Search results for: post 2000 period

Authors: Brid Dinnee, Jessica Taylor, Joseph Hartland, Michael Natarajan

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Background:The third stage of labour (TSL) can be complicated by Post-Partum Haemorrhage (PPH), which can have a significant impact on maternal mortality and morbidity. In Africa, 33.9% of maternal deaths are attributable to PPH1. In order to minimise this figure, current recommendations for the developing world are that all women have active management of the third stage of labour (AMTSL). The aim of this project was to examine TSL practice in a rural Ugandan Hospital, highlight any deviation from best practice and identify barriers to change in resource limited settings as part of a 4th year medical student External Student Selected Component field trip. Method: Five key elements from the current World Health Organisation (WHO) guidelines on AMTSL were used to develop an audit tool. All daytime vaginal deliveries over a two week period in July 2016 were audited. In addition to this, a retrospective comparison of PPH rates, between 2006 (when ubiquitous use of intramuscular oxytocin for management of TSL was introduced) and 2015 was performed. Results: Eight vaginal deliveries were observed; at all of which intramuscular oxytocin was administered and controlled cord traction used. Against WHO recommendation, all umbilical cords were clamped within one minute, and no infants received early skin-to-skin contact. In only one case was uterine massage performed after placental delivery. A retrospective comparison of data rates identified a 40% reduction in total number of PPHs from November 2006 to November 2015. Maternal deaths per delivery reduced from 2% to 0.5%. Discussion: Maternal mortality and PPH are still major issues in developing countries. Maternal mortality due to PPH can be reduced by good practices regarding TSL, but not all of these are used in low-resource settings. There is a notable difference in outcomes between the developed and developing world. At Kitovu Hospital, there has been a reduction in maternal mortality and number of PPHs following introduction of IM Oxytocin administration. In order to further improve these rates, staff education and further government funding is key.

Keywords: post-partum haemorrhage, PPH, third stage labour, Uganda

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Authors: Leon Pan

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The first programming course within post-secondary education has long been recognized as a challenging endeavor for both educators and students alike. Historically, these courses have exhibited high failure rates and a notable number of dropouts. Instructors often lament students' lack of effort in their coursework, and students often express frustration that the teaching methods employed are not effective. Drawing inspiration from the successful principles of Extreme Programming, this study introduces an approach—the Extremes-based teaching model — aimed at enhancing the teaching of introductory programming courses. To empirically determine the effectiveness of the model, a comparison was made between a section taught using the extreme-based model and another utilizing traditional teaching methods. Notably, the extreme-based teaching class required students to work collaboratively on projects while also demanding continuous assessment and performance enhancement within groups. This paper details the application of the extreme-based model within the post-secondary online classroom context and presents the compelling results that emphasize its effectiveness in advancing the teaching and learning experiences. The extreme-based model led to a significant increase of 13.46 points in the weighted total average and a commendable 10% reduction in the failure rate.

Keywords: extreme-based teaching model, innovative pedagogical methods, project-based learning, team-based learning

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Authors: Prangya Ranjan Rout, Puspendu Bhunia, Rajesh Roshan Dash

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In a developing country like India, providing reliable and affordable wastewater treatment facilities in rural areas is a huge challenge. With the aim of enhancing the nutrient removal from rural domestic wastewater while reducing the cost of treatment process, a novel, integrated treatment system consisting of a multistage bio-filter with drop aeration and a post positioned attached growth carbonaceous denitrifying-bioreactor was designed and developed in this work. The bio-filter was packed with ‘dolochar’, a sponge iron industry waste, as an adsorbent mainly for phosphate removal through physiochemical approach. The Denitrifying bio-reactor was packed with many waste organic solid substances (WOSS) as carbon sources and substrates for biomass attachment, mainly to remove nitrate in biological denitrification process. The performance of the modular system, treating real domestic wastewater was monitored for a period of about 60 days and the average removal efficiencies during the period were as follows: phosphate, 97.37%; nitrate, 85.91%, ammonia, 87.85%, with mean final effluent concentration of 0.73, 9.86, and 9.46 mg/L, respectively. The multistage bio-filter played an important role in ammonium oxidation and phosphate adsorption. The multilevel drop aeration with increasing oxygenation, and the special media used, consisting of certain oxides were likely beneficial for nitrification and phosphorus removal, respectively, whereas the nitrate was effectively reduced by biological denitrification in the carbonaceous bioreactor. This treatment system would allow multipurpose reuse of the final effluent. Moreover, the saturated dolochar can be used as nutrient suppliers in agricultural practices and the partially degraded carbonaceous substances can be subjected to composting, and subsequently used as an organic fertilizer. Thus, the system displays immense potential for treating domestic wastewater significantly decreasing the concentrations of nutrients and more importantly, facilitating the conversion of the waste materials into usable ones.

Keywords: nutrient removal, denitrifying bioreactor, multi-stage bio-filter, dolochar, waste organic solid substances

Procedia PDF Downloads 378

Authors: Marji Umil, Miane Karyle Urolaza, Ian Winston Dale Uy, John Charle Magne Valdez, Karen Elizabeth Valdez, Ervin Charles Valencia, Cheryleen Tan-Chua

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Objective: Distraction techniques can be successful in reducing the anxiety of children during medical procedures. Dental procedures, in particular, are associated with dental anxiety which has been identified as a significant and common problem in children, however, only limited studies were conducted to address such problem. Thus, this study determined the effectiveness of computer video games on the levels of anxiety of children between 5-12 years old scheduled for tooth extraction. Methods: A pre-test post-test quasi-experimental study was conducted involving 30 randomly-assigned subjects, 15 in the experimental and 15 in the control. Subjects in the experimental group played computer video games for a maximum of 15 minutes, however, no intervention was done on the control. The modified Yale Pre-operative Anxiety Scale (m-YPAS) with a Cronbach’s alpha of 0.9 was used to assess anxiety at two different points: upon arrival in the clinic (pre-test anxiety) and 15 minutes after the first measurement (post-test anxiety). Paired t-test and ANCOVA were used to analyze the gathered data. Results: Results showed that there is a significant difference between the pre-test and post-test anxiety scores of the control group (p=0.0002) which indicates an increased anxiety. A significant difference was also noted between the pre-test and post-test anxiety scores of the experimental group (p=0.0002) which indicates decreased anxiety. Comparatively, the experimental group showed lower anxiety score (p=<0.0001) than the control. Conclusion: The use of computer video games is effective in reducing the pre-operative anxiety among children and can be an alternative non-pharmacological management in giving pre-operative care.

Keywords: play therapy, preoperative anxiety, tooth extraction, video games

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Authors: B. Vijay Antony Raj, Umarani Gunasekaran, R. Thiru Kumara Raja Vallaban

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Fibrous autoclaved aerated concrete (FAAC) is concrete containing fibrous material in it which helps to increase its structural integrity when compared to that of convention autoclaved aerated concrete (CAAC). These short discrete fibers are uniformly distributed and randomly oriented, which enhances the bond strength within the aerated concrete matrix. Conventional red-clay bricks create larger impact to the environment due to red soil depletion and it also consumes large amount to time for construction. Whereas, AAC are larger in size, lighter in weight and it is environmentally friendly in nature and hence it is a viable replacement for red-clay bricks. Internal micro cracks and corner cracks are the only disadvantages of conventional autoclaved aerated concrete, to resolve this particular issue it is preferable to make use of fibers in it.These fibers are bonded together within the matrix and they induce the aerated concrete to withstand considerable stresses, especially during the post cracking stage. Hence, FAAC has the capability of enhancing the mechanical properties and energy absorption capacity of CAAC. In this research work, individual fibers like glass, nylon, polyester and polypropylene are used they generally reduce the brittle fracture of AAC.To study the fibre’s surface topography and composition, SEM analysis is performed and then to determine the composition of a specimen as a whole as well as the composition of individual components EDAX mapping is carried out and then an experimental approach was performed to determine the effect of hybrid (multiple) fibres at various dosage (0.5%, 1%, 1.5%) and curing temperature of 180-2000 C is maintained to determine the mechanical properties of autoclaved aerated concrete. As an analytical part, the outcome experimental results is compared with fuzzy logic using MATLAB.

Keywords: fiberous AAC, crack control, energy absorption, mechanical properies, SEM, EDAX, MATLAB

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Authors: Ebtehag Tolba, Ahmed Mousa, Mohamed Abd El-Salam

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The study presents a proposed program for nursery school children in Egypt. The program consists of a collection of artistic activities and aims to develop the language, mathematical, and artistic skills of preschool children. Furthermore, the researcher has presented a questionnaire to experts about the link between the target group and the content. Finally, the proposed program was applied to group of 30 children. In addition, the researcher has prepared another questionnaire for measuring the effect of the program. This questionnaire was used as a pre-test and post-test, and at the end of the study, a significant difference was determined in favour of the post-test results.

Keywords: developing, concepts, nursery, children, artistic activities

Procedia PDF Downloads 255

Authors: Siti Fatimah Kader Maideen, Abdul Rashid, Nur Indah Ahmad

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Introduction: Indigenous people have an increased risk of contracting zoonotic infections due to their practices. Similarly, the aborigines in Peninsular Malaysia, the Orang Asli, have a higher risk too. This study aimed to empower the Jahai children on the prevention of zoonotic infections by implementing a health promotion intervention program. Methods: A non-experimental pre and post-test interventional study was conducted among the indigenous primary school children aged between nine and 12 years in Perak, Malaysia. A structured questionnaire was used to assess the pre-and post-knowledge and attitudes towards zoonotic infections and hand hygiene practice. This is followed by three sessions of the health promotion program. Ethical approval was obtained prior to the data collection. Data were analysed using SPSS software. Results: The knowledge on whether diseases can spread from animals to humans, transmission via saliva and faeces, types of organisms that can infect, and signs and symptoms increased significantly between pre and post. Significant improvements were observed in the attitude and practices too. Conclusion: The intervention program demonstrated improvement in the knowledge, attitude, and practice among the children. The continuous program needs to be conducted for a sustainable outcome.

Keywords: health promotion, zoonotic infections, aborigines, knowledge, practice

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Authors: Kimberley Kennedy

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The major findings of this study discuss the importance of understanding and applying Systems thinking concepts to ensure an effective Project-Based Learning environment. A pilot project study of a major pedagogical change was conducted over a five year period with the goal to give students real world, hands-on learning experiences and the opportunity to apply what they had learned over the past two years of their business program. The first two weeks of the fifteen week semester utilized teaching methods of lectures, guest speakers and design thinking workshops to prepare students for the project work. For the remaining thirteen weeks of the semester, the students worked with actual business owners and clients on projects and challenges. The first three years of the five year study focused on student feedback to ensure a quality learning experience and continuous improvement process was developed. The final two years of the study, examined the conceptual understanding and perception of learning and teaching by faculty using Project-Based Learning pedagogy as compared to lectures and more traditional teaching methods was performed. Relevant literature was reviewed and data collected from program faculty participants who completed pre-and post-semester interviews and surveys over a two year period. Systems thinking concepts were applied to better understand the challenges for faculty using Project-Based Learning pedagogy as compared to more traditional teaching methods. Factors such as instructor and student fatigue, motivation, quality of work and enthusiasm were explored to better understand how to provide faculty with effective support and resources when using Project-Based Learning pedagogy as the main teaching method. This study provides value by presenting generalizable, foundational knowledge by offering suggestions for practical solutions to assure student and teacher engagement in Project-Based Learning courses.

Keywords: continuous improvement, project-based learning, systems thinking, teacher engagement

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Authors: Amaraja Taur, Pankaj Doshi, Hak Koon Yeoh

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The dripping modes for a Newtonian liquid of viscosity µ emanating from an inclined nozzle at flow rate Q is investigated experimentally. As the liquid flow rate Q increases, starting with period-1 with satellite drops, the system transitions to period-1 dripping without satellite, then to limit cycle before showing chaotic responses. Phase diagrams shows the changes in the transitions between the different dripping modes for different nozzle inclination angle θ is constructed in the dimensionless (Q, µ) space.

Keywords: dripping, inclined nozzle, phase diagram, satellite

Procedia PDF Downloads 286

Authors: Behailu Shigute Habtemariam

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The aim of the study was to examine the effects of training load on some selected fitness performance variables of volleyball players in the case of U-17 female volleyball project players in the central Ethiopia region. Methods: In this study, quasi-experimental design was used. For the purpose of this study, twenty-three volleyball players were used as a subject from the two projects. The data collected through fitness performance assessment were analyzed and interpreted into a meaningful idea using manually as well as with computer in order to compare physical fitness variables and changes observed among participants. Those are taking part in the effects of training load on some selected physical fitness variables. The collected data were analyzed by means of the Statistical Package for Social Science version (SPSS V 20). The independent t-test was used to show the mean differences between the groups, and the paired T-test was used to compare the mean differences of the pre and post-training within each group. The level of significance will be set at Alfa 0.05. Results: The results are displayed using tables and figures. A significant difference was found in the mean differences of pre-test values (19.7 cm) and post-test values (37.5 cm) of the Durame city project on the flexibility test (MD =17.8 cm, P = 0.00). On the other hand, there was a significant difference in the mean difference of pre-test values of (18 cm) and post-test values (26.3 cm) of the Hosana city project on the flexibility test ( MD = 8.3 cm, P = 0.00). Conclusion: According to the results of the present studies, there were significant improvements from pre to post-test at Durame City and Hosana City projects on agility, flexibility, power, and speed fitness tests. On the other hand, a significant difference was not found before beginning the exercise between the two projects; however, a significant difference was found after 12 weeks of training.

Keywords: overload, performance, training, volleyball

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Authors: Mona Yacoub, Ahmed Amin Mousa

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The current work presents a program for children in Egypt. This program involved a collection of artistic activities that purposes to improve some language, artistic skills of kindergarten children. The researchers have prepared a questionnaire for the link between the target group and the content. The questionnaire has been presented to experts for adjudicating. The program was applied to a group of 30 children. Another questionnaire has been prepared by the researchers for measuring the activities’ effect on the children. The second questionnaire was considered as the pre-test and post-test. Finally, after applying the activities and the questionnaire, the researchers detected a significant difference in favor of the post-test results.

Keywords: Developing, concepts, kindergarten, children, graphic activities

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Authors: Amer Obaid Saud

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Water quality index (WQI) is considered as an effective tool in categorization of water resources for its quality and suitability for different uses. The Canadian version of water quality index (CCME WQI) which based on the comparison of the water quality parameters to regulatory standards and give a single value to the water quality of a source was applied in this study to assess the water quality of Euphrates river in Iraq at Babylon Governorate north of Baghdad and determine its suitability for aquatic environment (GWQI), drinking water (PWSI) and irrigation(IWQI). Five stations were selected on the river in Babylon (Euphrates River/AL-Musiab, Hindia barrage, two stations at Hilla city and the fifth station at Al-Hshmeya north of Hilla. Fifteen water samples were collected every month during August 2013 to July 2014 at the study sites and analyzed for the physico-chemical parameters like (Temperature, pH, Electrical Conductivity, Total Dissolved Solids(TDS), Total Suspended Solids(TSS), Total Alkalinity, Total Hardness, Calcium and Magnesium Concentration, some of nutrient like Nitrite, Nitrate, Phosphate also the study of concentration of some heavy metals (Fe, Pb, Zn, Cu, Mn, and Cd) in water and comparison of measures to benchmarks such as guidelines and objectives to assess change in water quality. The result of Canadian version of(CCME .WQI) to assess the irrigation water quality (IWQI) of Euphrates river was (83-good) at site one during second seasonal period while the lowest was (66-Fair) in the second station during the fourth seasonal period, the values of potable water supply index (PWSI)that the highest value was (68-Fair) in the fifth site during the second period while the lowest value (42 -Poor) in the second site during the first seasonal period,the highest value for general water quality (GWQI) was (74-Fair) in site five during the second seasonal period, the lowest value (48-Marginal) in the second site during the first seasonal period. It was observed that the main cause of deterioration in water quality was due to the lack of, unprotected river sites ,high anthropogenic activities and direct discharge of industrial effluent.

Keywords: Babylon governorate, Canadian version, water quality, Euphrates river

Procedia PDF Downloads 394

Authors: Hussam Ashwi, Magbool Oraiby, Ali Muyidi, Hamad Al-Oufi, Mohammed Al-Oufi, Adel Al-Juhani, Salman Al-Zemaa, Saeed Al-Shahrani, Amal Abuallah, Wedad Sherwani, Mohammed Alattas, Ibraheem Attafi

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Ethanol must be accurately identified and quantified to establish their use and contribution in criminal cases and forensic medicine. In some situations, it may be necessary to reanalyze an old specimen; therefore, it is essential to comprehend the effect of storage conditions and how long the result of a reanalyzed specimen can be reliable and reproducible. Additionally, ethanol can be produced via multiple in vivo and in vitro processes, particularly in diabetic patients, and the results can be affected by storage conditions and time. In order to distinguish between in vivo and in vitro alcohol generation in diabetes patient urine samples, various factors should be considered. This study identifies and quantifies ethanol and EtG in diabetic patients' urine samples stored in two different settings over time. Ethanol levels were determined using gas chromatography-headspace (GC-HS), and ethyl glucuronide (EtG) levels were determined using the immunoassay (RANDOX) technique. Ten urine specimens were collected and placed in a standard container. Each specimen was separated into two containers. The specimens were divided into two groups: those kept at room temperature (25 °C) and those kept cold (2-8 °C). Ethanol and EtG levels were determined serially over a two-week period. Initial results showed that none of the specimens tested positive for ethanol or EtG. At room temperature (15-25 °C), 7 and 14 days after the sample was taken, the average concentration of ethanol increased from 1.7 mg/dL to 2 mg/dL, and the average concentration of EtG increased from 108 ng/mL to 186 ng/mL. At 2–8 °C, the average ethanol concentration was 0.4 and 0.5 mg/dL, and the average EtG concentration was 138 and 124 ng/mL seven and fourteen days after the sample was collected, respectively. When ethanol and EtG levels were determined 14 days post collection, they were considerably lower than when stored at room temperature. A considerable increase in EtG concentrations (14-day range 0–186 ng/mL) is produced during room-temperature storage, although negative initial results for all specimens. Because EtG might be produced after a sampling collection, it is not a reliable indicator of recent alcohol consumption. Given the possibility of misleading EtG results due to in vitro EtG production in the urine of diabetic patients.

Keywords: ethyl glucuronide, ethanol, forensic toxicology, diabetic

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Authors: Mohua Chatterjee, Rajib De

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Introduction: Bone Marrow Transplant (BMT) is often performed to treat patients with various types of leukemia. A majority of these patients develop complications like chronic musculoskeletal GVHD post-BMT where patients get scleroderma, pain and restricted range of motion of joints of hand. If not treated early, it may cause permanent deformity of hand. This study was done to find the effectiveness of physiotherapy in hand dysfunction caused due to chronic musculoskeletal GVHD of leukemia patients after BMT. Methodology: 23 patients diagnosed with leukemia and having musculoskeletal GVHD were treated with a set of exercises including active exercises and stretching. The outcome was measured by Cochin Hand Function Scale (CHFS) at baseline and after four weeks of intervention. Results: Two patients were not able to carry out exercises beyond two weeks due to relapse of disease and one patient defaulted. It was found that all the patients who received physiotherapy had significant improvement in hand function. Mean CHFS decreased from 63.67 to 27.43 (P value < 0.001) indicating improvement in hand function after four weeks of physiotherapy. Conclusion: Early intervention of physiotherapy is effective in reducing hand dysfunction of leukemia patients with musculoskeletal GVHD post-BMT.

Keywords: bone marrow transplant, hand dysfunction, leukemia, musculoskeletal graft versus host disease, physiotherapy

Procedia PDF Downloads 234

Authors: Hannah Patricia S., Louise Margarrette R., Josking Oliver L., Denisse Katrina C., Justine Kali O.

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Aims: In the Philippines, there has been an astronomical increase in the population of elderly sent to nursing home facilities which has been studied to induce despair and loss of self-worth. Nurses in institutionalized facilities generally care for the elderly. Although supportive group therapy has been explored to mend this psychological disparity, nursing research has limited published studies about this in the institutionalized setting. Hence, the study determined the effectiveness of supportive group therapy in depression, self-esteem and quality of life among institutionalized elderly. Methodology: A one-group pre-test-post-test design was conducted among 20-purposively selected institutionalized elderly after the Ethics Research Board approval. All eligible participants underwent the supportive group therapy after being subdivided into session groups. The Geriatric Depression Scale, which has a Cronbach’s alpha coefficient of 0.90; the Rosenberg Self-Esteem, which has a Cronbach’s alpha coefficient = 0.84; and the Older People Quality of Life, which has a Cronbach’s alpha coefficient =0.88, were utilized to measure depression, self-esteem, and quality of life, respectively. Descriptive statistics and Repeated Measures-Multivariate Analysis of Variance (RM-MANOVA) analyzed gathered data. Results: Results showed that the supportive group therapy significantly decreased post-test depression scores (F(1,19)=78.69,p=0.0001,partial η2=0.805), significantly improved post-test self-esteem score (F(1,19)=28.07,p=0.0001,partial η2=0.596), and significantly increased the post-test quality of life (F(1,19)=79.73,p=0.0001,partial η2=0.808) after the intervention has been rendered. Conclusion: Supportive group therapy is effective in alleviating depression and in improving self-esteem and quality of life among institutionalized elderly and can be utilized by nursing homes as an intervention to improve the over-all psychosocial status of elderly patients.

Keywords: supportive group therapy, institutionalized elderly, depression, self-esteem, quality of life

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Authors: Young-Taeg Kim, Gwang Ho Seo, Hyungju Oh, Ho Kyung Ha, Kuk Jin Kim

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Kim et al., hypothesized an increase in volume transport in the Korea Strait based on the concurrent increase in water temperature and mean sea level observed by the Korea Hydrographic and Oceanographic Agency (KHOA) in the vicinity of the Korea Strait from 2000 to 2009. Since then, to our best knowledge, no definitive studies have been reported on the increase in volume transport through the Korea Strait, but the observed water temperature (2000-2021) and sea level (1989-2021) in the Korea Strait and East Sea have been found to be increasing. In particular, the rapid increase rate in the mean sea level rise (2.55~3.53 mm/y) in these areas cannot be explained by only steric effect due to the increased water temperature. It is more reasonable interpretation that the sea level rise is due to an increase in the volume transport of warm and salty currents. If the increase in the volume transport is explained by the geostrophic equation without considering the sea level rise in the Korea Strait, the current velocity should increase. However, up to now, there are no reports of an increase in current velocity from direct observations using ADCP (e.g., observations of Camellia) or from various numerical models. Therefore, the increase in volume transport cannot be explained by the geostrophic equation. Another possible explanation for the increase in the volume transport is the effect of wind. Although Korea is dominated by monsoon, it is affected by winds according to El Niño and La Niña, which have a cycle of about 3 to 4 years. During El Niño (La Niña), northerly winds (southerly winds) prevail in Korea. Consequently, it is inferred that the transported volume in the Korea Strait slowly increases interannually. However, in this study, it was difficult to find a clear correlation between annually-averaged mean sea level and El Niño (or La Niña) during 1989-2021. This is probably due to the interactions of the PDO (Pacific Decadal Oscillation) and AO (Arctic Oscillation) along with the ENSO (El niño-Southern Oscillation). However, it is clear that the interannual variability of winds is affecting the volume transport in the Korean Strait. On the other hand, the effect of global sea level rise on the volume transport in the Korea Strait is small compared to the interannual variability of the volume transport, but it seems to play a constant role.

Keywords: mean sea level, volume transport, El nino, La nina

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Authors: Bidisha Chatterjee, Sonal Grover, Rekha Gurung

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Postpartum dissection of the internal carotid artery is a relatively rare condition and is considered as an underlying aetiology in 5% to 25% of strokes under the age of 30 to 45 years. However, 86% of these cases recover completely and 14% have mild focal neurological symptoms. Prognosis is generally good with early intervention. The risk quoted for a repeat carotid artery dissection in subsequent pregnancies is less than 2%. 36-year Caucasian primipara presented on postnatal day one of forceps delivery with tachycardia. In the intrapartum period she had a history of prolonged rupture of membranes and developed intrapartum sepsis and was treated with antibiotics. Postpartum ECG showed septal inferior T wave inversion and a troponin level of 19. Subsequently Echocardiogram ruled out post-partum cardiomyopathy. Repeat ECG showed improvement of the previous changes and in the absence of symptoms no intervention was warranted. On day 4 post-delivery, she had developed symptoms of droopy right eyelid, pain around the right eye and itching in the right ear. On examination, she had developed right sided ptosis, unequal pupils (Rt miotic pupil). Cranial nerve examination, reflexes, sensory examination and muscle power was normal. Apart from migraine, there was no medical or family history of note. In view of Horner’s on the right, she had a CT Angiogram and subsequently MR/MRA and was diagnosed with dissection of the cervical portion of the right internal carotid artery. She was discharged on a course of Aspirin 75mg. By 6 week post-natal follow up patient had recovered significantly with occasional episodes of unequal pupils and tingling of right toes which resolved spontaneously. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy with an estimated annual incidence of 2.6–3 per 100,000 pregnancy hospitalizations. Aetiology remains unclear though trauma during straining at labour, underlying arterial disease and preeclampsia have been implicated. Hypercoagulable state during pregnancy and puerperium could also be an important factor. 60-90% cases present with severe headache and neck pain and generally precede neurological symptoms like ipsilateral Horner’s syndrome, retroorbital pain, tinnitus and cranial nerve palsy. Although rare, the consequences of delayed diagnosis and management can lead to severe and permanent neurological deficits. Patients with a strong index of suspicion should undergo an MRI or MRA of head and neck. Antithrombotic and antiplatelet therapy forms the mainstay of therapy with selected cases needing endovascular stenting. Long term prognosis is favourable with either complete resolution or minimal deficit if treatment is prompt. Patients should be counselled about the recurrence risk and possibility of stroke in future pregnancy. Coronary artery dissection is rare and treatable but needs early diagnosis and treatment. Post-partum headache and neck pain with neurological symptoms should prompt urgent imaging followed by antithrombotic and /or antiplatelet therapy. Most cases resolve completely or with minimal sequelae.

Keywords: postpartum, dissection of internal carotid artery, magnetic resonance angiogram, magnetic resonance imaging, antiplatelet, antithrombotic

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Authors: A. Onur Kutlu, H. Tolga Bolukbasi

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Since the 1990s, governments, international organizations and scholars have drawn increasing attention to the significance of women in the labour force. While advanced industrial countries in North Western Europe and North America have managed to increase female labour force participation (FLFP) in the early post world war two period, emerging economies of the 1970s have only been able to increase FLFP only a decade later. Among these areas, Southern Europe features a wave of remarkable bounce backs in FLFP. However, despite striking similarities between the features in Southern Europe and those in Turkey, Turkey has not been able to pull women into the labour force. Despite a host of institutional similarities, Turkey has failed to reach to the level of her Southern European neighbours. This paper addresses the puzzle why Turkey lag behind in FLFP in comparison to her Southern European neighbours. There are signs showing that FLFP is currently reaching a critical threshold at a time when structural factors may allow a trend. It is not known, however, the constellation of conditions which may bring rising FLFP in Turkey. In order to gain analytical leverage from similar transitions in countries that share similar labour market and welfare state regime characteristics, this paper identifies the conditions in Southern Europe that brought rising FLFP to be able to explore the prospects for Turkey. Second, this paper takes these variables in the fuzzy set Qualitative Comparative Analysis (fsQCA) as conditions which can potentially explain the outcome of rising FLFP in Portugal, Spain, Italy, Greece and Turkey. The purpose here is to identify any causal pathway there may exist that lead to rising FLFP in Southern Europe. In order to do so, this study analyses two time periods in all cases, which represent different periods for different countries. The first period is identified on the basis of low FLFP and the second period on the basis of the transition to significantly higher FLFP. Third, the conditions are treated following the standard procedures in fsQCA, which provide equifinal: two distinct paths to higher levels of FLFP in Southern Europe, each of which may potentially increase FLFP in Turkey. Based on this analysis, this paper proposes that there exist two distinct paths leading to higher levels of FLFP in Southern Europe. Among these paths, salience of left parties emerges as a sufficient condition. In cases where this condition was not present, a second path combining enlarging service sector employment, increased tertiary education among women and increased childcare enrolment rates led to increasing FLFP.

Keywords: female labour force participation, fsQCA, Southern Europe, Turkey

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Authors: Steven W. Carruthers

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The purpose of the present research is to equate two test forms as part of a study to evaluate the educational effectiveness of the ARTé: Mecenas art history learning game. The researcher applied Item Response Theory (IRT) procedures to calculate item, test, and mean-sigma equating parameters. With the sample size n=134, test parameters indicated “good” model fit but low Test Information Functions and more acute than expected equating parameters. Therefore, the researcher applied equipercentile equating and linear equating to raw scores and compared the equated form parameters and effect sizes from each method. Item scaling in IRT enables the researcher to select a subset of well-discriminating items. The mean-sigma step produces a mean-slope adjustment from the anchor items, which was used to scale the score on the new form (Form R) to the reference form (Form Q) scale. In equipercentile equating, scores are adjusted to align the proportion of scores in each quintile segment. Linear equating produces a mean-slope adjustment, which was applied to all core items on the new form. The study followed a quasi-experimental design with purposeful sampling of students enrolled in a college level art history course (n=134) and counterbalancing design to distribute both forms on the pre- and posttests. The Experimental Group (n=82) was asked to play ARTé: Mecenas online and complete Level 4 of the game within a two-week period; 37 participants completed Level 4. Over the same period, the Control Group (n=52) did not play the game. The researcher examined between group differences from post-test scores on test Form Q and Form R by full-factorial Two-Way ANOVA. The raw score analysis indicated a 1.29% direct effect of form, which was statistically non-significant but may be practically significant. The researcher repeated the between group differences analysis with all three equating methods. For the IRT mean-sigma adjusted scores, form had a direct effect of 8.39%. Mean-sigma equating with a small sample may have resulted in inaccurate equating parameters. Equipercentile equating aligned test means and standard deviations, but resultant skewness and kurtosis worsened compared to raw score parameters. Form had a 3.18% direct effect. Linear equating produced the lowest Form effect, approaching 0%. Using linearly equated scores, the researcher conducted an ANCOVA to examine the effect size in terms of prior knowledge. The between group effect size for the Control Group versus Experimental Group participants who completed the game was 14.39% with a 4.77% effect size attributed to pre-test score. Playing and completing the game increased art history knowledge, and individuals with low prior knowledge tended to gain more from pre- to post test. Ultimately, researchers should approach test equating based on their theoretical stance on Classical Test Theory and IRT and the respective  assumptions. Regardless of the approach or method, test equating requires a representative sample of sufficient size. With small sample sizes, the application of a range of equating approaches can expose item and test features for review, inform interpretation, and identify paths for improving instruments for future study.

Keywords: effectiveness, equipercentile equating, IRT, learning games, linear equating, mean-sigma equating

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Authors: Sinead Impey, Gaye Stephens, Lucy Hederman, Declan O'Sullivan

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Continued paper use in the clinical area post-Electronic Health Record (EHR) adoption is regularly linked to hardware and software usability challenges. Although paper is used as a workaround to circumvent challenges, including limited availability of a computer, this perspective does not consider the important role paper, such as the nurses’ handover sheet, play in practice. The purpose of this study is to confirm the hypothesis that paper use post-EHR adoption continues as paper provides both a cognitive tool (that assists with workflow) and a compensation tool (to circumvent usability challenges). Distinguishing the different motivations for continued paper-use could assist future evaluations of electronic record systems. Methods: Qualitative data were collected from three clinical care environments (ICU, general ward and specialist day-care) who used an electronic record for at least 12 months. Data were collected through semi-structured interviews with 22 nurses. Data were transcribed, themes extracted using an inductive bottom-up coding approach and a thematic index constructed. Findings: All nurses interviewed continued to use paper post-EHR adoption. While two distinct motivations for paper use post-EHR adoption were confirmed by the data - paper as a cognitive tool and paper as a compensation tool - further finding was that there was an overlap between the two uses. That is, paper used as a compensation tool could also be adapted to function as a cognitive aid due to its nature (easy to access and annotate) or vice versa. Rather than present paper persistence as having two distinctive motivations, it is more useful to describe it as presenting on a continuum with compensation tool and cognitive tool at either pole. Paper as a cognitive tool referred to pages such as nurses’ handover sheet. These did not form part of the patient’s record, although information could be transcribed from one to the other. Findings suggest that although the patient record was digitised, handover sheets did not fall within this remit. These personal pages continued to be useful post-EHR adoption for capturing personal notes or patient information and so continued to be incorporated into the nurses’ work. Comparatively, the paper used as a compensation tool, such as pre-printed care plans which were stored in the patient's record, appears to have been instigated in reaction to usability challenges. In these instances, it is expected that paper use could reduce or cease when the underlying problem is addressed. There is a danger that as paper affords nurses a temporary information platform that is mobile, easy to access and annotate, its use could become embedded in clinical practice. Conclusion: Paper presents a utility to nursing, either as a cognitive or compensation tool or combination of both. By fully understanding its utility and nuances, organisations can avoid evaluating all incidences of paper use (post-EHR adoption) as arising from usability challenges. Instead, suitable remedies for paper-persistence can be targeted at the root cause.

Keywords: cognitive tool, compensation tool, electronic record, handover sheet, nurse, paper persistence

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Authors: Sonal Khosla

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A research is proposed in the present paper to explore the role of flow in coping with traumatic experiences and attaining post-traumatic growth. A grounded theory research is proposed to be carried by analyzing memoirs of people who have been through trauma. A pilot study was carried out on two memoirs of women who were held captive for over ten years and were sexually assaulted repeatedly. The role of flow in their coping experiences was explored by analyzing the books. Some of the flow activities that were used by them were- drawing and daydreaming. Their narratives show the evidence for flow as having cathartic and healing effects on them. Applicability of the findings can take two forms: 1. Flow can be applied as a preventive technique to help the people who are going through trauma, 2. Flow can be adopted into a positive intervention to help people suffering from PTSD.

Keywords: flow, positive intervention, PTSD, PTG

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Authors: M. A. Riurean, S. Heijnen, C. A. Knott, J. Makinde, D. Gotti, J. VD. Kamp

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Objectives: The current study is done in preparation for a randomized controlled study investigating the effects of an implicit motor learning protocol implemented using an extension-supporting glove. It will explore different protocols to find out which is preferred when studying motor learn-ing in the chronic stroke population that struggles with hand spasticity. Design: This exploratory study will follow 24 individuals who have a chronic stroke (> 6 months) during their usual care journey. We will record the results of two 9-Hole Peg Tests (9HPT) done during their therapy ses-sions with a physiotherapist or in their home before and after 4 weeks of them wearing an exten-sion-supporting glove used to employ the to-be-studied protocols. The participants will wear the glove 3 times/week for one hour while performing their activities of daily living and record the times they wore it in a diary. Their experience will be monitored through telecommunication once every week. Subjects: Individuals that have had a stroke at least 6 months prior to participation, hand spasticity measured on the modified Ashworth Scale of maximum 3, and finger flexion motor control measured on the Motricity Index of at least 19/33. Exclusion criteria: extreme hemi-neglect. Methods: The participants will be randomly divided into 3 groups: one group using the glove in a pre-set way of decreasing support (implicit motor learning), one group using the glove in a self-controlled way of decreasing support (autonomous motor learning), and the third using the glove with constant support (as control). Before and after the 4-week period, there will be an intake session and a post-assessment session. Analysis: We will compare the results of the two 9HPTs to check whether the protocols were effective. Furthermore, we will compare the results between the three groups to find the preferred one. A qualitative analysis will be run of the experience of participants throughout the 4-week period. Expected results: We expect that the group using the implicit learning protocol will show superior results.

Keywords: implicit learning, hand spasticity, stroke, error minimization, motor task

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Authors: Sidra Majeed, Irum Ali, Aroosa Ishfaq, Munazzah Parveen

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Objectives: The objective is to compare the effects of high-intensity interval training VS moderate moderate-intensity continuous training on cardiovascular endurance in young healthy females. Method: 30 young, healthy females were collected and randomly assigned into two training groups, HIIT and MICT, each group having a sample size of (n=15). There will be three parameters to be tested, including (VO2max, Resting heart rate, and Rate perceived exertion). Each group will be tested at three different times, e.g. (at Baseline measurement, after two weeks and after four weeks). For the first two weeks, the HIIT group has to perform at 70%HRR and for the third and fourth weeks, at 75%HRR for two minutes, followed by an active resting interval at 30%HRR for two minutes (1:1) with warm-up and cool-down period (2 minutes each period ) on the treadmill. For the first two weeks, the MICT group has to perform at 40%HRR and for the third and fourth weeks at 50% HRR for fifteen minutes continuously on the treadmill, including warm up and cool down period (2 minutes each period). Result: The final assessment of HIIT and MICT groups had shown p values for VO2max (p=.000), RHR (p=.323) and for RPE (p=.085). These values indicating significant improvement in these three parameters in both groups. Conclusion: This study showed that there were significant improvements in both groups but there were more improvements in VO2max in HIIT group so, it is proved that HIIT is more beneficial than MICT in improving cardiovascular endurance.

Keywords: HIIT, MICT, RPE, RHR

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Authors: C. S. Seema, P. R. Prince

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The characterization of spatio-temporal inhomogeneities occurring in the ionospheric F₂ layer is remarkable since these variations are direct consequences of electrodynamical coupling between magnetosphere and solar events. The temporal and spatial variations of the F₂ layer, which occur with a period of several days or even years, mainly owe to geomagnetic and meteorological activities. The hourly F₂ layer critical frequency (foF2) over 23rd solar cycle (1996-2008) of three ionosonde stations (Wakkanai, Kokunbunji, and Okinawa) in northern hemisphere, which falls within same longitudinal span, is analyzed using continuous wavelet techniques. Morlet wavelet is used to transform continuous time series data of foF2 to a two dimensional time-frequency space, quantifying the time evolution of the oscillatory modes. The presence of significant time patterns (periodicities) at a particular time period and the time location of each periodicity are detected from the two-dimensional representation of the wavelet power, in the plane of scale and period of the time series. The mean strength of each periodicity over the entire period of analysis is studied using global wavelet spectrum. The quasi biennial, annual, semiannual, 27 day, diurnal and 12 hour variations of foF2 are clearly evident in the wavelet power spectra in all the three stations. Critical frequency oscillations with multi-day periods (2-3 days and 9 days in the low latitude station, 6-7 days in all stations and 15 days in mid-high latitude station) are also superimposed over large time scaled variations.

Keywords: continuous wavelet analysis, critical frequency, ionosphere, solar cycle

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Authors: Dragana Bubulj

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The Former Republic of Yugoslavia was a sort of protective umbrella, a unique concept of gathering different ethnical, cultural, and religious identities, as well as diverse intersections of those. After 43-months long civil war and states disintegration in 1995, which resulted in 5 post-Yugoslav countries, Yugoslav Diaspora experienced radical changes. In Germany, one of the countries with the highest percentage of Yugoslav emigration, segregation on ethno-national grounds was empowered by the outbreak of the conflict: firstly on a socio-cultural level, and followed by changes on the level of institutional organizing. Psycho-emotional and financial involvement of Diaspora into the war is also not to be neglected. People of Serbian origin have been additionally overstrained with the designation of Serbs as war criminals in German media and the public sphere. In this way, the path from 'being a Yugoslav' toward 'becoming a Serb', outside nowadays Serbia, has been qualitatively different in comparison to potential identity shiftings experienced by other members of Former Yugoslav population. This paper is part of an ongoing PhD research and tackles biographical narratives of academics of Serbian origin in one German region. Paper addresses processes of post-Yugoslav identity negotiations in Diaspora settings, nationalistic tendentious among second generation youth, and discusses - based on NS-references founded in collected data - question of historicity of biographies.

Keywords: biography, diaspora, ethnography, former republic of Yugoslavia, identity

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Authors: Mamatha M. N.

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Traffic problems, congested traffic, and flow management were recognized as major problems mostly in all the areas, which have caused a problem for the ambulance which carries the emergency patient. The proposed paper aims in the development of ambulance which reaches the nearby hospital faster even in heavy traffic scenario. This process is activated by implementing hardware in an ambulance as well as in traffic post thus allowing a smooth flow to the ambulance to reach the hospital in time. 1) The design of the vehicle to have a communication between ambulance and traffic post. 2)Electronic Health Record with Data-acquisition system 3)Telemetry of acquired biological parameters to the nearest hospital. Thus interfacing all these three different modules and integrating them on the ambulance could reach the hospital earlier than the present ambulance. The system is accurate and efficient of 99.8%.

Keywords: bio-telemetry, data acquisition, patient database, automatic traffic control

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Authors: Ashneel Kumar Singh

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The COVID-19 pandemic has dramatically transformed the global workforce, leading to significant challenges in staffing and employment. The shift to remote work, the health risks posed by the virus, and the phenomenon known as ‘The Great Termination’ have all contributed to the disruption of traditional succession planning methods. This paper explores how agile succession planning can be effectively implemented in the post-COVID world to retain top talent and ensure organizational resilience. Through a review of the literature and practical examples, the paper discusses the difficulties of succession planning in the current environment and the importance of adopting an agile approach and offers recommendations for businesses to navigate the complexities of succession planning in a rapidly changing landscape.

Keywords: agile succession planning, adopt a culture of continuous learning, create a multi-successor planning approach, the great termination

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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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Authors: M. Umar Dahot, G. S. Mangrio

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In this study Agro-industrial waste was used as a carbon source, which is a low cost substrate. Along with this, various sugars and molasses of 2.5% and 5% were investigated as substrate/carbon source for the growth of A.niger and Pectinase production. Different nitrogen sources were also used. An overview of results obtained show that 5% sucrose, 5% molasses and 0.4% (NH4)2SO4 were found the best carbon and nitrogen sources for the production of pectinase by A. niger. The maximum production of pectinase (26.87units/ml) was observed at pH 6.0 after 72 hrs incubation. The optimum temperature for the maximum production of pectinase was achieved at 35ºC when maximum production of pectinase was obtained as 28.25Units/ml.Pectinase enzyme was purified with ammonium sulphate precipitation and dialyzed sample was finally applied on gel filtration chromatography (Sephadex G-100) and Ion Exchange DEAE A-50. The enzyme was purified 2.5 fold by gel chromatography on Sephadex G-100 and Four fractions were obtained, Fraction 1, 2, 4 showed single band while Fraction -3 showed multiple bands on SDS Page electrophoresis. Fraction -3 was pooled, dialyzed and separated on Sephdex A-50 and two fractions 3a and 3b showed single band. The molecular weights of the purified fractions were detected in the range of 33000 ± 2000 and 38000± 2000 Daltons. The purified enzyme was specifically most active with pure pectin, while pectin, Lemon pectin and orange peel given lower activity as compared to (control). The optimum pH and temperature for pectinase activity was found between pH 5.0 and 6.0 and 40°- 50°C, respectively. The enzyme was stable over the pH range 3.0-8.0. The thermostability of was determined and it was observed that the pectinase activity is heat stable and retains activity more than 40% when incubated at 90°C for 10 minutes. The pectinase activity of F3a and F3b was increased with different metal ions. The Pectinase activity was stimulated in the presence of CaCl2 up to 10-30%. ZnSO4, MnSO4 and Mg SO4 showed higher activity in fractions F3a and F3b, which indicates that the pectinase belongs to metalo-enzymes. It is concluded that A. niger is capable to produce pH stable and thermostable pectinase, which can be used for industrial purposes.

Keywords: pectinase, a. niger, production, purification, characterization

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Authors: Raya Morag

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This paper proposes a new paradigm for cinema/trauma studies - the trauma of the perpetrator. Canonical trauma research from Freud’s Aetiology of Hysteria to the present has been carried out from the perspective of identification with the victim, as have cinema trauma research and contemporary humanities-based trauma studies, climaxing during the 1990s in widespread interest in the victim vis-à-vis the Holocaust, war, and domestic violence. Breaking over 100 years of repression of the abhorrent and rejected concept of the perpetrator in psychoanalytic-based research proposes an uncanny shift in our conception of psychoanalysis' trajectory from women's 'hysteria' to 'post-traumatic stress disorder'. This new paradigm is driven by the global emergence of new waves of films (2007-2015) representing trauma suffered by perpetrators involved in the new style of war entailing deliberate targeting of non-combatants. Analyzing prominent examples from Israeli post-second Intifada documentaries (e.g., Ari Folman’s Waltz with Bashir), and post post-Iraq (and Afghanistan) War American documentaries (e.g., Errol Morris' Standard Operating Procedure), the paper discusses the limitations of victim trauma by the firm boundaries it (rightly) set in order to defend such victims of nineteenth and especially twentieth-century catastrophes; the epistemological processes needed in order to consider perpetrators’ trauma as an inevitable part of psychiatric-psychological and cultural perspectives on trauma, and, thus, the definition of perpetrators' trauma in contrast to victims'. It also analyzes the perpetrator's figure in order to go beyond the limitation of current trauma theory's relation to the Real, thus transgressing the 'unspeakableness' of the trauma itself. The paper seeks an exploration of what perpetrator trauma teaches us not only as a counter-paradigm to victim trauma, but as a reflection on the complex intertwining of the two paradigms in the twenty-first century collective new war unconscious, and on what psychoanalysis might offer us in the first decade of this terrorized-ethnicized century.

Keywords: American war documentaries, Israeli war documentaries, 'new war', perpetrator trauma

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