Search results for: Rupert Ward

Authors: Yu-Shi Ye, Jia-Min Wu, Jhih-Ci Li

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Background: Most orthopedic inpatients and primary caregivers are elderly, and patients are at high risk of falls. We set up a quality control team to analyze the root cause and found the following issues: 1. The nursing staff did not conduct cognitive assessments of patients and their primary caregivers to ensure that health education content was understood. 2. Nurses prefer to use spoken language in health education but lack the skills to use diverse teaching materials. 3. Newly recruited nurses have insufficient awareness of fall prevention. Methods: The study subjects were 16 nurses in the orthopedic ward of a teaching hospital in central Taiwan. We implemented the following strategies: 1. Developed a fall simulation teaching plan and conducted teaching courses and assessments in the morning meeting; 2. Designed and used a "fall prevention awareness card" to improve the prevention awareness of elderly patients; 3. All staff (including new staff) received experiential education training. Results: In 2021, 40% of patients in the orthopedic wards were aged 60-79 years (792/1979) with a high risk of falls. According to data collection, the incidence of falls in hospitalized patients was 0.04% (5/12651), which exceeded the threshold of 0.02% in our ward. After completing the on-the-job education training in October, the nursing staff expressed that they were more aware of the special situation of fall prevention. Through practical sharing and drills, combined with experiential teaching strategies, nurses can reconstruct the safety awareness of fall prevention and deepen their cognitive memory. Participants scored between 30 and 80 on the pretest (16 students, mean: 72.6) and between 90 and 100 on the post-test (16 students, mean: 92.6), resulting in a 73.8% improvement in overall scores. We have a total of 4 new employees who have all completed the first 3 months of compulsory PGY courses. From January to April 2022, the incidence of falls in hospitalized patients was 0.025% (1/3969). We have made good improvements and will continue to track the outcome. Discussion: In addition to enhancing the awareness of falls among nursing staff, how-to guide patients and primary caregivers to prevent falls is also the focus of improvement. The proper way of health education can be better understood through practical exercises and case sharing.

Keywords: experiential teaching strategies, fall prevention, cognitive card, elderly patients, orthopedic wards

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Authors: Ashraf M. Ward, Ruban S. Yu

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Data consisting of 2757 records from tow Holstein herds made between 2000 and 2010 were used to examine environmental factors affecting age at first calving (AFC) and calving intervals (CI) and consequently estimate genetic and phenotypic parameters and trends. The overall means and standard errors for AFC and CI were 39.4 ± 7.2 months and 487.5 ± 151.6 days respectively. The respective heritability estimates were 0.091 ± 0.05 and 0.044 ± 0.032, while the repeatability estimate for CI was 0.096 ± 0.001. The genetic trends for CI and AFC were -0.6 d/yr and -0.01 mo/yr respectively and were both significant (P < 0.001), indicating a decrease in mean breeding value over the study period. Phenotypic trends were -0.31 mo/yr and -0.35 d/yr for AFC and CI respectively though non-significant (P > 0.05). The low heritability for CI and AFC indicated that temporary environmental influences were much greater than genetic influences or permanent environmental influences on these traits.

Keywords: Holstein, reproductive, genetic parameters, heritability

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Authors: Jeewantha Ranawaka, Gunawardane Kapila, Wijethunaga Mudiyanselage B. G. Jayathilake

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Introduction: Sweeping of the membranes is a fairly simple technique that may positively influence the shift from maintenance of pregnancy to the beginning of labor. Objective: To assess the effectiveness and acceptability of twice versus once-only membrane sweeping in uncomplicated primi gravid at 40 weeks of gestational age in a tertiary care hospital in Sri Lanka. Methods: A randomized controlled clinical trial was done in Ward 05 of Teaching Hospital, Kandy. The participants were primi-gravida with a singleton live fetus who was at 40 weeks of gestation with intact fetal membranes and with a Modified Bishop’s score <5. After randomization both groups received membrane sweeping at 40 weeks of gestation and the experimental group received membrane sweeping after 48 hours (40+2 days). The modified Bishop Score was assessed at 40+5 days. In two groups who did not go into natural labor at 40+5 days were managed according to the ward policy of cervical ripening and with labor induction at 40+5 days. Two different methods were used to assess discomfort and pain. Patient acceptability was assessed using recommendation to another patient and acceptance during next pregnancy. Perinatal, maternal and labour outcomes were assessed. Results: A change of the Bishops score was 67.3% (n= 31 of 46) in experimental group whereas in control group it was 57.5% (n= 38 of 66). (p = 0.21, OR-1.52, CI = 0.6 -3.34). Mean (SD) of Modified Bishop score was 6.36 (1.94) in experimental group and 6.03 (.84) in control group (p = 0.354). The probability of having the spontaneous onset of labour in experimental group was 61.6% (n=74 of 120) whereas in control group it was 45% (n= 54 of 120) (p=0.01, OR-1.966, CI = 1.17 – 3.28 NNT = 5.99). Recommending the method to another among experimental group was 75% (n= 90 of 120) whereas in control group it was 79.2% (n= 95 of 120) (p= 0.443). Accepting membrane Sweeping for subsequent pregnancy among experimental was 72.5% (n=87 of 120) whereas in control group was 72.5% (n=87 of 120) (p= 1.00) Need of formal induction of labour at 40+ 5 days in experimental group was 38.4% (n=46 of 120) whereas in control group was 61.6% (n=66 of 120) (p=0.01, OR=0.5, CI= 0.3 – 0.8, NNT=6). Neonatal outcome, labour outcome such as Cesarean -section rate, need for augmentation and maternal complications such as fever, Premature rupture of membrane, bleeding were comparable in two groups. Conclusions and Recommendations: It can be concluded that twice sweeping of membrane was effective to reduce the need of formal induction of labour and increase the chances of having spontaneous onset of labour (SOL) at 40+5 days without increasing maternal or fetal morbidity. Acceptability of twice sweeping is not different from sweeping once. Hence we recommend consideration of multiple membranes sweeping as first line for women at 40 weeks of gestation.

Keywords: acceptability, induction, labour, membrane sweeping

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Authors: M. Walmsley, S. Elmatarri, S. Mannion

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Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved.

Keywords: adult major trauma, attempted suicide, self-inflicted major trauma, inpatient management

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Authors: Marc Sebastián-Romagosa, Woosang Cho, Rupert Ortner, Christy Li, Christoph Guger

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Neurorehabilitation based on Brain-Computer Interfaces (BCIs) shows important rehabilitation effects for patients after stroke. Previous studies have shown improvements for patients that are in a chronic stage and/or have severe hemiparesis and are particularly challenging for conventional rehabilitation techniques. For this publication, seven stroke patients in the chronic phase with hemiparesis in the lower extremity were recruited. All of them participated in 25 BCI sessions about 3 times a week. The BCI system was based on the Motor Imagery (MI) of the paretic ankle dorsiflexion and healthy wrist dorsiflexion with Functional Electrical Stimulation (FES) and avatar feedback. Assessments were conducted to assess the changes in motor improvement before, after and during the rehabilitation training. Our primary measures used for the assessment were the 10-meters walking test (10MWT), Range of Motion (ROM) of the ankle dorsiflexion and Timed Up and Go (TUG). Results show a significant increase in the gait speed in the primary measure 10MWT fast velocity of 0.18 m/s IQR = [0.12 to 0.2], P = 0.016. The speed in the TUG was also significantly increased by 0.1 m/s IQR = [0.09 to 0.11], P = 0.031. The active ROM assessment increased 4.65º, and IQR = [ 1.67 - 7.4], after rehabilitation training, P = 0.029. These functional improvements persisted at least one month after the end of the therapy. These outcomes show the feasibility of this BCI approach for chronic stroke patients and further support the growing consensus that these types of tools might develop into a new paradigm for rehabilitation tools for stroke patients. However, the results are from only seven chronic stroke patients, so the authors believe that this approach should be further validated in broader randomized controlled studies involving more patients. MI and FES-based non-invasive BCIs are showing improvement in the gait rehabilitation of patients in the chronic stage after stroke. This could have an impact on the rehabilitation techniques used for these patients, especially when they are severely impaired and their mobility is limited.

Keywords: neuroscience, brain computer interfaces, rehabilitat, stroke

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Authors: Abdulla Rahil, Rupert Gammon, Neil Brown

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The rapid growth of renewable energy sources and their integration into the grid have been motivated by the depletion of fossil fuels and environmental issues. Unfortunately, the grid is unable to cope with the predicted growth of renewable energy which would lead to its instability. To solve this problem, energy storage devices could be used. Electrolytic hydrogen production from an electrolyser is considered a promising option since it is a clean energy source (zero emissions). Choosing flexible operation of an electrolyser (producing hydrogen during the off-peak electricity period and stopping at other times) could bring about many benefits like reducing the cost of hydrogen and helping to balance the electric systems. This paper investigates the price of hydrogen during flexible operation compared with continuous operation, while serving the customer (hydrogen filling station) without interruption. The optimization algorithm is applied to investigate the hydrogen station in both cases (flexible and continuous operation). Three different scenarios are tested to see whether the off-peak electricity price could enhance the reduction of the hydrogen cost. These scenarios are: Standard tariff (1 tier system) during the day (assumed 12 p/kWh) while still satisfying the demand for hydrogen; using off-peak electricity at a lower price (assumed 5 p/kWh) and shutting down the electrolyser at other times; using lower price electricity at off-peak times and high price electricity at other times. This study looks at Derna city, which is located on the coast of the Mediterranean Sea (32° 46′ 0 N, 22° 38′ 0 E) with a high potential for wind resource. Hourly wind speed data which were collected over 24½ years from 1990 to 2014 were in addition to data on hourly radiation and hourly electricity demand collected over a one-year period, together with the petrol station data.

Keywords: hydrogen filling station off-peak electricity, renewable energy, off-peak electricity, electrolytic hydrogen

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Authors: Charlie Jeffkins

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Sickle cell disease is a serious life-limiting condition which can reduce the quality of life for many patients. Public Health England (PHE), in partnership with the Sickle Cell Society (SCS), has created guidelines to prevent severe complications from sickle cell disease. Data was collected from Children’s Hospital for Wales between 15/03/21-26/03/21. Methods: A manual search of patient records for children under the care of Rocket Ward and a key term search of online records was used. Results: Penicillin prophylaxis was given at 90 days for 89%, 77% of TCDs scans were done at 2-3 years, and 72% have had a scan in the last year. 53% of patients have had discussions about hydroxycarbamide, whilst 65% have started it. PPV vaccination was documented for 19%. Conclusion: Overall, none of the four standards were reached; however, TCD uptake has improved. There is a need for better documentation of treatment and annual re-audits.

Keywords: paediatric, haematology, sickle cell, audit

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Authors: Chris Landorf, Stephen Ward

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This paper addresses a virtual environment approach to work integrated learning for students in construction-related disciplines. The virtual approach provides a safe and pedagogically rigorous environment where students can apply theoretical knowledge in a simulated real-world context. The paper describes the development of a 4-dimensional digital construction environment and associated learning activities funded by the Australian Office for Learning and Teaching. The environment was trialled with over 1,300 students and evaluated through questionnaires, observational studies and coursework analysis. Results demonstrate a positive impact on students’ technical learning and collaboration skills, but there is need for further research in relation to critical thinking skills and work-readiness.

Keywords: architectural education, construction industry, digital learning environments, immersive learning

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Authors: Melissa Langevin, Natalie Ward, Colleen Fitzgibbons, Christa Ramsey, Melanie Hogue, Anna Theresa Lobos

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Description: Root Cause Analysis (RCA) is used by health care teams to examine adverse events (AEs) to identify causes which then leads to recommendations for prevention Despite widespread use, RCA has limitations. Best practices have not been established for implementing recommendations or tracking the impact of interventions after AEs. During phase 1 of this study, we used simulation to analyze two fictionalized AEs that occurred in hospitalized paediatric patients to identify and understand how the errors occurred and generated recommendations to mitigate and prevent recurrences. Scenario A involved an error of commission (inpatient drug error), and Scenario B involved detecting an error that already occurred (critical care drug infusion error). Recommendations generated were: improved drug labeling, specialized drug kids, alert signs and clinical checklists. Aim: Use simulation to optimize interventions recommended post critical event analysis prior to implementation in the clinical environment. Methods: Suggested interventions from Phase 1 were designed and tested through scenario simulation in the clinical environment (medicine ward or pediatric intensive care unit). Each scenario was simulated 8 times. Recommendations were tested using different, voluntary teams and each scenario was debriefed to understand why the error was repeated despite interventions and how interventions could be improved. Interventions were modified with subsequent simulations until recommendations were felt to have an optimal effect and data saturation was achieved. Along with concrete suggestions for design and process change, qualitative data pertaining to employee communication and hospital standard work was collected and analyzed. Results: Each scenario had a total of three interventions to test. In, scenario 1, the error was reproduced in the initial two iterations and mitigated following key intervention changes. In scenario 2, the error was identified immediately in all cases where the intervention checklist was utilized properly. Independently of intervention changes and improvements, the simulation was beneficial to identify which of these should be prioritized for implementation and highlighted that even the potential solutions most frequently suggested by participants did not always translate into error prevention in the clinical environment. Conclusion: We conclude that interventions that help to change process (epinephrine kit or mandatory checklist) were more successful at preventing errors than passive interventions (signage, change in memory aids). Given that even the most successful interventions needed modifications and subsequent re-testing, simulation is key to optimizing suggested changes. Simulation is a safe, practice changing modality for institutions to use prior to implementing recommendations from RCA following AE reviews.

Keywords: adverse events, patient safety, pediatrics, root cause analysis, simulation

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Authors: Ward Makhoul

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Code-switching (CS) is known as a ubiquitous phenomenon in multilingual societies and countries. Vernacular Palestinian Arabic (PA) variety spoken in Israel is among these languages, informally used for day-to-day conversations only. Such conversations appear to contain code-switched instances from Hebrew, the formal and dominant language of the country, even in settings where the need for CS seems to be unnecessary. This study examines the CS practices in PA and investigates the reason behind these CS instances in controlled settings and the correlation between bilingual dominance and CS. In the production-task interviews and Bilingual Language Profile test (BLP), there was a correlation between language dominance and CS; 13 participants were interviewed to elicit and analyze natural speech-containing CS instances, along with undergoing a BLP test. The acceptability judgment task observed the limits and boundaries of different code-switched linguistic structures.

Keywords: code-switching, Hebrew, Palestinian-Arabic, vernacular

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Authors: Mohd Izmir Bin Yamin, Thomas Arthur Ward

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Past aerodynamic studies of flapping wing flight have shown that it has increased aerodynamic performances compared to fixed wing steady flight. One of the dominant mechanisms that is responsible for causing this phenomenon is a leading edge vortex, generated by the flapping motion of a flexible wing. Wind tunnel experiments were conducted to observe the aerodynamic profile of a flapping wing, by measuring the lift, drag and thrust. Analysis was done to explain how unsteady aerodynamics leads towards better power performances than a fixed wing flight. The information from this study can be used as a base line for designing future Bio-mimetic Micro Air Vehicles that are based on flying insect aerodynamic mechanisms.

Keywords: flapping wing flight, leading edge vortex, aerodynamics performances, wind tunnel test

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Authors: ShuYing Chung, Minchuan Huang, Iping Chen

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Taking the medical staff in an emergency ward of a medical center in Central Taiwan as the research object, the questionnaire data were collected by anonymous and voluntary reporting methods with structured questionnaire to explore the actual situation, willingness and attitude of organ donation. Only 80 valid questionnaires were collected. Among the 8 questions, the average correct rate was 5.9 + 1.2, and the correct rate was 73.13%. The willingness of organ donation that 7.5% of the people are not willing; 92.5% of the people are willing, of which 62.5% have considered but have not yet decided; 21.3% are willing but have not signed the consent of organ donation; They have signed the consent of organ donation 8.7%. The average total score (standard deviation) of attitude towards organ donation was 36.2. There is no significant difference between the demographic variables and the awareness and willingness of organ donation, but there is a significant correlation between the marital status and the attitude of organ donation.

Keywords: clinical psychology, organ donation, doctors affecting psychological disorders, commitment

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Authors: Jui Chen Wu, Ming Yi Hsu

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Background and Purpose: Shift work of nursing staff is inevitable in hospital to provide continuing medical care. However, shift work is considered as a health hazard that may cause physical and psychological problems. Serious workplace fatigue of nursing shift work might impact on family, social and work life, moreover, causes serious reduction of quality of medical care, or even malpractice. This study aims to explore relationships among nursing staff’s shift, workplace fatigue and quality of working life. Method: Structured questionnaires were used in this study to explore relationships among shift work, workplace fatigue and quality of working life in nursing staffs. We recruited 590 nursing staffs in different Community Teaching hospitals in Taiwan. Data analysed by descriptive statistics, single sample t-test, single factor analysis, Pearson correlation coefficient and hierarchical regression, etc. Results: The overall workplace fatigue score is 50.59 points. In further analysis, the score of personal burnout, work-related burnout, over-commitment and client-related burnout are 57.86, 53.83, 45.95 and 44.71. The basic attributes of nursing staff are significantly different from those of workplace fatigue with different ages, licenses, sleeping quality, self-conscious health status, number of care patients of chronic diseases and number of care people in the obstetric ward. The shift variables revealed no significant influence on workplace fatigue during the hierarchical regression analysis. About the analysis on nursing staff’s basic attributes and shift on the quality of working life, descriptive results show that the overall quality of working life of nursing staff is 3.23 points. Comparing the average score of the six aspects, the ranked average score are 3.47 (SD= .43) in interrelationship, 3.40 (SD= .46) in self-actualisation, 3.30 (SD= .40) in self-efficacy, 3.15 (SD= .38) in vocational concept, 3.07 (SD= .37) in work aspects, and 3.02 (SD= .56) in organization aspects. The basic attributes of nursing staff are significantly different from quality of working life in different marriage situations, education level, years of nursing work, occupation area, sleep quality, self-conscious health status and number of care in medical ward. There are significant differences between shift mode and shift rate with the quality of working life. The results of the hierarchical regression analysis reveal that one of the shifts variables 'shift mode' which does affect staff’s quality of working life. The workplace fatigue is negatively correlated with the quality of working life, and the over-commitment in the workplace fatigue is positively related to the vocational concept of the quality of working life. According to the regression analysis of nursing staff’s basic attributes, shift mode, workplace fatigue and quality of working life related shift, the results show that the workplace fatigue has a significant impact on nursing staff’s quality of working life. Conclusion: According to our study, shift work is correlated with workplace fatigue in nursing staffs. This results work as important reference for human resources management in hospitals to establishing a more positive and healthy work arrangement policy.

Keywords: nursing staff, shift, workplace fatigue, quality of working life

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Authors: Angelos Kaminis, Dakotah Stirnweis

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Advances in robotic technology have driven the development of improved robotic companions in the last couple decades. However, commercially available robotic companions lack the ability to create an emotional connection with their user. By developing a companion robot that has a symbiotic relationship with a plant, an element of co-dependency is introduced into the human companion robot dynamic. This companion robot, while theoretically capable of providing most of the plant’s needs, still requires human interaction for watering, moving obstacles, and solar panel cleaning. To facilitate the interaction between human and robot, the robot is capable of limited auditory and visual communication to help express its and the plant’s needs. This paper seeks to fully describe the Autonomous Plant Care Robot system and its symbiotic relationship with its botanical ward and the plant and robot’s dependent relationship with their owner.

Keywords: symbiotic, robotics, autonomous, plant-care, companion

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Authors: Shinji Kawakura, Ryosuke Shibasaki

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We have been grouping and developing various kinds of practical, promising sensing applied systems concerning agricultural advancement and technical tradition (guidance). These include advanced devices to secure real-time data related to worker motion, and we analyze by methods of various advanced statistics and human dynamics (e.g. primary component analysis, Ward system based cluster analysis, and mapping). What is more, we have been considering worker daily health and safety issues. Targeted fields are mainly common farms, meadows, and gardens. After then, we observed and discussed time-line style, changing data. And, we made some suggestions. The entire plan makes it possible to improve both the aforementioned applied systems and farms.

Keywords: advanced statistical analysis, wearable sensing system, tradition of skill, supporting for workers, detecting crisis

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Authors: Miriam Schiff, Hadas Rosenne, Ran Nir-Paz, Shiri Shinan Altman

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To examine (1) the level, predictors, and subjective perception of professional quality of life (PRoQL), posttraumatic growth, roles, task changes during the pandemic, and perceived preparedness for the next pandemic. These variables were added as part of an international study on social workers in healthcare stress, resilience, and perceived preparedness we took part in, along with Australia, Canada, China, Hong Kong, Singapore, and Taiwan. (2) The extent to which background variables, rate of exposure to the virus, working in COVID wards, profession, personal resilience, and resistance to organizational change predict posttraumatic growth, perceived preparedness, and PRoQL (the latter was examined among social workers only). (3) The teams' perceptions of how the pandemic impacted them at the personal, professional, and organizational levels and what assisted them. Methodologies: Mixed quantitative and qualitative methods were used. 1039 hospital healthcare workers from various professions participated in the quantitative study while 32 participated in in-depth interviews. The same methods were used in six other countries. Findings: The level of PRoQL was moderate, with higher burnout and secondary traumatization level than during routine times. Differences between countries in the level of PRoQL were found as well. Perceived preparedness for the next pandemic at the personal level was moderate and similar among the different health professions. Higher exposure to the virus was associated with lower perceived preparedness of the hospitals. Compared to other professions, doctors and nurses perceived hospitals as significantly less prepared for the next pandemic. The preparedness of the State of Israel for the next pandemic is perceived as low by all healthcare professionals. A moderate level of posttraumatic growth was found. Staff who worked at the COVID ward reported a greater level of growth. Doctors reported the lowest level of growth. The staff's resilience was high, with no differences among professions or levels of exposure. Working in the COVID ward and resilience predicted better preparedness, while resistance to organizational change predicted worse preparedness. Findings from the qualitative part of the study revealed that healthcare workers reported challenges at the personal, professional and organizational level during the different waves of the pandemic. They also report on internal and external resources they either owned or obtained during that period. Conclusion: Exposure to the COVID-19 virus is associated with secondary traumatization on one hand and personal posttraumatic growth on the other hand. Personal and professional discoveries and a sense of mission helped cope with the pandemic that was perceived as a historical event, war, or mass casualty event. Personal resilience, along with the support of colleagues, family, and direct management, were seen as significant components of coping. Hospitals should plan ahead and improve their preparedness to the next pandemic.

Keywords: covid-19, health-care, social workers, burnout, preparedness, international perspective

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Authors: Jiexiu Chen

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This research aims to examine several vital issues relating to the foreign scholars’ cross-cultural adaptation in China, including how they perceive about the adaptation process, what the affecting factors are in the adaptation, and which strategies they will apply to deal with perceived cultural differences. The target population of this research is academics regularly working or long-term visiting in these joint colleges, and semi-structured interviews are used in data collection. Moreover, the theoretical perspectives mainly include Ward’s sociocultural and psychological adaptation theory, Berry’s adaptation strategies and Black and his colleague’s expatriate’s adjustment model. This research offers an in-depth profile as well as theory-based analysis about this unique group, and the results of this research are profound in offering directory suggestions for foreign scholars to facilitate their adaptation in China better and for the Chinese universities to eliminate intercultural obstacles, and optimize the international cooperation programs in China.

Keywords: cross-cultural adaptation, foreign scholars, expatriates

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Authors: Eng Lye, Ooi

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The Old Man and The Sea is a novella written by Ernest Hemingway that depicts an old fisherman’ journey out into the deep sea in his pursuit to catch a big fish. Through this novella, Hemingway creates a world for his protagonist, Santiago who is portrayed as an old man who has gone eighty-four days without catching a fish, at last hooks an eighteen-foot marlin, the largest he ever known. The old man endures pain and struggles to bring back to shore. Looking through the lens of gerotranscendence, we can see that the old man has his dreams, and goals in life. In his pursuit for happiness, he has fought tirelessly to ward off the shark attacks and finally he won even though only half of his fish is left. Hemingway has portrayed Santiago as an old man as a transcendent self leaping from the dimension of “The Self” to the cosmic dimension with the personal and social relationship dimension in tow. The Old Man and The Sea offers a glimpse of the struggles of an old man, who is old and gaunt but spiritually undefeated in his battle out in the sea. He is surprisingly strong and powerful despite his old age, he respects the sea, the birds. the turtles, the sharks and the fish. He can endure suffering and is focussed on achieving his goals. This is what Hemingway has portrayed Santiago to be a gerotranscendent in the eyes of the gerotranscendental approach in respect of the changes and development as seen in Santiago, the protagonist in this novella.

Keywords: gerotranscendence, gerotranscendenatal, old man, the sea, hemingway

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Authors: Trung Le Thanh

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Soil permeability coefficient is an important parameter that affects the effectiveness of mortar restoration work to reinforce soft soil. Currently, there are many methods to determine the permeability coefficient of ground through laboratory and field experiments. However, the value of the permeability coefficient is determined very differently depending on the geology in general and the sand base in particular. This article presents how to determine the permeability coefficient of sand foundation in Phu My Ward, Tan Uyen City, Binh Duong. The author analyzes and evaluates the advantages and disadvantages of assessment methods based on the data and results obtained, and on that basis recommends a suitable method for determining the permeability coefficient for sand foundations. The research results serve the evaluation of the effectiveness of grouting to reinforce soft ground in general, and grouting of bored piles in particular.

Keywords: permeability coefficient, soft soil, shaft grouting, post grouting, jet grouting

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Authors: Paulina Clara Appiah, Kofi Issah, Timothy Letsa, Kennedy Nartey, Amanua Chinbuah, Adoma Dwomo-Fokuo, Jacqeline G. Asibey

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Background: The Every Newborn Action Plan provides evidence–based interventions to end preventable deaths in high burden countries. Brong Ahafo Region is one of ten regions in Ghana with less than half of its district hospitals having sick newborn units. Facility-based neonatal care is not prioritized and under-funded, and there is also inadequate knowledge and competence to manage the sick. The aim of this intervention was to make available in–patient care for sick newborns in all 19 district hospitals through the strengthening of facility-based systems. Methods: With the development and dissemination of the National Newborn Strategy and Action Plan 2014-2018, the country was able to attract PATH which provided the region with basic resuscitation equipment, supported hospital providers’ capacity building in Helping Babies Breathe, Essential Care of Every Baby, Infection Prevention and Management and held a symposia on managing the sick newborn. Newborn advocacy was promoted through newborn champions at the facility and community levels. Hospital management was then able to mobilize resources from communities, corporate organizations and from internally generated funds; created or expanded sick newborn care units and provided essential medicines and equipment. Kangaroo Mother Care was initiated in 6 hospitals. Pediatric specialist outreach services initiated comprised telephone consultations, teaching ward rounds and participating in perinatal death audits meetings. Newborn data capture and management was improved through the provision and training on the use of standard registers provided from the national level. Results: From February 2015 to November 2017, hospitals with sick newborn units increased from 7 to 19 (37%-100%). 180 pieces each of newborn ventilation bags and masks size 0, 1 and penguin suction bulbs were distributed to the hospitals, in addition to 20 newborn mannequin sets and 90 small clinical reminder posters. 802 providers (96.9%) were trained in resuscitation, of which 96% were successfully followed up in 6 weeks, 91% in 6 months and 80% in 12 months post-training. 53 clinicians (65%) were trained and mentored to manage sick newborns. 56 specialist teaching ward rounds were conducted. Data completeness improved from 92.6% - 99.9%. Availability of essential medicines improved from 11% to 100%. Number of hospital cots increased from 116 to 248 (214%). Cot occupancy rate increased from 57.4% to 92.5%. Hospitals with phototherapy equipment increased from 0 to 12 (63%). Hospitals with incubators increased from 1 to 12 (5%-63%). Newborn deaths among admissions reduced from 6.3% to 5.4%. Conclusion: Access to in-patient care increased significantly. Newborn advocacy successfully mobilized resources required for strengthening facility –based systems.

Keywords: facility-based systems, Ghana, in-patient care, newborn advocacy

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Authors: Boma Nellie S, Nambiar Ritu, K. Kanchanmala, T. Rashida, Israell Imelda, Moul Khusnud, Michael Marina

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Gestational diabetes (GDM) imparts an increased life long risk of developing Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease in women. Once diagnosed with GDM women have up to 74% increased cumulative risk developing T2DM in 10-15 years. Identifying women at increased risk of developing T2DM and offering them pharmacological and lifestyle management interventions will delay or eliminate the development of diabetes in this population. While ADA recommends that all gestational diabetics be offered postnatal screening, worldwide the screening rates from 35-75% and Al Rahba Hospital with a robust universal antenatal screening program for GDM was at a dismal 9% in 2011. A multidisciplinary team was put together involving OB/Gyn Physicians, Midwives, Nurses (ward and OPD) Diabetic Educators, Dietitians, Medical Records, Laboratory & IT with the implementation of multiple strategies to increase the uptake of postpartum screening of the gestational diabetic.

Keywords: GDM, postnatal screening, preventing type 2 diabetes, lifestyle management

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Authors: Anjana Sreedharan, Harish Rao

Abstract:

Background: India has the world’s third largest population of people living with HIV/AIDS, with a prevalence rate of 0.69 in the state of Karnataka. This study aims at assessing the HIV/AIDS related knowledge, attitude and behavior of the medical personnel in 3 hospitals in the city of Mangalore. Methods: Surgeons, Anesthetists, OT staff nurses, ward nursing staff, House surgeons working in the hospitals associated with Kasturba Medical college, Mangalore were given questionnaires and interviewed. Their knowledge about HIV, their attitude towards HIV positive patients and bias in management of the patients was assessed. Conclusion: So far, it has been found that amongst doctors, discrimination was mainly in the form of HIV testing without consent and a lack of confidentiality. However, the doctors rarely changed the treatment plan on knowing the HIV status of the patient. Amongst the nursing staff and interns, there is a serious lacuna of knowledge regarding HIV transmission, as compared to consultants. The patient seldom faced verbal abuse from the team. Use of universal precautions is less among the entire team due to insufficient availability of the same.

Keywords: discrimination, HIV/ AIDS, medical colleges, stigma

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Authors: P. Hajyalikhani, B. Hudson, D. Boll, L. Boren, Z. Sparks, M. Ward

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Wood Light frame construction is one of the most common types of construction methods for residential and light commercial building in North America and parts of Europe. The typical roof framing for wood framed building is sloped and consists of several structural members such as rafters, hips, and valleys which are connected to the ridge and ceiling joists. The common slopes for roofs are 3/12, 8/12, and 12/12. Wood framed residential roof failure is most commonly caused by wind damage in such buildings. In the recent study, one of the weaknesses of wood framed roofs is long unsupported structural member lengths, such as hips and valleys. The purpose of this research is to find the critical support location for long hips and valleys with different slopes. ForteWeb software is used to find the critical location. The analysis results demonstrating the maximum unbraced hip and valley length are from 8.5 to 10.25 ft. dependent on the slope and roof type.

Keywords: wood frame, stick framing, hip, valley

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Authors: Intan Izafina Idrus, Mardina Abdullah, Alina Marie Hasbi, Asnawi Husin

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This paper presents the result of large-scale traveling ionospheric disturbance (LSTID) observation during moderate magnetic storm event on 25 October 2011 with SYM-H ~ -160 nT and Kp ~ 7 over Peninsular Malaysia at equatorial region using vertical total electron content (VTEC) from the Global Positioning System (GPS) observation measurement. The propagation of the LSTID signatures in the TEC measurements over Peninsular Malaysia was also investigated using VTEC map. The LSTID was found to propagate equator-ward during this event. The results showed that the LSTID propagated with an average phase velocity of 526.41 m/s and average periods of 140 min. The occurrence of this LSTID was also found to be the subsequent effects of substorm activities in the auroral region.

Keywords: Global Positioning System (GPS), large-scale traveling ionospheric disturbance (LSTID), moderate geomagnetic storm, vertical total electron content (VTEC)

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Authors: Ibrahim Shaker, Amr El Hossany, Moustafa Osman, Mohamed El Raey

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This paper will explore integration model between GIS–SCADA system and enclosure quantification model to approach the impact of failure-safe event. There are real demands to identify spatial objects and improve control system performance. Nevertheless, the employed methodology is predicting electro-mechanic operations and corresponding time to environmental incident variations. Open processing, as object systems technology, is presented for integration enclosure database with minimal memory size and computation time via connectivity drivers such as ODBC:JDBC during main stages of GIS–SCADA connection. The function of Geographic Information System is manipulating power distribution in contrast to developing issues. In other ward, GIS-SCADA systems integration will require numerical objects of process to enable system model calibration and estimation demands, determine of past events for analysis and prediction of emergency situations for response training.

Keywords: air dispersion model, environmental management, SCADA systems, GIS system, integration power system

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Authors: Ram Chandra Sah

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Few years back, naturally a very beautiful country Nepal was facing a lot of problems related to the practice of open defecation (having no toilet) by almost 98% people of the country. Now, the scenario is changed. Government of Nepal set the target of achieving the situation of basic level sanitation (toilets) facilities by 2017 AD for which the Sanitation and Hygiene Master Plan (SHMP) was brought in 2011 AD with the major beauty as institutional set up formation, local formal authority leadership, locally formulated strategic plan; partnership, harmonized and coordinated approach to working; no subsidy or support at a blanket level, community and local institutions or organizations mobilization approaches. Now, the Open Defecation Free (ODF) movement in the country is at a full swing. The Sanitation and Hygiene Master Plan (SHMP) has clearly defined Total Sanitation which is accepted to be achieved if all the households of the related boundary have achieved the 6 indicators such as the access and regular use of toilet(s), regular use of soap and water at the critical moments, regular practice of use of food hygiene behavior, regular practice of use of water hygiene behavior including household level purification of locally available drinking water, maintenance of regular personal hygiene with household level waste management and the availability of the state of overall clean environment at the concerned level of boundary. Nepal has 3158 Village Development Committees (VDC's) in the rural areas. Amarapuri VDC was selected for the purpose of achieving Total Sanitation. Based on the SHMP; different methodologies such as updating of Village Water Sanitation and Hygiene Coordination Committee (V-WASH-CC), Total Sanitation team formation including one volunteer for each indicator, campaigning through settlement meetings, midterm evaluation which revealed the need of ward level 45 (5 for all 9 wards) additional volunteers, ward wise awareness creation with the help of the volunteers, informative notice boards and hoarding boards with related messages at important locations, management of separate waste disposal rings for decomposable and non-decomposable wastes, related messages dissemination through different types of local cultural programs, public toilets construction and management by community level; mobilization of local schools, offices and health posts; reward and recognition to contributors etc. were adopted for achieving 100 % coverage of each indicator. The VDC was in a very worse situation in 2010 with just 50, 30, 60, 60, 40, 30 percent coverage of the respective indicators and became the first VDC of the country declared with Total Sanitation. The expected result of 100 percent coverage of all the indicators was achieved in 2 years 10 months and 19 days. Experiences of Amarapuri were replicated successfully in different parts of the country and many VDC's have been declared with the achievement of Total Sanitation. Thus, Community Mobilized Total Sanitation Movement in Nepal has supported a lot for achieving a Total Sanitation situation of the country with a minimal cost and it is believed that the approach can be very useful for other developing or under developed countries of the world.

Keywords: community mobilized, open defecation free, sanitation and hygiene master plan, total sanitation

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Authors: Chui Ling Teng, R. Matsa

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We report a case with combined overdose of Lercanidipine (non-dihydropyridine calcium channel blocker), Quetiapine (Atypical antipsychotic), Ramipril and Duloxetine. A 66-year old male presented to the Emergency Department 12-hours after the ingestion of 1.2g Lercanidipine, 3g Quetiapine, 280mg of Ramipril and 420mg of Duloxetine. He describes lethargic, drowsiness and was unable to pass any urine since overdosed. He was found to be bradycardic, hypotensive and anuric. He had refractory hypotension and anuric despite fluid resuscitation, glucagon therapy and intravenous naloxone. His care was escalated to Intensive care, requiring noradrenaline, adrenaline, vasopressin, and hyperinsulinaemic euglycaemia therapy. He achieved haemodynamic stability and kidney function improved gradually with the support received. The total length of therapy lasted for 30 horus in which individual therapy was weaned down based on the requirement. He was then transferred to medical ward for further psychiatric assessment. This is a the first repored case of mixed overdose with lercanidipine, Quetiapine, Rampmipril and Duloxetine.

Keywords: calcium channel blocker, hyperinsulinaemic Euglycaemia therapy, lercanidipine, overdose

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Authors: Da Eun Sung

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In today’s world, cyber security has become an important international agenda. As the information age has arrived, the need for cyber defense against cyber attacks is mounting, and the significance of cyber cooperation in the international community is drawing attention. Through the course, international society has agreed that the institutionalization of international norms dealing with cyber space and cyber security is crucial ever. Nevertheless, the West, led by the United States of America, and 'the East', composed of Russia and China, have shown conflicting views on forming international norms and principles which would regulate and ward off the possible threats in cyber space. Thus, the international community hasn’t yet to reach an agreement on cyber security. In other words, the difference between both sides on the approach and understanding of principles, objects, and the definition has rendered such. Firstly, this dissertation will cover the Russia’s perception, strategy, and definition on cyber security through analyzing primary source. Then, it will delve into the two contrasting cyber security strategy between Russia and the US by comparing them. And in the conclusion, it will seek the possible solution for the cooperation in the field of cyber security. It is quite worthwhile to look into Russia’s views, which is the main counterpart to the US in this field, especially when the efforts to institutionalize cyber security by the US-led international community have met with their boundaries, and when the legitimacy of them have been challenged.

Keywords: cyber security, cyber security strategic, international relation in cyberspace, Russia

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Authors: Shohra Qaderi

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Introduction: Tetanus is a severe infection characterized by the spasm of skeletal muscles that often progresses toward respiratory failure. Acute Renal failure (ARF) is an important complication associated Tetanus infection, occurring in 15%-39% of cases. Presentation of cases: A previous healthy 14-year-old boy was admitted to the Tetanus ward of a hospital in Kabul, presenting with severe muscle spasms. On day four of admission, he started having cola-colored urine with decreased urine output. Due to lack of peritoneal dialysis, he went under hemodialysis in view of rapidly raising in blood urea (from baseline 32 mg/dl to 150 mg/dl) and creatinine from (baseline 0.9 mg/dl to 6.2g/dl). Despite all efforts, he had a sudden cardiac arrest and passed away on day 6 of admission. Discussion: ARF is a complication of tetanus, reported to be mild and non-oliguric. Suggested pathological mechanisms include autonomic dysfunction and rhabdomyolysis, owing to uncontrolled muscle spasms. Autonomic dysfunction, most evident in the first two weeks of infection. Conclusion: The prevalence and mortality of tetanus is high in Afghanistan. Physicians and pediatricians need to be aware of this complication of tetanus so as to take appropriate preventive measures and recognize and manage it early.

Keywords: afghanistan, acute renal failure, child, mortality

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Authors: Amanda Burrell, Tonia Gary, David Wright, Kumara Ward

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This paper explores the concept of academic identity as it relates to the lecture, in particular, the digitized lecture delivered to a camera, in the absence of a student audience. Many academics have the performance aspect of the role thrust upon them with little or no training. For the purpose of this study, we look at the performance of the academic identity and examine tailored film presence coaching for its contributions toward academic identity, specifically in relation to feelings of self-confidence and diminishment of discomfort or stage fright. The case is articulated through the lens of scholar-practitioners, using expert facilitated participatory action research. It demonstrates in our sample of experienced academics, all reported some feelings of uncertainty about presenting lectures to camera prior to coaching. We share how power poses and reframing fear, produced improvements in the ease and competency of all participants. We share exactly how this insight could be adapted for self-coaching by any academic when called to present to a camera and consider the relationship between this and academic identity.

Keywords: academic identity, digitized lecture, embodied learning, performance coaching

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