship on Phrygian has begun to more closely examine the long-held belief that Greek and Phrygian are two very closely related languages. It is now clear that Graeco-Phrygian can be firmly postulated as a subclade of the Indo-European languages. The present paper will focus on the reconstruction of the phonological and phonetic segments of Proto-Graeco-Phrygian (= PGPh.) by providing relevant correspondence sets and reconstructing the classes of segments. The PGPh. basic vowel system consisted of ten phonemic oral vowels: */a e o ā ē ī ō ū/. The correspondences of the vowels are clear and leave little open to ambiguity. There were four resonants and two semi-vowels in PGPh.: */r l m n i̯ u̯/, which could appear in both a consonantal and a syllabic function, with the distribution between the two still being phonotactically predictable. Of note is the fact that the segments *m and *n seem to have merged when their phonotactic position would see them used in a syllabic function. Whether the segment resulting from this merger was a nasalized vowel (most likely *[ã]) or a syllabic nasal *[N̥] (underspecified for place of articulation) cannot be determined at this stage. There were three fricatives in PGPh.: */s h ç/. *s and *h are easily identifiable. The existence of *ç, which may seem unexpected, is postulated on the basis of the correspondence Gr. ὄς ~ Phr. yos/ιος. It is of note that Bozzone has previously proposed the existence of *ç ( < PIE *h₁i̯-) in an early stage of Greek even without taking into account Phrygian data. Finally, the system of stops in PGPh. distinguished four places of articulation (labial, dental, velar, and labiovelar) and three phonation types. The question of which three phonation types were actually present in PGPh. is one of great importance for the ongoing debate on the realization of the three series in PIE. Since the matter is still very much in dispute, we ought to, at this stage, endeavour to reconstruct the PGPh. system without recourse to the other IE languages. The three series of correspondences are: 1. Gr. T (= tenuis) ~ Phr. T; 2. Gr. D (= media) ~ Phr. T; 3. Gr. TA (= tenuis aspirata) ~ Phr. M. The first series must clearly be reconstructed as composed of voiceless stops. The second and third series are more problematic. With a bottom-up approach, neither the second nor the third series of correspondences are compatible with simple modal voicing, and the reflexes differ greatly in voice onset time. Rather, the defining feature distinguishing the two series was [±spread glottis], with ancillary vibration of the vocal cords. In PGPh. the second series was undergoing further spreading of the glottis. As the two languages split, this process would continue, but be affected by dissimilar changes in VOT, which was ultimately phonemicized in both languages as the defining feature distinguishing between their series of stops.

Keywords: bottom-up reconstruction, Proto-Graeco-Phrygian, spread glottis, syllabic resonant

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Authors: Donna Woodhouse, Beth Fielding-Lloyd, Ruth Sequerra

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This paper explores the structure and culture of the English Football Association (FA) the governing body of soccer in England, in relation to the development of the FA Women’s Super League (WSL). In doing so, it examines the organisation’s journey from banning the sport in 1921 to establishing the country’s first semi professional female soccer league in 2011. As the FA has a virtual monopoly on defining the structures of the elite game, we attempted to understand its behaviour in the context of broader issues of power, control and resistance by giving voice to the experiences of those affected by its decisions. Observations were carried out at 39 matches over three years. Semi structured interviews with 17 people involved in the women’s game, identified via snowball sampling, were also carried out. Transcripts accompanied detailed field notes and were inductively coded to identify themes. What emerged was the governing body’s desire to create a new product, jettisoning the long history of the women’s game in order to shape and control the sport in a way it is no longer able to, with the elite male club game. The League created was also shaped by traditional conceptualisations of gender, in terms of the portrayal of its style of play and target audience, setting increased participation and spectatorship targets as measures of ‘success’. The national governing body has demonstrated pseudo inclusion and a lack of enthusiasm for the implementation of equity reforms, driven by a belief that the organisation is already representative, fair and accessible. Despite a consistent external pressure, the Football Association is still dominated at its most senior levels by males. Via claiming to hold a monopoly on expertise around the sport, maintaining complex committee structures and procedures, and with membership rules rooted in the amateur game, it remains a deeply gendered organisation, resistant to structural and cultural change. In WSL, the FA's structure and culture have created a franchise over which it retains almost complete control, dictating the terms of conditions of entry and marginalising alternative voices. The organisation presents a feminised version of both play and spectatorship, portraying the sport as a distinct, and lesser, version of soccer.

Keywords: football association, organisational culture, soccer, women’s super league

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Authors: Teemu Saressalo

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This article examines the evolution of the Israel Defence Forces’ information operation activities during an eight-year timespan from the 2006 war with Hezbollah to more recent operations such as Pillar of Defence and Protective Edge. To this end, the case study will show a change in the Israel Defence Forces’ activities in the information domain. In the 2006 war with Hezbollah in Lebanon, Israel inflicted enormous damage on the Lebanese infrastructure, leaving more than 1,200 people dead and 4,400 injured. Casualties among Hezbollah, Israel’s main adversary, were estimated to range from 250 to 700 fighters. Damage to the Lebanese infrastructure was estimated at over USD 2.5bn, with almost 2,000 houses and buildings damaged and destroyed. Even this amount of destruction did not force Hezbollah to yield and while both sides were claiming victory in the war, Israel paid a heavier price in political backlashes and loss of reputation, mainly due to failures in the media and the way in which the war was portrayed and perceived in Israel and abroad. Much of this can be credited to Hezbollah’s efficient use of the media, and Israel’s failure to do so. Israel managed the next conflict it was engaged in completely differently – it had learnt its lessons and built up new ways to counter its adversary’s propaganda and media operations. In Operation Cast Lead at the turn of 2009, Hamas, Israel’s adversary and Gaza’s dominating faction, was not able to utilize the media in the same way that Hezbollah had. By creating a virtual and physical barrier around the Gaza Strip, Israel almost totally denied its adversary access to the worldwide media, and by restricting the movement of journalists in the area, Israel could let its voice be heard above all. The operation Cast Lead began with a deception operation, which caught Hamas totally off guard. The 21-day campaign left the Gaza Strip devastated, but did not cause as much protest in Israel during the operation as the 2006 war did, mainly due to almost total Israeli dominance in the information dimension. The most important outcome from the Israeli perspective was the fact that Operation Cast Lead was assessed to be a success and the operation enjoyed domestic support along with support from many western nations, which had condemned Israeli actions in the 2006 war. Later conflicts have shown the same tendency towards virtually total dominance in the information domain, which has had an impact on target audiences across the world. Thus, it is clear that well-planned and conducted information operations are able to shape public opinion and influence decision-makers, although Israel might have been outpaced by its rivals.

Keywords: Hamas, Hezbollah, information operations, Israel Defence Forces

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Authors: Lauren Schuldt Wilson

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Felicia Hemans’ memorializing of the unwritten lives of women and the consequent allowance for marginalized voices to remember and be remembered has been considered by many critics in terms of ekphrasis and elegy, terms which privilege the question of whether Hemans’ poeticizing can represent lost voices of history or only her poetic expression. Amy Gates, Brian Elliott, and others point out Hemans’ acknowledgement of the self-projection necessary for imaginatively filling the absences of unrecorded histories. Yet, few have examined the complex temporal positioning Hemans inscribes in these moments of self-projection and imaginative historicizing. In poems like ‘The Image in Lava,’ Hemans maps not only a lost past, but also a lost potential future onto the image of a dead infant in its mother’s arms, the discovery and consideration of which moves the imagined viewer to recover and incorporate the ‘hope’ encapsulated in the figure of the infant into a reevaluation of national time embodied by the ‘relics / Left by the pomps of old.’ By examining Hemans’ acknowledgement and response to Percy Bysshe Shelley’s ‘Ozymandias,’ this essay explores how Hemans’ depictions of imaginative historicizing open new horizons of possibility and reevaluate temporal value structures by imagining previously undiscovered or unexplored potentialities of the past. Where Shelley’s poem mocks the futility of national power and time, this essay outlines Hemans’ suggestion of alternative threads of identity and temporal meaning-making which, regardless of historical veracity, exist outside of and against the structures Shelley challenges. Counter to previous readings of Hemans’ poem as celebration of either recovered or poetically constructed maternal love, this essay argues that Hemans offers a meditation on sites of reproduction—both of personal reproductive futurity and of national reproduction of power. This meditation culminates in Hemans’ gesturing towards a method of historicism by which the imagined viewer reinvigorates the sterile, ‘shattered visage’ of national time by forming temporal identity through the imagining of trans-historical hope inscribed on the infant body of the universal, individual subject rather than the broken monument of the king.

Keywords: futurity, national temporalities, reproduction, revisionary histories

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Authors: Ana Ferraz, Martim Santos, M. Graça Pereira

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Distress among parents of children with acute lymphoblastic leukemia (ALL) is common during treatment and can persist several years post-diagnosis, impacting the adjustment of children and parents themselves. Current evidence is needed to examine the scope and nature of parental distress in childhood ALL. This review focused on associated variables, predictors, and outcomes of parental distress following their ALL diagnosis of their child. PubMed, Web of Science, and PsycINFO databases were searched for English and Spanish papers published from 1983 to 2021. PRISMA statement was followed, and papers were evaluated through a standardized methodological quality assessment tool (NHLBI). Of the 28 papers included, 16 were evaluated as fair, eight as good, and four as poor. Regarding results, 11 papers reported subgroup differences, and 15 found potential predictors of parental distress, including sociodemographic, psychosocial, psychological, family, health, and ALL-specific variables. Significant correlations were found between parental distress, social support, illness cognitions, and resilience, as well as contradictory results regarding the impact of sociodemographic variables on parental distress. Family cohesion and caregiver burden were associated with distress, and the use of healthy coping strategies was associated with less anxiety. Caregiver strain contributed to distress, and the overall impact of illness positively predicted anxiety in mothers and somatization in fathers. Differences in parental distress were found regarding group risk, time since diagnosis, and treatment phases. Thirteen papers explored the outcomes of parental distress on psychological, family, health, and social/education outcomes. Parental distress was the most important predictor of family strain. Significant correlations were found between parental distress at diagnosis and further psychological adjustment of parents themselves and their children. Most papers reported correlations between parental distress on children’s adjustment and quality of life, although few studies reported no association. Correlations between maternal depression and child participation in education and social life were also found. Longitudinal studies are needed to better understand parental distress and its consequences on health outcomes, in particular. Future interventions should focus mainly on parents on distress reduction and psychological adjustment, both in parents and children over time.

Keywords: childhood acute lymphoblastic leukemia, family, parental distress, psychological adjustment, quality of life

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Authors: H. Y. Al-Matubsi, G. A. Oriquat, M. Abu-Samak, O. A. Al Hanbali, M. Salim

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Background: Uncontrolled diabetes mellitus (DM) is an etiological factor for recurrent pregnancy loss and major congenital malformations in the offspring. Antioxidant therapy has been advocated to overcome the oxidant-antioxidant disequilibrium inherent in diabetes. The aims of this study were to evaluate the protective effect of lipoic acid (LA) on fetal outcome and to elucidate changes that may be involved in the mechanism(s) implicit diabetic fetopathy. Methods: Female rats were rendered hyperglycemic using streptozocin and then mated with normal male rat. Pregnant non-diabetic (group1; n=9; and group2; n=7) or pregnant diabetic (group 3; n=10; and group 4; n=8) rats were treated daily with either lipoic acid (LA) (30 mg/kg body weight; groups 2 and 4) or vehicle (groups 1 and 3) between gestational days 0 and 15. On day 15 of gestation, the rats were sacrificed, and the fetuses, placentas and membranes dissected out of the uterine horns. Following morphological examination, the fetuses, placentas and membranes were homogenized, and used to measure cyclooxygenases (COX) activities and metabolisms of prostaglandin (PG) E2 (PGEM) and PGF2 (PGFM) levels. Maternal liver and plasma total glutathione levels were also determined. Results: Supplementation of diabetic rats with LA was found to significantly (P<0.05) reduce resorption rates in diabetic rats and increased mean fetal weight compared to diabetic group. Treatment of diabetic rats with LA leads to a significant (P<0.05) increase in liver and plasma total glutathione, in comparison with diabetic rats. Decreased levels of PGEM and elevated levels of PGFM in the fetuses, placentas and membranes were characteristic of experimental diabetic gestation associated with malformation. LA treatment to diabetic mothers failed to normalize levels of PGEM to the non-diabetic control rats. However, the levels of PGEM in malformed fetuses from LA-treated diabetic mothers was significantly (P < 0.05) higher than those in malformed fetuses from diabetic rats. Conclusions: We conclude that LA can reduce congenital malformations in the offspring of diabetic rats at day 15 of gestation. However, LA treatment did not completely prevent the occurrence of malformations, other factors, such as arachidonic acid deficiency and altered prostaglandin metabolismmay be involved in the pathogenesis of diabetes-induced congenital malformations.

Keywords: diabetes, lipoic acid, pregnancy, prostaglandins

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Authors: S. Nakayama

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For non-native English speakers, using English modal auxiliary verbs appropriately can be among the most challenging tasks. This research sought to identify differences in modal verb usage between Japanese non-native English speakers (JNNS) and native speakers (NS) from two different perspectives: frequency of use and distribution of verb phrase structures (VPS) where modal verbs occur. This study can contribute to the identification of JNNSs' interlanguage with regard to modal verbs; the main aim is to make a suggestion for the improvement of teaching materials as well as to help language teachers to be able to teach modal verbs in a way that is helpful for learners. To address the primary question in this study, usage of nine central modals (‘can’, ‘could’, ‘may’, ‘might’, ‘shall’, ‘should’, ‘will’, ‘would’, and ‘must’) by JNNS was compared with that by NSs in the International Corpus Network of Asian Learners of English (ICNALE). This corpus is one of the largest freely-available corpora focusing on Asian English learners’ language use. The ICNALE corpus consists of four modules: ‘Spoken Monologue’, ‘Spoken Dialogue’, ‘Written Essays’, and ‘Edited Essays’. Among these, this research adopted the ‘Written Essays’ module only, which is the set of 200-300 word essays and contains approximately 1.3 million words in total. Frequency analysis revealed gaps as well as similarities in frequency order. Specifically, both JNNSs and NSs used ‘can’ with the most frequency, followed by ‘should’ and ‘will’; however, usage of all the other modals except for ‘shall’ was not identical to each other. A log-likelihood test uncovered JNNSs’ overuse of ‘can’ and ‘must’ as well as their underuse of ‘will’ and ‘would’. VPS analysis revealed that JNNSs used modal verbs in a relatively narrow range of VPSs as compared to NSs. Results showed that JNNSs used most of the modals with bare infinitives or the passive voice only whereas NSs used the modals in a wide range of VPSs including the progressive construction and the perfect aspect, both of which were the structures where JNNSs rarely used the modals. Results of frequency analysis suggest that language teachers or teaching materials should explain other modality items so that learners can avoid relying heavily on certain modals and have a wide range of lexical items to reflect their feelings more accurately. Besides, the underused modals should be more stressed in the classroom because they are members of epistemic modals, which allow us to not only interject our views into propositions but also build a relationship with readers. As for VPSs, teaching materials should present more examples of the modals occurring in a wide range of VPSs to help learners to be able to express their opinions from a variety of viewpoints.

Keywords: corpus linguistics, Japanese learners of English, modal auxiliary verbs, International Corpus Network of Asian Learners of English

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Authors: Maria Lucia G. Lourenco, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Congenital malformations are organ defects due to genetic or teratogenic causes, which can lead to high mortality in dog litters. This study assessed and described the congenital malformations in newborn dogs. The study included litters attend in the São Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil. One hundred seventy-eight litters and 803 newborns were evaluated. The occurrence of litters with malformations was 24.7%, and of newborns was 6.7%. Twenty-seven different malformations were registered: anasarca, anal atresia, cleft lip, cleft palate, duplicated right ribcage, equinovarus, exencephaly, gastroschisis, hydrocephaly, lissencephaly, macroglossia, microphthalmia, mitral valve dysplasia, omphalocele, eyelid agenesis, persistent urachus, polydactyly, pulmonary hypoplasia, pulmonary valve stenosis, rectovaginal fistula, agenesis of abdominal muscles, rib hypoplasia, scoliosis, segmental aplasia of the intestines, tricuspid valve dysplasia, unilateral kidney agenesis, and vaginal atresia. 68.7% of newborns died as a result of malformations. The pure breeds with the highest chances of manifesting malformations in contrast with mixed breeds were French Bulldog, Pug, English Bulldog, Rottweiler, German Spitz, Pinscher, Pitbull, Yorkshire Terrier, and Shih-Tzu. Significant values (P<0.05) occurred in races French Bulldogs and Pugs. The causes of congenital disabilities are possibly related to hereditary genetic factors considering that the highest incidence of malformations was observed among purebreds. There as one case of exposure to a teratogenic agent, but no other mothers were exposed to such agents during pregnancy. Two cases of consanguineal breeding between siblings were reported. The mortality rate was high. Genetic breeding programs for reproduction, avoiding consanguineous mating, care in choosing parents, and avoiding maternal exposure to teratogenic agents are of utmost importance in reducing dog malformations and consequent mortality.

Keywords: congenital defects, teratogenesis, canine neonatology, newborn puppy

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Authors: Maria L. G. Lourenco, Keylla H. N. P. Pereira, Viviane Y. Hibaru, Fabiana F. Souza, Joao C. P. Ferreira, Simone B. Chiacchio, Luiz H. A. Machado

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Neonatal sepsis is a systemic response of acute infection by bacteria that may lead to high mortality in a litter. This study aims to report a case of sepsis by alpha-hemolytic Streptococcus and Mannheimia haemolytica in neonate dogs. A pregnant, mixed-breed bitch at approximately the 60th day of pregnancy was admitted to the Sao Paulo State University (UNESP) Veterinary Hospital, Botucatu, Sao Paulo, Brazil, and subjected to a c-section due to uterine atony and fetuses no heartbeats on the ultrasound examination. The mother presented leukopenia of 1.6 thousand leukocytes, and there was no other information regarding previous clinical history. Among the offspring, four were stillborn, and five were born alive. On clinical examination, neonates weighed between 312 and 384 grams. Reflexes were present, and the newborn's body temperature was between 89.9 ºF and 96.4 ºF. Neonates also presented clinical signs of neonatal infection: omphalitis, abdomen, and extremities with cyanotic color, hematuria, and diarrhea (meconium). Complementary tests revealed leukopenia. The presence of alpha hemolytic streptococcus and Mannheimia haemolytica was revealed in the bacterial culture. The bacteria were sensitive to cephalosporins and penicillin on the antibiogram. Treatment for sepsis was instituted with the drug ceftriaxone, at a dose of 50 mg per kilogram, administered intravenous (jugular vein). Subsequently administered subcutaneous, every 12 hours, for seven days. Heated fluid therapy was performed, with Ringer lactate, at a dose of 4 ml per 100 grams of weight, intravenous. Heating measures were instituted. Blood plasma was also administered, at a dose of 2 mL per 100 grams of weight, administered subcutaneous, as a source of passive immunity. A maternal milk substitute was instituted, and lactation was discontinued since the mother was unable to nurse due to the infection. The mother was neutered during the c-section and treated with ceftriaxone (50 mg/kg). After seven days, the newborns presented normal clinical signs and no alterations in the hemogram. Early diagnosis and intervention were essential for the survival of these patients.

Keywords: neonatal infection, puppies, bacteria, newborn

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Authors: Wanwadee Neamsakul

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VARK learning style is an effective method of learning that could enhance all skills of the students like visual (V), auditory (A), read/write (R), and kinesthetic (K). This learning style benefits the students in terms of professional competencies, critical thinking and lifelong learning which are the desirable characteristics of the nursing students. This study aimed to develop a model of teaching and learning clinical practicum at postpartum ward for nursing students by using VARK learning styles, and evaluate the nursing students’ opinions about the developmental model. A methodology used for this study was research and development (R&D). The model was developed by focus group discussion with five obstetric nursing instructors who have experiences teaching Maternal Newborn and Midwifery I subject. The activities related to practices in the postpartum (PP) ward including all skills of VARK were assigned into the matrix table. The researcher asked the experts to supervise the model and adjusted the model following the supervision. Subsequently, it was brought to be tried out with the nursing students who practiced on the PP ward. Thirty third year nursing students from one of the northern Nursing Colleges, Academic year 2015 were purposive sampling. The opinions about the satisfaction of the model were collected using a questionnaire which was tested for its validity and reliability. Data were analyzed using descriptive statistics. The developed model composed of 27 activities. Seven activities were developed as enhancement of visual skills for the nursing students (25.93%), five activities as auditory skills (18.52%), six activities as read and write skills (22.22%), and nine activities as kinesthetic skills (33.33%). Overall opinions about the model were reported at the highest level of average satisfaction (mean=4.63, S.D=0.45). In the aspects of visual skill (mean=4.80, S.D=0.45) was reported at the highest level of average satisfaction followed by auditory skill (mean=4.62, S.D=0.43), read and write skill (mean=4.57, S.D=0.46), and kinesthetic skill (mean=4.53, S.D=0.45) which were reported at the highest level of average satisfaction, respectively. The nursing students reported that the model could help them employ all of their skills during practicing and taking care of the postpartum women and newborn babies. They could establish self-confidence while providing care and felt proud of themselves by the benefits of the model. It can be said that using VARK learning style to develop the model could enhance both nursing students’ competencies and positive attitude towards the nursing profession. Consequently, they could provide quality care for postpartum women and newborn babies effectively in the long run.

Keywords: model, nursing students, postpartum ward, teaching and learning clinical practicum

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Authors: Chen-Chang Lee, Po-Chou Chen, Jo-Chi Jao, Chun-Chung Lui, Leung-Chit Tsang, Lain-Chyr Hwang

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Fetal Magnetic Resonance Imaging (MRI) is a challenge task because the fetal movements could cause motion artifact in MR images. The remedy to overcome this problem is to use fast scanning pulse sequences. The Single-Shot Fast Spin-Echo (SSFSE) T2-weighted imaging technique is routinely performed and often used as a gold standard in clinical examinations. Fast spoiled gradient-echo (FSPGR) T1-Weighted Imaging (T1WI) is often used to identify fat, calcification and hemorrhage. Fast Imaging Employing Steady-State Acquisition (FIESTA) is commonly used to identify fetal structures as well as the heart and vessels. The contrast of FIESTA image is related to T1/T2 and is different from that of SSFSE. The advantages and disadvantages of these two scanning sequences for fetal imaging have not been clearly demonstrated yet. This study aimed to compare these three rapid MRI techniques (SSFSE, FIESTA, and FSPGR) for fetal MRI examinations. The image qualities and influencing factors among these three techniques were explored. A 1.5T GE Discovery 450 clinical MR scanner with an eight-channel high-resolution abdominal coil was used in this study. Twenty-five pregnant women were recruited to enroll fetal MRI examination with SSFSE, FIESTA and FSPGR scanning. Multi-oriented and multi-slice images were acquired. Afterwards, MR images were interpreted and scored by two senior radiologists. The results showed that both SSFSE and T2W-FIESTA can provide good image quality among these three rapid imaging techniques. Vessel signals on FIESTA images are higher than those on SSFSE images. The Specific Absorption Rate (SAR) of FIESTA is lower than that of the others two techniques, but it is prone to cause banding artifacts. FSPGR-T1WI renders lower Signal-to-Noise Ratio (SNR) because it severely suffers from the impact of maternal and fetal movements. The scan times for these three scanning sequences were 25 sec (T2W-SSFSE), 20 sec (FIESTA) and 18 sec (FSPGR). In conclusion, all these three rapid MR scanning sequences can produce high contrast and high spatial resolution images. The scan time can be shortened by incorporating parallel imaging techniques so that the motion artifacts caused by fetal movements can be reduced. Having good understanding of the characteristics of these three rapid MRI techniques is helpful for technologists to obtain reproducible fetal anatomy images with high quality for prenatal diagnosis.

Keywords: fetal MRI, FIESTA, FSPGR, motion artifact, SSFSE

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Authors: Yufeng Wu, Yifan Gu, Bin Li, Wei Wang

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Resource recycling process contains a subsystem with interactions of three dimensions including coupling allocation of primary and secondary resources, responsibility coordination of stakeholders in forward and reverse supply chains, and trans-boundary transfer of hidden resource and environmental responsibilities between regions. Overlap or lack of responsibilities is easy to appear at the intersection of the three management dimensions. It is urgent to make an overall design of the policy system for recycling resources. From theoretical perspective, this paper analyzes the unique external differences of resource and environment in various dimensions and explores the reason why the effects of trans-dimensional policies are strongly correlated. Taking the example of the copper resources contained in the waste electrical and electronic equipment, this paper constructs reduction effect accounting model of resources recycling and set four trans-dimensional policy scenarios including resources tax and environmental tax reform of the raw and secondary resources, application of extended producer responsibility system, promotion of clean development mechanism, and strict entry barriers of imported wastes. In these ways, the paper simulates the impact effect of resources recycling process on resource deduction and emission reduction of waste water and gas, and constructs trans-dimensional policy mix scenario through integrating dominant strategy. The results show that combined application of various dimensional policies can achieve incentive compatibility and the trans-dimensional policy mix scenario can reach a better effect. Compared with baseline scenario, this scenario will increase 91.06% copper resources reduction effect and improve emission reduction of waste water and gas by eight times from 2010 to 2030. This paper further analyzes the development orientation of policies in various dimension. In resource dimension, the combined application of compulsory, market and authentication methods should be promoted to improve the use ratio of secondary resources. In supply chain dimension, resource value, residual functional value and potential information value contained in waste products should be fully excavated to construct a circular business system. In regional dimension, it should give full play to the comparative advantages of manufacturing power to improve China’s voice in resource recycling in the world.

Keywords: resource recycling, trans-dimension, policy design, incentive compatibility, life cycle

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