Search results for: parent’s expectations
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1245

Search results for: parent’s expectations

345 Enhancing the Aussie Optimism Positive Thinking Skills Program: Short-term Effects on Anxiety and Depression in Youth aged 9-11 Years Old

Authors: Rosanna M. Rooney, Sharinaz Hassan, Maryanne McDevitt, Jacob D. Peckover, Robert T. Kane

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Anxiety and depression are the most common mental health problems experienced by Australian children and adolescents. Research into youth mental health points to the importance of considering emotional competence, parental influence on the child’s emotional development, and the fact that cognitions are still developing in childhood when designing and implementing positive psychology interventions. Additionally, research into such interventions has suggested the inclusion of a coaching component aimed at supporting those implementing the intervention enhances the effects of the intervention itself. In light of these findings and given the burden of anxiety and depression in the longer term, it is necessary to enhance the Aussie Optimism Positive Thinking Skills program and evaluate its efficacy in terms of children’s mental health outcomes. It was expected that the enhancement of the emotional and cognitive aspects of the Aussie Optimism Positive Thinking Skills program, the addition of coaching, and the inclusion of a parent manual would lead to significant prevention effects in internalizing problems at post-test, 6- and 18-months after the completion of the intervention. 502 students (9-11 years old) were randomly assigned to the intervention group (n = 347) or control group (n = 155). At each time point (baseline, post-test, 6-month follow-up, and 18-month follow-up), students completed a battery of self-report measures. The ten intervention sessions making up the enhanced Aussie Optimism Positive Thinking Skills program were run weekly. At post-test and 6-month follow-up, the intervention group reported significantly lower depression than the control group, with no group differences at the 18-month follow-up. The intervention group reported significantly lower anxiety than the control group only at the 6-month follow-up, with no group differences in the post-test or at the 18-month follow-up. Results suggest that the enhanced Aussie Optimism Positive Thinking Skills program can reduce depressive and anxious symptoms in the short term and highlight the importance of universally implemented positive psychology interventions.

Keywords: positive psychology, emotional competence, internalizing symptoms, universal implementation

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344 Suicide Attempts and Gender: A Qualitative Analysis in Cuba

Authors: Alejandro Arnaldo Barroso Martinez

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Unlike sex, which is constituted by anatomic-physiological differences, gender is a social construction. Our thoughts and behaviors as females and males are not etched in stone by our biology but rather from how society expects us to think and behave based on our sex assignment in the womb. Social expectations, values, and roles are taken on by individuals and shape the ways considered acceptable and linked to our bodies, feelings, and interpersonal relationships. Furthermore, these evolve into dire consequences for those who do not meet these disciplinary, economic, and cultural standards. Then, the social learning of gender identity implies the individual’s psychological sense of being, and it might be highly linked to a sense of life and suicide attempts. As a result, suicide has been considered a gender issue with differences in the rates and means used by men and women worldwide. Nevertheless, there has been a misunderstanding of the meaning of being male or female in a particular context and how it becomes a risk process for suicide attempts. For this reason, the general objective of the current research is to explain how this process occurs in Cuba. From a Critical Sociology and Social Psychology, a qualitative methodology was developed through six case studies and qualitative in-depth interviews. The analysis is focused on the sequence and interplay between two dimensions of meaning: signifiers and voices. Findings show that the risk process of suicide attempts in Cuba means some patriarchal beliefs and practices as part of informal educational models and some positivist practices in mental health attention. Findings also show that community relations create a sense of belonging, and it is a protection against suicide attempts in Cuba. Those frames of signifiers and voices explain in both males and females but differently when and how they are suffering from isolation, violence, the normalization of emotional awareness, and emotional distress expression. Suicide prevention programs should take gender learning into account as a cultural process.

Keywords: social constructions, gender identity, meanings, suicide attempt

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343 Cyber Bullying, Online Risks and Parental Mediation: A Comparison between Adolescent Reports and Parent Perceptions in South Africa

Authors: Masa Popovac, Philip Fine

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Information and Communication Technologies (ICTs) have altered our social environments, and young people in particular have immersed themselves in the digital age. Despite countless benefits, younger ICT users are being exposed to various online risks such as contact with strangers, viewing of risky content, sending or receiving sexually themed images or comments (i.e. ‘sexting’) as well as cyber bullying. Parents may not be fully aware of the online spaces their children inhabit and often struggle to implement effective mediation strategies. This quantitative study explored (i) three types of online risks (contact risks, content risks and conduct risks), (ii) cyber bullying victimization and perpetration, and (iii) parental mediation among a sample of 689 South African adolescents aged between 12-17 years. Survey data was also collected for 227 of their parents relating to their perceptions of their child’s online experiences. A comparison between adolescent behaviors and parental perceptions was examined on the three variables in the study. Findings reveal various online risk taking behaviors. In terms of contact risks, 56% of adolescents reported having contact with at least one online stranger, with many meeting these strangers in person. Content risks included exposure to harmful information such as websites promoting extreme diets or self-harm as well as inappropriate content: 84% of adolescents had seen violent content and 75% had seen sexual content online. Almost 60% of adolescents engaged in conduct risks such as sexting. Eight online victimization behaviors were examined in the study and 79% of adolescents had at least one of these negative experiences, with a third (34%) defining this experience as cyber bullying. A strong connection between victimization and perpetration was found, with 63% of adolescents being both a victim and perpetrator. Very little parental mediation of ICT use was reported. Inferential statistics revealed that parents consistently underestimated their child’s online risk taking behaviors as well as their cyber bullying victimization and perpetration. Parents also overestimated mediation strategies in the home. The generational gap in the knowledge and use of ICTs is a barrier to effective parental mediation and online safety, since many negative online experiences by adolescents go undetected and can continue for extended periods of time thereby exacerbating the potential psychological and emotional distress. The study highlights the importance of including parents in online safety efforts.

Keywords: cyber bullying, online risk behaviors, parental mediation, South Africa

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342 Examining Predictive Coding in the Hierarchy of Visual Perception in the Autism Spectrum Using Fast Periodic Visual Stimulation

Authors: Min L. Stewart, Patrick Johnston

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Predictive coding has been proposed as a general explanatory framework for understanding the neural mechanisms of perception. As such, an underweighting of perceptual priors has been hypothesised to underpin a range of differences in inferential and sensory processing in autism spectrum disorders. However, empirical evidence to support this has not been well established. The present study uses an electroencephalography paradigm involving changes of facial identity and person category (actors etc.) to explore how levels of autistic traits (AT) affect predictive coding at multiple stages in the visual processing hierarchy. The study uses a rapid serial presentation of faces, with hierarchically structured sequences involving both periodic and aperiodic repetitions of different stimulus attributes (i.e., person identity and person category) in order to induce contextual expectations relating to these attributes. It investigates two main predictions: (1) significantly larger and late neural responses to change of expected visual sequences in high-relative to low-AT, and (2) significantly reduced neural responses to violations of contextually induced expectation in high- relative to low-AT. Preliminary frequency analysis data comparing high and low-AT show greater and later event-related-potentials (ERPs) in occipitotemporal areas and prefrontal areas in high-AT than in low-AT for periodic changes of facial identity and person category but smaller ERPs over the same areas in response to aperiodic changes of identity and category. The research advances our understanding of how abnormalities in predictive coding might underpin aberrant perceptual experience in autism spectrum. This is the first stage of a research project that will inform clinical practitioners in developing better diagnostic tests and interventions for people with autism.

Keywords: hierarchical visual processing, face processing, perceptual hierarchy, prediction error, predictive coding

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341 Evaluation of Student Satisfaction Level Towards Anadolu University E-Services through E-Government Model and Importance Performance Analysis Method

Authors: Emrah Ayhan, Puspa Saananta Irfani, Ömer Doğukan Şahin

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Public services, which are important for the order and continuity of social life, have begun to transform into electronic services (E-service) with the development of information and communication technologies in recent years. In particular, as a result of the widespread use of the internet and the increase in citizen demands, it has become necessary to provide public services electronically. In addition to facilitating traditional public services, new types of e-services strengthen the interaction, cooperation, accessibility, transparency, citizen participation (e-governance) and accountability between citizens and the state. In this context, the factors in the literature that are considered to influence the citizens’ satisfaction towards e-services will be examined through the example of student satisfaction with the e-services (Anasis, Mergen, E-mail, library, cafeteria and other transactions) offered by Anadolu University (Eskişehir, Türkiye) through university website and mobile application. The data for the analysis will be obtained from the survey research that will be used to measure user satisfaction with university e-services of 1,000 students studying at 9 different faculties and graduate schools of Anadolu University. These data will be analyzed with a unique methodology that uses the E-GovQual model and Importance Performance Analysis (IPA) methods together. The e-GovQual model serves as a framework for evaluating the quality of e-services, allowing a detailed understanding of students' perceptions. On the other hand, the IPA method will be used to determine the performance level of Anadolu University in the provision of e-services and to understand the areas that require improvement and student expectations. Strategic goals and suggestions will be made to decision-makers, students, and researchers in line with the findings obtained in the research. Thus, it is planned to contribute to e-governance and user satisfaction in educational institutions and to reveal practical implications for optimizing online platforms to better serve student needs.

Keywords: e-service, Anadolu university, student satisfaction, e-governance, e-govqual, importance performance analysis

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340 A Mixed Method Systematic Review of the Experience of Communication in the Care of Children with Palliative Care Needs

Authors: Maha Atout, Pippa Hemingway, Jane Seymour

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Background: A mixed method systematic review was undertaken in order to explore issues related to the experiences of health care providers and parents in the care of children with palliative care needs. The aims of this systematic review were to identify existing evidence about the experiences of communication in the care of children with palliative care needs, to appraise the research conducted in this area and to identify gaps in the literature in order to recommend for future related studies. Method: A mixed method systematic review of research on the experience of communication in the care of children with palliative care needs, conducted with parents and health professionals was undertaken. The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period of 2000-2016. Inclusion was limited to studies of communication experience in the care of children with palliative care needs. Result: Thirty-eight studies were found. The studies were conducted in a variety of countries: Uganda, Jordan, USA, UK, Taiwan, Turkey, Ireland, Poland, Brazil, Australia, Switzerland, Sweden, Netherland, Lebanon, Spain, Greece, and China. The current review shows that parents tend to protect their children when they are discussing their illnesses with them, particularly where they have a life-threatening or life-limiting condition. The approach of parents towards the discussion of sensitive issues concerning death with their children is significantly affected by the cultural background of the families. Conservative cultures encourage collusion behaviours which tend to keep children unaware of the incurable nature of the disease. The major communication challenges reported by health professionals are facing difficulties in judging how much information should be given to parents, responding to difficult questions, conflicts with families and inadequate skills to support grieving families. Conclusion: It is probably significant for the future studies to consider the change of parent-child communication experience over time in order to understand how the parents could change their interaction styles with their children according to the different stages of their children’s disease. Moreover, further studies are required to investigate the experience of communication of parents of children with non-malignant life-threatening and life-limiting illnesses.

Keywords: children with life-threatening or life- limiting illnesses, end of life, experience of communication, healthcare care providers, paediatric palliative care

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339 Ergonomics and Its Applicability in the Design Process in Egypt Challenges and Prospects

Authors: Mohamed Moheyeldin Mahmoud

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Egypt suffers from a severe shortage of data and charts concerning the physical dimensions, measurements, qualities and consumer behavior. The shortage of needed information and appropriate methods has forced the Egyptian designer to use any other foreign standard when designing a product for the Egyptian consumer which has led to many problems. The urgently needed database concerning the physical specifications, measurements of the Egyptian consumers, as well as the need to support the Ergonomics given courses in many colleges and institutes with the latest technologies, is stated as the research problem. Descriptive analytical method relying on the compiling, comparing and analyzing of information and facts in order to get acceptable perceptions, ideas and considerations is the used methodology by the researcher. The research concludes that: 1. Good interaction relationship between users and products shows the success of that product. 2. An integration linkage between the most prominent fields of science specially Ergonomics, Interaction Design and Ethnography should be encouraged to provide an ultimately updated database concerning the nature, specifications and environment of the Egyptian consumer, in order to achieve a higher benefit for both user and product. 3. Chinese economic policy based on the study of market requirements long before any market activities should be emulated. 4. Using Ethnography supports the design activities creating new products or updating existent ones through measuring the compatibility of products with their environment and user expectations, While contracting a joint cooperation between military colleges, sports education institutes from one side, and design institutes from the other side to provide an ultimately updated (annually updated) database concerning some specifications about students of both sexes applying in those institutes (height, weight, etc.) to provide the Industrial designer with the needed information when creating a new product or updating an existing one concerning that category is recommended by the researcher.

Keywords: adapt, ergonomics, ethnography, interaction design

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338 Influence of Titanium Oxide on Crystallization, Microstructure and Mechanical Behavior of Barium Fluormica Glass-Ceramics

Authors: Amit Mallik, Anil K. Barik, Biswajit Pal

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The galloping advancement of research work on glass-ceramics stems from their wide applications in electronic industry and also to some extent in application oriented medical dentistry. TiO2, even in low concentration has been found to strongly influence the physical and mechanical properties of the glasses. Glass-ceramics is a polycrystalline ceramic material produced through controlled crystallization of glasses. Crystallization is accomplished by subjecting the suitable parent glasses to a regulated heat treatment involving the nucleation and growth of crystal phases in the glass. Mica glass-ceramics is a new kind of glass-ceramics based on the system SiO2•MgO•K2O•F. The predominant crystalline phase is synthetic fluormica, named fluorophlogopite. Mica containing glass-ceramics flaunt an exceptional feature of machinability apart from their unique thermal and chemical properties. Machinability arises from the randomly oriented mica crystals with a 'house of cards' microstructures allowing cracks to propagate readily along the mica plane but hindering crack propagation across the layers. In the present study, we have systematically investigated the crystallization, microstructure and mechanical behavior of barium fluorophlogopite mica-containing glass-ceramics of composition BaO•4MgO•Al2O3•6SiO2•2MgF2 nucleated by addition of 2, 4, 6 and 8 wt% TiO2. The glass samples were prepared by the melting technique. After annealing, different batches of glass samples for nucleation were fired at 730°C (2wt% TiO2), 720°C (4 wt% TiO2), 710°C (6 wt% TiO2) and 700°C (8 wt% TiO2) batches respectively for 2 h and ultimately heated to corresponding crystallization temperatures. The glass batches were analyzed by differential thermal analysis (DTA) and x-ray diffraction (XRD), scanning electron microscopy (SEM) and micro hardness indenter. From the DTA study, it is found that the fluorophlogopite mica crystallization exotherm appeared in the temperature range 886–903°C. Glass transition temperature (Tg) and crystallization peak temperature (Tp) increased with increasing TiO2 content up to 4 wt% beyond this weight% the glass transition temperature (Tg) and crystallization peak temperature (Tp) start to decrease with increasing TiO2 content up to 8 wt%. Scanning electron microscopy confirms the development of an interconnected ‘house of cards’ microstructure promoted by TiO2 as a nucleating agent. The increase in TiO2 content decreases the vicker’s hardness values in glass-ceramics.

Keywords: crystallization, fluormica glass, ‘house of cards’ microstructure, hardness

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337 Corn Flakes Produced from Different Cultivars of Zea Mays as a Functional Product

Authors: Milenko Košutić, Jelena Filipović, Zvonko Nježić

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Extrusion technology is thermal processing that is applied to improve the nutritional, hygienic, and physical-chemical characteristics of the raw material. Overall, the extrusion process is an efficient method for the production of a wide range of food products. It combines heat, pressure, and shear to transform raw materials into finished goods with desired textures, shapes, and nutritional profiles. The extruded products’ quality is remarkably dependent upon feed material composition, barrel temperature profile, feed moisture content, screw speed, and other extrusion system parameters. Given consumer expectations for snack foods, a high expansion index and low bulk density, in addition to crunchy texture and uniform microstructure, are desired. This paper investigates the effects of simultaneous different types of corn (white corn, yellow corn, red corn, and black corn) addition and different screw speed (350, 500, 650 rpm) on the physical, technological, and functional properties of flakes products. Black corn flour and screw speed at 350 rpm positively influenced physical, technological characteristics, mineral composition, and antioxidant properties of flake products with the best total score analysis of 0,59. Overall, the combination of Tukey's HSD test and PCA enables a comprehensive analysis of the observed corn products, allowing researchers to identify them. This research aims to analyze the influence of different types of corn flour (white corn, yellow corn, red corn, and black corn) on the nutritive and sensory properties of the product (quality, texture, and color), as well as the acceptance of the new product by consumers on the territory of Novi Sad. The presented data point that investigated corn flakes from black corn flour at 350 rpm is a product with good physical-technological and functional properties due to a higher level of antioxidant activity.

Keywords: corn types, flakes product, nutritive quality, acceptability

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336 Teaching Self-Advocacy Skills to Students With Learning Disabilities: The S.A.M.E. Program of Instruction

Authors: Dr. Rebecca Kimelman

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Teaching students to self-advocate has become a central topic in special education literature and practice. However, many special education programs do not address this important skill area. To this end, I created and implemented the Self Advocacy Made Easy (S.A.M.E.) program of instruction, intended to enhance the self-advocacy skills of young adults with mild to moderate disabilities. The effectiveness of S.A.M.E., the degree to which self-advocacy skills were acquired and demonstrated by the students, the level of parental support, and the impact of culture on the process, and teachers’ beliefs and attitudes about the role of self-advocacy skills for their students were measured using action research that employed mixed methodology. Conducted at an overseas American International School, this action research study sought answers to these questions by providing an in-depth portrayal of the S.A.M.E. program, as well as the attitudes and perceptions of the stakeholders involved in the study (thirteen students, their parents, teachers and counsellors). The findings of this study were very positive. The S.A.M.E. program was found to be a valid and valuable instructional tool for teaching self-advocacy skills to students with learning disabilities and ADHD. The study showed participation in the S.A.M.E. program led to an increased understanding of the important elements of self-advocacy, an increase in students’ skills and abilities to self-advocate, and a positive increase in students’ feelings about themselves. Inclusion in the Student-Led IEP meetings, an authentic student assessment within the S.A.M.E. program, also yielded encouraging results, including a higher level of ownership of one’s profile and learning needs, a higher level of student engagement and participation in the IEP meeting, and a growing student awareness of the relevance of the document and the IEP process to their lives. Without exception, every parent believed that participating in the Student-Led IEP led to a growth in confidence in their children, including that it taught them how to ‘own’ their disability and an improvement in their communication skills. Teachers and counsellors that participated in the study felt the program was worthwhile, and led to an increase in the students’ ability to acknowledge their learning profile and to identify and request the accommodations (such as extended time or use of a calculator) they need to overcome or work around their disability. The implications for further research are many, and include an examination of the degree to which participation in S.A.M.E. fosters student achievement, the long-term effects of participation in the program, and the degree to which student participation in the Student-Led IEP meeting increases parents’ level of understanding and involvement.

Keywords: self-advocacy, learning disabilities, ADHD, student-led IEP process

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335 Israeli Households Caring for Children and Adults with Intellectual and Developmental Disabilities: An Explorative Study

Authors: Ayelet Gur

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Background: In recent years we are witnessing a welcome trend in which more children/persons with disabilities are living at home with their families and within their communities. This trend is related to various policy innovations as the UN Convention on the Rights of People with Disabilities that reflect a shift from the medical-institutional model to a human rights approach. We also witness the emergence of family centered approaches that perceive the family and not just the individual with the disability as a worthy target of policy planning, implementation and evaluation efforts. The current investigation aims to explore economic, psychological and social factors among households of families of children or adults with intellectual disabilities in Israel and to present policy recommendation. Methods: A national sample of 301 households was recruited through the education and employment settings of persons with intellectual disability. The main caregiver of the person with the disability (a parent) was interviewed. Measurements included the income and expense surveys; assets and debts questionnaire; the questionnaire on resources and stress; the social involvement questionnaire and Personal Wellbeing Index. Results: Findings indicate significant gaps in financial circumstances between households of families of children with intellectual disabilities and households of the general Israeli society. Households of families of children with intellectual disabilities report lower income and higher expenditures and loans than the general society. They experience difficulties in saving and coping with unexpected expenses. Caregivers (the parents) experience high stress, low social participation, low financial support from family, friend and non-governmental organizations and decreased well-being. They are highly dependent on social security allowances which constituted 40% of the household's income. Conclusions: Households' dependency on social security allowances may seem contradictory to the encouragement of persons with intellectual disabilities to favor independent living in light of the human rights approach to disability. New policy should aim at reducing caregivers' stress and enhance their social participation and support, with special emphasis on families of lower socio-economic status. Finally, there is a need to continue monitoring the economic and psycho-social needs of households of families of children with intellectual disabilities and other developmental disabilities.

Keywords: disability policy, family policy, intellectual and developmental disabilities, Israel, households study, parents of children with disabilities

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334 A Tool Tuning Approximation Method: Exploration of the System Dynamics and Its Impact on Milling Stability When Amending Tool Stickout

Authors: Nikolai Bertelsen, Robert A. Alphinas, Klaus B. Orskov

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The shortest possible tool stickout has been the traditional go-to approach with expectations of increased stability and productivity. However, experimental studies at Danish Advanced Manufacturing Research Center (DAMRC) have proven that for some tool stickout lengths, there exist local productivity optimums when utilizing the Stability Lobe Diagrams for chatter avoidance. This contradicts with traditional logic and the best practices taught to machinists. This paper explores the vibrational characteristics and behaviour of a milling system over the tool stickout length. The experimental investigation has been conducted by tap testing multiple endmills where the tool stickout length has been varied. For each length, the modal parameters have been recorded and mapped to visualize behavioural tendencies. Furthermore, the paper explores the correlation between the modal parameters and the Stability Lobe Diagram to outline the influence and importance of each parameter in a multi-mode system. The insights are conceptualized into a tool tuning approximation solution. It builds on an almost linear change in the natural frequencies when amending tool stickout, which results in changed positions of the Chatter-free Stability Lobes. Furthermore, if the natural frequency of two modes become too close, it will onset of the dynamic absorber effect phenomenon. This phenomenon increases the critical stable depth of cut, allowing for a more stable milling process. Validation tests on the tool tuning approximation solution have shown varying success of the solution. This outlines the need for further research on the boundary conditions of the solution to understand at which conditions the tool tuning approximation solution is applicable. If the conditions get defined, the conceptualized tool tuning approximation solution outlines an approach for quick and roughly approximating tool stickouts with the potential for increased stiffness and optimized productivity.

Keywords: milling, modal parameters, stability lobes, tap testing, tool tuning

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333 An Infinite Mixture Model for Modelling Stutter Ratio in Forensic Data Analysis

Authors: M. A. C. S. Sampath Fernando, James M. Curran, Renate Meyer

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Forensic DNA analysis has received much attention over the last three decades, due to its incredible usefulness in human identification. The statistical interpretation of DNA evidence is recognised as one of the most mature fields in forensic science. Peak heights in an Electropherogram (EPG) are approximately proportional to the amount of template DNA in the original sample being tested. A stutter is a minor peak in an EPG, which is not masking as an allele of a potential contributor, and considered as an artefact that is presumed to be arisen due to miscopying or slippage during the PCR. Stutter peaks are mostly analysed in terms of stutter ratio that is calculated relative to the corresponding parent allele height. Analysis of mixture profiles has always been problematic in evidence interpretation, especially with the presence of PCR artefacts like stutters. Unlike binary and semi-continuous models; continuous models assign a probability (as a continuous weight) for each possible genotype combination, and significantly enhances the use of continuous peak height information resulting in more efficient reliable interpretations. Therefore, the presence of a sound methodology to distinguish between stutters and real alleles is essential for the accuracy of the interpretation. Sensibly, any such method has to be able to focus on modelling stutter peaks. Bayesian nonparametric methods provide increased flexibility in applied statistical modelling. Mixture models are frequently employed as fundamental data analysis tools in clustering and classification of data and assume unidentified heterogeneous sources for data. In model-based clustering, each unknown source is reflected by a cluster, and the clusters are modelled using parametric models. Specifying the number of components in finite mixture models, however, is practically difficult even though the calculations are relatively simple. Infinite mixture models, in contrast, do not require the user to specify the number of components. Instead, a Dirichlet process, which is an infinite-dimensional generalization of the Dirichlet distribution, is used to deal with the problem of a number of components. Chinese restaurant process (CRP), Stick-breaking process and Pólya urn scheme are frequently used as Dirichlet priors in Bayesian mixture models. In this study, we illustrate an infinite mixture of simple linear regression models for modelling stutter ratio and introduce some modifications to overcome weaknesses associated with CRP.

Keywords: Chinese restaurant process, Dirichlet prior, infinite mixture model, PCR stutter

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332 Computational Approach to Identify Novel Chemotherapeutic Agents against Multiple Sclerosis

Authors: Syed Asif Hassan, Tabrej Khan

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Multiple sclerosis (MS) is a chronic demyelinating autoimmune disorder, of the central nervous system (CNS). In the present scenario, the current therapies either do not halt the progression of the disease or have side effects which limit the usage of current Disease Modifying Therapies (DMTs) for a longer period of time. Therefore, keeping the current treatment failure schema, we are focusing on screening novel analogues of the available DMTs that specifically bind and inhibit the Sphingosine1-phosphate receptor1 (S1PR1) thereby hindering the lymphocyte propagation toward CNS. The novel drug-like analogs molecule will decrease the frequency of relapses (recurrence of the symptoms associated with MS) with higher efficacy and lower toxicity to human system. In this study, an integrated approach involving ligand-based virtual screening protocol (Ultrafast Shape Recognition with CREDO Atom Types (USRCAT)) to identify the non-toxic drug like analogs of the approved DMTs were employed. The potency of the drug-like analog molecules to cross the Blood Brain Barrier (BBB) was estimated. Besides, molecular docking and simulation using Auto Dock Vina 1.1.2 and GOLD 3.01 were performed using the X-ray crystal structure of Mtb LprG protein to calculate the affinity and specificity of the analogs with the given LprG protein. The docking results were further confirmed by DSX (DrugScore eXtented), a robust program to evaluate the binding energy of ligands bound to the ligand binding domain of the Mtb LprG lipoprotein. The ligand, which has a higher hypothetical affinity, also has greater negative value. Further, the non-specific ligands were screened out using the structural filter proposed by Baell and Holloway. Based on the USRCAT, Lipinski’s values, toxicity and BBB analysis, the drug-like analogs of fingolimod and BG-12 showed that RTL and CHEMBL1771640, respectively are non-toxic and permeable to BBB. The successful docking and DSX analysis showed that RTL and CHEMBL1771640 could bind to the binding pocket of S1PR1 receptor protein of human with greater affinity than as compared to their parent compound (Fingolimod). In this study, we also found that all the drug-like analogs of the standard MS drugs passed the Bell and Holloway filter.

Keywords: antagonist, binding affinity, chemotherapeutics, drug-like, multiple sclerosis, S1PR1 receptor protein

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331 Banking Union: A New Step towards Completing the Economic and Monetary Union

Authors: Marijana Ivanov, Roman Šubić

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The single rulebook together with the Single Supervisory Mechanism and the Single Resolution Mechanism - as two main pillars of the banking union, represent important steps towards completing the Economic and Monetary Union. It should provide a consistent application of common rules and administrative standards for supervision, recovery and resolution of banks – with the final aim that a former practice of the bail-out is replaced with the bail-in system through which bank failures will be resolved by their own funds, i.e. with minimal costs for taxpayers and real economy. It has to reduce the financial fragmentation recorded in the years of crisis as the result of divergent behaviors in risk premium, lending activities, and interest rates between the core and the periphery. In addition, it should strengthen the effectiveness of monetary transmission channels, in particular the credit channels and overflows of liquidity on the single interbank money market. However, contrary to all the positive expectations related to the future functioning of the banking union, low and unbalanced economic growth rates remain a challenge for the maintenance of financial stability in the euro area, and this problem cannot be resolved just by a single supervision. In many countries bank assets exceed their GDP by several times, and large banks are still a matter of concern because of their systemic importance for individual countries and the euro zone as a whole. The creation of the SSM and the SRM should increase transparency of the banking system in the euro area and restore confidence that have been disturbed during the depression. It would provide a new opportunity to strengthen economic and financial systems in the peripheral countries. On the other hand, there is a potential threat that future focus of the ECB, resolution mechanism and other relevant institutions will be extremely oriented to the large and significant banks (whereby one half of them operate in the core and most important euro area countries), while it is questionable to what extent the common resolution funds will be used for rescue of less important institutions.

Keywords: banking union, financial integration, single supervision mechanism (SSM)

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330 A Folk’s Theory of the MomConnect (mHealth) Initiative in South Africa

Authors: Eveline Muika Kabongo, Peter Delobelle, Ferdinand Mukumbang, Edward Nicol

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Introduction: Studies have been conducted to establish the effect of the MomConnect program in South Africa, but these studies did not focus on the stakeholders' and implementers' perspectives and the underlying program theory of the MomConnect initiative program. We strived to obtain stakeholders’ perspectives and assumptions on the MomConnect program and develop an initial program theory (IPT) of how the MomConnect initiative was expected to work. Methods: A realist-informed explanatory design used. The interviewer was performed with 10 key informants selected purposively among MomConnect key informants at the a national level of NDoH South Africa. The interview was done via zoom and lasted for 30 to 60 minutes. Introduction and abduction inferencing approaches were applied. The deductive and inductive approaches were performed during the analysis. ICAMO hereustic framework was used to analysed the data in order to get key informants expectations on how the MomConnect will work or not. Results: We developed three folk’s theories illustrating how the key informants’ expected the MomConnect to work. These theories showed that the MomConnect intended to provide users with health information and education that will empower and motivate them with knowledge which will allow the improvement of health services delivery among HCPs and improvement of the uptake of MCH services among pregnant women and mothers and decrease the rate of maternal and child mortality in the country. The lack of an updated mechanism to link women to the outcome was an issue. Another problem enlightened was the introduction of the WhatsApp program instead of SMS messaging, which was free of charge to women. Conclusion: The Folk’s theory developed from this study provided an insight into how the MomConnect was expected to work and what did not work. The folk’s theory will be merged with information from candidate theories on synthesis review and document review to develop our initial program theory of the MomConnect initiative.

Keywords: mHealth, MomConnect program, realist evaluation, maternal and child health, maternal and child health services, introduction, theory-driven

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329 In Search of Good Fortune: Individualization, Youth and the Spanish Labour Market within a Context of Crisis

Authors: Matthew Lee Turnbough

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In 2007 Spain began to experience the effects of a deep economic crisis, which would generate a situation characterised by instability and uncertainty. This has been an obstacle, especially acute for the youth of this country seeking to enter the workforce. As a result of the impact of COVID-19, the youth in Spain are now suffering the effects of a new crisis that has deepened an already fragile labour environment. In this paper, we analyse the discourses that have emerged from a precarious labour market, specifically from two companies dedicated to operating job portals and job listings in Spain, Job Today, and CornerJob. These two start-up businesses have developed mobile applications geared towards young adults in search of employment in the service sector, two of the companies with the highest user rates in Spain. Utilizing a discourse analysis approach, we explore the impact of individualization and how the process of psychologization may contribute to an increasing reliance on individual solutions to social problems. As such, we seek to highlight the expectations and demands that are placed upon young workers and the type of subjectivity that this dynamic could foster, all this within an unstable framework seemingly marked by chance, a context which is key for the emergence of individualization. Furthermore, we consider the extent to which young adults incorporate these discourses and the strategies they employ basing our analysis on the VULSOCU (New Forms of Socio-Existential Vulnerability, Supports, and Care in Spain) research project, specifically the results of nineteen in-depth interviews and three discussion groups with young adults in this country. Consequently, we seek to elucidate the argumentative threads rooted in the process of individualization and underline the implications of this dynamic for the young worker and his/her labour insertion while also identifying manifestations of the goddess of fortune as a representation of chance in this context. Finally, we approach this panorama of social change in Spain from the perspective of the individuals or young adults who find themselves immersed in this transition from one crisis to another.

Keywords: chance, crisis, discourses, individualization, work, youth

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328 The Hidden Characteristics That Tutors Hope Dundee Mmed Graduates Might Have after Graduation

Authors: Afnan Khoja, Ittisak Subrungruang, Kritchaya Ritruechai, Linda Jones, David Wall

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Background: Some characteristics might be stated as an objective of the curriculum and some might be hidden. The hidden curriculum is the unwritten and unintended lessons and perspectives that students absorb in school. Though, the hidden characteristics are expected that tutors hope students might have in order to become medical educators. We suspected our faculty hoped we would develop skills, know and develop beyond the written outcomes. Our research question aimed to explore the hidden curriculum; as part of our learning; we had to design and report findings. Summary of Work: We undertook semi-structured interviews with a sample of the centre for medical education faculty at Dundee. Participants answered the question , of what are the hidden characteristics that they hope Dundee MMed graduates might have after graduation. Thematic analysis was carried out on the interview scripts. Summary of Results: A thematic analysis was carried out on the interview transcripts. Three main themes were identified from all respondents' comments. These were lifelong learners, being flexible and problem solvers. In addition individual respondents also described sense of humour, collaboration, humility, role model, inquisitiveness, optimism, and ability to express oneself clearly. Discussion: Tutors put great value on three behaviours lifelong learner, flexible, and problem solver, which are part of professional characteristics in leadership. Therefore, leadership characteristics is incorporated as the outcomes of hidden characteristics that tutors would like to see. Conclusion: Tutors in the Master's program of medical education at the University of Dundee hope that medical education students should present the three main hidden characteristics, which are lifelong learner, flexible, and problem solver after graduation. Take-home Messages: These hidden characteristics are considered as informal unless a change has been made to the formal curriculum. Therefore, to reach the tutors’ expectations, further studies might be held to make this personal characteristics transformation more accessible.

Keywords: characteristics, hidden curriculum, transformation, informal

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327 Qualitative Needs Assessment for Development of a Smart Thumb Prosthetic

Authors: Syena Moltaji, Stephanie Posa, Sander Hitzig, Amanda Mayo, Heather Baltzer

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Purpose: To critically assess deficits following thumb amputation and delineate elements of an ideal thumb prosthesis from the end-user perspective. Methods: This was a qualitative study based on grounded theory. End-user stakeholder groups of thumb amputees and prosthetists were interviewed. Transcripts were reviewed whole first for familiarity. Data coding was then performed by two individual authors. Coded units were grouped by similarity and reviewed to reach a consensus. Codes were then analyzed for emergent themes by each author. A consensus meeting was held with all authors to finalize themes. Results: Three patients with traumatic thumb amputation and eight prosthetists were interviewed. Seven themes emerged. First was the significant impact of losing a thumb, in which codes of functional impact, mental impact, and occupational impact were included. The second theme was the unique nature of each thumb amputee, including goals, readiness for prosthesis, nature of the injury, and insurance. The third emergent theme was cost, surrounding government funding, insurability, and prosthetic pricing. The fourth theme was patient frustration, which included mismatches of prosthetic expectations and realities, activity limitations, and causes of devices abandonment. Themes five and six surrounded the strengths and weaknesses of current prosthetics, respectively. Theme seven was the ideal design for a thumb prosthetic, including abilities, suspension, and materials. Conclusions: Representative data from stakeholders mapped the current status of thumb prosthetics. Preferences for an ideal thumb prosthetic emerged, with suggestions for a simple, durable design. The ability to oppose, grasp and sense pressure was reported as functional priorities. Feasible cost and easy fitting emerged as systemic objectives. This data will be utilized in the development of a sensate thumb prosthetic.

Keywords: smart thumb, thumb prosthetic, sensate prosthetic, amputation

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326 Study on Horizontal Ecological Compensation Mechanism in Yangtze River Economic Belt Basin: Based on Evolutionary Game Analysis and Water Quality and Quantity Model

Authors: Tingyu Zhang

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The horizontal ecological compensation (HEC) mechanism is the key to stimulating the active participation of the whole basin in ecological protection. In this paper, we construct an evolutionary model for HEC in the Yangtze River Economic Belt (YREB) basin with the introduction of the central government constraint and incentive mechanism (CGCIM) and explore the conditions for the realization of a (Protection and compensation) strategy that meets the social expectations. Further, the water quality-water quantity model is utilized to measure the HEC amount with the characteristic factual data of the YREB in 2020-2022. The results show that the stability of the evolutionary game model of upstream and downstream governments in the YREB is closely related to the CGCIM. If (Protection Compensation) is to be realized as the only evolutionary stable strategy of the evolutionary game system composed of upstream and downstream governments, it is necessary for the CGCIM to satisfy that the sum of the incentives for the protection side and its unilateral or bilateral constraints is greater than twice the input cost of the active strategy, and the sum of the incentives for the compensation side and its unilateral or bilateral constraints is greater than the amount of ecological compensation that needs to be paid by it when it adopts the active strategy. At this point, the total amount of HEC that the downstream government should give to the upstream government of the YREB is 2856.7 million yuan in 2020, 5782.1 million yuan in 2021, and 23166.7 million yuan in 2022. The results of the study can provide a reference for promoting the improvement and refinement of the HEC mechanism in the YREB.

Keywords: horizontal ecological compensation, Yangtze river economic belt, evolutionary game analysis, water quality and quantity model research on territorial ecological restoration in Mianzhu city, Sichuan, under the dual evaluation framework

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325 Revealing Thermal Degradation Characteristics of Distinctive Oligo-and Polisaccharides of Prebiotic Relevance

Authors: Attila Kiss, Erzsébet Némedi, Zoltán Naár

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As natural prebiotic (non-digestible) carbohydrates stimulate the growth of colon microflora and contribute to maintain the health of the host, analytical studies aiming at revealing the chemical behavior of these beneficial food components came to the forefront of interest. Food processing (especially baking) may lead to a significant conversion of the parent compounds, hence it is of utmost importance to characterize the transformation patterns and the plausible decomposition products formed by thermal degradation. The relevance of this work is confirmed by the wide-spread use of these carbohydrates (fructo-oligosaccharides, cyclodextrins, raffinose and resistant starch) in the food industry. More and more functional foodstuffs are being developed based on prebiotics as bioactive components. 12 different types of oligosaccharides have been investigated in order to reveal their thermal degradation characteristics. Different carbohydrate derivatives (D-fructose and D-glucose oligomers and polymers) have been exposed to elevated temperatures (150 °C 170 °C, 190 °C, 210 °C, and 220 °C) for 10 min. An advanced HPLC method was developed and used to identify the decomposition products of carbohydrates formed as a consequence of thermal treatment. Gradient elution was applied with binary solvent elution (acetonitrile, water) through amine based carbohydrate column. Evaporative light scattering (ELS) proved to be suitable for the reliable detection of the UV/VIS inactive carbohydrate degradation products. These experimental conditions and applied advanced techniques made it possible to survey all the formed intermediers. Change in oligomer distribution was established in cases of all studied prebiotics throughout the thermal treatments. The obtained results indicate increased extent of chain degradation of the carbohydrate moiety at elevated temperatures. Prevalence of oligomers with shorter chain length and even the formation of monomer sugars (D-glucose and D-fructose) might be observed at higher temperatures. Unique oligomer distributions, which have not been described previously are revealed in the case of each studied, specific carbohydrate, which might result in various prebiotic activities. Resistant starches exhibited high stability when being thermal treated. The degradation process has been modeled by a plausible reaction mechanism, in which proton catalyzed degradation and chain cleavage take place.

Keywords: prebiotics, thermal degradation, fructo-oligosaccharide, HPLC, ELS detection

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324 Identifying Game Variables from Students’ Surveys for Prototyping Games for Learning

Authors: N. Ismail, O. Thammajinda, U. Thongpanya

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Games-based learning (GBL) has become increasingly important in teaching and learning. This paper explains the first two phases (analysis and design) of a GBL development project, ending up with a prototype design based on students’ and teachers’ perceptions. The two phases are part of a full cycle GBL project aiming to help secondary school students in Thailand in their study of Comprehensive Sex Education (CSE). In the course of the study, we invited 1,152 students to complete questionnaires and interviewed 12 secondary school teachers in focus groups. This paper found that GBL can serve students in their learning about CSE, enabling them to gain understanding of their sexuality, develop skills, including critical thinking skills and interact with others (peers, teachers, etc.) in a safe environment. The objectives of this paper are to outline the development of GBL variables from the research question(s) into the developers’ flow chart, to be responsive to the GBL beneficiaries’ preferences and expectations, and to help in answering the research questions. This paper details the steps applied to generate GBL variables that can feed into a game flow chart to develop a GBL prototype. In our approach, we detailed two models: (1) Game Elements Model (GEM) and (2) Game Object Model (GOM). There are three outcomes of this research – first, to achieve the objectives and benefits of GBL in learning, game design has to start with the research question(s) and the challenges to be resolved as research outcomes. Second, aligning the educational aims with engaging GBL end users (students) within the data collection phase to inform the game prototype with the game variables is essential to address the answer/solution to the research question(s). Third, for efficient GBL to bridge the gap between pedagogy and technology and in order to answer the research questions via technology (i.e. GBL) and to minimise the isolation between the pedagogists “P” and technologist “T”, several meetings and discussions need to take place within the team.

Keywords: games-based learning, engagement, pedagogy, preferences, prototype

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323 Psychometrics of the Farsi Version of the Newcastle Nursing Care Satisfaction Scale in Patients Admitted to the Internal and General Surgery Departments of Hospitals Affiliated with Ardabil University of Medical Sciences in 2017

Authors: Mansoureh Karimollahi, Mehriar Adrmohammadi, Mohsen Mohammadi

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Introduction: Patient satisfaction with nursing care is considered as an important indicator of the quality and effectiveness of the health care system, and improving the quality of care is not possible without paying attention to the opinions and expectations of patients. Considering that the scales for assessing satisfaction with nursing care in our country are not comprehensive and measure very few areas, therefore, in this study, psychometrically, the Persian version of the Newcastle Nursing Care Satisfaction Scale was used in patients hospitalized in the wards. Internal medicine and general surgery were discussed. Methods: This cross-sectional study was conducted on 200 patients admitted to the surgery and internal departments of hospitals affiliated to Ardabil University of Medical Sciences. The Newcastle nursing care satisfaction scale was used for the first time in Iran in comparison with the good nursing care scale from the patients' point of view to evaluate the criterion validity. The Newcastle nursing care satisfaction scale was used after translation, validity, and reliability. Results: The level of satisfaction of patients and the experience of patients with nursing care was at a favorable level, respectively, with an average of 111.8 ± 14.2 and 69.07 ± 14.8. Total CVI was estimated at 0.96 for the experience section, 0.95 for the satisfaction section, and 0.96 for the whole scale. The index (CVR) was also 0.95 for the experience section, 0.95 for the satisfaction section, and 0.95 for the whole scale. Criterion validity was also estimated using 0.725 correlation. The validity of the construct was also confirmed using the goodness of fit index (X2=1932/05, p=0.013, KMO=0.913). Convergent validity was estimated at 0.99 in the experience subscale and 0.98 in the satisfaction subscale. . The overall reliability in the experience subscale and satisfaction subscale was 94%, 92%, and 98%, respectively, which indicated the acceptable reliability of the questionnaire. Conclusion: The Persian version of the Newcastle nursing care satisfaction scale as a comprehensive tool that can be easily completed by patients and is easy to interpret, has good validity and reliability and can be used in patient care centers, in departments Surgery, and internal medicine are recommended.

Keywords: psychometrics, Newcastle nursing care satisfaction scale, nursing care satisfaction, general surgery department

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322 A Research Study on Planning of Water-Based Recreation Operation on the Deriner Reservoir and Its Near Around

Authors: Hi̇lal Surat

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People who want to get rid of stress and intensive working tempo for a while head for recreation operations in order to get rest and have fun. Therefore, planning recreation operation makes contributions to social, physiological, economic and psychological development of an individual and the community in a way that the needs of people meet regularly and constantly. The rapid increase of world population rate makes necessary of benefit from natural or man-made resources in a multiple way. Dams and reservoirs which are built near urban area with the aim of electrical energy conversion and agricultural irrigation are considered as natural area providing various opportunities such as recreation operations. Dams have a great importance regarding to protection and improvement of water resources and coming into service of community. There should be a priority to protect these water resources, which are essential for nature and living organisms. It should be taken into consideration that these water resources are the most important input in the area and have high nature value to make sustainability of recreation effectiveness. The Deriner reservoir that has been built yet near the province of Artvin with natural and cultural properties is considered as an alternative option for meeting the needs of people for sportive and recreation activities and as a potential for planning of water-based recreation activities. Hence, in this study, activities that meet the expectations of people who get benefit from the area considering to natural, cultural and sportive recreation opportunities will be developed. In the first place, planning criteria for some sportive and water-based recreation operations will be defined in order to use the area for recreation and sportive activities and these criteria will be a base for a macro planning work within the holistic perspective of natural, cultural, and economical structure of the area. After this time, necessities of local people and evaluation of reservoir recreational potential will be determined, end then different socio-economic groups according to their in-come, age groups will be chosen and the questionnaire which has already prepared will be done these groups, as a result of these questionnaire recreational activities in water necessities will determine and we are going to develop different suggestion for this reservoir.

Keywords: dam, dam lakes, Deriner, recreation, water based activities

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321 Effective Coaching for Teachers of English Language Learners: A Gap Analysis Framework

Authors: Armando T. Zúñiga

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As the number of English Language Learners (ELLs) in public schools continues to grow, so does the achievement gap between ELLs and other student populations. In an effort to support classroom teachers with effective instructional strategies for this student population, many districts have created instructional coaching positions specifically to support classroom teachers of ELLs—ELL Teachers on Special Assignment (ELL TOSAs). This study employed a gap analysis framework to the ELL TOSA professional support program in one California school district to examine knowledge, motivation, and organizational influences (KMO) on the ELL TOSAs’ goal of supporting classroom teachers of ELLs. Three themes emerged as a result of data analysis. First, there was evidence to illustrate the interaction between knowledge and the organization. Data from ELL TOSAs indicated an understanding of the role that collaboration plays in coaching and how to operationalize it in their support of teachers. Further, all of the ELL TOSAs indicated they have received professional development on effective strategies for instructional coaching. Additionally, a large percentage of the ELL TOSAs indicated a knowledge of modeling as an effective coaching practice. Accordingly, all of the ELL TOSAs indicated that they had knowledge of feedback as an effective coaching strategy. However, there was not sufficient evidence to support that they learned the latter two strategies through professional development. A second theme surfaced as there was evidence to illustrate an interaction between motivation and the organization. Some ELL TOSAs indicated that their sense of self-efficacy was affected by conflicting roles and expectations for the job. Most of the ELL TOSAs indicated that their sense of self-efficacy was affected by an increased workload brought about by fiscal decision making. Finally, there was evidence illustrating the interaction between the organization and motivation. The majority of the of ELL TOSAs indicated that there is confusion about how their roles are perceived, leaving the ELL TOSAs to feel that their actions did not contribute to instructional change. In conclusion, five research-based recommendations to support ELL TOSA goal attainment and considerations for future research on instructional coaches for classroom teachers of ELLs are provided.

Keywords: English language development, English language acquisition, language and leadership, language coaching, English language learners, second language acquisition

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320 Jointly Optimal Statistical Process Control and Maintenance Policy for Deteriorating Processes

Authors: Lucas Paganin, Viliam Makis

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With the advent of globalization, the market competition has become a major issue for most companies. One of the main strategies to overcome this situation is the quality improvement of the product at a lower cost to meet customers’ expectations. In order to achieve the desired quality of products, it is important to control the process to meet the specifications, and to implement the optimal maintenance policy for the machines and the production lines. Thus, the overall objective is to reduce process variation and the production and maintenance costs. In this paper, an integrated model involving Statistical Process Control (SPC) and maintenance is developed to achieve this goal. Therefore, the main focus of this paper is to develop the jointly optimal maintenance and statistical process control policy minimizing the total long run expected average cost per unit time. In our model, the production process can go out of control due to either the deterioration of equipment or other assignable causes. The equipment is also subject to failures in any of the operating states due to deterioration and aging. Hence, the process mean is controlled by an Xbar control chart using equidistant sampling epochs. We assume that the machine inspection epochs are the times when the control chart signals an out-of-control condition, considering both true and false alarms. At these times, the production process will be stopped, and an investigation will be conducted not only to determine whether it is a true or false alarm, but also to identify the causes of the true alarm, whether it was caused by the change in the machine setting, by other assignable causes, or by both. If the system is out of control, the proper actions will be taken to bring it back to the in-control state. At these epochs, a maintenance action can be taken, which can be no action, or preventive replacement of the unit. When the equipment is in the failure state, a corrective maintenance action is performed, which can be minimal repair or replacement of the machine and the process is brought to the in-control state. SMDP framework is used to formulate and solve the joint control problem. Numerical example is developed to demonstrate the effectiveness of the control policy.

Keywords: maintenance, semi-Markov decision process, statistical process control, Xbar control chart

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319 Clinical Outcomes and Symptom Management in Pediatric Patients Following Eczema Action Plans: A Quality Improvement Project

Authors: Karla Lebedoff, Susan Walsh, Michelle Bain

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Eczema is a chronic atopy condition requiring long-term daily management in children. Written action plans for other chronic atopic conditions, such as asthma and food allergies, are widely recommended and distributed to pediatric patients' parents and caregivers, seeking to improve clinical outcomes and become empowered to manage the patient's ever-changing symptoms. Written action plans for eczema, referred to as "asthma of the skin," are not routinely used in practice. Parents of children suffering from eczema rarely receive a written action plan to follow, and commendations supporting eczema action plans are inconsistent. Pediatric patients between birth and 18 years old who were followed for eczema at an urban Midwest community hospital were eligible to participate in this quality improvement project. At the initial visit, parents received instructions on individualized eczema action plans for their child and completed two validated surveys: Health Confidence Score (HCS) and Patient-Oriented Eczema Measure (POEM). Pre- and post-survey responses were collected, and clinical symptom presentation at follow-up were outcome determinants. Project implementation was guided by Institute for Healthcare Improvement's Step-up Framework and the Plan-Do-Study-Act cycle. This project measured clinical outcomes and parent confidence in self-management of their child's eczema symptoms with the responses from 26 participant surveys. Pre-survey responses were collected from 36 participants, though ten were lost to follow-up. Average POEM scores improved by 53%, while average HCS scores remained unchanged. Of seven completed in-person follow-up visits, six clinical progress notes documented improvement. Individualized eczema action plans can be seamlessly incorporated into primary and specialty care visits for pediatric patients suffering from eczema. Following a patient-specific eczema action plan may lessen the daily physical and mental burdens of uncontrolled eczema for children and parents, managing symptoms that chronically flare and recede. Furthermore, incorporating eczema action plans into practice potentially reduces the likely underestimated $5.3 billion economic disease burden of eczema on the U.S. healthcare system.

Keywords: atopic dermatitis, eczema action plan, eczema symptom management, pediatric eczema

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318 Experiences of Military Nurse-Manager: Implication to Clinical Leadership

Authors: Maria Monica D. Espinosa

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This study aimed to identify and examine the characteristics of an effective leader in a Hospital institution from the perspectives of military nurse-managers. The researcher extracted the different facets of leadership from the stories of six nurse- managers from a military hospital. The stories which are in pre-reflective stage convey an unbiased perspective from which clinical leadership may be defined. Using Phenomenology as a method of Research, the lived experiences of the military nurse-managers served as empirical data which were reflected upon until the formulation of insights. The information from the co-researchers became gallows from which the characteristics of effective leadership in the clinical area were drawn. These insights were synthesized through layers of reflection that resulted to the knowledge about clinical leadership. The reflections are the following, (a) Clinical leaders develop their skills through experiences and hardwork; (b) Clinical leaders are devoted; (c) Clinical leaders are focused; (d) Clinical leaders are good in interpersonal relationship; (e) Clinical leaders are mentors; (f) Clinical leaders seek affirmation and recognition; and (g) Clinical leaders are responsible and dependable. The common themes that emerged from the nurse manager’s stories showed that clinical leadership maybe attained if leaders possessed the following traits, (a) The gift to establish a steadfast and firm management; (b) The proficiency to guide and encourage others towards the achievement of their goals and objectives; (c) The ability to instigate participative and collaborative work among his/her subordinates and (d) The aptitude and skill to address the institutional concerns in their unit. In the future, Clinical leaders should continually adapt an evaluation program on how they can relate socially with their subordinates, the result of which can be used as a basis in developing strategies on relationship enhancement. Moreover, they should empower the nurses by allowing them to voice out their opinions and concerns regarding assignments, role expectations, and workload issues to improve and strengthen the relationships among nurses. Lastly, they can incorporate a collaborative strategy to promote professional socialization attitudes of nurse managers who work with staff nurses to improve the quality of their proficiencies and enhance a positive clinical environment.

Keywords: clinical leadership, experiences, implications, military nurse - managers, phenomenology

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317 Intensive Neurophysiological Rehabilitation System: New Approach for Treatment of Children with Autism

Authors: V. I. Kozyavkin, L. F. Shestopalova, T. B. Voloshyn

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Introduction: Rehabilitation of children with Autism is the issue of the day in psychiatry and neurology. It is attributed to constantly increasing quantity of autistic children - Autistic Spectrum Disorders (ASD) Existing rehabilitation approaches in treatment of children with Autism improve their medico- social and social- psychological adjustment. Experience of treatment for different kinds of Autistic disorders in International Clinic of Rehabilitation (ICR) reveals the necessity of complex intensive approach for healing this malady and wider implementation of a Kozyavkin method for treatment of children with ASD. Methods: 19 children aged from 3 to 14 years were examined. They were diagnosed ‘Autism’ (F84.0) with comorbid neurological pathology (from pyramidal insufficiency to para- and tetraplegia). All patients underwent rehabilitation in ICR during two weeks, where INRS approach was used. INRS included methods like biomechanical correction of the spine, massage, physical therapy, joint mobilization, wax-paraffin applications. They were supplemented by art- therapy, ergotherapy, rhythmical group exercises, computer game therapy, team Olympic games and other methods for improvement of motivation and social integration of the child. Estimation of efficacy was conducted using parent’s questioning and done twice- on the onset of INRS rehabilitation course and two weeks afterward. For efficacy assessment of rehabilitation of autistic children in ICR standardized tool was used, namely Autism Treatment Evaluation Checklist (ATEC). This scale was selected because any rehabilitation approaches for the child with Autism can be assessed using it. Results: Before the onset of INRS treatment mean score according to ATEC scale was 64,75±9,23, it reveals occurrence in examined children severe communication, speech, socialization and behavioral impairments. After the end of the rehabilitation course, the mean score was 56,5±6,7, what indicates positive dynamics in comparison to the onset of rehabilitation. Generally, improvement of psychoemotional state occurred in 90% of cases. Most significant changes occurred in the scope of speech (16,5 before and 14,5 after the treatment), socialization (15.1 before and 12,5 after) and behavior (20,1 before and 17.4 after). Conclusion: As a result of INRS rehabilitation course reduction of autistic symptoms was noted. Particularly improvements in speech were observed (children began to spell out new syllables, words), there was some decrease in signs of destructiveness, quality of contact with the surrounding people improved, new skills of self-service appeared. The prospect of the study is further, according to evidence- based medicine standards, deeper examination of INRS and assessment of its usefulness in treatment for Autism and ASD.

Keywords: intensive neurophysiological rehabilitation system (INRS), international clinic od rehabilitation, ASD, rehabilitation

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316 Research on Transverse Ecological Compensation Mechanism in Yangtze River Economic Belt Based on Evolutionary Game Theory

Authors: Tingyu Zhang

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The cross-basin ecological compensation mechanism is key to stimulating active participation in ecological protection across the entire basin. This study constructs an evolutionary game model of cross-basin ecological compensation in the Yangtze River Economic Belt (YREB), introducing a central government constraint and incentive mechanism (CGCIM) to explore the conditions for achieving strategies of protection and compensation that meet societal expectations. Furthermore, using a water quality-water quantity model combined with factual data from the YREB in 2020, the amount of ecological compensation is calculated. The results indicate that the stability of the evolutionary game model of the upstream and downstream governments in the YREB is closely related to the CGCIM. When the sum of the central government's reward amount to the upstream government and the penalty amount to both sides simultaneously is greater than 39.948 billion yuan, and the sum of the reward amount to the downstream government and the penalty amount to only the lower reaches is greater than 1.567 billion yuan, or when the sum of the reward amount to the downstream government and the penalty amount to both sides simultaneously is greater than 1.567 billion yuan, and the sum of the reward amount to the upstream government and the penalty amount to only the upstream government is greater than 399.48 billion yuan, the protection and compensation become the only evolutionarily stable strategy for the evolutionary game system composed of the upstream and downstream governments in the YREB. At this point, the total ecological compensation that the downstream government of the YREB should pay to the upstream government is 1.567 billion yuan, with Hunan paying 0.03 billion yuan, Hubei 2.53 billion yuan, Jiangxi 0.18 billion yuan, Anhui 1.68 billion yuan, Zhejiang 0.75 billion yuan, Jiangsu 6.57 billion yuan, and Shanghai 3.93 billion yuan. The research results can provide a reference for promoting the improvement and perfection of the cross-basin ecological compensation system in the YREB.

Keywords: ecological compensation, evolutionary game model, central government constraint and incentive mechanism, Yangtze river economic belt

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