Search results for: data integrity and privacy

Authors: Wanlapa Boonsod, Nisachon Yangprasong, Udomsak Kitthawee

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Thermal physics education is a complicated and challenging topic to discuss in any classroom. As a result, most students tend to be uninterested in learning this topic. In the current study, a convection experiment set was devised to show how heat can be transferred by a convection system to a thermoelectric plate until a LED flashes. This research aimed to 1) create a natural convection experimental set, 2) study learning achievement on the convection experimental set with the predict-observe-explain (POE) technique, and 3) study satisfaction for the convection experimental set with the predict-observe-explain (POE) technique. The samples were chosen by purposive sampling and comprised 28 students in grade 11 at Patumkongka School in Bangkok, Thailand. The primary research instrument was the plan for predict-observe-explain (POE) technique on heat transfer using a convection experimental set. Heat transfer experimental set by convection. The instruments used to collect data included a heat transfer achievement model by convection, a Satisfaction Questionnaire after the learning activity, and the predict-observe-explain (POE) technique for heat transfer using a convection experimental set. The research format comprised a one-group pretest-posttest design. The data was analyzed by GeoGebra program. The statistics used in the research were mean, standard deviation and t-test for dependent samples. The results of the research showed that achievement on heat transfer using convection experimental set was composed of thermo-electrics on the top side attached to the heat sink and another side attached to a stainless plate. Electrical current was displayed by the flashing of a 5v LED. The entire set of thermo-electrics was set up on the top of the box and heated by an alcohol burner. The achievement of learning was measured with the predict-observe-explain (POE) technique, with the natural convection experimental set statistically higher than before learning at a 0.01 level. Satisfaction with POE for physics learning of heat transfer by using convection experimental set was at a high level (4.83 from 5.00).

Keywords: convection, heat transfer, physics education, POE

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Authors: Mohammad Idrees Yusofzai, Hirobata Yasuhiro, Matsuo Kojiro

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Kabul is the capital of Afghanistan. It is the focal point of educational, industrial, etc. of Afghanistan. Additionally, the population of Kabul has grown recently and will increase because of return of refugees and shifting of people from other province to Kabul city. However, this increase in population, the issues of urban congestion and other related problems of urban transportation in Kabul city arises. One of the problems is public transport (large buses) service and needs to be modified and enhanced especially large bus routes that are operating in each zone of the 22 zone of Kabul City. To achieve the above mentioned goal of improving public transport, Spatial Accessibility Analysis is one of the important attributes to assess the effectiveness of transportation system and urban transport policy of a city, because accessibility indicator as an alternative tool to support public policy that aims the reinforcement of sustainable urban space. The case study of this research compares the present model (present bus route) and the modified model of public transport. Furthermore, present model, the bus routes in most of the zones are active, however, with having low frequency and unpublished schedule, and accessibility result is analyzed in four cases, based on the variables of accessibility. Whereas in modified model all zones in Kabul is taken into consideration with having specified origin and high frequency. Indeed the number of frequencies is kept high; however, this number is based on the number of buses Millie Bus Enterprise Authority (MBEA) owns. The same approach of cases is applied in modified model to figure out the best accessibility for the modified model. Indeed, the modified model is having a positive impact in congestion level in Kabul city. Besides, analyses of person trip and trip distribution have been also analyzed because how people move in the study area by each mode of transportation. So, the general aims of this research are to assess the present movement of people, identify zones in need of public transport and assess equity level of accessibility in Kabul city. The framework of methodology used in this research is based on gravity analysis model of accessibility; besides, generalized cost (time) of travel and travel mode is calculated. The main data come from person trip survey, socio-economic characteristics, demographic data by Japan International Cooperation Agency, 2008, study of Kabul city and also from the previous researches on travel pattern and the remaining data regarding present bus line and routes have been from MBEA. In conclusion, this research explores zones where public transport accessibility level is high and where it is low. It was found that both models the downtown area or central zones of Kabul city is having high level accessibility. Besides, the present model is the most unfavorable compared with the modified model based on the accessibility analysis.

Keywords: accessibility, bus generalized cost, gravity model, public transportation network

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Authors: Mathew Hoyes

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This paper is a collation of data, studies and anecdotes on the way education is funded in New Zealand, the ideals which have lead to this method, as well as the issues it has created when combined with other factors and government policy on education over the last two decades. The purpose of this paper is to provide a historical perspective of this situation and to contribute to the global discussion of how to fund schools in an equitable manner, given that the world has become increasingly more globalised and the perception of widening gaps between the rich and the poor in the western world.

Keywords: education funding equity, egalitarianism, socio-economic, New Zealand colonialism

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Authors: Leigh G. Hayden, Susan E. Shepley, Cristina Passarelli, William Tingo

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Introduction: Sensory interventions are popular therapeutic and recreational approaches for people living with all stages of dementia. However, it is unknown which sensory interventions are used to achieve which outcomes across all subtypes of dementia. Methods: To address this gap, we conducted a scoping review of sensory interventions for people living with dementia. We conducted a search of the literature for any article published in English from 1 January 1990 to 1 June 2019, on any sensory or multisensory intervention targeted to people living with any kind of dementia, which reported on patient health outcomes. We did not include complex interventions where only a small aspect was related to sensory stimulation. We searched the databases Medline, CINHAL, and Psych Articles using our institutional discovery layer. We conducted all screening in duplicate to reduce Type 1 and Type 2 errors. The data from all included papers were extracted by one team member, and audited by another, to ensure consistency of extraction and completeness of data. Results: Our initial search captured 7654 articles, and the removal of duplicates (n=5329), those that didn’t pass title and abstract screening (n=1840) and those that didn’t pass full-text screening (n=281) resulted in 174 articles included. The countries with the highest publication in this area were the United States (n=59), the United Kingdom (n=26) and Australia (n=15). The most common type of interventions were music therapy (n=36), multisensory rooms (n=27) and multisensory therapies (n=25). Seven articles were published in the 1990’s, 55 in the 2000’s, and the remainder since 2010 (n=112). Discussion: Multisensory rooms have been present in the literature since the early 1990’s. However, more recently, nature/garden therapy, art therapy, and light therapy have emerged since 2008 in the literature, an indication of the increasingly diverse scholarship in the area. The least popular type of intervention is a traditional food intervention. Taste as a sensory intervention is generally avoided for safety reasons, however it shows potential for increasing quality of life. Agitation, behavior, and mood are common outcomes for all sensory interventions. However, light therapy commonly targets sleep. The majority (n=110) of studies have very small sample sizes (n=20 or less), an indicator of the lack of robust data in the field. Additional small-scale studies of the known sensory interventions will likely do little to advance the field. However, there is a need for multi-armed studies which directly compare sensory interventions, and more studies which investigate the use of layering sensory interventions (for example, adding an aromatherapy component to a lighting intervention). In addition, large scale studies which enroll people at early stages of dementia will help us better understand the potential of sensory and multisensory interventions to slow the progression of the disease.

Keywords: sensory interventions, dementia, scoping review

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Authors: Mary-Ellen Hooper, Graeme Browne, Anthony Paul O'Brien

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Background: It has been reported that the experience of the organisational workplace culture for new graduate mental health nurses plays an important role in their attraction and retention to the discipline. Additionally, other research indicates that a negative workplace culture contributes to their dissatisfaction and attrition rate. Method: An ethnographic research design was applied to explore the subcultural experiences of new graduate nurses as they encounter mental health nursing. Data was collected between April and September 2017 across 6 separate Australian, NSW, mental health units. Data comprised of semi-structured interviews (n=24) and 31 episodes of field observation (62 hours). A total number of 26 new graduate and recent graduate nurses participated in the study – 14 new graduate nurses and 12 recently graduated nurses. Results: A key finding from this study was the New Graduate difficulty in articulating the role the of mental health nurse. Participants described a dichotomy between their ideological view of the mental health nurse and the reality of clinical practice. The participants’ ideological view of the mental health nurse involved providing holistic and individualised care within a flexible framework. Participants, however, described feeling powerless to change the recovery practices within the mental health service(s) because of their low status within the hierarchy. Resulting in participants choosing to fit into the existing culture, or considering leaving the field altogether. Conclusion: An incongruence between the values and ideals of an organisational culture and the reality shock of practice are shown to contribute to role ambiguity within its members. New graduate nurses entering the culture of mental health nursing describe role ambiguity resulting in dissatisfaction with practice. The culture and philosophy inherent to a service are posited to be crucial in creating positive experiences for graduate nurses.

Keywords: culture, mental health nurse, mental health nursing role, new graduate nurse

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Authors: Abderrahmane Diaf, Assia Cherfa, Lamia Karadaniz

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Multiple tray solar distillation offers an interesting alternative for small-scale desalination and production high quality distilled water at a competitive cost using solar energy. In this work, we present indoor/outdoor trial performance data of our multiple tray solar distillation as well as the results of cost estimation analysis.

Keywords: solar desalination, tray distillation, multi-étages solaire, solar distillation

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Authors: O. Delage, H. Bencherif, T. Portafaix, A. Bourdier

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The main purpose of time series analysis is to learn about the dynamics behind some time ordered measurement data. Two approaches are used in the literature to get a better knowledge of the dynamics contained in observation data sequences. The first of these approaches concerns time series decomposition, which is an important analysis step allowing patterns and behaviors to be extracted as components providing insight into the mechanisms producing the time series. As in many cases, time series are short, noisy, and non-stationary. To provide components which are physically meaningful, methods such as Empirical Mode Decomposition (EMD), Empirical Wavelet Transform (EWT) or, more recently, Empirical Adaptive Wavelet Decomposition (EAWD) have been proposed. The second approach is to reconstruct the dynamics underlying the time series as a trajectory in state space by mapping a time series into a set of Rᵐ lag vectors by using the method of delays (MOD). Takens has proved that the trajectory obtained with the MOD technic is equivalent to the trajectory representing the dynamics behind the original time series. This work introduces the singular spectrum decomposition (SSD), which is a new adaptive method for decomposing non-linear and non-stationary time series in narrow-banded components. This method takes its origin from singular spectrum analysis (SSA), a nonparametric spectral estimation method used for the analysis and prediction of time series. As the first step of SSD is to constitute a trajectory matrix by embedding a one-dimensional time series into a set of lagged vectors, SSD can also be seen as a reconstruction method like MOD. We will first give a brief overview of the existing decomposition methods (EMD-EWT-EAWD). The SSD method will then be described in detail and applied to experimental time series of observations resulting from total columns of ozone measurements. The results obtained will be compared with those provided by the previously mentioned decomposition methods. We will also compare the reconstruction qualities of the observed dynamics obtained from the SSD and MOD methods.

Keywords: time series analysis, adaptive time series decomposition, wavelet, phase space reconstruction, singular spectrum analysis

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Authors: Hayder H. Kareem, Shunqi Pan

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Groundwater is a vital water resource in many areas in the world, particularly in the Middle-East region where the water resources become scarce and depleting. Sustainable management and planning of the groundwater resources become essential and urgent given the impact of the global climate change. In the recent years, numerical models have been widely used to predict the flow pattern and assess the water resources security, as well as the groundwater quality affected by the contaminants transported. In this study, MODFLOW is used to study the current status of groundwater resources and the risk of water resource security in the region centred at Al-Najaf City, which is located in the mid-west of Iraq and adjacent to the Euphrates River. In this study, a conceptual model is built using the geologic and hydrogeologic collected for the region, together with the Digital Elevation Model (DEM) data obtained from the "Global Land Cover Facility" (GLCF) and "United State Geological Survey" (USGS) for the study area. The computer model is also implemented with the distributions of 69 wells in the area with the steady pro-defined hydraulic head along its boundaries. The model is then applied with the recharge rate (from precipitation) of 7.55 mm/year, given from the analysis of the field data in the study area for the period of 1980-2014. The hydraulic conductivity from the measurements at the locations of wells is interpolated for model use. The model is calibrated with the measured hydraulic heads at the locations of 50 of 69 wells in the domain and results show a good agreement. The standard-error-of-estimate (SEE), root-mean-square errors (RMSE), Normalized RMSE and correlation coefficient are 0.297 m, 2.087 m, 6.899% and 0.971 respectively. Sensitivity analysis is also carried out, and it is found that the model is sensitive to recharge, particularly when the rate is greater than (15mm/year). Hydraulic conductivity is found to be another parameter which can affect the results significantly, therefore it requires high quality field data. The results show that there is a general flow pattern from the west to east of the study area, which agrees well with the observations and the gradient of the ground surface. It is found that with the current operational pumping rates of the wells in the area, a dry area is resulted in Al-Najaf City due to the large quantity of groundwater withdrawn. The computed water balance with the current operational pumping quantity shows that the Euphrates River supplies water into the groundwater of approximately 11759 m3/day, instead of gaining water of 11178 m3/day from the groundwater if no pumping from the wells. It is expected that the results obtained from the study can provide important information for the sustainable and effective planning and management of the regional groundwater resources for Al-Najaf City.

Keywords: Al-Najaf city, conceptual modelling, groundwater, unconfined aquifer, visual MODFLOW

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Authors: Fulufhelo Oscar Makananise

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Digital technologies have played a significant role in bridging the information gap between the haves and the have nots in society. In developing countries such as South Africa, historically marginalised groups such as women in rural communities have an opportunity to use digital technologies to network among themselves as well as interact with their government, thereby enhancing prospects for poverty eradication, political participation, community development and democracy. However, the extent to which these goals can be achieved in a developing context through harnessing digital technologies is not quite clear, particularly given the fact that access to these technologies is not evenly distributed and the fact that women’s access to digital technologies is hampered by factors that go beyond the question of infrastructure. Informed by the technological dependency theory, this paper is about how female youth in rural South Africa are deploying digital media tools for socio-economic empowerment. In particular, the study investigated the extent to which female youth in Limpopo province, South Africa access and use digital media platforms and gadgets and the extent to which those technologies are breaking down barriers that stand in the way of female youth empowerment. Data were gathered using a self-administered questionnaire disseminated to selected 100 female youth in Limpopo Province, South Africa. The data were analysed using SPSS version 9, and the results were analysed using descriptive statistics. The paper argues that wider and constant access to digital media by female youth in rural areas is indicative of the great potential for empowering female youth in rural areas through harnessing digital media. The study established that the majority of female youth had access to digital media technologies and used them to share valuable information among themselves. The study further established that female youth are active users of digital media in South Africa, which is the significant driver for socio-economic empowerment.

Keywords: digital technologies, empowerment, female youth, South Africa, survey, technological dependency

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Authors: Fatemeh Faramarzi, Hosein Mahjoob

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Building dams on rivers for utilization of water resources causes problems in hydrodynamic equilibrium and results in leaving all or part of the sediments carried by water in dam reservoir. This phenomenon has also significant impacts on water and sediment flow regime and in the long term can cause morphological changes in the environment surrounding the river, reducing the useful life of the reservoir which threatens sustainable development through inefficient management of water resources. In the past, empirical methods were used to predict the sedimentation amount in dam reservoirs and to estimate its efficient lifetime. But recently the mathematical and computational models are widely used in sedimentation studies in dam reservoirs as a suitable tool. These models usually solve the equations using finite element method. This study compares the results from tow software packages, GSTARS4 & HEC-6, in the prediction of the sedimentation amount in Dez dam, southern Iran. The model provides a one-dimensional, steady-state simulation of sediment deposition and erosion by solving the equations of momentum, flow and sediment continuity and sediment transport. GSTARS4 (Generalized Sediment Transport Model for Alluvial River Simulation) which is based on a one-dimensional mathematical model that simulates bed changes in both longitudinal and transverse directions by using flow tubes in a quasi-two-dimensional scheme to calibrate a period of 47 years and forecast the next 47 years of sedimentation in Dez Dam, Southern Iran. This dam is among the highest dams all over the world (with its 203 m height), and irrigates more than 125000 square hectares of downstream lands and plays a major role in flood control in the region. The input data including geometry, hydraulic and sedimentary data, starts from 1955 to 2003 on a daily basis. To predict future river discharge, in this research, the time series data were assumed to be repeated after 47 years. Finally, the obtained result was very satisfactory in the delta region so that the output from GSTARS4 was almost identical to the hydrographic profile in 2003. In the Dez dam due to the long (65 km) and a large tank, the vertical currents are dominant causing the calculations by the above-mentioned method to be inaccurate. To solve this problem, we used the empirical reduction method to calculate the sedimentation in the downstream area which led to very good answers. Thus, we demonstrated that by combining these two methods a very suitable model for sedimentation in Dez dam for the study period can be obtained. The present study demonstrated successfully that the outputs of both methods are the same.

Keywords: Dez Dam, prediction, sedimentation, water resources, computational models, finite element method, GSTARS4, HEC-6

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Authors: Fatemeh Abbasi, Sahand Daneshvar

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Productivity is one of the essential goals of companies to improve performance, which as a strategy-oriented method, determines the basis of the company's economic growth. The history of productivity goes back centuries, but most researchers defined productivity as the relationship between a product and the factors used in production in the early twentieth century. Productivity as the optimal use of available resources means that "more output using less input" can increase companies' economic growth and prosperity capacity. Also, having a quality life based on economic progress depends on productivity growth in that society. Therefore, productivity is a national priority for any developed country. There are several methods for calculating productivity growth measurements that can be divided into parametric and non-parametric methods. Parametric methods rely on the existence of a function in their hypotheses, while non-parametric methods do not require a function based on empirical evidence. One of the most popular non-parametric methods is Data Envelopment Analysis (DEA), which measures changes in productivity over time. The DEA evaluates the productivity of decision-making units (DMUs) based on mathematical models. This method uses multiple inputs and outputs to compare the productivity of similar DMUs such as banks, government agencies, companies, airports, Etc. Non-parametric methods are themselves divided into the frontier and non frontier approaches. The Malmquist productivity index (MPI) proposed by Caves, Christensen, and Diewert (1982), the Hicks–Moorsteen productivity index (HMPI) proposed by Bjurek (1996), or the Luenberger productivity indicator (LPI) proposed by Chambers (2002) are powerful tools for measuring productivity changes over time. This study will compare the Malmquist, Hicks–Moorsteen, and Luenberger indices theoretically and empirically based on DEA models and review their strengths and weaknesses.

Keywords: data envelopment analysis, Hicks–Moorsteen productivity index, Leuenberger productivity indicator, malmquist productivity index

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Authors: Ramin Dabirian, Yi Zhang, Ilias Gavrielatos, Ram Mohan, Ovadia Shoham

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Oil-water emulsions can be found in almost every part of the petroleum industry, namely in reservoir rocks, drilling cuttings circulation, production in wells, transportation pipelines, surface facilities and refining process. However, it is necessary for oil production and refinery engineers to resolve the petroleum emulsion problems as well as to eliminate the contaminants in order to meet environmental standards, achieve the desired product quality and to improve equipment reliability and efficiency. A state-of-art Dispersion Characterization Rig (DCR) has been utilized to investigate crude oil-distilled water dispersion separation. Over 80 experimental tests were ran to investigate the flow behavior and stability of the dispersions. The experimental conditions include the effects of water cuts (25%, 50% and 75%), NaCl concentrations (0, 3.5% and 18%), mixture flow velocities (0.89 and 1.71 ft/s), and also orifice place types on the separation rate. The experimental data demonstrate that the water cut can significantly affects the separation time and efficiency. The dispersion with lower water cut takes longer time to separate and have low separation efficiency. The medium and lower water cuts will result in the formation of Mousse emulsion and the phase inversion happens around the medium water cut. The data also confirm that increasing the NaCl concentration in aqueous phase can increase the crude oil water dispersion separation efficiency especially at higher salinities. The separation profile for dispersions with lower salt concentrations has a lower sedimentation rate slope before the inflection point. Dispersions in all tests with higher salt concentrations have a larger sedimenting rate. The presence of NaCl can influence the interfacial tension gradients along the interface and it plays a role in avoiding the Mousse emulsion formation.

Keywords: oil-water dispersion, separation mechanism, phase inversion, emulsion formation

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Authors: Petronella Lunda, Catharina Susanna Minnie, Welma Lubbe

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Background This review aimed to provide healthcare professionals with a scientific summary of the best available research evidence on factors influencing respectful perinatal care. The review question was ‘What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?’ Methods A detailed search was done on electronic databases: EBSCOhost: Medline, OAlster, Scopus, SciELO, Science Direct, PubMed, Psych INFO, and SocINDEX. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during the selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. Results Studies conducted in various settings were included in the study. Multiple factors influencing respectful perinatal care were identified. During data synthesis, three themes emerged: healthcare institution, healthcare professionals, and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women’s knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of the care. Conclusion Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care.

Keywords: doctors, maternity care, midwives, obstetrician, perceptions, perinatal care, respectful care

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Authors: Jarmila Bernasovska, Pavel Ružbarský, Ivan Bernasovsky, Regina Lohajová Behulová

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The paper presents the results of the application of molecular genetics methods in sport research, with special emphasis on the most advanced methods and trends in diagnosing of motoric predispositions for the sake of identifying talented children. Genetic tests differ in principle from the traditional motoric tests, because the DNA of an individual does not change during life. Genetics is important in determining the capacity of an individual and for professional sport level. Genetic information can be used for individual genetic predispositions in early childhood. The phenotypes are influenced by a combination of genetic and environmental factors. The aim of the presented study was to examine physical condition, coordination skills, motoric docility and to determine the frequency of ACTN3 (R577X) gene in Romany children from Eastern Slovakia and compared their motoric performance with non-Romany children. This paper is not looking just for a performance, but also its association to genetic predispositions in relation to ACTN3 gene and its R577X polymorphism. Genotype data were obtained from 175 Romany children from 6 to 15 years old and 218 non-Romany children at the same age from Eastern Slovakia. Biological material for genetic analyses comprised samples of buccal swabs. Genotypes were determined using Real Time High resolution melting PCR method (Rotor Gene 6000 Corbett and LightCycler 480 Roche). Romany children of analyzed group legged to non-Romany children at the same age in all the compared tests. The % distribution of R and X alleles in children was different from controls. The frequency of XX genotype was 11,45% which is comparable to a frequency of an Indian population. Data were analysed with the ANOVA statistical programme and parametric and nonparametric tests. This work was supported by grants APVV-0716-10, ITMS 26220120023 and ITMS 26220120041.

Keywords: ACTN3 gene, R577X polymorphism, Romany children, sport performance, Slovakia

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Authors: Arman Kishan, Mark Haft, Steve Li, Duc Nguyen, Dawn Laporte

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Objective: Patients with Type 2 diabetes (T2DM) often face higher postoperative complication rates. Limited data exist on outcomes in T2DM patients undergoing carpal tunnel release (CTR). This study aims to compare complication rates between endoscopic CTR (ECTR) and open CTR (OCTR) in patients with T2DM. Methods: This was a retrospective cohort study using the TriNetX database of 56741 patients with T2DM undergoing ECTR (N= 14,949) or OCTR (N= 41,792). Demographic data, medical comorbidities, and complication rates were analyzed. We used multivariable analysis to identify differences in postoperative complication rates between the two treatment methods in patients with T2DM. Results: Patients with T2DM undergoing ECTR had a significantly lower incidence of 90-day wound infection (p < 0.001), 90-day wound dehiscence (p < 0.001), and nerve injury (p < 0.001) when compared to patients who underwent OCTR. After matching, there was a significantly higher number of T2DM patients undergoing ECTR who had peripheral vascular disease (p = 0.045) and hypertension (p = 0.020) when compared to the OCTR group. These patients also had a lower incidence of fluid and electrolyte disorders (p = 0.002) and chronic blood loss anemia (p = 0.025). Conclusion: ECTR presents a superior choice for T2DM patients undergoing CTR, yielding significantly lower rates of wound infection, wound dehiscence, and nerve injury within 90 days post-surgery—reducing the risk by 31%, 48%, and 59%, respectively. These findings support the adoption of ECTR as the preferred method in this patient population, potentially leading to improved postoperative outcomes.

Keywords: endoscopic treatment of carpal tunnel syndrome, open treatment of carpal tunnel syndrome, carpal tunnel syndrome, postoperative complications in patients with diabetes mellitus

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Authors: Farshid Marbouti, Jale Ulas, Julia Thompson

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The main sources of stress among college students are: changes in sleeping and eating habits, undertaking new responsibilities, and financial difficulties as the most common sources of stress, exams, meeting new people, career decisions, fear of failure, and pressure from parents, transition to university especially if it requires leaving home, working with people that they do not know, trouble with parents, and relationship with the opposite sex. The students use a variety of stress coping strategies, including talking to family and friends, leisure activities and exercising. The Yerkes–Dodson law indicates while a moderate amount of stress may be beneficial for performance, too high stress will result in weak performance. In other words, if students are too stressed, they are likely to have low academic performance. In a preliminary study conducted in 2017 with engineering students enrolled in three high failure rate classes, the majority of the students stated that they have high levels of stress mainly for academic, financial, or family-related reasons. As the second stage of the study, the main purpose of this research is to investigate the students’ level of stress, sources of stress, their relationship with student demographic background, students’ coping strategies, and academic performance. A device is being developed to gather data from students breathing patterns and measure their stress levels. In addition, all participants are asked to fill out a survey. The survey under development has the following categories: exam stressor, study-related stressors, financial pressures, transition to university, family-related stress, student response to stress, and stress management. After the data collection, Structural Equation Modeling (SEM) analysis will be conducted in order to identify the relationship among students’ level of stress, coping strategies, and academic performance.

Keywords: college student stress, coping strategies, academic performance, measuring stress

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Authors: Anselm Ego Onyimonyi, Maduako Johnpaul O.

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The study was designed to investigate into the socio-ecological impact of migration of Fulani herders in Anambra state of Nigeria, through a climate justice lens. Nigeria is one of the world’s most densely populated countries with a population of over 284 million people, half of which are considered to be in abject poverty. There is no doubt that livestock production provides sustainable contributions to food security and poverty reduction to Nigeria economy, but not without some environmental implications like any other economic activities. Nigeria is recognized as being vulnerable to climate change. Climate change and global warming if left unchecked will cause adverse effects on livelihoods in Nigeria, such as livestock production, crop production, fisheries, forestry and post-harvest activities, because the rainfall regimes and patterns will be altered, floods which devastate farmlands would occur, increase in temperature and humidity which increases pest and disease would occur and other natural disasters like desertification, drought, floods, ocean and storm surges, which not only damage Nigerians’ livelihood but also cause harm to life and property, would occur. This and other climatic issue as it affects Fulani herdsmen was what this study investigated. In carrying out this research, a survey research design was adopted. A simple sampling technique was used. One local government area (LGA) was selected purposively from each of the four agricultural zone in the state based on its predominance of Fulani herders. For appropriate sampling, 25 respondents from each of the four Agricultural zones in the state were randomly selected making up the 100 respondent being sampled. Primary data were generated by using a set of structured 5-likert scale questionnaire. Data generated were analyzed using SPSS and the result presented using descriptive statistics. From the data analyzed, the study indentified; Unpredicted rainfall (mean = 3.56), Forest fire (mean = 4.63), Drying Water Source (mean = 3.99), Dwindling Grazing (mean 4.43), Desertification (mean = 4.44), Fertile land scarcity (mean = 3.42) as major factor predisposing Fulani herders to migrate southward while rejecting Natural inclination to migrate (mean = 2.38) and migration to cause trouble as a factor. On the reason why Fulani herders are trying to establish a permanent camp in Anambra state; Moderate temperature (mean= 3.60), Avoiding overgrazing (4.42), Search for fodder and water (mean = 4.81) and (mean = 4.70) respectively, Need for market (4.28), Favorable environment (mean = 3.99) and Access to fertile land (3.96) were identified. It was concluded that changing climatic variables necessitated the migration of herders from Northern Nigeria to areas in the South were the variables are most favorable to the herders and their animals.

Keywords: socio-ecological, migration, fulani, climate, justice, lens

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Authors: Hager Elsheikh

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Context: Pancreatitis is a condition characterized by inflammation in the pancreas, which can lead to serious complications if untreated. Both acute and chronic pancreatitis are associated with immune reactions and fibrosis, which further damage the pancreas. The type 2 immune response, primarily driven by alternative activated macrophages (AAMs), plays a significant role in the development of fibrosis. The IL-4/STAT6 pathway is a crucial signaling pathway for the activation of M2 macrophages. Pancreatic fibrosis is induced by dysregulated inflammatory responses and can result in the autodigestion and necrosis of pancreatic acinar cells. Research Aim: The aim of this study is to investigate the impact of STAT6, a crucial molecule in the IL-4/STAT6 pathway, on the severity and development of fibrosis during acute and chronic pancreatitis. The research also aims to understand the influence of the JAK/STAT6 signaling pathway on the balance between fibrosis and regeneration in the presence of different macrophage populations. Methodology: The research utilizes murine models of acute and chronic pancreatitis induced by cerulean injection. Animal models will be employed to study the effect of STAT6 knockout on disease severity and fibrosis. Isolation of acinar cells and cell culture techniques will be used to assess the impact of different macrophage populations on wound healing and regeneration. Various techniques such as PCR, histology, immunofluorescence, and transcriptomics will be employed to analyze the tissues and cells. Findings: The research aims to provide insights into the mechanisms underlying tissue fibrosis and wound healing during acute and chronic pancreatitis. By investigating the influence of the JAK/STAT6 signaling pathway and different macrophage populations, the study aims to understand their impact on tissue fibrosis, disease severity, and pancreatic regeneration. Theoretical Importance: This research contributes to our understanding of the role of specific signaling pathways, macrophage polarization, and the type 2 immune response in pancreatitis. It provides insights into the molecular mechanisms underlying tissue fibrosis and the potential for targeted therapies. Data Collection and Analysis Procedures: Data will be collected through the use of murine models, isolation and culture of acinar cells, and various experimental techniques such as PCR, histology, immunofluorescence, and transcriptomics. Data will be analyzed using appropriate statistical methods and techniques, and the findings will be interpreted in the context of the research objectives. Conclusion: By investigating the mechanisms of tissue fibrosis and wound healing during acute and chronic pancreatitis, this research aims to enhance our understanding of the disease progression and potential therapeutic targets. The findings have theoretical importance in expanding our knowledge of pancreatic fibrosis and the role of macrophage polarization in the context of the type 2 immune response.

Keywords: immunity in chronic diseases, pancreatitis, macrophages, immune response

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Authors: Hyelim Park, Juan Martin Zorrilla

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Climate change influences very widely and in various ways ocean ecosystem functioning. The consequences of climate change on marine ecosystems are an increase in temperature and irregular behavior of some solute concentrations. These changes would affect fisheries catches in several ways. Our aim is to assess the quantitative contribution change of fishery catches along the time and express them through four environment variables: Sea Surface Temperature (SST4) and the concentrations of Chlorophyll (CHL), Particulate Inorganic Carbon (PIC) and Particulate Organic Carbon (POC) at two spatial scales: Global and the nineteen FAO Major Fishing Areas divisions. Data collection was based on the FAO FishStatJ 2014 database as well as MODIS Aqua satellite observations from 2002 to 2012. Some data had to be corrected and interpolated using some existing methods. As the results, a multivariable regression model for average Global fisheries captures contained temporal mean of SST4, standard deviation of SST4, standard deviation of CHL and standard deviation of PIC. Global vector auto-regressive (VAR) model showed that SST4 was a statistical cause of global fishery capture. To accommodate varying conditions in fishery condition and influence of climate change variables, a model was constructed for each FAO major fishing area. From the management perspective it should be recognized some limitations of the FAO marine areas division that opens to possibility to the discussion of the subdivision of the areas into smaller units. Furthermore, it should be treated that the contribution changes of fishery species and the possible environment factor for specific species at various scale levels.

Keywords: fisheries-catch, FAO FishStatJ, MODIS Aqua, sea surface temperature (SST), chlorophyll, particulate inorganic carbon (PIC), particulate organic carbon (POC), VAR, granger causality

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Authors: Aayush Anant, Roshni Thendiyath

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Aridity impacts on agriculture, as well as ecological, human health, and economic activities. In the present study, the effect of climate change on aridity index has been analysed in South Bihar for the past 30 year period by five types of aridity indices as Lang AI, De-Martonne AI, Erinc AI, Pinna combinative AI and UNEP AI. For the study of aridity index, the analysis of rainfall and temperature is significant. Rainfall was analysed for 30 year period from data of 23 gridded stations in for the period 1991-2020. The results show that rainfall pattern was decreasing with respect to previous decades for majority of stations. Trend of maximum, minimum and mean annual temperature has been observed, which shows increasing trend. Structural breakpoint was observed for mean annual temperature data series in year 2004. In period 1991-2004 mean annual temperature was 25.25 ºC, and in period 2005-2020, mean annual temperature was 25.7 ºC. Average aridity index has been calculated by all the above mentioned methods for whole 30 period. Lang AI shows that eastern part of study area is Humid type, and rest all is semi arid. De-Martonne AI also reveals that east part is humid, but rest of the study area is moist sub humid. According to Erinc AI and Pinna, combinative AI shows that whole south Bihar is dry sub humid and semi dry, respectively. UNEP AI shows most of the part as sub humid, and very small part in west is semi arid, while small part of east is humid. Temporal distribution of all the aridity indices shows a decreasing trend. This indicates a decrease in the humid areas in south Bihar for the selected time period.

Keywords: drought, aridity index, climate change, rainfall, temperature

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Authors: Brittany Richardson, Ying Wang

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For physical therapy, exercise prescription, athlete training, and regular fitness training, it is crucial to perform health assessments or fitness assessments periodically. An accurate assessment is propitious for tracking recovery progress, preventing potential injury and making long-range training plans. Assessments include necessary measurements, height, weight, blood pressure, heart rate, body fat, etc. and advanced evaluation, muscle group strength, stability-mobility, and movement evaluation, etc. In the current standard assessment procedures, the accuracy of assessments, especially advanced evaluations, largely depends on the experience of physicians, coaches, and personal trainers. And it is challenging to track clients’ progress in the current assessment. Unlike the tradition assessment, in this paper, we present a deep learning based face recognition algorithm for accurate, comprehensive and trackable assessment. Based on the result from our assessment, physicians, coaches, and personal trainers are able to adjust the training targets and methods. The system categorizes the difficulty levels of the current activity for the client or user, furthermore make more comprehensive assessments based on tracking muscle group over time using a designed landmark detection method. The system also includes the function of grading and correcting the form of the clients during exercise. Experienced coaches and personal trainer can tell the clients' limit based on their facial expression and muscle group movements, even during the first several sessions. Similar to this, using a convolution neural network, the system is trained with people’s facial expression to differentiate challenge levels for clients. It uses landmark detection for subtle changes in muscle groups movements. It measures the proximal mobility of the hips and thoracic spine, the proximal stability of the scapulothoracic region and distal mobility of the glenohumeral joint, as well as distal mobility, and its effect on the kinetic chain. This system integrates data from other fitness assistant devices, including but not limited to Apple Watch, Fitbit, etc. for a improved training and testing performance. The system itself doesn’t require history data for an individual client, but the history data of a client can be used to create a more effective exercise plan. In order to validate the performance of the proposed work, an experimental design is presented. The results show that the proposed work contributes towards improving the quality of exercise plan, execution, progress tracking, and performance.

Keywords: exercise prescription, facial recognition, landmark detection, fitness assessments

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Authors: Nditsheni Ramakuela, Sonto Maputle, Base Khoza, Augustine Tugli

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Inadequate health literacy can cause difficulties in understanding and compliance to treatment plan. With diabetic condition, self-care activities include behaviours of following a diet plan, avoiding high fat foods, increased exercise, self-glucose monitoring, and foot care. Patients with poor health literacy have difficulty interpreting medication warning labels, following directions on a prescription label and identifying their medications. Difficulties in understanding and performing self-care and health-related activities may ultimately lead to poor health outcomes. The study explored and described factors affecting health literacy and self-care to diabetic regimen by female patients at selected hospital in Limpopo Province of South Africa. Qualitative and explorative research design was used. Female patients who were admitted and diagnosed with diabetes in female medical ward constituted the study population. Non-probability, purposive sampling was used to select 20 female patients diagnosed with diabetes, who were above 18 years and admitted during April–November 2014. An in-depth face-to-face, unstructured interview was used to collect data. Data were analysed using open coding method. Measures to ensure trustworthiness and ethical considerations were adhered to. Findings revealed factors affecting health literacy for diabetic self-care activities amongst patients were; patient, family, disease and facility related. Proposed recommendations were; to strengthen diabetes education and patient-provider partnership. This is important and must be transferred to strengthen self-care activities to fully benefit the patient.

Keywords: compliance, diabetes mellitus, diabetic regimen, health literacy, self activities

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Authors: Ru-Yu Lien, Shih-Hsin Hung, Shu-Fen Lu, Ju-Jen Shie, Wen-Ju Yang, Yuann-Meei Tzeng, Chien-Ying Wang

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Background: The quality of care in intensive care units (ICUs) is crucial, especially for terminally ill patients. Shared decision-making (SDM) with families is essential to ensure appropriate care and reduce suffering. Aim: This study explores the effectiveness of an end-of-life decision support Patient Decision Aid (PDA) in an ICU setting. Methods: This study employed a cross-sectional research design conducted in an ICU from August 2020 to June 2023. Participants included family members of end-of-life patients aged 20 or older. A total of 319 participants. Family members of end-of-life patients received the PDA, and data were collected after they made medical decisions. Data collection involved providing family members with a PDA during family meetings. A post-PDA questionnaire with 17 questions assessed PDA effectiveness and anxiety levels. Statistical analysis was performed using SPSS 22.0. Results: The PDA significantly reduced anxiety levels among family members (p < 0.001). It helped them organize their thoughts, prepare for discussions with doctors, and understand critical decision factors. Most importantly, it influenced decision outcomes, with a shift towards palliative care and withdrawal of life-sustaining treatment. Conclusion: This study highlights the importance of family-centered end-of-life care in ICUs. PDAs promote informed decision-making, reduce conflicts, and enhance patient and family involvement. These tools align patient values and goals with medical recommendations, ultimately leading to decisions that prioritize comfort and quality of life. Implementing PDAs in healthcare systems can ensure that patients' care aligns with their values.

Keywords: shared decision-making, patient decision aid, end-of-life care, intensive care unit, family-centered care

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Authors: Yu-Tzu Chen, Luh-Maan Chang

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Construction is an inherently risky industry. The projects have been dominated by reactive actions owing to non-routine in nature. The on-site activities are especially crucial for successful project control. In order to alter actions from reactive to proactive, this paper presents an on-site data collection system utilizing advanced technology RFID and GPS in assisting on-site management with near real time progress monitoring.

Keywords: On-Site management, progress monitoring, RFID, GPS

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Authors: Bingying Liu, Dandong Ge, Xinlan Zhang, Haoyang Liang

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Over the past two years, a new generation of No-Pile Bike sharing, represented by the Ofo, Mobike and HelloBike, has sprung up in various cities in China, and spread rapidly in countries such as Britain, Japan, the United States and Singapore. As a new green public transportation mode, bike sharing can bring a series of benefits to urban space. At first, this paper analyzes the specific impact of bike sharing on urban space in China. Based on the market research and data analyzing, it is found that bike sharing can improve the quality of urban space in three aspects: expanding the radius of public transportation service, filling service blind spots, alleviating urban traffic congestion, and enhancing the vitality of urban space. On the other hand, due to the immature market and the imperfect system, bike sharing has gradually revealed some difficulties, such as parking chaos, malicious damage, safety problems, imbalance between supply and demand, and so on. Then the paper investigates the characteristics of shared bikes, business model, operating mechanism on Chinese market currently. Finally, in order to make bike sharing serve urban construction better, this paper puts forward some specific countermeasures from four aspects. In terms of market operations, it is necessary to establish a public-private partnership model and set up a unified bike-sharing integrated management platform. From technical methods level, the paper proposes to develop an intelligent parking system for regulating parking. From policy formulation level, establishing a bike-sharing assessment mechanism would strengthen supervision. As to urban planning, sharing data and redesigning slow roadway is beneficial for transportation and spatial planning.

Keywords: bike sharing, impact analysis, improvement strategy, urban space

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Authors: Sandra Christina Gressler

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Resting is essentially the physical and mental relaxation. So, can behaviors that go beyond the merely physical relaxation to some extent be understood as a behavior of restoration? Studies on restorative environments emphasize the physical, mental and social benefits that some environments can provide and suggest that activities in natural environments reduce the stress of daily lives, promoting recovery against the daily wear. These studies, though specific in their results, do not unify the different possibilities of restoration. Considering the importance of restorative environments by promoting well-being, this research aims to verify the applicability of the theory on restorative environments in a Brazilian context, inquiring about the environment/behavior of rest. The research sought to achieve its goals by; a) identifying daily ways of how participants interact/connect with nature; b) identifying the resting environments/behavior; c) verifying if rest strategies match the restorative environments suggested by restorative studies; and d) verifying different rest strategies related to time. Workers from different companies in which certain functions require focused attention, and high school students from different schools, participated in this study. An interview was used to collect data and information. The data obtained were compared with studies of attention restoration theory and stress recovery. The collected data were analyzed through the basic descriptive inductive statistics and the use of the software ALCESTE® (Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte). The open questions investigate perception of nature on a daily basis – analysis using ALCESTE; rest periods – daily, weekends and holidays – analysis using ALCESTE with tri-croisé; and resting environments and activities – analysis using a simple descriptive statistics. According to the results, environments with natural characteristics that are compatible with personal desires (physical aspects and distance) and residential environments when they fulfill the characteristics of refuge, safety, and self-expression, characteristics of primary territory, meet the requirements of restoration. Analyzes suggest that the perception of nature has a wide range that goes beyond the objects nearby and possible to be touched, as well as observation and contemplation of details. The restoration processes described in the studies of attention restoration theory occur gradually (hierarchically), starting with being away, following compatibility, fascination, and extent. They are also associated with the time that is available for rest. The relation between rest behaviors and the bio-demographic characteristics of the participants are noted. It reinforces, in studies of restoration, the need to insert not only investigations regarding the physical characteristics of the environment but also behavior, social relationship, subjective reactions, distance and time available. The complexity of the theme indicates the necessity for multimethod studies. Practical contributions provide subsidies for developing strategies to promote the welfare of the population.

Keywords: attention restoration theory, environmental psychology, rest behavior, restorative environments

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Authors: Vadim Vagin, Marina Fomina, Oleg Morosin

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This paper contains the description of argumentation approach for the problem of inductive concept formation. It is proposed to use argumentation, based on defeasible reasoning with justification degrees, to improve the quality of classification models, obtained by generalization algorithms. The experiment’s results on both clear and noisy data are also presented.

Keywords: argumentation, justification degrees, inductive concept formation, noise, generalization

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Authors: Hidehiro Endo, Taizo Shigemichi

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Introduction & Objectives: In 2008, the revised course of study for elementary schools was published by MEXT, and from the beginning of the academic year of 2011-2012, foreign language activities (English lessons) became mandatory for 5th and 6th graders in Japanese elementary schools. Foreign language activities are currently offered once a week for approximately 50 minutes by elementary school teachers, assistant language teachers who are native speakers of English, volunteers, among others, with the purpose of helping children become accustomed to functional English. However, the new policy has disclosed a myriad of issues in conducting foreign language activities since the majority of the current elementary school teachers has neither English teaching experience nor English proficiency. Nevertheless, converting foreign language activities into English, as a subject in Japanese elementary schools (for 5th and 6th graders) from 2020 is what MEXT currently envisages with the purpose of reforming English education in Japan. According to their new proposal, foreign language activities will be mandatory for 3rd and 4th graders from 2020. Consequently, gaining better access to English learning opportunities becomes one of the primary concerns even in early childhood education. Thus, in this project, we aim to explore some nursery schools’ attempts at providing toddlers with online English lessons via Skype. The main purpose of this project is to look deeply into what roles online English lessons in the nursery schools play in guiding nursery school children to enjoy learning the English language as well as to acquire English communication skills. Research Methods: Setting; The main research site is a nursery school located in the northern part of Japan. The nursery school has been offering a 20-minute online English lesson via Skype twice a week to 7 toddlers since September 2015. The teacher of the online English lessons is a male person who lives in the Philippines. Fieldwork & Data; We have just begun collecting data by attending the Skype English lessons. Direct observations are the principal components of the fieldwork. By closely observing how the toddlers respond to what the teacher does via Skype, we examine what components stimulate the toddlers to pay attention to the English lessons. Preliminary Findings & Expected Outcomes: Although both data collection and analysis are ongoing, we found that the online English teacher remembers the first name of each toddler and calls them by their first name via Skype, a technique that is crucial in motivating the toddlers to actively participate in the lessons. In addition, when the teacher asks the toddlers the name of a plastic object such as grapes in English, the toddlers tend to respond to the teacher in Japanese. Accordingly, the effective use of Japanese in teaching English for nursery school children need to be further examined. The anticipated results of this project are an increased recognition of the significance of creating English language learning opportunities for nursery school children and a significant contribution to the field of early childhood education.

Keywords: teaching children, English education, early childhood education, nursery school

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Authors: Tinnaphop Sinsomboonthong

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The hashtag, #LoveWins, has been widely used for celebrating the victory of the LGBTQ movement since June 2015 when the US Supreme Court enacted the rights of same-sex marriage. Nowadays, the hashtag is generally used among active social media users in many countries, including Thailand. Amidst the political conflict between advocates of the junta-backed legislation related to same-sex marriage laws, known as ‘Thailand’s Civil Partnership Draft Bills,’ and its detractors, the hashtag becomes crucial for Thailand’s 2019 national election season and shortly afterward as it was one of the most crucial parts of a political campaign to rebrand many political parties’ image, create an LGBT-friendly atmosphere and neutralize the bi-polarized politics of the law. The use of the hashtag is, therefore, not just an online entertainment but a politico-discursive tool, used by many actors for many purposes. Behind the confrontation between supporters and opposers of the law, the hashtag is used by both sides to highlight the Western-centric normativity of homosexual love, closely associated with Eurocentric modernity and heteronormativity. As an online ethnographical study, this paper aims to analyze how #LoveWins is used among Thai social media users in late 2018 to mid-2019 and how it is signified by Thai social media users during the Drafted-Bills period and the 2019 national election. A number of preliminary surveys of data on Twitter were conducted in December 2018 and, more intensely, in January 2019. Later, the data survey was officially conducted twice during February and April 2019, while the data collection was done during May-June 2019. Only public posts on Twitter that include the hashtag, #LoveWins, or any hashtags quoting ‘love’ and ‘wins’ are the main targets of this research. As a result of this, the use of the hashtag can be categorized into three levels, including banal decoration, homosexual love celebration, and colonial discourse on homosexual love. Particularly in the third type of the use of the hashtag, discourse analysis is applied to reveal that this hashtag is closely associated with the discourse of development and modernity as most of the descriptive posts demonstrate aspirations to become more ‘developed and modernized’ like many Western countries and Taiwan, the LGBT capital in Asia. Thus, calls for the ‘right to homosexual love’ and the ‘right to same-sex marriage’ in Thailand are shaped and formulated within the discursive linkage between modernity, development, and love. Also, the use of #LoveWins can be considered as a de-queering process of love as only particular types of gender identity, sexual orientation, and relationships that reflect Eurocentric modernity and heteronormativity are acceptable and advocated. Due to this, more inclusive queer loves should be supported rather than a mere essentialist-traditionalist homosexual love. Homonormativity must be deconstructed, and love must no longer be reserved for only one particular type of relationship that is standardized from/by the West. It must become more inclusive.

Keywords: #LoveWins, homosexual love, LGBT rights, same-sex marriage

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Authors: Kyngäs Helvi, Patala-Pudas, Kaakinen Pirjo

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It has been reported that COPD -patients may experience much emotional distress, which can compromise positive health outcomes. The aim of this study was to explore disease-related uncertainty as reported by Chronic Obstructive Pulmonary Disease (COPD) patients. Uncertainty was defined as a lack of confidence; negative feelings; a sense of confidence; and awareness of the sources of uncertainty. Research design was a non-experimental cross-sectional survey. The data (n=141) was collected by validated questionnaire during COPD -patients’ visits or admissions to a tertiary hospital. The response rate was 62%. The data was analyzed by statistical methods. Around 70% of the participants were male with COPD diagnosed many years ago. Fifty-four percent were under 65 years and used an electronic respiratory aid apparatus (52%) (oxygen concentrator, ventilator or electronic inhalation device). Forty-one percent of the participants smoked. Disease-related uncertainty was widely reported. Seventy-three percent of the participants had uncertainty about their knowledge of the disease, the pulmonary medication and nutrition. One-quarter (25%) did not feel sure about managing COPD exacerbation. About forty percent (43%) reported that they did not have a written exacerbation decision aid indicating how to act in relation to COPD symptoms. Over half of the respondents were uncertain about self-management behavior related to health habits such as exercise and nutrition. Over a third of the participants (37%) felt uncertain about self-management skills related to giving up smoking. Support from the care providers was correlated significantly with the patients’ sense of confidence. COPD -patients who felt no confidence stated that they received significantly less support in care. Disease-related uncertainty should be considered more closely and broadly in the patient care context, and those strategies within patient education that enhance adherence should be strengthened and incorporated into standard practice.

Keywords: adherence, COPD, disease-management, uncertainty

Procedia PDF Downloads 239