Search results for: child advocacy

Authors: Ana Rita Conde, Pilar Mota, Tânia Botelho, Suzana Caldeira, Isabel Rego, Jessica Pacheco, Osvaldo Silva, Áurea Sousa

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Tourism promotes well-being and health to children with ASD and their families. Literature indicates the need to provide tourist activities that integrate the therapeutic component, to promote the development and well-being of children with ASD. The study aims to implement tourist offers in Azores that integrate the therapeutic feature, assess their suitability and impact on the well-being and health of the child and caregivers. Using a mixed methodology, the study integrates families that experience and evaluate the impact of tourism products developed specifically for them.

Keywords: austism spectrum disorder, children, therapeutic tourism activities, well-being, health, inclusive tourism

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Authors: Apurva Patil, Ashay Aswale, Akshay Kulkarni, Shubham Bharadiya

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The potential benefit of gravity compensation of linkages in mechanisms using springs to reduce actuator requirements is well recognized, but practical applications have been elusive. Although existing methods provide exact spring balance, they require additional masses or auxiliary links, or all the springs used originate from the ground, which makes the resulting device bulky and space-inefficient. This paper uses a method of static balancing of mechanisms with conservative loads such as gravity and spring loads using non-zero-free-length springs with child–parent connections and no auxiliary links. Application of this method to the developed arm of a humanoid robot is presented here. Spring balancing is particularly important in this case because the serial chain of linkages has to work against gravity.This work involves approximate spring balancing of the open-loop chain of linkages using minimization of potential energy variance. It uses the approach of flattening the potential energy distribution over the workspace and fuses it with numerical optimization. The results show the considerable reduction in actuator torque requirement with practical spring design and arrangement. Reduced actuator torque facilitates the use of lower end actuators which are generally smaller in weight and volume thereby lowering the space requirements and the total weight of the arm. This is particularly important for humanoid robots where the parent actuator has to handle the weight of the subsequent actuators as well. Actuators with lower actuation requirements are more energy efficient, thereby reduce the energy consumption of the mechanism. Lower end actuators are lower in cost and facilitate the development of low-cost devices. Although the method provides only an approximate balancing, it is versatile, flexible in choosing appropriate control variables that are relevant to the design problem and easy to implement. The true potential of this technique lies in the fact that it uses a very simple optimization to find the spring constant, free-length of the spring and the optimal attachment points subject to the optimization constraints. Also, it uses physically realizable non-zero-free-length springs directly, thereby reducing the complexity involved in simulating zero-free-length springs from non-zero-free-length springs. This method allows springs to be attached to the preceding parent link, which makes the implementation of spring balancing practical. Because auxiliary linkages can be avoided, the resultant arm of the humanoid robot is compact. The cost benefits and reduced complexity can be significant advantages in the development of this arm of the humanoid robot.

Keywords: actuator torque, child-parent connections, spring balancing, the arm of a humanoid robot

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Authors: Natalia Banasik

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Comprehension of verbal irony is an example of pragmatic competence in understanding figurative language. The knowledge of how it develops may shed new light on the understanding of social and communicative competence that is crucial for one's effective functioning in the society. Researchers agree it is a competence that develops late in a child’s development. One of the abilities that seems crucial for irony comprehension is theory of mind (ToM), that is the ability to understand that others may have beliefs, desires and intentions different from one’s own. Although both theory of mind and irony comprehension require the ability to understand the figurative use of the false description of the reality, the exact relationship between them is still unknown. Also, even though irony comprehension in children has been studied for over thirty years, the results of the studies are inconsistent as to the age when this competence are acquired. The presented study aimed to answer questions about the developmental trajectories of irony comprehension and ascribing function to ironic utterances by preschool children. Specifically, we were interested in how it is related to the development of ToM and how comprehension of the function of irony changes with age. Data was collected from over 150 monolingual, Polish-speaking children and (so far) thirty bilingual children speaking Polish and English who live in the US. Four-, five- and six-year-olds were presented with a story comprehension task in the form of audio and visual stimuli programmed in the E-prime software (pre-recorded narrated stories, some of which included ironic utterances, and pictures accompanying the stories displayed on a touch screen). Following the presentation, the children were then asked to answer a series of questions. The questions checked the children’s understanding of the intended utterance meaning, evaluation of the degree to which it was funny and evaluation of how nice the speaker was. The children responded by touching the screen, which made it possible to measure reaction times. Additionally, the children were asked to explain why the speaker had uttered the ironic statement. Both quantitive and qualitative analyses were applied. The results of our study indicate that for irony recognition there is a significant difference among the three age groups, but what is new is that children as young as four do understand the real meaning behind the ironic statement as long as the utterance is not grammtically or lexically complex also, there is a clear correlation of ToM and irony comprehension. Although four-year olds and six-year olds understand the real meaning of the ironic utterance, it is not earlier than at the age of six when children start to explain the reason of using this marked form of expression. They talk about the speaker's intention to tell a joke, be funny, or to protect the listener's emotions. There are also some metalinguistic references, such as "mommy sometimes says things that don't make sense and this is called a metaphor".

Keywords: child's pragmatics, figurative speech, irony comprehension in children, theory of mind and irony

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Authors: Bronwyn Griffin, Caroline Acton, Tona Gillen, Roy Kimble

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Background: Bicycle riding is a common recreational activity enjoyed by many children throughout Australia that has been associated with the usual caveat of benefits related to exercise and recreation. Given Australia was the first country in the world to introduce cyclist helmet laws in 1991, very few publications have reviewed paediatric cycling injuries (fatal or non-fatal) since. Objectives: To identify trends in children (0-16 years) who required admission for greater than 24 hours following a bicycle-related injury (fatal and non-fatal) in Queensland. Further, to discuss changes that have occurred in paediatric cycling injury trends in Queensland since a prominent local study/publication in 1995. This paper aims to establish evidence to inform interventions promoting safer riding to parents, children and communities. Methods: Data on paediatric (0-16 years) cycling injuries in Queensland resulting in hospital admission more than 24 hours across three tertiary paediatric hospitals in Brisbane between November 2008-June 2015 was compiled by the Paediatric Trauma Data Registry for non-fatal injuries. The Child Death Review Team at the Queensland Families and Childhood Commission provided data on fatalities in children <17years from (June 2004 –June 2015). Comparing trends to a local study published in 1995 Results: Between 2008-2015 there were 197 patients admitted for greater than 24 hours following a cycling injury. The median age was 11 years, with males more frequently involved (n=139, 87%) compared to females. Mean length of stay was three days, with 47 (28%) children admitted to PICU, location of injury was most often the street (n=63, 37%). Between 2004 –2015 there were 15 fatalities (Incidence rate 0.25/100,000); all were male, 14/15 occurred on the street, with eight stated to have not been wearing a helmet, 11/15 children came from the least advantaged socio-economic group (SEIFA) compared to a local publication in 1995, finding of 94 fatalities between (1981-1992). Conclusions: There has been a notable decrease in incidence of fatalities between the two time periods with incidence rates dropping from 1.75-0.25/100,000. More statistics need to be run to ascertain if this is a true reduction or perhaps a decrease in children riding bicycles. Injuries that occur on the street that come in contact with a car remain of serious concern. The purpose of this paper is not to discourage bicycle riding among child and adolescent populations, rather, inform parents and the wider community about the risks associated with cycling in order to reduce injuries associated with this sport, whilst promoting safe cycling.

Keywords: paediatric, cycling, trauma, prevention, emergency

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Authors: Adenike Akinrotimi

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Globally, education has been identified as vital tool for any form of development for any society (community); be it economic, social, political and cultural development. It is the determinant level of prosperity, welfare, security and sustenance of the people of a particular community. Education could be formal, informal and non-formal. Cultural development of an individual and of the community as it were is a lifelong process, where individual learns from daily experiences, exposure to the environment at home, at work, at play and it enriches human and environmental potentials. This type of education can be referred to as cultural heritage. It is built on learner participation and assimilation. Preschool programme also referred to as Early Childhood Education is critical to holistic development of a child cultural development inclusive. This paper examines the impact that technology has on cultural heritage among preschool children.

Keywords: cultural heritage, education, pre-school, technology

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Authors: Mary Dorothy Roxas, Jeian Mae Dungca, Reginald Agor, Beatriz Figueroa, Lennon Andre Patricio, Honey Joy Cabahug

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Parentification occurs when children are expected to provide instrumental or emotional caregiving within the family. It was found that parentification has the latter effect on adolescents’ cognitive and emotional vulnerability. Attachment theory helps clarify the process of parentification as it involves the relationship between the child and the parent. Carandang theory of “taga-salo” helps explain parentification in the Philippines setting. The present study examined the potential risk of parentification on adolescent’s memory retention by hypothesizing that there is a correlation between the two. The research was conducted with 249 female adolescents ages 12-24, residing in Valenzuela City. Results indicated that there is a significant inverse correlation between parentification and memory retention.

Keywords: memory retention, neurocognitive, parentification, stress

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Authors: Anisur Rahman, Sabyasachi Behera, Pawan Pathak, Benazir Patil, Rajesh Khanna

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Background: Nearly half of India’s population is expected to reside in urban areas by 2030. The extent to which India's health system can provide for this large and growing city-based population will determine the country's success in achieving universal health coverage and improved national health indices. National Urban Health Mission (NUHM) strive for improving access to primary health care in urban areas. Implementation of NUHM solicits sensitive, effective and sustainable strategies to strengthen the service delivery mechanisms. The Challenge Initiative for Healthy Cities (TCIHC) is working with the Government of India and three provincial states to develop effective service delivery mechanisms for reproductive, maternal, newborn and child health (RMNCH) through a health systems approach for the urban poor. Method: A rapid assessment study was conceptualized and executed to generate evidence in order to address the challenges impeding in functioning of urban health facilities to deliver effective, efficient and equitable health care services in 7 cities spread across two project States viz. Madhya Pradesh and Odisha. Results: The findings of the assessment reflect: 1. The overall ecosystem pertaining to planning and management of public health interventions is not conducive. 2. The challenges regarding population dynamics like migration keeps on influencing the demand-supply-enabling environment triangle for both public and private service providers. 3. Lack of norms for planning and benchmark for service delivery further impedes urban health system as a whole. 4. Operationalization of primary level services have enough potential to meet the demand of slum dwellers at large. 5. Lack of policy driven strategies on how to integrate the NUHM with other thematic areas of Maternal, Newborn & Child Health (MNCH) and Family Planning (FP). 5. The inappropriate capacity building and acute shortage of Human Resources has huge implication on service provisioning and adherence to the service delivery protocols. Conclusion: The findings from rapid assessment are aimed to inform pertinent stakeholders to develop a multiyear city health action plan to strengthen the health systems in order to improve the efficacy of service delivery mechanism in urban settings.

Keywords: city health plan, health system, rapid assessment, urban mission

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Authors: John Acord, Ankita Batla, Kiran Khepar, Maude Schmidt, Charlotte Allen, Russ Bradford

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Objectives: Despite the availability oftreatment options, Parkinson’s disease (PD) continues to impact heavily on a patient’s quality of life (QoL), as many symptoms that bother the patient remain unexplored and untreated in clinical settings. The aims of this research were to understand the burden of PDsymptoms from a patient perspective, particularly those which are the most persistent and debilitating, and to determine if current treatments and treatment algorithms adequately focus on their resolution. Methods: A13-question, online, patient-reported survey was created based on the MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)and symptoms listed on Parkinson’s Disease Patient Advocacy Groups websites, and then validated by 10 Parkinson’s patients. In the survey, patients were asked to choose both their most common and their most bothersome symptoms, whether they had received treatment for those and, if so, had it been effective in resolving those symptoms. Results: The most bothersome symptoms reported by the 111 participants who completed the survey were sleep problems (61%), feeling tired (56%), slowness of movements (54%), and pain in some parts of the body (49%). However, while 86% of patients reported receiving dopamine or dopamine like drugs to treat their PD, far fewer reported receiving targeted therapies for additional symptoms. For example, of the patients who reported having sleep problems, only 33% received some form of treatment for this symptom. This was also true for feeling tired (30% received treatment for this symptom), slowness of movements (62% received treatment for this symptom), and pain in some parts of the body (61% received treatment for this symptom). Additionally, 65% of patients reported that the symptoms they experienced were not adequately controlled by the treatments they received, and 9% reported that their current treatments had no effect on their symptoms whatsoever. Conclusion: The survey outcomes highlight that the majority of patients involved in the study received treatment focused on their disease, however, symptom-based treatments were less well represented. Consequently, patient-reported symptoms such as sleep problems and feeling tired tended to receive more fragmented intervention than ‘classical’ PD symptoms, such as slowness of movement, even though they were reported as being amongst the most bothersome symptoms for patients. This research highlights the need to explore symptom burden from the patient’s perspective and offer Customised treatment/support for both motor and non-motor symptoms maximize patients’ quality of life.

Keywords: survey, patient reported symptom burden, unmet needs, parkinson's disease

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Authors: Brian Carey Sims

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The current study examines psychological factors relevant to child custody litigation among African American fathers. Thirty-seven fathers engaged in various stages of custody litigation involving their children were surveyed about their perceptions of racial stereotypes, parental motivations, and racialized dynamics of the court/ legal process. Data were analyzed using a Critical Race Theory model designed to statistically isolate fathers’ perceptions of the existence and maintenance of structural racism through the legal process. Results indicate significant correlations between fathers’ psychological measures and structural outcomes of their cases. Findings are discussed in terms of ethical implications for family court judicial systems and attorney practice.

Keywords: ethics, family, legal psychology, policy, race

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Authors: George Hikah Benson

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The promotion of lesbian, gay, bisexual, transgender, queer and Intersex (LGBTQIs) rights within the continent of Africa in general and Ghana, in particular, has for some time now, met the fiercest of resistance; premised mainly on socio-cultural-religious factors. This phenomenon contrasts with notions of countries of the Global North where persons within the context of their fundamental freedoms and rights have the right to sexual choices and preferences. A Private Member’s Bill was introduced to the Ghanaian Parliament in 2021, seeking to criminalize the promotion and advocacy of LGBTQIs related activities. This paper in assessing public views on the matter also seeks to ascertain the security implications regarding the passage of the law at the community level. The study also evaluates LGBTQIs rights vis-a-vis the provisions of Chapter 5 of the 1992 Ghana Constitution and global legal jurisprudence on fundamental human rights. To that end, the study adopted a mixed design approach (quantitative and qualitative) to gather data from 1,550 respondents from all ‘walks of life, across all sixteen regions of Ghana. The main findings are that first, over 85% of Ghanaians abhor the practices of LGBTQIs in keeping with the societal, cultural and religious beliefs of Ghanaians, and will go any length to prevent its survival in the country. Further, the time is not ripe for the acceptance of LGBTQ rights in Ghana as the activities will disrupt family values and poison the existing peace that Ghanaians are currently enjoying. However, it is generally believed that when the bill is passed into law, Ghana’s international image will be dented, and 60% of participants and respondents will be unmoved. Against this hostile, intolerant backdrop regarding LGBTQIs rights in the country and in many other African countries, the study foremost recommends that such a law, when passed, should come with a ‘human face’ that will not just seek to be punitive of LGBTQIs persons but corrective. Additionally, the law should be one that offers them support in line with their rights as Ghanaian and African citizens. Moreover, religious and traditional bodies should endeavor to engage LGBTQIs persons in a friendlier, corrective and loving manner rather than in the current hostile environment that society exposes them to.

Keywords: Ghanaian parliament, LGBTQIs rights, perceptions, socio-culture-religious

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Authors: Fei Wan Ngai

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Background: Family and marital functioning has become an important public health issue because it is vital to child development and well-being. Objective: This study was designed to examine the changes in family and marital functioning among Chinese women during the transition to motherhood. Methods: A longitudinal design was used. A convenience sample of 202 Chinese childbearing women completed the Medical Outcomes Study Family and Marital Functioning Measures during pregnancy, at 6 weeks and at 6 months postpartum. Results: The results showed that women experienced substantial decline in their family and marital functioning from pregnancy to 6 weeks and 6 months postpartum. Conclusions: The findings of this study highlight the need for more attention to family and marital functioning among women after childbirth. Culturally relevant interventions should be developed to assist women in facing the challenges of new motherhood and achieving a better family and marital functioning.

Keywords: family and marital functioning, perinatal period, women

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Authors: Mou Juliet Rebeiro, S. M. Abul Kalam Azad

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This study was carried out to see the anxiety and depression in caregivers of autistic children. The objectives of the research were to assess depression and anxiety among caregivers of autistic children and to find out the experience of caregivers. For this purpose, the research was conducted on a sample of 39 caregivers of autistic children. Participants were taken from a special school. To collect data for this study each of the caregivers were administered questionnaire comprising scales to measure anxiety and depression and some responses of the participants were taken through interview based on a topic guide. Obtained quantitative data were analyzed by using statistical analysis and qualitative data were analyzed according to themes. Mean of the anxiety score (55.85) and depression score (108.33) is above the cutoff point. Results showed that anxiety and depression is clinically present in caregivers of autistic children. Most of the caregivers experienced behavior, emotional, cognitive and social problems of their child that is linked with anxiety and depression.

Keywords: anxiety, autism, caregiver, depression

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Authors: Hiromi Kawai

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This study investigates the nature of EFL older children’s L2 perceptive and productive abilities using classroom data, in order to find a pedagogical solution to the teaching of L2 sounds at an early stage of learning in a formal school setting. It is still inconclusive whether older children with only EFL formal school instruction at the initial stage of L2 learning are able to attain native-like perception and production in English within the very limited amount of exposure to the target language available. Based on the notion of the lack of study of EFL Japanese children’s acquisition of English segments, the researcher uses a model of L1 speech processing which was developed for investigating L1 English children’s speech and literacy difficulties using a psycholinguistic framework. The model is composed of input channel, output channel, and lexical representation, and examines how a child receives information from spoken or written language, remembers and stores it within the lexical representations and how the child selects and produces spoken or written words. Concerning language universality and language specificity in the language acquisitional process, the aim of finding any sound errors in L1 English children seemed to conform to the author’s intention to find abilities of English sounds in older Japanese children at the novice level of English in an EFL setting. 104 students in Grade 5 (between the ages of 10 and 11 years old) of an elementary school in Tokyo participated in this study. Four tests to measure their perceptive ability and three oral repetition tests to measure their productive ability were conducted with/without reference to lexical representation. All the test items were analyzed to calculate item facility (IF) indices, and correlational analyses and Structural Equation Modeling (SEM) were conducted to examine the relationship between the receptive ability and the productive ability. IF analysis showed that (1) the participants were better at perceiving a segment than producing a segment, (2) they had difficulty in auditory discrimination of paired consonants when one of them does not exist in the Japanese inventory, (3) they had difficulty in both perceiving and producing English vowels, and (4) their L1 loan word knowledge had an influence on their ability to perceive and produce L2 sounds. The result of the Multiple Regression Modeling showed that the two production tests could predict the participants’ auditory ability of real words in English. The result of SEM showed that the hypothesis that perceptive ability affects productive ability was supported. Based on these findings, the author discusses the possible explicit method of teaching English segments to EFL older children in a formal school setting.

Keywords: EFL older children, english segments, perception, production, speech processing system

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Authors: Yasser Sanad, Thu Trang Dao

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Introduction: Implementing the One Health (OH) approach requires an integrated, interdisciplinary, and cross-sectoral methodology. OH is a key tool for developing and implementing programs and projects and includes developing ambitious policies that consider the common needs and benefits of human, animal, plant, and ecosystem health. OH helps humanity readjust its path to environmentally friendly and impartial sustainability. As co-leader of the Global Health Security Agenda’s Zoonotic Disease Action Package, Vietnam pioneered a strong OH approach to effectively address early waves of the COVID-19 outbreak in-country. Context and Aim: The repeated surges in COVID-19 in Vietnam challenged the capabilities of the national system and disclosed the gaps in multi-sectoral coordination and resilience. To address this, FHI 360 advocated for the standardization of the OH platform by government actors to increase the resiliency of the system during and post COVID-19. Methods: FHI 360 coordinated technical resources to develop and implement evidence-based OH policies, promoting high-level policy dialogue between the Ministries of Health, Agriculture, and the Environment, and policy research to inform developed policies and frameworks. Through discussions, an OH-building Partnership (OHP) was formed, linking climate change, the environment, and human and animal health. Findings: The OHP Framework created a favorable policy environment within and between sectors, as well as between governments and international health security partners. It also promoted strategic dialogue, resource mobilization, policy advocacy, and integration of international systems with National Steering Committees to ensure accountability and emphasize national ownership. Innovative contribution to policy, practice and/or research: OHP was an effective evidence-based research-to-policy platform linking to the National One Health Strategic Plan (2021-2025). Collectively they serve as a national framework for the implementation and monitoring of OH activities. Through the adoption of policies and plans, the risk of zoonotic pathogens, environmental agent spillover, and antimicrobial resistance can be minimized through strengthening multi-sectoral OH collaboration for health security.

Keywords: one health, national policies, health security, COVID-19, Vietnam

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Authors: Yu-Lin Chen, Kimberly Koester, Marissa Raymond-Flesh, Anika Thapar, Jay Thapar

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Purpose: Effectively communicating adolescent health topics to teens and their parents is crucial. This study emphasizes critically evaluating the optimal use of artificial intelligence tools (AI), which are increasingly prevalent in disseminating health information. By fostering a deeper understanding of AI voice preference in the context of health, the research aspires to have a ripple effect, enhancing the collective health literacy and decision-making capabilities of both teenagers and their parents. This study explores AI voices' potential within health learning modules for annual well-child visits. We aim to identify preferred voice characteristics and understand factors influencing perceived trustworthiness, ultimately aiming to improve health literacy and decision-making in both demographics. Methods: A cross-sectional study assessed preferences and trust perceptions of AI voices in learning modules among teens (11-18) and their parents/guardians in Northern California. The study involved the development of four distinct learning modules covering various adolescent health-related topics, including general communication, sexual and reproductive health communication, parental monitoring, and well-child check-ups. Participants were asked to evaluate eight AI voices across the modules, considering a set of six factors such as intelligibility, naturalness, prosody, social impression, trustworthiness, and overall appeal, using Likert scales ranging from 1 to 10 (the higher, the better). They were also asked to select their preferred choice of voice for each module. Descriptive statistics summarized participant demographics. Chi-square/t-tests explored differences in voice preferences between groups. Regression models identified factors impacting the perceived trustworthiness of the top-selected voice per module. Results: Data from 104 participants (teen=63; adult guardian = 41) were included in the analysis. The mean age is 14.9 for teens (54% male) and 41.9 for the parent/guardian (12% male). At the same time, similar voice quality ratings were observed across groups, and preferences varied by topic. For instance, in general communication, teens leaned towards young female voices, while parents preferred mature female tones. Interestingly, this trend reversed for parental monitoring, with teens favoring mature male voices and parents opting for mature female ones. Both groups, however, converged on mature female voices for sexual and reproductive health topics. Beyond preferences, the study delved into factors influencing perceived trustworthiness. Interestingly, social impression and sound appeal emerged as the most significant contributors across all modules, jointly explaining 71-75% of the variance in trustworthiness ratings. Conclusion: The study emphasizes the importance of catering AI voices to specific audiences and topics. Social impression and sound appeal emerged as critical factors influencing perceived trustworthiness across all modules. These findings highlight the need to tailor AI voices by age and the specific health information being delivered. Ensuring AI voices resonate with both teens and their parents can foster their engagement and trust, ultimately leading to improved health literacy and decision-making for both groups. Limitations and future research: This study lays the groundwork for understanding AI voice preferences for teenagers and their parents in healthcare settings. However, limitations exist. The sample represents a specific geographic location, and cultural variations might influence preferences. Additionally, the modules focused on topics related to well-child visits, and preferences might differ for more sensitive health topics. Future research should explore these limitations and investigate the long-term impact of AI voice on user engagement, health outcomes, and health behaviors.

Keywords: artificial intelligence, trustworthiness, voice, adolescent

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Authors: Kavita Khoiwal, Vatsla Dadhwal, K. Aparna Sharma, Dipika Deka, Plabani Sarkar

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Introduction: About 2.4 million (1.93 - 3.04 million) people are living with HIV/AIDS in India. Of all HIV infections, 39% (9,30,000) are among women. 5.4% of infections are from mother to child transmission (MTCT), 25,000 infected children are born every year. Besides the risk of mother to child transmission of HIV, these women are at risk of the higher adverse pregnancy outcome. The objectives of the study were to compare the obstetric and neonatal outcome in women who are HIV positive with low-risk HIV negative women and effect of antiretroviral drugs on preterm birth and IUGR. Materials and Methods: This is a retrospective case record analysis of 212 HIV-positive women delivering between 2002 to 2015, in a tertiary health care centre which was compared with 238 HIV-negative controls. Women who underwent medical termination of pregnancy and abortion were excluded from the study. Obstetric outcome analyzed were pregnancy induced hypertension, HIV positive intrauterine growth restriction, preterm birth, anemia, gestational diabetes and intrahepatic cholestasis of pregnancy. Neonatal outcome analysed were birth weight, apgar score, NICU admission and perinatal transmission.HIV-positiveOut of 212 women, 204 received antiretroviral therapy (ART) to prevent MTCT, 27 women received single dose nevirapine (sdNVP) or sdNVP tailed with 7 days of zidovudine and lamivudine (ZDV + 3TC), 15 received ZDV, 82 women received duovir and 80 women received triple drug therapy depending upon the time period of presentation. Results: Mean age of 212 HIV positive women was 25.72+3.6 years, 101 women (47.6 %) were primigravida. HIV positive status was diagnosed during pregnancy in 200 women while 12 women were diagnosed prior to conception. Among 212 HIV positive women, 20 (9.4 %) women had preterm delivery (< 37 weeks), 194 women (91.5 %) delivered by cesarean section and 18 women (8.5 %) delivered vaginally. 178 neonates (83.9 %) received exclusive top feeding and 34 neonates (16.03 %) received exclusive breast feeding. When compared to low risk HIV negative women (n=238), HIV positive women were more likely to deliver preterm (OR 1.27), have anemia (OR 1.39) and intrauterine growth restriction (OR 2.07). Incidence of pregnancy induced hypertension, diabetes mellitus and ICP was not increased. Mean birth weight was significantly lower in HIV positive women (2593.60+499 gm) when compared to HIV negative women (2919+459 gm). Complete follow up is available for 148 neonates till date, rest are under evaluation. Out of these 7 neonates found to have HIV positive status. Risk of preterm birth (P value = 0.039) and IUGR (P value = 0.739) was higher in HIV positive women who did not receive any ART during pregnancy than women who received ART. Conclusion: HIV positive pregnant women are at increased risk of adverse pregnancy outcome. Multidisciplinary team approach and use of highly active antiretroviral therapy can optimize the maternal and perinatal outcome.

Keywords: antiretroviral therapy, HIV infection, IUGR, preterm birth

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Authors: Merav Meiron-Goren, Orna Braun-Lewensohn, Tal Litvak-Hirsh

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In recent years, there has been an increasing tendency towards separation and divorce in relationships. Nevertheless, many couples in a first marriage do not anticipate this as a probable possibility and do not make any preparation for it. Same sex couples establishing a family encounter a much more complicated situation than do heterosexual couples. Although there is a trend towards legal recognition of same sex marriage, many countries, including Israel, do not recognize it. The absence of legal recognition or the existence of partial recognition creates complexity for these couples. They have to fight for their right to establish a family, like the recognition of the biological child of a woman, as a child of her woman spouse too, or the option of surrogacy for a male couple who want children, and more. The lack of legal recognition is burden on the lives of these couples. In the absence of clear norms regarding the conduct of the family unit, the couples must define for themselves the family structure, and deal with everyday dilemmas that lack institutional solutions. This may increase the friction between the two couple members, and it is one of the factors that make it difficult for them to maintain the relationship. This complexity exists, perhaps even more so, in separation. The end of relationship is often accompanied by a deep crisis, causing pain and stress. In most cases, there are also other conflicts that must be settled. These are more complicated when rights are in doubt or do not exist at all. Complex issues for separating same sex couples may include matters of property, recognition of parenthood, and care and support for the children. The significance of the study is based on the fact that same sex relationships are becoming more and more widespread, and are an integral part of the society. Even so, there is still an absence of research focusing on such relationships and their ending. The objective of the study is to research the perceptions of same sex couples regarding the possibility of separation, preparing for it, conflict management and resolving disputes through the separation process. It is also important to understand the point of view of couples that have gone through separation, how they coped with the emotional and practical difficulties involved in the separation process. The doctoral research will use a qualitative research method in a phenomenological approach, based on semi-structured in-depth interviews. The interviewees will be divided into three groups- at the beginning of a relationship, during the separation crisis and after separation, with a time perspective, with about 10 couples from each group. The main theoretical model serving as the basis of the study will be the Lazarus and Folkman theory of coping with stress. This model deals with the coping process, including cognitive appraisal of an experience as stressful, appraisal of the coping resources, and using strategies of coping. The strategies are divided into two main groups, emotion-focused forms of coping and problem-focused forms of coping.

Keywords: conflict management, coping, legal recognition, same-sex relationship, separation

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Authors: Vladimíra Hornáčková

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This paper points out at the importance of creativity development in children of preschool age and analyses certain conditions and pedagogical principles which should be respected during the development of creativity in kindergartens. Research survey focuses on the development of creativity reflection at children in kindergartens at preschool age and based on a test of creativity it compares creativity of children in experimental and control groups. The goal is to find out if there are any differences among children in experimental and control classrooms in kindergartens; wherein experimental groups, there is preschool education with the use of drama education while in control groups there is not. On the basis of certain aspects, the gained data is compared through descriptive methods and correlations. Research results refer to reserves in creativity development in modern pre-primary education in the context of implemented and expected changes in didactic approach in the education of kindergartens.

Keywords: preschool child, drama in education, research, test of creativity

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Authors: Isabel Mousinho de Figueiredo

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Pure economic loss can be brought into the 21st century and become a useful tool to keep the tort of negligence within reasonable limits, provided the concept is minutely reexamined. The term came about when wealth was physical, and Law wanted to be a modern science. As a tool to draw the line, it leads to satisfactory decisions in most cases, but needlessly creates distressing conundrums in others, and these are the ones parties bother to litigate about. Economic loss is deemed to be pure based on a blind negative criterion of physical harm, that inadvertently smelts vastly disparate problems into an indiscernible mass, with arbitrary outcomes. These shortcomings are usually dismissed as minor byproducts, for the lack of a better formula. Law could instead stick to the sound paradigms of the intended rule, and be more specific in identifying the losses deserving of compensation. This would provide a better service to Bench and Bar, and effectively assist everyone navigating the many challenges of Accident Law.

Keywords: accident law, comparative tort law, negligence, pure economic loss

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Authors: Bambi Ward

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Children of Holocaust survivors have been described as inheriting their parents’ trauma as a result of ‘vicarious memory’. The term refers to a process whereby second generation Holocaust survivors subconsciously remember aspects of Holocaust trauma, despite not having directly experienced it. This can occur even when there has been a conspiracy of silence in which survivors chose not to discuss the Holocaust with their children. There are still people born in various parts of the world such as Poland, Hungary, other parts of Europe, USA, Canada and Australia, who have only learnt of their Jewish roots as adults. This discovery may occur during a parent’s deathbed confession, or when an adult child is sorting through the personal belongings of a deceased family member. Some Holocaust survivors chose to deny their Jewish heritage and raise their children as Christians. Reasons for this decision include the trauma experienced during the Holocaust for simply being Jewish, the existence of anti-Semitism, and the desire to protect one’s self and one’s family. Although there has been considerable literature written about the transgenerational impact of trauma on children of Holocaust survivors, there has been little scholarly investigation into the effects of a hidden Jewish identity on these children. This paper presents a case study of an adult child of Hungarian Holocaust survivors who was raised as a Christian. At the age of eight she was told about her family’s Jewish background, but her parents insisted that she keep this a secret, even if asked directly. She honoured their request until she turned forty. By that time she had started the challenging process of reclaiming her Jewish identity. The paper outlines the tension between family loyalty and individual freedom, and discusses the role that art and art therapy played in assisting the subject of the case study to reclaim her Jewish identity and commence writing a memoir about her spiritual journey. The main methodology used in this case study is creative practice-led research. Particular attention is paid to the utilisation of an autoethnographic approach. The autoethnographic tools used include reflective journals of the subject of the case study. These journals reflect on the subject’s collection of autobiographical data relating to her family history, and include memories, drawings, products of art therapy, diaries, letters, photographs, home movies, objects, and oral history interviews with her mother. The case study illustrates how art and art therapy benefitted a second generation Holocaust survivor who was brought up having to suppress her Jewish identity. The process allowed her to express subconscious thoughts and feelings about her identity and free herself from the burden of the long term secret she had been carrying. The process described may also be of assistance to other traumatised people who have been trying to break the silence and who are seeking to express themselves in a positive and healing way.

Keywords: art, hidden identity, holocaust, silence

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Authors: Tanvi Rajesh Sanghavi

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Introduction: Neurodiversity is a concept which captures the different ways in which everyone's brain functions and is considered as part of normal variation. It is a strength-based approach which focuses on the individual's strengths and capabilities and believes in providing support wherever necessary. In many parts of the world, those diagnosed with autism spectrum disorder have been ostracized and ridiculed due to their sensory and communication differences. Hence, it becomes important for the teachers to have knowledge about autism and understand the needs of children with Autism. Need: India is rich in terms of culture, languages and religious diversity. It is important to study neurodiversity in such a population for better understanding of neurodiverse individuals and appropriate intervention. Aim & objectives: This study seeks teachers' knowledge of the causes, traits and educational requirements of children with autism spectrum disorder (ASD). It also aims to find out whether mainstream schools actually provide training programs to the teachers to manage such children along with the necessary accommodations. Method: The current study was a cross-sectional study conducted among school teachers. A total of 30 school teachers were taken for the study. The participants were enrolled after informed consent. The participants were directed to a google form consisting of objective questions. The first part of the questionnaire elicited information about school, teaching experience, qualification, etc. There were specific questions extracting details on attending/conducting sensitization and professional programs in regard to care for autistic children. The second part of the questionnaire consisted of some basic questions on the teacher’s understanding of diagnosis, traits, causes, road to recovery and understanding the educational and communication needs of autistic children from the teacher’s perspective. The responses were tabulated and analyzed descriptively. Results: Most of the teachers had 5–10 years of teaching experience. The majority of the teachers used the term “special child” for autistic children. Around 54.8% (17 teachers) of the total teachers felt that the parents of autistic children should teach their child to learn adaptive skills and 41.9% of the teachers felt that they should take medical intervention. About 50% of the teachers felt that the cause of autism is related to pre-natal maternal factors and about 40% felt that its cause is genetic. Only a small percentage of teachers felt that they were trained to manage the children with autism. More than 50% of the teachers mentioned that their schools do not conduct training programs for managing these children. Discussion & Conclusion: In this study, the knowledge and perspectives of teachers on children with ASD were studied. The most widely held contemporary belief is that genetic factors play a major part in the development of ASD, although the existing evidence is muddled, with numerous opposing perspectives on the nature of this mechanism. It is worth noting that any culture's level of humanity is mirrored in how that society "treats" its vulnerable population.

Keywords: autism, neurodiversity, awareness, education

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Authors: Franco Lorenzo D. Morales

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‘Toshi-no-sakon,’ which translates to as ‘age gap marriage,’ is a term that has been popularized by celebrity couples in the Japanese entertainment industry. Japan is distinct for a developed nation for its rapidly aging population, declining marital and fertility rates, and the reinforcement of traditional gender roles. Statistical data has shown that the average age of marriage in Japan is increasing every year, showing a growing tendency for late marriage. As a result, the government has been trying to curb the declining trends by encouraging marriage and childbirth among the populace. This graduate thesis seeks to analyze the ‘toshi-no-sakon’ phenomenon in lieu of Japan’s current economic and social situation, and to see what the implications are for these kinds of married couples. This research also seeks to expound more on age gaps within married couples, which is a factor rarely-touched upon in Japanese family studies. A literature review was first performed in order to provide a framework to study ‘toshi-no-sakon’ from the perspective of four fields of study—marriage, family, aging, and gender. Numerous anonymous online statements by ‘toshi-no-sakon’ couples were then collected and analyzed, which brought to light a number of concerns. Couples wherein the husband is the older partner were prioritized in order to narrow down the focus of the research, and ‘toshi-no-sakon’ is only considered when the couple’s age gap is ten years or more. Current findings suggest that one of the perceived merits for a woman to marry an older man is that financial security would be guaranteed. However, this has been shown to be untrue as a number of couples express concern regarding their financial situation, which could be attributed to their husband’s socio-economic status. Having an older husband who is approaching the age of retirement presents another dilemma as the wife would be more obliged to provide care for her aging husband. This notion of the wife being a caregiver likely stems from an arrangement once common in Japanese families in which the wife must primarily care for her husband’s elderly parents. Childbearing is another concern as couples would be pressured to have a child right away due to the age of the husband, in addition to limiting the couple’s ideal number of children. This is another problematic aspect as the husband would have to provide income until his child has finished their education, implying that retirement would have to be delayed indefinitely. It is highly recommended that future studies conduct face-to-face interviews with couples and families who fall under the category of ‘toshi-no-sakon’ in order to gain a more in-depth perspective into the phenomenon and to reveal any undiscovered trends. Cases wherein the wife is the older partner in the relationship should also be given focus in future studies involving ‘toshi-no-sakon’.

Keywords: age gap, family structure, gender roles, marriage trends

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Authors: Jemely M. Punzalan, Christine B. Bernal, Beatrice B. Canonigo, Maria Rosario F. Cabansag, Dennis S. Flores, Paul Joseph T. Galutira, Remedios D. Chan

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Background: Systemic lupus erythematosus (SLE) is one of the most common autoimmune disorders predominates in women of childbearing age. Simple Measure of Impact of Lupus Erythematosus in Youngsters (SMILEY) is the only health specific quality of life tool for pediatric SLE, which has been translated to different languages except in Filipino. Objective: The primary objective of this study was to develop a Filipino translation of the SMILEY and to examine the validity and reliability of this translation. Methodology: The SMILEY was translated into Filipino by a bilingual individual and back-translated by another bilingual individual blinded from the original English version. The translation was evaluated for content validity by a panel of experts and subjected to pilot testing. The pilot-tested translation was used in the validity and reliability testing proper. The SMILEY, together with the previously validated PEDSQL 4.0 Generic Core Scale was administered to lupus pediatric patients and their parent at two separate occasions: a baseline and a re-test seven to fourteen days apart. Tests for convergent validity, internal consistency, and test-retest reliability were performed. Results: A total of fifty children and their parent were recruited. The mean age was 15.38±2.62 years (range 8-18 years), mean education at high school level. The mean duration of SLE was 28 months (range 1-81 months). Subjects found the questionnaires to be relevant, easy to understand and answer. The validity of the SMILEY was demonstrated in terms of content validity, convergent validity, internal consistency, and test-retest reliability. Age, socioeconomic status and educational attainment did not show a significant effect on the scores. The difference between scores of child and parent report was showed to be significant with SMILEY total (p=0.0214), effect on social life (p=0.0000), and PEDSQL physical function (p=0.0460). Child reports showed higher scores for the following domains compared to their parent. Conclusion: SMILEY is a brief, easy to understand, valid and reliable tool for assessing pediatric SLE specific HRQOL. It will be useful in providing better care, understanding and may offer critical information regarding the effect of SLE in the quality of life of our pediatric lupus patients. It will help physician understands the needs of their patient not only on treatment of the specific disease but as well as the impact of the treatment on their daily lives.

Keywords: systemic lupus erythematosus, pediatrics, quality of life, Simple Measure of Impact of Lupus Erythematosus in Youngsters (SMILEY)

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Authors: C. Asarkaya, S. Z. Siretioglu Girgin

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Turkish migrants constitute the largest group among people with migration background living in Germany. Turkish women’s labor market participation is of significant importance for their social and economic integration to the German society. This paper thus aims to investigate their labor market positions. Turkish migrant women participate less in the labor market compared to men, and are responsible for most of the housework, child care, and elderly care. This is due to their traditional roles in the family, educational level, insufficient knowledge of German language, and insufficient professional experience. We strongly recommend that wide-reaching integration policies for women are formulated, so as to encourage participation of not only migrant women but also their husbands, fathers and/or brothers, and natives.

Keywords: empowerment, Germany, labor market, migration, Turkish, women

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Authors: M. Iqbal Hossain, Azharul Islam Khan, S. M. Rafiqul Islam, Tahmeed Ahmed

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Objective: Moderate acute malnutrition (MAM) is a major cause of morbidity and mortality in under-5 children of low-income countries. Approximately 14.6% of all under-5 mortality worldwide is attributed to MAM with >3 times increased risk of death compared to well-nourished peers. Prevalence of MAM among under-5 children in Bangladesh is ~12% (~1.7 million). Providing a diet containing adequate nutrients is the mainstay of treatment of children with MAM. It is now possible to process fish into fish peptides with longer shelf-life without refrigerator, known as ‘Fish Surimi peptide’ and this could be an attractive alternative to supply fish protein in the diet of children in low-income countries like Bangladesh. We conducted this study to assess the acceptability of Fish Surimi peptide given with various foods/meals in 2-5 years old children with MAM. Design/methods: Fish Surimi peptide is broken down from white fish meat using plant-derived enzyme and the ingredient is just fish meat consisted of 20 different kinds of amino acids including nine essential amino acids. In a convenience sample of 34 children we completed the study ward of Dhaka Hospital of icddr,b in Bangladesh during November 2014 through February 2015. For each child the study was for two consecutive days: i.e. direct observation of food intake of two lunches and two suppers. In a randomly and blinded manner and cross over design an individual child received Fish Surimi peptide (5g at lunch and 5g at supper) mixed meal [e.g. 30g rice and 30g dahl (thick lentil soup) or 60g of a vegetables-lentil-rice mixed local dish known as khichuri in one day and the same meal on other day without any Fish Surimi peptide. We observed the completeness and eagerness of eating and any possible side effect (e.g. allergy, vomiting, diarrhea etc.) over these two days. Results: The mean±SD age of the enrolled children was 38.4±9.4 months, weight 11.22±1.41 kg, height 91.0±6.3 cm, and WHZ was -2.13±0.76. Their mean±SD total feeding time (minutes) for lunch was 25.4±13.6 vs. 20.6±11.1 (p=0.130) and supper was 22.3±9.7 vs. 19.7±11.2 (p=0.297), and total amount (g) of food eaten in lunch and supper was found similar 116.1±7.0 vs. 117.7±8.0 (p=3.01) in A (Fish Surimi) and B group respectively. Score in Hedonic scale by mother on test of food given to children at lunch or supper was 3.9±0.2 vs. 4.0±0.2 (p=0.317) and on overall acceptance (including the texture, smell, and appearance) of food at lunch or supper was 3.9±0.2 vs. 4.0±0.2 (p=0.317) for A and B group respectively. No adverse event was observed in any food group during the study period. Conclusions: Fish Surimi peptide may be a cost effective supplementary food, which should be tested by appropriately designed randomized community level intervention trial both in wasted children and stunted children.

Keywords: protein-energy malnutrition, moderate acute malnutrition, weight-for-height z-score, mid upper arm circumference, acceptability, fish surimi peptide, under-5 children

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Authors: Naseer Ahmad

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This research investigates the intricate dynamics of language policy, ideology, and the choice of educational language as a medium of instruction in rural Pakistan. Focused on addressing the complexities of language practices in underexplored educational contexts, the study employed a case study approach, analyzing interviews with education authorities, teachers, and students, alongside classroom observations in English-medium and Urdu-medium rural schools. The research underscores the significance of understanding linguistic diversity within rural communities. The analysis of interviews and classroom observations revealed that language policies in rural schools are influenced by multiple factors, including historical legacies, societal language ideologies, and government directives. The dominance of Urdu and English as the preferred languages of instruction reflected a broader language hierarchy, where regional languages are often marginalized. This language ideology perpetuates a sense of linguistic inferiority among students who primarily speak regional languages. The impact of language choices on students' learning experiences and outcomes is a central focus of the research. It became evident that while policies advocate for specific language practices, the implementation often diverges due to multifarious socio-cultural, economic, and institutional factors. This disparity significantly impacts the effectiveness of educational processes, influencing pedagogical approaches, student engagement, academic outcomes, social mobility, and language choices. Based on the findings, the study concluded that due to policy and practice gap, rural people have complex perceptions and language choices. They perceived Urdu as a national, lingua franca, cultural, easy, or low-status language. They perceived English as an international, lingua franca, modern, difficult, or high-status language. They perceived other languages as mother tongue, local, religious, or irrelevant languages. This research provided insights that are crucial for theory, policy, and practice, addressing educational inequities and inclusive language policies. It set the stage for further research and advocacy efforts in the realm of language policies in diverse educational settings.

Keywords: language-in-education policy, language ideology, educational language choice, pakistan

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Authors: Elizabeth B. Katana, Brenda N. Simbwa, Josephine Namayanja, Bob O. Amodan, Edirisa J. Nsubuga, Eva A. O. Laker

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Background: Understanding stakeholders’ perceptions towards the implementation of a mass vaccination campaign is important to ensure the design of better strategies to address challenges. We explored stakeholders’ perceptions of the implementation of a nationwide door-to-door mass vaccination campaign for the oral polio vaccine (nOPV2) in Uganda for the two rounds that occurred in January and November 2022. Methods: A qualitative study was conducted among stakeholders who participated in the campaign implementation from 8 districts in Uganda using random sampling. We conducted 46 In-depth interviews lasting 30 – 40 minutes with 6 national/central supervisors, 12 district, 14 sub-county, and 14 parish-level supervisors. Stakeholders were asked about their experiences in the campaign implementation, including challenges faced and their opinions of the campaign impact and use of the door-to-door strategy. Data were analyzed thematically in line with the major campaign activities. Results: Most of the stakeholders were primarily concerned about poor planning, inadequate training of vaccination teams, community resistance including schools, challenges with recruitment and teaming of vaccinators, poor and delayed payments, lack of logistics and motivation for vaccination teams, the timing of the activities and implementing amidst COVID-19 and Ebola. The stakeholders believed that the first round was not well planned and implemented, while the second round was leveraged in their previous experiences. On the other hand, some positive experiences were noted with regard to communication, advocacy and mobilization, vaccine delivery and distribution, district readiness assessments, and cold chain management. Conclusion: This study identified many challenges that were faced in the implementation of the door-to-door mass campaign for nOPV2 in Uganda. This study identified that more needs to be done to improve door-to-door mass campaigns with a focus on motivating the implementers. These findings highlight the need for conducting performance reviews, improved planning, especially routine updates and verification of target populations and training in microplanning, and adequate mapping of community resistance to inform the implementation of future mass campaigns.

Keywords: mass polio vaccination campaigns, door-to-door strategy, stakeholders' perceptions, implementation challenges

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Authors: Ella Abaev, Shany Segal, Miri Gabay

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Background: Choking is a blockage of airways that prevents efficient breathing and air flow to the lungs. Choking may be partial or full and is an emergency situation. Complete or prolonged choking leads to apnea, lack of oxygen in the tissues of the body and brain, and can cause death. There are three mechanisms of choking: obstruction of internal respiratory tracts by food or object aspiration, any material that blocks or covers external air passages, external pressure on the neck or trapping between objects. Children's airways are narrower than that of adults and therefore the risk of choking is greater, due to the aspiration of food and other foreign bodies into the lungs. In the Child Development Center at Safra Children’s Hospital, Tel Hashomer in Israel are treated infants, toddlers, and children aged 0-18 years with various developmental disabilities. Due to the increase in reports of ‘almost an event’ of choking in the past year and the serious consequences of choking event, it was decided to give an emphasis to the issue. Incidence and methods: The number of reports of ‘almost an event’ or a choking event was examined at the center during the years 2013-2018 and a thorough research work was conducted on the subject in order to build a prevention program. Findings: Between 2013 and 2018 the center reported about ten cases of ‘almost choking events’. In the middle of 2018 alone three cases of ‘almost an event’ were reported. Objective: Providing knowledge leads to awareness raise, change of perception, change in behavior and prevention. The center employs more than 130 staff members from various sectors so that it is the work of multi-professional teams to promote the quality and safety of the treatment. The familiarity of the staff with risk factors, prevention guidelines, identification of choking signs, and treatment are most important and significant in determining the outcome of a choking event. Conclusions and recommendations: After in-depth research work was carried out in cooperation with the Risk Management Unit on the subject of choking, which include a description of the definitions, mechanisms, risk factors, treatment methods and extensive recommendations for prevention (e.g. using treatment and stimulation accessories with standards association stamps and adjustment of the type of food and the way it is served to match to the child's age and the ability to swallow). The expected stages of development and emphasis on the population of children with special needs were taken into account. The research findings will be published by the staff and parents of the patients, professional publications, and lectures and there is an expectation to decrease the number of choking events in the next years.

Keywords: children with special needs, choking, educational system, prevention guidelines

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Authors: Joy Chadwick

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This Study of Teaching and Learning (SoTL) research focused on the experiences of teacher candidates involved in an inclusive education methods course within a four-year direct entry Bachelor of Education program. The placement of this course within the final fourteen-week practicum semester is designed to facilitate deeper theory-practice connections between effective inclusive pedagogical knowledge and the real life of classroom teaching. The course focuses on supporting teacher candidates to understand that effective instruction within an inclusive classroom context must be intentional, responsive, and relational. Diversity is situated not as exceptional but rather as expected. This interpretive qualitative study involved the analysis of twenty-nine teacher candidate reflective journals and six individual teacher candidate semi-structured interviews. The journal entries were completed at the start of the semester and at the end of the semester with the intent of having teacher candidates reflect on their beliefs of what it means to be an effective inclusive educator and how the course and practicum experiences impacted their understanding and approaches to teaching in inclusive classrooms. The semi-structured interviews provided further depth and context to the journal data. The journals and interview transcripts were coded and themed using NVivo software. The findings suggest that instructional frameworks such as universal design for learning (UDL), differentiated instruction (DI), response to intervention (RTI), social emotional learning (SEL), and self-regulation supported teacher candidate’s abilities to meet the needs of their students more effectively. Course content that focused on specific exceptionalities also supported teacher candidates to be proactive rather than reactive when responding to student learning challenges. Teacher candidates also articulated the importance of reframing their perspective about students in challenging moments and that seeing the individual worth of each child was integral to their approach to teaching. A persisting question for teacher educators exists as to what pedagogical knowledge and understanding is most relevant in supporting future teachers to be effective at planning for and embracing the diversity of student needs within classrooms today. This research directs us to consider the critical importance of addressing personal attributes and mindsets of teacher candidates regarding children as well as considering instructional frameworks when designing coursework. Further, the alignment of an inclusive education course during a teaching practicum allows for an iterative approach to learning. The practical application of course concepts while teaching in a practicum allows for a deeper understanding of instructional frameworks, thus enhancing the confidence of teacher candidates. Research findings have implications for teacher education programs as connected to inclusive education methods courses, practicum experiences, and overall teacher education program design.

Keywords: inclusion, inclusive education, pre-service teacher education, practicum experiences, teacher education

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Authors: Hsiao-Lin Fang

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Every life is precious, and comprehensive care should be provided to individuals who are in the final stages of their lives. Hospice-shared care aims to provide optimal symptom control and palliative care to terminal (cancer) patients through the implementation of shared care, and to support patients and their families in making various physical and psychological adjustments in the face of death. This report examines a 10-year-boy diagnosed with Out-of-Hospital Cardiac Arrest (OHCA). The individual fainted when swimming at school and underwent 31 minutes of cardiopulmonary resuscitation (CPR). While receiving treatment at the hospital, the individual received extracorporeal membrane oxygenation(ECMO) due to unstable hemodynamics. Urgent cardiac catheterization found: Suspect acute fulminant myocarditis or underlying cardiomyopathy with acute decompensation, After the active rescue by the medical team, hemodynamics still showed only mean pressure value. With respect to the patient, interdepartmental hospice-shared care was implemented and a do-not-resuscitate (DNR) order was signed after family discussions were conducted. Assistance and instructions were provided as part of the comfort care process. A farewell gathering attended by the patient’s relatives, friends, teachers, and classmates was organized in an intensive care unit (ICU) in order to look back on the patient’s life and the beautiful memories that were created, as well as to alleviate the sorrow felt by family members, including the patient’s father and sister. For example, the patient was presented with drawings and accompanied to a garden to pick flowers. In this manner, the patient was able to say goodbye before death. Finally, the patient’s grandmother and father participated in the clinical hospice care and post-mortem care processes. A hospice-shared care clinician conducted regular follow-ups and provided care to the family of the deceased, supporting family members through the sorrowful period. Birth, old age, sickness, and death are the natural phases of human life. In recent years, growing attention has been paid to human-centered hospice care. Hospice care is individual holistic care provided by a professional team and it involves the provision of comprehensive care to a terminal patient. Hospice care aims to satisfy the physical, psychological, mental, and social needs of patients and their families. It does not involve the cessation of treatment but rather avoids the exacerbation or extension of the suffering endured by patients, thereby preserving the dignity and quality of life during the end-of-life period. Patients enjoy the company of others as they complete the last phase of their lives, and their families also receive guidance on how they can move on with their own lives after the patient’s death.

Keywords: hospice-shared care, extracorporeal membrane oxygenation (ECMO), hospice-shared care, child patient

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