Search results for: education outcomes

Authors: Jayanthi Rajendran

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Experience is what makes a man perfect. Though we tend to learn many a different things in life through practice still we need to go an extra mile to gain experience which would be profitable only when it is integrated with regular practice. A clear phenomenal idea is that every teacher is a learner. The centralized idea of this paper would focus on the integrated practices carried out among the students of Jizan University which enhances learning through experiences. Integrated practices like student-directed activities, balanced curriculum, phonological based activities and use of consistent language would enlarge the vision and mission of students to earn experience through learning. Students who receive explicit instruction and guidance could practice the skills and strategies through student-directed activities such as peer tutoring and cooperative learning. The second effective practice is to use consistent language. Consistent language provides students a model for talking about the new concepts which also enables them to communicate without hindrances. Phonological awareness is an important early reading skill for all students. Students generally have phonemic awareness in their home language can often transfer that knowledge to a second language. And also a balanced curriculum requires instruction in all the elements of reading. Reading is the most effective skill when both basic and higher-order skills are included on a daily basis. Computer based reading and listening skills will empower students to understand a language in a better way. English language learners can benefit from sound reading instruction even before they are fully proficient in English as long as the instruction is comprehensible. Thus, if students have to be well equipped in learning they should foreground themselves in various integrated practices through multifarious experience for which teachers are moderators and trainers. This type of learning prepares the students for a constantly changing society which helps them to meet the competitive world around them for better employability fulfilling the vision and mission of the institution.

Keywords: consistent language, employability, phonological awareness, balanced curriculum

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Authors: Bryana Woodard, Monica Mitchell, Kasey Harry, Ebony Washington, Megan Harris, Marcia Boyd, Regina Lynch, Daphene Baines, Surbi Bankar

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Introduction: African Americans experience mental health illnesses (i.e., depression, anxiety, etc.) at higher rates than their white counterparts. Despite this, they utilize mental health resources less and have lower mental health literacy, perhaps due to cultural barriers- including but not limited to mistrust. Research acknowledges African Americans’ close ties to community networks, identifying these linkages as key to establishing comfort and trust. Similarly, the church has historically been a space that creates unity and community among African Americans. Studies show that longstanding academic-community partnerships with organizations, such as churches and faith-based entities, have the capability to effectively address health and mental health barriers and needs in African Americans. The importance of implementing faith-based approaches is supported in the literature, however few empirical studies exist. This project describes the First Ladies for Health and Cincinnati Children's Hospital Medical Center (CCHMC) Partnership (FLFH-CCHMC Partnership) and the implementation and assessment of an annual Mental Health Symposium, the overall aim of which was to increase mental health awareness and decrease stigma in African American communities. Methods: The specific goals of the FLFH Mental Health Symposium were to (1) Collaborate with trusted partners to build trust with community participants; (2) Increase mental health literacy and decrease mental health stigma; (3) Understand the barriers to improving mental health and improving trust; (4) Assess the short-term outcomes two months following the symposium. Data were collected through post-event and follow-up surveys using a mixed methods approach. Results: More than 100 participants attended each year with over 350 total participants over three years. 98.7% of participants were African American, 86.67% female, 11.6% male, and 11.6% LGBTQ+/non-binary; 10.5% of participants were teens, with the remainder aged 20 to 80 plus. The event was successful in achieving its goals: (1a) Eleven different speakers from 8 community and church organizations presented; (1b) 93% of participants rated the overall symposium as very good or excellent (2a) Mental health literacy significantly increased each year with over 90% of participants reporting improvement in their “understanding” and “awareness of mental health (2b) Participants 'personal stigma surrounding mental health illness decreased each year with 92.3% of participants reporting changes in their “willingness to talk about and share” mental health challenges; (3) Barriers to mental health care were identified and included social stigma, lack of trust, and the cost of care. Data were used to develop priorities and an action plan for the FLFH-CCHMC Mental Health Partnership; (4) Follow-up data showed that participants sustained benefits of the FLFH Symposium and took actionable steps (e.g., meditation, referrals, etc.). Additional quantitative and qualitative data will be shared. Conclusions: Lower rates of mental health literacy and higher rates of stigma among participants in this initiative demonstrate the importance of mental health providers building trust and partnerships in communities. Working with faith-based entities provides an opportunity to mitigate and address mental health equity in African American communities.

Keywords: community psychology, faith-based, african-american, culturally competent care, mental health equity

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Authors: Laxmi R. Kasaraneni

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The Internet connects all the networks, including the nation’s critical infrastructure that are used extensively by not only a nation’s government and military to protect sensitive information and execute missions, but also the primary infrastructure that provides services that enable modern conveniences such as education, potable water, electricity, natural gas, and financial transactions. It has become the central nervous system for the government, the citizens, and the industries. When it is attacked, the effects can ripple far and wide impacts not only to citizens’ well-being but nation’s economy, civil infrastructure, and national security. As such, these critical services may be targeted by malicious hackers during cyber warfare, it is imperative to not only protect them and mitigate any immediate or potential threats, but to also understand the current or potential impacts beyond the IT networks or the organization. The Nation’s IT infrastructure which is now vital for communication, commerce, and control of our physical infrastructure, is highly vulnerable to attack. While existing technologies can address some vulnerabilities, fundamentally new architectures and technologies are needed to address the larger structural insecurities of an infrastructure developed in a more trusting time when mass cyber attacks were not foreseen. This research is intended to improve the core functions of the Internet and critical-sector information systems by providing a clear path to create a safe, secure, and resilient cyber environment that help stakeholders at all levels of government, and the private sector work together to develop the cybersecurity capabilities that are key to our economy, national security, and public health and safety. This research paper also emphasizes the present and future cyber security threats, the capabilities and goals of cyber attackers, a strategic concept and steps to implement cybersecurity for maximum effectiveness, enabling technologies, some strategic assumptions and critical challenges, and the future of cyberspace.

Keywords: critical challenges, critical infrastructure, cyber security, enabling technologies, national security

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Authors: Ali Raza

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The dynamic landscape of communication has brought about significant advancements that intersect with the realms of public health and journalism. This abstract explores the evolving synergy between these fields, highlighting how their intersection has contributed to informed societies and improved public health outcomes. In the digital age, communication plays a pivotal role in shaping public perception, policy formulation, and collective action. Public health, concerned with safeguarding and improving community well-being, relies on effective communication to disseminate information, encourage healthy behaviors, and mitigate health risks. Simultaneously, journalism, with its commitment to accurate and timely reporting, serves as the conduit through which health information reaches the masses. Advancements in communication technologies have revolutionized the ways in which public health information is both generated and shared. The advent of social media platforms, mobile applications, and online forums has democratized the dissemination of health-related news and insights. This democratization, however, brings challenges, such as the rapid spread of misinformation and the need for nuanced strategies to engage diverse audiences. Effective collaboration between public health professionals and journalists is pivotal in countering these challenges, ensuring that accurate information prevails. The synergy between public health and journalism is most evident during public health crises. The COVID-19 pandemic underscored the pivotal role of journalism in providing accurate and up-to-date information to the public. However, it also highlighted the importance of responsible reporting, as sensationalism and misinformation could exacerbate the crisis. Collaborative efforts between public health experts and journalists led to the amplification of preventive measures, the debunking of myths, and the promotion of evidence-based interventions. Moreover, the accessibility of information in the digital era necessitates a strategic approach to health communication. Behavioral economics and data analytics offer insights into human decision-making and allow tailored health messages to resonate more effectively with specific audiences. This approach, when integrated into journalism, enables the crafting of narratives that not only inform but also influence positive health behaviors. Ethical considerations emerge prominently in this alliance. The responsibility to balance the public's right to know with the potential consequences of sensational reporting underscores the significance of ethical journalism. Health journalists must meticulously source information from reputable experts and institutions to maintain credibility, thus fortifying the bridge between public health and the public. As both public health and journalism undergo transformative shifts, fostering collaboration between these domains becomes essential. Training programs that familiarize journalists with public health concepts and practices can enhance their capacity to report accurately and comprehensively on health issues. Likewise, public health professionals can gain insights into effective communication strategies from seasoned journalists, ensuring that health information reaches a wider audience. In conclusion, the convergence of public health and journalism, facilitated by communication advancements, is a cornerstone of informed societies. Effective communication strategies, driven by collaboration, ensure the accurate dissemination of health information and foster positive behavior change. As the world navigates complex health challenges, the continued evolution of this synergy holds the promise of healthier communities and a more engaged and educated public.

Keywords: public awareness, journalism ethics, health promotion, media influence, health literacy

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Authors: Bello, A., Muhammed Ibrahim Abba., Abdullahi, M., Dauda, Sabo, & Shittu, A. T.

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This study investigated the Predictors of Lecturers Knowledge Sharing Acceptance on Open Educational Resources (OER) in North-East Nigerian in Universities. The study population comprised of 632 lecturers of Federal Universities in North-east Nigeria. The study sample covered 338 lecturers who were selected purposively from Adamawa, Bauchi and Borno State Federal Universities in Nigeria. The study adopted a prediction correlational research design. The instruments used for data collection was the questionnaire. Experts in the field of educational technology validated the instrument and tested it for reliability checks using Cronbach’s alpha. The constructs on lecturers’ acceptance to share OER yielded a reliability coefficient of; α = .956 for Performance Expectancy, α = .925; for Effort Expectancy, α = .955; for Social Influence, α = .879; for Facilitating Conditions and α = .948 for acceptance to share OER. the researchers contacted the Deanery of faculties of education and enlisted local coordinators to facilitate the data collection process at each university. The data was analysed using multiple sequential regression statistic at a significance level of 0.05 using SPSS version 23.0. The findings of the study revealed that performance expectancy (β = 0.658; t = 16.001; p = 0.000), effort expectancy (β = 0.194; t = 3.802; p = 0.000), social influence (β = 0.306; t = 5.246; p = 0.000), collectively indicated that the variables have a predictive capacity to stimulate lecturer’s acceptance to share their resources on OER repository. However, the finding revealed that facilitating conditions (β = .053; t = .899; p = 0.369), does not have a predictive capacity to stimulate lecturer’s acceptance to share their resources on OER repository. Based on these findings, the study recommends among others that the university management should consider adjusting OER policy to be centered around actualizing lecturers career progression.

Keywords: acceptance, lecturers, open educational resources, knowledge sharing

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Authors: T. Aragaw, P. Gari

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In spite of social, political, and economic marginalization, women are still considered as the backbone of Ethiopia, one of the least developed countries in the world. The general purpose of this study was to assess factors that affect participation of women in politics, social and economic decisions at Kelem-Wollega Administrative Zone of Oromia Regional State, Ethiopia. Data used in this paper is mainly primary, and a few secondary data were incorporated. Respondents were selected using a systematic random sampling method and were placed questionnaires containing open-ended and closed-ended. Focus group discussion was also used for the study subjects in two offices. According to the information collected from the KWAZ Development and Social Service Office, a total of 18,473 tax-paying employees are present in the Zone, which is 14% of the total population of the Zone. Among the total number of employees in the Zone, 2,617 have been recruited for this study based on the criteria stated. This showed 1.8% of them were comprised of several churches and religious owned integrated development projects in the KWAZ. The 2,103 (80.34%) study participants responded personally, and they completed and returned the questionnaire to the researchers. The study revealed that in public institutions existed in KWAZ, the majority of women were having an educational status of diploma and lower, practicing lower non-decision making and leadership positions. Conclusion: Major barriers hindering women include: Socio-cultural attitudes, lack of necessary experience, education, the burden of domestic responsibilities, and lack of role models of women leaders in the Zone. Empowerment of women via social organizations, critical involvement of the government, and Affirmative action for women is critical. Further research is needed on the scope and challenges in implementing the strategies.

Keywords: women, affirmative action, leadership, empowerment, Ethiopia

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Authors: Mahdi PourAsghar, Abbas Mas'udzadeh, Abdulhakim Tirgari, Saeed Dabiri Roushan, Hooman Rashidi, Fariba Salehi

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Objective: One of the major objectives in sports areas is to achieve maximum athletic performance. Physical and psychological preparations are the basic factors for achieving maximum performance in athletes. Unfortunately, in the field of physical preparation, we can see maximum attention and planning of trainers and sports officials. But despite the importance of psychological preparation of athletes and its serious and profound effect on athletic performance, the results of sports competitions show that less attention is paid to this topic, and it is less under the control of counselors and psychologists in different areas of our sport. Therefore, this study aimed to evaluate the attitude of athletes and coaches to sport psychology. Materials and methods: A descriptive study with a sample size of 234 elite athletes and 216 skilled coaches was conducted in different areas of sports, in Sari, Mazandaran in 2015.The instrument was a questionnaire consisting of two parts of demographic data and Martin questionnaire, assessing the attitude to sport psychology. The data from this study were analyzed using Spss version 18, descriptive statistics tests, and Chi-square test. Results: In this study, positive attitudes of participants in need and confidence towards sport psychology consultation in athletes and coaches group were 55/1 and 56/5 percent, respectively. The positive attitude of female athletes in belief to psychology consultation was more than male athletes. Athletes with higher education had more positive attitude towards the presence of psychologists and psychiatrists in fields of sports. Conclusion: According to the findings based on the need to the psychology consultation in different areas of sports, it is recommended that through training of specialists in the field of sport psychology and review of sports programs in different fields of sports, the presence of these counselors to maintain the psychological preparation of athletes to achieve maximum athletic performance and reduce anxiety and stress be used.

Keywords: Keywords: Athletes, Eliteathletes, Coaches, Attitude, Sport psychology.

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Authors: Aryan Sood, Shruti Pathak, Dipanshu Chaudhary, Shreyanshi, Yogesh Pal

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In this comprehensive meta-analysis, the study delves into the widespread issue of body shaming, revealing its pervasive impact on various aspects of human life and its profound implications for mental health. The paper first explores the origins of body shaming, including societal norms, media influences, and interpersonal dynamics. It highlights the various forms it takes and its detrimental effects on self-esteem, body image, and psychological well-being. Particularly among adolescents and teenagers in today's social media-driven world, the pressure to conform to idealized beauty standards is significant, leading to negative consequences for their development and health. The research emphasizes the long-lasting mental health effects of body shaming, including depression, body dysmorphia, low self-esteem, and eating disorders. The study also discusses the emergence of body positivity movements as a means to challenge societal norms and promote inclusivity and empathy. Furthermore, the research addresses body shaming in the workplace and presents strategies to combat it, stressing the importance of awareness campaigns, education, and policy changes. In conclusion, the study underscores the critical need for a culture of acceptance and support, the promotion of positive body image, and efforts to mitigate the severe mental health toll that body shaming takes on individuals and communities. Overall, this research provides a comprehensive overview of body shaming, its root causes, and its far-reaching impacts on mental health and well-being. It highlights the urgency of addressing this issue in various contexts, from adolescence to the workplace, and offers solutions, such as awareness campaigns and societal changes, to foster a more inclusive and empathetic future.

Keywords: body shaming, mental health, age, gender, societal norms, appearance-based discrimination, cyberbullying, self-esteem, social media, depression, acceptance

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Authors: G. H. B. Dilhari, A. A. D. T. Saparamadu

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Sri Lanka is one of the prominent countries for the coir production. The coir is one of the by-products of the coconut and the coir industry is considered to be one of the traditional industries in Sri Lanka. Because of the inherent nature of the coir industry, labourers play a significant role in the coir production process. The study has analyzed the determinants of the income of the household level coir yarn labourers. The study was conducted in the Kumarakanda Grama Niladhari division. Simple random sampling was used to generate a sample of 100 household level coir yarn labourers and structured questionnaire, personal interviews, and discussion were performed to gather the required data. The obtained data were statistically analyzed by using Statistical Package for Social Science (SPSS) software. Mann-Whitney U and Kruskal-Wallis test were performed for mean comparison. The findings revealed that the household level coir yarn industry is dominated by the female workers and it was identified that fewer numbers of workers have engaged in this industry as the main occupation. In addition to that, elderly participation in the industry is higher than the younger participation and most of them have engaged in the industry as a source of extra income. Level of education, the methods of engagement, satisfaction, engagement in the industry by the next generation, support from the government, method of government support, working hours per day, employed as a main job, number of completed units per day, suffering from job related diseases and type of the diseases were related with income level of household level coir yarn laboures. The recommendations as to flourish in future includes, technological transformation for coir yarn production, strengthening the raw material base and regulating the raw material supply, introduction of new technologies, markets and training programmes, the establishment of the labourers’ association, the initiation of micro credit schemes and better consideration about the job oriented diseases.

Keywords: coir yarn, determinants, income, Sri Lanka

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Authors: Akram Rasheed

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Background: Simulation in the health care field has been increasingly used over the last years in the training of resuscitation and life support practices. It has shown the advantage of improving the decision-making and technical skills through deliberate practice and return demonstration. Local Problem: This article reports on the integration of simulation-based training (SBT) in the training program about proper team dynamics and leadership skills during cardiopulmonary resuscitation (CPR) in the intensive care unit (ICU). Method and Intervention: Training of 180 critical care nurses was conducted using SBT between 1st January and 30th 2020. We had conducted 15 workshops, with the integration of SBT using high fidelity manikins and using demonstration and return-demonstration approach to train the nursing staff about proper team dynamics and leadership skills during CPR. Results: After completing the SBT session, all 180 nurses completed the evaluation form. The majority of evaluation items were rated over 95% for the effectiveness of the education; four items were less than 95% (88–94%). Lower rated items considered training and practice time, improved competency, and commitment to apply to learn. The team dynamics SBT was evaluated as an effective means to improve team dynamics and leadership skills during CPR in the intensive care unit (ICU). Conclusion: The use of simulation-based training to improve team dynamics and leadership skills is an effective method for better patient management during CPR. Besides skills competency, closed-loop communication, clear messages, clear roles, and assignments, knowing one’s limitations, knowledge sharing, constructive interventions, re-evaluating and summarizing, and mutual respect are all important concepts that should be considered during team dynamics training. However, participants reported the need for a repeated practice opportunity to build competency.

Keywords: cardiopulmonary resuscitation, high fidelity manikins, simulation-based training, team dynamics

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Authors: Charalabos Antonatos, Mariza Panoutsopoulou, Georgios K. Georgakilas, Evangelos Evangelou, Yiannis Vasilopoulos

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The extended tissue damage and severe clinical outcomes of autoimmune diseases, accompanied by the high annual costs to the overall health care system, highlight the need for an efficient therapy. Increasing knowledge over the pathophysiology of specific chronic inflammatory diseases, namely Psoriasis (PsO), Inflammatory Bowel Diseases (IBD) consisting of Crohn’s disease (CD) and Ulcerative colitis (UC), and Rheumatoid Arthritis (RA), has provided insights into the underlying mechanisms that lead to the maintenance of the inflammation, such as Tumor Necrosis Factor alpha (TNF-α). Hence, the anti-TNFα biological agents pose as an ideal therapeutic approach. Despite the efficacy of anti-TNFα agents, several clinical trials have shown that 20-40% of patients do not respond to treatment. Nowadays, high-throughput technologies have been recruited in order to elucidate the complex interactions in multifactorial phenotypes, with the most ubiquitous ones referring to transcriptome quantification analyses. In this context, a random effects meta-analysis of available gene expression cDNA microarray datasets was performed between responders and non-responders to anti-TNFα therapy in patients with IBD, PsO, and RA. Publicly available datasets were systematically searched from inception to 10th of November 2020 and selected for further analysis if they assessed the response to anti-TNFα therapy with clinical score indexes from inflamed biopsies. Specifically, 4 IBD (79 responders/72 non-responders), 3 PsO (40 responders/11 non-responders) and 2 RA (16 responders/6 non-responders) datasetswere selected. After the separate pre-processing of each dataset, 4 separate meta-analyses were conducted; three disease-specific and a single combined meta-analysis on the disease-specific results. The MetaVolcano R package (v.1.8.0) was utilized for a random-effects meta-analysis through theRestricted Maximum Likelihood (RELM) method. The top 1% of the most consistently perturbed genes in the included datasets was highlighted through the TopConfects approach while maintaining a 5% False Discovery Rate (FDR). Genes were considered as Differentialy Expressed (DEGs) as those with P ≤ 0.05, |log2(FC)| ≥ log2(1.25) and perturbed in at least 75% of the included datasets. Over-representation analysis was performed using Gene Ontology and Reactome Pathways for both up- and down-regulated genes in all 4 performed meta-analyses. Protein-Protein interaction networks were also incorporated in the subsequentanalyses with STRING v11.5 and Cytoscape v3.9. Disease-specific meta-analyses detected multiple distinct pro-inflammatory and immune-related down-regulated genes for each disease, such asNFKBIA, IL36, and IRAK1, respectively. Pathway analyses revealed unique and shared pathways between each disease, such as Neutrophil Degranulation and Signaling by Interleukins. The combined meta-analysis unveiled 436 DEGs, 86 out of which were up- and 350 down-regulated, confirming the aforementioned shared pathways and genes, as well as uncovering genes that participate in anti-inflammatory pathways, namely IL-10 signaling. The identification of key biological pathways and regulatory elements is imperative for the accurate prediction of the patient’s response to biological drugs. Meta-analysis of such gene expression data could aid the challenging approach to unravel the complex interactions implicated in the response to anti-TNFα therapy in patients with PsO, IBD, and RA, as well as distinguish gene clusters and pathways that are altered through this heterogeneous phenotype.

Keywords: anti-TNFα, autoimmune, meta-analysis, microarrays

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Authors: Arnold Missiame

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In Ghana, rural dwellers who depend primarily on agriculture for their livelihood constitute about 60% of the country’s population. This shows the critical role and potentials of the agricultural sector in helping to achieve Ghana’s vision 2030. With the current threat of climate change and advancements in technology, agricultural extension is not just about technology transfer and improvements in productivity, but it is also about improving the managerial and technical skills of farmers. In Ghana, the government of Ghana as well as other players in the sector like; non-governmental organizations, NGOs, local and international funding agencies, for decades now, have made capacity-building-investments in smallholder farmers by way of extension services delivery. This study sought to compare the technical efficiency of farmers who have access to agricultural extension and farmers who do not in Ghana. The study employed the stochastic meta-frontier model to analyze household survey data comprising 300 smallholder cassava farmers from the Fanteakwa district of Ghana. The farmers were selected through a two-stage sampling technique where 5 communities were purposively selected in the first stage and then 60 smallholder cassava farmers were randomly selected from each of the 5 communities. Semi-structured questionnaires were used to collect data on farmers’ socioeconomic and farm-level characteristics. The results showed that farmers who have access to agricultural extensions services have higher technical efficiencies (TE) and produce much closer to their meta-production frontiers (higher technology gap ratios (TGR) than farmers who do not have access to such extension services. Furthermore, experience in cassava cultivation and formal education significantly improves the technical efficiencies of farmers. The study recommends that the mode and scope of agricultural extension service delivery in the country should be enhanced to ensure that smallholder farmers have easy access to extension agents.

Keywords: agricultural extension, Ghana, smallholder farmers, stochastic meta-frontier model, technical efficiency

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Authors: Raeed Alanazi

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Introduction: Nursing students have a crucial role to play in the inhibition of infectious diseases and, therefore, must be trained in infection control and prevention modules prior to entering clinical settings. Simulations have been found to have a positive impact on infection control skills and the use of standard precautions. Aim: The purpose of this study was to use the four sources of self-efficacy in explaining the level of clinical self-efficacy and adherence to infection control practices in Saudi nursing students during simulation practice. Method: A cross-sectional design with convenience sampling was used. This study was conducted in all Saudi nursing schools, with a total number of 197 students participated in this study. Three scales were used simulation self- efficacy Scale (SSES), the four sources of self-efficacy scale (SSES), and Compliance with Standard Precautions Scale (CSPS). Multiple linear regression was used to test the use of the four sources of self-efficacy (SSES) in explaining level of clinical self-efficacy and adherence to infection control in nursing students. Results: The vicarious experience subscale (p =.044) was statistically significant. The regression model indicated that for every one unit increase in vicarious experience (observation and reflection in simulation), the participants’ adherence to infection control increased by .13 units (β =.22, t = 2.03, p =.044). In addition, the regression model indicated that for every one unit increase in education level, the participants’ adherence to infection control increased by 1.82 units (beta=.34= 3.64, p <.001). Also, the mastery experience subscale (p <.001) and vicarious experience subscale (p = .020) were shared significant associations with clinical self-efficacy. Conclusion: The findings of this research support the idea that simulation-based learning can be a valuable teaching-learning method to help nursing students develop clinical competence, which is essential in providing quality and safe nursing care.

Keywords: simulation-based learning, clinical self-efficacy, infection control, nursing students

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Authors: Neslihan Şahin Çelik, Ali Eraslan

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In recent years, mathematics educators have frequently stressed the necessity of instructing students about models and modeling approaches that encompass cognitive and metacognitive thought processes, starting from the first years of school and continuing on through the years of higher education. The purpose of this study is to examine the thought processes of 4th-grade primary school students in their modeling activities and to explore the difficulties encountered in these processes, if any. The study, of qualitative design, was conducted in the 2015-2016 academic year at a public state-school located in a central city in the Black Sea Region of Turkey. A preliminary study was first implemented with designated 4th grade students, after which the criterion sampling method was used to select three students that would be recruited into the focus group. The focus group that was thus formed was asked to work on the model eliciting activity of the Paper Airplane Problem and the entire process was recorded on video. The Paper Airplane Problem required the students to determine the winner with respect to: (a) the plane that stays in the air for the longest time; (b) the plane that travels the greatest distance in a straight-line path; and (c) the overall winner for the contest. A written transcript was made of the video recording, after which the recording and the students' worksheets were analyzed using the Blum and Ferri modeling cycle. The results of the study revealed that the students tested the hypotheses related to daily life that they had set up, generated ideas of their own, verified their models by making connections with real life, and tried to make their models generalizable. On the other hand, the students had some difficulties in terms of their interpretation of the table of data and their ways of operating on the data during the modeling processes.

Keywords: primary school students, model eliciting activity, mathematical modeling, modeling process, paper airplane problem

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Authors: Joan Esper Kuhnly, Jess Holden, Lynn Shelley, Nicole Kuhnly

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Empathy serves as a foundational nursing principle inherent in the nurse’s ability to form those relationships from which to care for patients. Evidence supports, including empathy in nursing and healthcare education, but there is limited data on what methods are effective to do so. Building evidence supports experiential and interactive learning methods to be effective for students to gain insight and perspective from a personalized experience. The purpose of this project is to evaluate learning activities designed to promote the attainment of empathic behaviors across 5 levels of the nursing curriculum. Quantitative analysis will be conducted on data from pre and post-learning activities using the Toronto Empathy Questionnaire. The main hypothesis, that simulation learning activities will increase empathy, will be examined using a repeated measures Analysis of Variance (ANOVA) on Pre and Post Toronto Empathy Questionnaire scores for three simulation activities (Stroke, Poverty, Dementia). Pearson product-moment correlations will be conducted to examine the relationships between continuous demographic variables, such as age, credits earned, and years practicing, with the dependent variable of interest, Post Test Toronto Empathy Scores. Krippendorff’s method of content analysis will be conducted to identify the quantitative incidence of empathic responses. The researchers will use Colaizzi’s descriptive phenomenological method to describe the students’ simulation experience and understand its impact on caring and empathy behaviors employing bracketing to maintain objectivity. The results will be presented, answering multiple research questions. The discussion will be relevant to results and educational pedagogy in the nursing curriculum as they relate to the attainment of empathic behaviors.

Keywords: curriculum, empathy, nursing, simulation

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Authors: Huang Chiung Chiu

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This article is about the nursing experience of assisting an outpatient with premature menopause, osteoporosis and sarcopenia through a multi-discipline care model. The nursing period is from September 22nd, 2020, to December 7th, 2020, collecting data through interviews with the patient, observation, and physical assessment. It was found that the main health problems were insufficient nutrition, less physical need, insomnia, and potentially dangerous falls. As an outpatient nurse, the author observed that in recent years, the age group of women with premature menopause, osteoporosis and sarcopenia had shifted downward. Integrated multi-disciplinary interventions were provided upon the initial diagnosis of osteoporosis and sarcopenia. Under the outpatient care setting, the collaborative team works between the doctors, nutritionists, osteoporosis educators, rehabilitates, physical therapists and other specialized teams were applied to provide individualized, integrated multi-disciplinary care. Through empathy and the establishment of attentive care, companionship and trust, we discussed care plans and treatment guidelines with the case, providing accurate, complete disease information and feedback education to strengthen the patient’s knowledge and motivation for exercise. Nursing guidance regarding the dietary nutrition and adjustment of daily routine was provided to increase the self-care ability, improve the health problems of muscle weakness and insomnia, and prevent falls. For patients with postmenopausal osteoporosis and sarcopenia, it is recommended that the nurses coordinate the multi-discipline integrated care model, adjust patients’ lifestyle and diet, and establish a regular exercise plan so that the cases can be evaluated holistically to improve the quality of care and physical and mental comfort.

Keywords: multi-discipline care model, premature menopause, osteoporosis, sarcopenia, insomnia

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Authors: Meera Shanker

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Excellent education and financial need have encouraged Indian women to go out and work in well-paid and high-status occupations. In the era of cutthroat competition, women are expected to work hard to produce the desired result; hence, workload and expectations haveincreased. At home, they are anticipated to take care of family members, children, and household work. Women are stretching themselves mechanically to remain in the job competition and try to give their best at home. Consequentially, they are under tremendous pressure, stressed, and having issues related to physical-mental wellness. Mental healthcare is often ignored and not accepted due to a lack of awareness and cultural barriers. These further compounds the problem, resulting in decreased productivity in economic terms and an increase in stress-related physical-mental ailments. The main objective of the study was to find out the impact of stress on the physical-mental wellbeing of working women in India, along with their awareness and acceptability related to mental health. Six hundred and one woman working at various levels took part in this study, responding to the items related to stress and physical-mental illness. Finally, 21 items were retained under four meaningful factors measuring stress dimensions along with 17 items with three factors measuring physical-mental wellbeing. Confirmatory Factor Analysis (CFA), path analysis, in Structural Equation Modeling (SEM), was used to get a relationship, validity of the instruments. The psychometric properties of items and Cronbach’s Alpha reliabilities calculated for the subscales were relatively acceptable. The subscale correlations, regression, and path analysis of stress dimensions with physical-mental illness were found to be positive, indicating the growing stress among working women in India, which is impacting their physical-mental health. Single item analysis revealed that 77 percent of women have never visited psychologists. However, 70 percent of working women were not ready to seek the help of a psychologist.

Keywords: working women, stress, physical-mental well-being, confirmatory factor analysis

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Authors: Mualla McManus, Jenna Luche Thaye

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World Health Organisation International Classification of Disease codes were created to define disease including infections in order to guide and educate diagnosticians. Most infectious diseases such as syphilis are clearly defined by their ICD 10 codes and aid/help to educate the clinicians in syphilis diagnosis and treatment globally. However, current ICD 10 codes for relapsing fever Borreliosis and Lyme disease are less clearly defined and can impede appropriate diagnosis especially if the clinician is not familiar with the symptoms of these infectious diseases. This is despite substantial number of scientific articles published in peer-reviewed journals about relapsing fever and Lyme disease. In the USA there are estimated 380,000 people annually contacting Lyme disease, more cases than breast cancer and 6x HIV/AIDS cases. This represents estimated 0.09% of the USA population. If extrapolated to the global population (7billion), 0.09% equates to 63 million people contracting relapsing fever or Lyme disease. In many regions, the rate of contracting some form of infection from tick bite may be even higher. Without accurate and appropriate diagnostic codes, physicians are impeded in their ability to properly care for their patients, leaving those patients invisible and marginalized within the medical system and to those guiding public policy. This results in great personal hardship, pain, disability, and expense. This unnecessarily burdens health care systems, governments, families, and society as a whole. With accurate diagnostic codes in place, robust data can guide medical and public health research, health policy, track mortality and save health care dollars. Better defined ICD codes are the way forward in educating the diagnosticians about relapsing fever and Lyme diseases.

Keywords: WHO ICD codes, relapsing fever, Lyme diseases, World Health Organisation

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Authors: Manana Lobzhanidze, Marine Kobalava, Lali Chikviladze

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The global pandemic crisis has had a significant impact on educational migration, substantially limiting young people’s access to education abroad. Therefore, it became necessary to study the economic, demographic, social, cultural and other factors associated with educational migration, to identify the economic and political challenges of educational migration and to develop recommendations. The aim of the research is to study the effects of the atypical crisis on educational migration and to make recommendations on effective migration opportunities based on the identification of economic and policy challenges in this area. Bibliographic research is used to assess the effects of the impact of the atypical crisis on educational migration presented in the papers of various scholars. Against the background of the restrictions imposed during the COVID19 pandemic, migration rates have been analyzed, endogenous and exogenous factors affecting educational migration have been identified. Quantitative and qualitative research of students and graduates of TSU Economics and Business Faculty is conducted, the results have been processed by SPSS program, the factors hindering educational migration and the challenges have been identified. The Internet and digital technologies have been shown to play a vital role in alleviating the challenges posed by the COVID-19 pandemic, however, lack of Internet access and limited financial resources have played a disruptive role in the educational migration process. The analysis of quantitative research materials revealed the problems of educational migration caused by the atypical crisis, while some issues were clarified during the focus group meetings. The following theoretical-methodological approaches were used during the research: a bibliographic research, analysis, synthesis, comparison, selection-grouping are used; Quantitative and qualitative research has been carried out, the results have been processed by SPSS program. The article presents the consequences of the atypical crisis for educational migration, identifies the main economic and policy challenges in the field of educational migration, and develops appropriate recommendations to overcome them.

Keywords: educational migration, atypical crisis, economic-political challenges, educational migration factors

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Authors: Kathryn Strachan, Sameer Otoom, Amal AL-Gallaf, Ahmed Al Ansari

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Introduction: Introducing a reliable method to select graduates for an award in higher education can be challenging but is not impossible. Multisource feedback (MSF) is a popular assessment tool that relies on evaluations of different groups of people, including physicians and non-physicians. It is useful for assessing several domains, including professionalism, communication and collaboration and may be useful for selecting the best interns to receive a University award. Methods: 16 graduates responded to an invitation to participate in the student award, which was conducted by the Royal College of Surgeons of Ireland-Bahrain Medical University of Bahrain (RCSI Bahrain) using the MSF process. Five individuals from the following categories rated each participant: physicians, nurses, and fellow students. RCSI Bahrain graduates were assessed in the following domains; professionalism, communication, and collaboration. Mean and standard deviation were calculated and the award was given to the graduate who scored the highest among his/her colleagues. Cronbach’s coefficient was used to determine the questionnaire’s internal consistency and reliability. Factor analysis was conducted to examine for the construct validity. Results: 16 graduates participated in the RCSI-Bahrain interns’ award based on the MSF process, giving us a 16.5% response rate. The instrument was found to be suitable for factor analysis and showed 3 factor solutions representing 79.3% of the total variance. Reliability analysis using Cronbach’s α reliability of internal consistency indicated that the full scale of the instrument had high internal consistency (Cronbach’s α 0.98). Conclusion: This study found the MSF process to be reliable and valid for selecting the best graduates for the interns’ awards. However, the low response rates may suggest that the process is not feasible for allowing the majority of the students to participate in the selection process. Further research studies may be required to support the feasibility of the MSF process in selecting graduates for the university award.

Keywords: MSF, RCSI, validity, Bahrain

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Authors: Siddhant Yadav, Ann Vincent, Sanjeev Nanda, Karen M. Fischer, Jessica A. Wright

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Statement of the Problem: Despite the growing popularity of cannabis in the general population, there are several unknowns regarding its use, specific reasons for use, patient’s choice of products, health benefits, and adverse effects. The aim of our study was to evaluate patient-reported information related to cannabis use that was recorded in the electronic medical records. Methodology & Theoretical Orientation: We manually reviewed the electronic medical records of cannabis users who were part of a large pharmacogenomic study. Data abstracted included demographics, level of education, concurrent alcohol and tobacco use, type of cannabis utilized, formulation, indication, symptomatic improvement, or adverse effects reported. Following this, we did a descriptive statistical analysis. Findings: Our sample of 164 cannabis users were predominantly female (73.2%); 66% of users reported using cannabis for medical indications. Of the 109 patients who recorded information pertaining to alcohol/tobacco use, two-thirds of cannabis users reported concurrent use of alcohol, and about half of them were former or current tobacco users. The mean age of cannabis use was 66 years. Regarding the type of cannabis, 34.1% reported using marijuana, 32.3% reported CBD use, 1.8% reported using THC, and 1.2% reported using Marinol. Oral formulations (capsules, oils, suspensions, brownies, cakes, and tea) were the most common route (44 %). Indications for use included chronic pain (n=76), anxiety (n=9), counteracting side effects of chemotherapy (n=4), and palliative reasons (n=2). Fifty-eight of the 76 users endorsed improvement in chronic pain (80%), 5 users reported improvement in anxiety, and 2 reported improvement in side effects of chemotherapy. Conclusion & Significance: The majority of our cannabis users were Caucasian females, and there was a high likelihood of coinciding use of alcohol/tobacco in patients using cannabis. Most of our patients used the oral formulation for chronic pain. Importantly, a considerable number of patients reported improvements in chronic pain, anxiety, and side effects of chemotherapy.

Keywords: cannabis use, adverse effects, medical practice, indications

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Authors: Brian Bilich

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A typical global learning program is a two-week project based, culturally immersive and academically relevant experience built around a project with purpose and catered to student and business groups. Global Learning in Continuing Education at Austin Community College promotes global readiness through projects with purpose with special attention given to balancing learning, hospitality and travel. A recent project involved CommunityFirst! Village; a 51-acre planned community which provides affordable, permanent housing for men and women coming out of chronic homelessness. Global Learning students collaborated with residents and staff at the Community First! Village on a project to produce two-dimensional remodeling plans of residents’ tiny homes with a focus on but not limited to design improvements on elements related to accessibility, increased usability of living and storage space and esthetic upgrades to boost psychological and emotional appeal. The goal of project-based learning in the context of global learning in Continuing Educaiton at Austin Community Collegen general is two fold. One, in rapid fashion we develop a project which gives the learner a hands-on opportunity to exercise soft and technical skills, like creativity and communication and analytical thinking. Two, by basing projects on global social conflict issues, the project of purpose promotes the development of empathy for other people and fosters a sense of corporate social responsibility in future generations of business leadership. In the example provide above the project informed the student group on the topic of chronic homelessness and promoted awareness and empathy for this underserved segment of the community. Project-based global learning based on projects with purpose has the potential to cultivate global readiness by developing empathy and strengthening emotional intelligence for future generations.

Keywords: project-based learning, global learning, global readiness, globalization, international exchange, collaboration

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Authors: Sandra Maria Cerqueira Da Silva

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In Brazil, women are the majority of the country's population. They have advanced in terms of years of education and professional training. However, this has not prevented the differences in the labor market from being sustained, particularly the wage gap and inequalities concerning the access to command positions and promotions, i.e., in the gender relations and treatment. One of the conditions which constitute a barrier to career advancement is the necessary support chain to support women when they are in the labor market. Therefore, the purpose of this research is to demonstrate, describe, and criticize some of the current conformations of support chains and how these compete to promote the phenomenon known as glass ceiling in the country. However, this support may come even from inside a woman's own home, with a fairer division of household activities between men and women. Such behavior can free an entire network of women within the same family. In addition, it can serve as pressure to structure better conditions for women as a whole, improving the living conditions of the poor population. This can occur through programs and projects for qualification and retraining of adult women. In answer to the question that guides this study, it is concluded that a family support system is critical to the success of women in management positions. To meet this demand, one of the ways could be the development of specific gender policies by the public authorities, in accordance with the emerging global economic policies, in order to provide and structure the necessary support. This would respond to feminist manifestations - which should go on pointing needs – although the legislative assembly should also propose ideas to change this picture. This is a qualitative research, with a poststructuralist approach, featuring a cutout corpus of three interviews carried out with women holding leadership positions in the academia. Questions related to this very discussion are many. New studies could address points as the promotion of qualification and expansion of skills of women in subaltern condition. There is also need to investigate possible support systems, considering the inequalities and local economic conditions.

Keywords: gender and labor market, glass ceiling, post-structuralism, support chain

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Authors: S. O. Ayansina, O. A. Adekunle

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There is an increasing demand for a functional extension delivery services in Nigeria with a view to meet up with the food and fiber needs of the ever growing population of human and animal respectively. The study was therefore designed to examine the farmers’ preference for public and private extension services in Southwestern Nigeria, specifically to determine the farmers’ level of participation in the two types of organizations involved and also to evaluate the Performance level of personnel in the two organizations in order to ascertain the beneficiaries’ satisfaction. A multi-stage random sampling technique was used to samples 30 respondents from each of the three selected organizations in each of the three states sampled in Southwestern Nigeria. Hence, 270 respondents were sampled for the study. Data collected were analyzed with Kruskal Wallis one-way Analysis of variance to test the difference between the participation of beneficiaries in the public and private extension services and the level of benefit accrued from the two organizations involved in the study. Results generally revealed that private organizations were performing better and were more preferred by the beneficiaries. Results of the tested hypotheses as shown by Kruskal Wallis test of difference (x2=0.709) indicates no significant difference between farmers’ participation in the extension services of public and private organizations but however shows significant difference (X2=12.074) in the benefits achieved by respondents in the two organizations, such benefits include: increased quantity of Crop produced, farm income, skill acquisition, and improved Education in private extension organizations. Based on this result, it could be inferred that beneficiaries generally preferred private extension organizations because of their effectiveness and vibrancy in programme administration. Public extension is therefore recommended for general overhauling and possibly “merging” of public and private sectors in order to cater for teeming population of farmers demanding for efficient and functional extension services to better their lots both in production and processing.

Keywords: public and private involvement, extension services, farmers’ preferences, Kruskal Wallis Test

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Authors: Reem Alsager, James Milton

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Coxhead’s (2000) Academic Word List (AWL) believed to be essential for students pursuing higher education and helps differentiate English for Academic Purposes (EAP) from General English as a course of study, and it is thought to be important for comprehending English academic texts. It has been described that AWL is an infrequent, discrete set of vocabulary items unreachable from general language. On the other hand, it has been known for a period of time that general vocabulary knowledge is a good predictor of academic achievement. This study, however, is an attempt to measure and compare the contribution of academic knowledge and general vocabulary knowledge to learners’ GPA and examine what knowledge is a better predictor of academic achievement and investigate whether AWL as a specialised list of infrequent words relates to the frequency effect. The participants were comprised of 44 international postgraduate students in Swansea University, all from the School of Management, following the taught MSc (Master of Science). The study employed the Academic Vocabulary Size Test (AVST) and the XK_Lex vocabulary size test. The findings indicate that AWL is a list based on word frequency rather than a discrete and unique word list and that the AWL performs the same function as general vocabulary, with tests of each found to measure largely the same quality of knowledge. The findings also suggest that the contribution that AWL knowledge provides for academic success is not sufficient and that general vocabulary knowledge is better in predicting academic achievement. Furthermore, the contribution that academic knowledge added above the contribution of general vocabulary knowledge when combined is really small and noteworthy. This study’s results are in line with the argument and suggest that it is the development of general vocabulary size is an essential quality for academic success and acquiring the words of the AWL will form part of this process. The AWL by itself does not provide sufficient coverage, and is probably not specialised enough, for knowledge of this list to influence this general process. It can be concluded that AWL as an academic word list epitomizes only a fraction of words that are actually needed for academic success in English and that knowledge of academic vocabulary combined with general vocabulary knowledge above the most frequent 3000 words is what matters most to ultimate academic success.

Keywords: academic achievement, academic vocabulary, general vocabulary, vocabulary size

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Authors: Andrea Scapolo, Zaya Rustamova, Arturo Matute Castro

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The “Voices in Dissent” initiative aims at collecting and making available in a digital format, testimonies, letters, and other narratives produced by victims of political oppression from different geographical spaces across the Atlantic. By recovering silenced voices behind the official narratives, this open-access online database will provide indispensable tools for rewriting the history of authoritarian regimes from the margins as memory debates continue to provoke controversy among academic and popular transnational circles. In providing an extensive database of non-hegemonic discourses in a variety of political and social contexts, the project will complement the existing European and Latin-American studies, and invite further interdisciplinary and trans-national research. This digital resource will be available to academic communities and the general audience and will be organized geographically and chronologically. “Voices in Dissent” will offer a first comprehensive study of these personal accounts of persecution and repression against determined historical backgrounds and their impact on collective memory formation in contemporary societies. The digitalization of these texts will allow to run metadata analyses and adopt comparatist approaches for a broad range of research endeavors. Most of the testimonies included in our archive are testimonies of trauma: the trauma of exile, imprisonment, torture, humiliation, censorship. The research on trauma has now reached critical mass and offers a broad spectrum of critical perspectives. By putting together testimonies from different geographical and historical contexts, our project will provide readers and scholars with an extraordinary opportunity to investigate how culture shapes individual and collective memories and provides or denies resources to make sense and cope with the trauma. For scholars dealing with the epistemological and rhetorical analysis of testimonies, an online open-access archive will prove particularly beneficial to test theories on truth status and the formation of belief as well as to study the articulation of discourse. An important aspect of this project is also its pedagogical applications since it will contribute to the creation of Open Educational Resources (OER) to support students and educators worldwide. Through collaborations with our Library System, the archive will form part of the Digital Commons database. The texts collected in this online archive will be made available in the original languages as well as in English translation. They will be accompanied by a critical apparatus that will contextualize them historically by providing relevant background information and bibliographical references. All these materials can serve as a springboard for a broad variety of educational projects and classroom activities. They can also be used to design specific content courses or modules. In conclusion, the desirable outcomes of the “Voices in Dissent” project are: 1. the collections and digitalization of political dissent testimonies; 2. the building of a network of scholars, educators, and learners involved in the design, development, and sustainability of the digital archive; 3. the integration of the content of the archive in both research and teaching endeavors, such as publication of scholarly articles, design of new upper-level courses, and integration of the materials in existing courses.

Keywords: digital archive, dissent, open educational resources, testimonies, transatlantic studies

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Authors: Petcharat Kerdonfag, Surasak Taneepanichskul, Winai Wadwongtham

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Background: Although there have not been effective treatments for Noise Induced Hearing Loss (NIHL), it can be definitely preventable with promoting the use of Hearing Protection devices (HPDs) among workers who have been exposed to excessive noise for a long period. Objectives: The objectives of this study were to explore the use of HPDs among steel industrial workers in the high noise level zone in Samut Prakan province, Thailand and to examine the relationships of the HPDs use and hearing loss. Materials and Methods: In this cross-sectional study, eligible ninety-three participants were recruited in the designated zone of higher noise (> 85dBA) of two factories, using simple random sampling. The use of HPDs was gathered by the self-record form, examined and confirmed by the researcher team. Hearing loss was assessed by the audiometric screening at the regional Samut Prakan hospital. If an average threshold level exceeds 25 dBA at high frequency (4 and 6 Hz) in each ear, participants would be lost of hearing. Data were collected from October to December, 2016. All participants were examined by the same examiners for the validity. An Audiometric testing was performed with the participants who have been exposed to high noise levels at least 14 hours from workplace. Results: Sixty participants (64.5%) had secondary level of education. The average mean score of percent time of using HPDs was 60.5% (SD = 25.34). Sixty-seven participants (72.0%) had abnormal hearing which they have still needed to increase lower percent time of using HPDs (Mean = 37.01, SD = 23.81) than those having normal hearing (Mean = 45.77, SD = 28.44). However, there was no difference in the mean average of percent time of using HPDs between these two groups.Conclusion: The findings of this study have confirmed that the steel industrial workers still need to be motivated to use HPDs regularly. Future research should pay more attentions for creating a meaningful innovation to steel industrial workers.

Keywords: hearing protection devices, noise induced hearing loss, audiometric testing, steel industry

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Authors: Dennis Schmickle

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Introductory statement: Augmented reality (AR) can be used to breathe life into traditional graphic design media, such as posters, book covers, and album art. AR superimposes a unique image/video on a user’s view of the real world, which makes it more immersive and realistic than traditional 2D media. This study developed a series of projects that utilize both traditional and AR media to teach the fundamental principles of graphic design. The results of this study suggest that AR can be an effective tool for teaching graphic design. Abstract: Traditional graphic design media, such as posters, book covers, and album art, could be considered to be “old media.” However, augmented reality (AR) can breathe life into these formats by making them more interactive and engaging for students and audiences alike. AR is a technology that superimposes a computer-generated image on a user’s view of the real world. This allows users to interact with digital content in a way that is more immersive and interactive than traditional 2D media. AR is becoming increasingly popular, as more and more people have access to smartphones and other devices that can support AR experiences. This study is comprised of a series of projects that utilize both traditional and AR media to teach the fundamental principles of graphic design. In these projects, students learn to create traditional design objects, such as posters, book covers, and album art. However, they are also required to create an animated version of their design and to use AR software to create an AR experience with which viewers can interact. The results of this study suggest that AR can be an effective and exciting tool for teaching graphic design. The students who participated in the study were able to learn the fundamental principles of graphic design, and they also developed the skills they need to create effective AR content. This study has implications for the future of graphic design education. As AR becomes more popular, it is likely that it will become an increasingly important tool for teaching graphic design.

Keywords: graphic design, augmented reality, print media, new media, AR, old media

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Authors: Caroline Seo, Jennifer Stephens, Kirstin H. Heinrich

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Background: Clostridiodes (formerly Clostridium) difficile infection (CDI) is an anaerobic, spore-forming bacterium with manifestations including diarrhea, pseudomembranous colitis and toxic megacolon. Despite general understanding that CDI may be associated with marked burden on patients’ health, there has been limited information available on the humanistic burden of CDI. The objective of this literature review was to summarize the published data on the humanistic burden of CDI globally, in order to better inform future research efforts and increase awareness of the patient perspective in this disease. Methods: A comprehensive literature review of the past 15 years (2002-2017) was conducted using MEDLINE, Embase and Cumulative Index of Nursing and Allied Health Literature. Additional searches were conducted from conference proceedings (2015-2017). Articles selected were studies specifically designed to examine the humanistic burden of illness associated with adult patients with CDI. Results: Of 3,325 articles or abstracts identified, 33 remained after screening and full text review. Sixty percent (60%) were published in 2016 or 2017. Data from the United States or Western Europe were most common. Data from Brazil, Canada, China and Spain also exist. Thirteen (13) studies used validated patient-reported outcomes instruments, mostly EQ-5D utility and SF-36 generic instruments. Three (3) studies used CDI-specific instruments (CDiff32, CDI-DaySyms). The burden of CDI impacts patients in multiple health-related quality of life (HRQOL) domains. SF-36 domains with the largest decrements compared to other GI diarrheal diseases (IBS-D and Crohn’s) were role physical, physical functioning, vitality, social functioning, and role emotional. Reported EQ-5D utilities for CDI ranged from 0.35-0.42 compared to 0.65 in Crohn’s and 0.72 in IBS-D. The majority of papers addressed physical functioning and mental health domains (67% for both). Across various studies patients reported weakness, lack of appetite, sleep disturbance, functional dependence, and decreased activities of daily lives due to the continuous diarrhea. Due to lack of control over this infection, CDI also impacts the psychological and emotional quality of life of the patients. Patients reported feelings of fear, anxiety, frustration, depression, and embarrassment. Additionally, the type of disease (primary vs. recurrent) may impact mental health. One study indicated that there is a decrement in SF-36 mental scores in patients with recurrent CDI, in comparison to patients with primary CDI. Other domains highlighted by these studies include pain (27%), social isolation (27%), vitality and fatigue (24%), self-care (9%), and caregiver burden (0%). Two studies addressed work productivity, with 1 of these studies reporting that CDI patients had the highest work productivity and activity impairment scores among the gastrointestinal diseases. No study specifically included caregiver self-report. However, 3 studies did provide mention of patients’ worry on how their diagnosis of CDI would impact family, caregivers, and/or friends. Conclusions: Despite being a serious public health issue there has been a paucity of research on the HRQOL among those with CDI. While progress is being made, gaps exist in understanding the burden on patients, caregivers, and families. Future research is warranted to aid understanding of the CDI patient perspective.

Keywords: burden, Clostridiodes, difficile, humanistic, infection

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Authors: Monalisha Ghosh, Asit Mohanty

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The lack of sanitation increases living costs, decreases spend on education and nutrition, lowers income earning potential, and threatens safety and welfare. This is especially true for rural India. Only 32% of rural households have their own toilets and that less than half of Indian households have a toilet at home. Of the estimated billion people in the world who defecate in the open, more than half reside in rural India. It is empirically established that poor sanitation leads to high infant mortality rate and low income generation in rural India. In India, 1,600 children die every day before reaching their fifth birthday and 24% of girls drop out of school as the lack of basic sanitation. Above all, lack of sanitation is not a symptom of poverty but a major contributing factor. According to census 2011, 67.3% of the rural households in the country still did not have access to sanitation facilities. India’s sanitation deficit leads to losses worth roughly 6% of its gross domestic product (GDP) according to World Bank estimates by raising the disease burden in the country. The dropout rate for girl child is thirty percent in schools in rural areas because of lack of sanitation facilities for girl students. The productivity loss per skilled labors during a year is calculated at Rs.44, 160 in Odisha. The performance of the state of Odisha has not been satisfactory in improving sanitation facilities. The biggest challenge is triggering behavior change in vast section of rural population regarding need to use toilets. Another major challenge is funding and implementation for improvement of sanitation facility. In an environment of constrained economic resources, Public Private Partnership in form of performance based management or maintenance contract will be all the more relevant to improve the sanitation status in rural sector.

Keywords: rural sanitation, infant mortality rate, income, granger causality, pooled OLS method test public private partnership

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