Search results for: profound disability

Authors: Jee-Young Lee, Joaquim J. Ferreira, Hyeo-il Ma, José-Francisco Rocha, Beomseok Jeon

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The effective management of wearing-off is a key driver of medication changes for patients with Parkinson’s disease (PD) treated with levodopa (L-DOPA). While L-DOPA is well tolerated and efficacious, its clinical utility over time is often limited by the development of complications such as dyskinesia. Still, common first-line option includes adjusting the daily L-DOPA dose followed by adjunctive therapies usually counting for the L-DOPA equivalent daily dose (LEDD). The LEDD conversion formulae are a tool used to compare the equivalence of anti-PD medications. The aim of this work is to compare the effects of opicapone (OPC) 50 mg, a catechol-O-methyltransferase (COMT) inhibitor, and an additional 100 mg dose of L-DOPA in reducing the off time in PD patients with early motor fluctuations receiving different daily L-DOPA doses. OPC was found to be well tolerated and efficacious in advanced PD population. This work utilized patients' home diary data from a 4-week Phase 2 pharmacokinetics clinical study. The Korean ADOPTION study randomized (1:1) patients with PD and early motor fluctuations treated with up to 600 mg of L-DOPA given 3–4 times daily. The main endpoint was change from baseline in off time in the subgroup of patients receiving 300–400 mg/day L-DOPA at baseline plus OPC 50 mg and in the subgroup receiving >300 mg/day L-DOPA at baseline plus an additional dose of L-DOPA 100 mg. Of the 86 patients included in this subgroup analysis, 39 received OPC 50 mg and 47 L-DOPA 100 mg. At baseline, both L-DOPA total daily dose and LEDD were lower in the L-DOPA 300–400 mg/day plus OPC 50 mg group than in the L-DOPA >300 mg/day plus L-DOPA 100 mg. However, at Week 4, LEDD was similar between the two groups. The mean (±standard error) reduction in off time was approximately three-fold greater for the OPC 50 mg than for the L-DOPA 100 mg group, being -63.0 (14.6) minutes for patients treated with L-DOPA 300–400 mg/day plus OPC 50 mg, and -22.1 (9.3) minutes for those receiving L-DOPA >300 mg/day plus L-DOPA 100 mg. In conclusion, despite similar LEDD, OPC demonstrated a significantly greater reduction in off time when compared to an additional 100 mg L-DOPA dose. The effect of OPC appears to be LEDD independent, suggesting that caution should be exercised when employing LEDD to guide treatment decisions as this does not take into account the timing of each dose, onset, duration of therapeutic effect and individual responsiveness. Additionally, OPC could be used for keeping the L-DOPA dose as low as possible for as long as possible to avoid the development of motor complications which are a significant source of disability.

Keywords: opicapone, levodopa, pharmacokinetics, off-time

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Authors: Naziema Jappie

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There is a wealth of knowledge about JEDI (Justice Equity Diversity Inclusion), but unfortunately this remains at a discrete initiative level at universities. South African universities are committed to social justice by promoting inclusive teaching, learning and research environments, diversity and equity in access and participation of students and staff regardless of age; disability; gender; sexual orientation; nationality, ethnic or national origin; religion; and socioeconomic background in all aspects of higher education at a national level. Universities strive to promote and protect equal rights and equity of access is safeguarded for international students by recognizing the foreign policies and practices. Nevertheless, many international students remain underrepresented, alienated and often without employment. Universities see internationalisation as a commercial venture, but where does JEDI fit into this plan? Given the focus on diversity in higher education institutions, one would assume that JEDI should have a broader compass rather than a narrow scope. Over the past decades, national trends have emerged in the commitment to international diversification by admitting students and recruiting staff, mainly from the African continent. Most importantly, emergence of statements of broader diversity and equity plans across the campuses, included in the strategic plans of institutions are counterproductive to the statements of the Employment Equity plans and targets when aligned to the recruitment processes. These trends are certainly significant and relevant given the increasing diverse populations in higher education. What is missing in JEDI initiatives is the lack of global perspective and situating JEDI within a larger and inclusive context to embrace institutional internationalization. It is not a separate construct but internationalization framework takes the JEDI vision from local to global. Embracing JEDI and internationalization are fundamental for future economic growth. JEDI creates diverse perspectives and builds a team of top diverse and international talent that will gives a competitive edge. Increasing internationalization efforts and creating a knowledge platform will affect the innovation performance of the economy. Transforming South African policies require a comprehensive educational strategy on justice, equity, diversity, and inclusion (JEDI).

Keywords: equity, diversity, inclusion, internationalization, justice, higher education

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Authors: Margot Whitfield, Andrea Ducent, Marie Catherine Rombaut, Katia Iassinovskaia, Deborah Fels

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Learning how to create inclusive media, such as closed captioning (CC) and audio description (AD), in North America is restricted to the private sector, proprietary company-based training. We are delivering (through synchronous and asynchronous online learning) the first Canadian post-secondary, practice-based continuing education course package in inclusive media for broadcast production and processes. Despite the prevalence of CC and AD taught within the field of translation studies in Europe, North America has no comparable field of study. This novel approach to audio visual translation (AVT) education develops evidence-based methodology innovations, stemming from user study research with blind/low vision and Deaf/hard of hearing audiences for television and theatre, undertaken at Ryerson University. Knowledge outcomes from the courses include a) Understanding how CC/AD fit within disability/regulatory frameworks in Canada. b) Knowledge of how CC/AD could be employed in the initial stages of production development within broadcasting. c) Writing and/or speaking techniques designed for media. d) Hands-on practice in captioning re-speaking techniques and open source technologies, or in AD techniques. e) Understanding of audio production technologies and editing techniques. The case study of the curriculum development and deployment, involving first-time online course delivery from academic and practitioner-based instructors in introductory Captioning and Audio Description courses (CDIM 101 and 102), will compare two different instructors' approaches to learning design, including the ratio of synchronous and asynchronous classroom time and technological engagement tools on meeting software platform such as breakout rooms and polling. Student reception of these two different approaches will be analysed using qualitative thematic and quantitative survey analysis. Thus far, anecdotal conversations with students suggests that they prefer synchronous compared with asynchronous learning within our hands-on online course delivery method.

Keywords: inclusive media theory, broadcasting practices, AVT post secondary education, respeaking, audio description, learning design, virtual education

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Authors: Lindsay Foreman

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Introduction: Goals have become synonymous with the quest for the good life and the pursuit of happiness, with coaching and positive psychology gaining popularity as an approach in recent decades. And yet mental health is on the rise and the leading cause of disability, wellbeing is on the decline, stress is leading to 50-60% of workday absences and the need for action is indisputable and urgent. Purpose: The purpose of this study is to better understand two things we cannot see, but that play the most significant role in these outcomes - what we think and how we feel. With many working on the assumption that positive thinking and an optimistic outlook are necessary or valuable components of goal pursuit, this study uncovers the reality of the ‘inner-game’ from the coachees perspective. Method: With a mixed methods design using a Q Method study of subjectivity to ‘make the unseen seen’. First, a wide-ranging universe of subjective thoughts and feelings experienced during goal pursuit are explored.. These are generated from literature and a Qualtrics survey to create a Q-Set of 40 statements. Then 19 participants in professional and organisational settings offer their perspectives on these 40 Q-Set statements. Each rank them in a semi-forced distribution from ‘most like me’ to ‘least like me’ using Q-Sort software. From these individual perspectives, clusters of perspectives are identified using factor analysis and four distinct viewpoints, have emerged. Findings: These Goal Pursuit Viewpoints offer insight into the states and self-talk experienced by coachees and may not reflect the assumption of positive thinking associated with achieving goals. The four Viewpoints are 1) the Positive View, 2) the Realistic View 3) The Dreamer View and 4) The Conflicted View. With only a quarter of the Dreamer View, and a third of the Positive view going on to achieve their goals, these assumptions need review. And with all the Realistic View going on to achieve their goals, the role of self-doubt, overwhelm and anxiousness in goal achievement cannot be overlooked. Contribution: This study offers greater insight and understanding of people's inner experiences as they pursue goals and highlights the necessary and normal negative states associated with goal achievement. It also offers a practical tool of 40 ‘Clarity Card’ Q-set statements to help coaches and coachees explore the current state and help navigate the journey towards goal achievement. It calls into question whether goals should always be part of coaching, and if values, identity, and purpose may play a greater role than goals

Keywords: self-talk, mental health, inner critic, inner coach

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Authors: Michelle Jennett, Jana Dengler, Maytal Perlman

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Background: Cervical spinal cord injury (SCI) is a devastating event that results in upper limb paralysis, loss of independence, and disability. People living with cervical SCI have identified improvement of upper limb function as a top priority. Nerve and tendon transfer surgery has successfully restored upper limb function in cervical SCI but is not universally used or available to all eligible individuals. This exploratory mixed-methods study used an implementation science approach to better understand these factors that influence access to upper limb reconstruction in the Canadian context and design an intervention to increase access to care. Methods: Data from the Canadian Institute for Health Information’s Discharge Abstracts Database (CIHI-DAD) and the National Ambulatory Care Reporting System (NACRS) were used to determine the annual rate of nerve transfer and tendon transfer surgeries performed in cervical SCI in Canada over the last 15 years. Semi-structured interviews informed by the consolidated framework for implementation research (CFIR) were used to explore Ontario healthcare provider knowledge and practices around upper limb reconstruction. An inductive, iterative constant comparative process involving descriptive and interpretive analyses was used to identify themes that emerged from the data. Results: Healthcare providers (n = 10 upper extremity surgeons, n = 10 SCI physiatrists, n = 12 physical and occupational therapists working with individuals with SCI) were interviewed about their knowledge and perceptions of upper limb reconstruction and their current practices and discussions around upper limb reconstruction. Data analysis is currently underway and will be presented. Regional variation in rates of upper limb reconstruction and trends over time are also currently being analyzed. Conclusions: Utilization of nerve and tendon transfer surgery to improve upper limb reconstruction in Canada remains low. There are a complex array of interrelated individual-, provider- and system-level barriers that prevent individuals with cervical SCI from accessing upper limb reconstruction. In order to offer equitable access to care, a multi-modal approach addressing current barriers is required.

Keywords: cervical spinal cord injury, nerve and tendon transfer surgery, spinal cord injury, upper extremity reconstruction

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Authors: Carlos V. Gonzalez

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Background: Providers of in-home and community based services strive for the elimination of preventable harm to the people under their care as well as to the employees who support them. Traditional models of safety and protection from harm have assumed that the absence of incidents of harm is a good indicator of safe practices. However, this model creates an illusion of safety that is easily shaken by sudden and inadvertent harmful events. As an alternative, we have developed and implemented an evidence-based resilient model of safety known as C.O.P.E. (Caring, Observing, Predicting and Evaluating). Within this model, safety is not defined by the absence of harmful incidents, but by the presence of continuous monitoring, anticipation, learning, and rapid response to events that may lead to harm. Objective: The objective was to evaluate the effectiveness of the C.O.P.E. model for the reduction of harm to individuals with mental disabilities who receive home and community based services. Methods: Over the course of 2 years we counted the number of incidents of harm and near misses. We trained employees on strategies to eliminate incidents before they fully escalated. We trained employees to track different levels of patient status within a scale from 0 to 10. Additionally, we provided direct support professionals and supervisors with customized smart phone applications to track and notify the team of changes in that status every 30 minutes. Finally, the information that we collected was saved in a private computer network that analyzes and graphs the outcome of each incident. Result and conclusions: The use of the COPE model resulted in: A reduction in incidents of harm. A reduction the use of restraints and other physical interventions. An increase in Direct Support Professional’s ability to detect and respond to health problems. Improvement in employee alertness by decreasing sleeping on duty. Improvement in caring and positive interaction between Direct Support Professionals and the person who is supported. Developing a method to globally measure and assess the effectiveness of prevention from harm plans. Future applications of the COPE model for the reduction of harm to people who receive home and community based services are discussed.

Keywords: harm, patients, resilience, safety, mental illness, disability

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Authors: Stéphanie Looser, Walter Wehrmeyer

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Given the limited research on Small and Mediumsized Enterprises’ (SMEs) contribution to Corporate Social Responsibility (CSR) and even scarcer research on Swiss SMEs, this paper helps to fill these gaps by enabling the identification of supranational SME parameters and to make a contribution to the evolving field of these topics. Thus, the paper investigates the current state of SME practices in Switzerland and across 15 other countries. Combining the degree to which SMEs demonstrate an explicit (or business case) approach or see CSR as an implicit moral activity with the assessment of their attributes for “variety of capitalism” defines the framework of this comparative analysis. According to previous studies, liberal market economies, e.g. in the United States (US) or United Kingdom (UK), are aligned with extrinsic CSR, while coordinated market systems (in Central European or Asian countries) evolve implicit CSR agendas. To outline Swiss small business CSR patterns in particular, 40 SME owner-managers were interviewed. The transcribed interviews were coded utilising MAXQDA for qualitative content analysis. A secondary data analysis of results from different countries (i.e., Australia, Austria, Chile, Cameroon, Catalonia (notably a part of Spain that seeks autonomy), China, Finland, Germany, Hong Kong (a special administrative region of China), Italy, Netherlands, Singapore, Spain, Taiwan, UK, US) lays groundwork for this comparative study on small business CSR. Applying the same coding categories (in MAXQDA) for the interview analysis as well as for the secondary data research while following grounded theory rules to refine and keep track of ideas generated testable hypotheses and comparative power on implicit (and the lower likelihood of explicit) CSR in SMEs retrospectively. The paper identifies Swiss small business CSR as deep, profound, “soul”, and an implicit part of the day-to-day business. Similar to most Central European, Mediterranean, Nordic, and Asian countries, explicit CSR is still very rare in Swiss SMEs. Astonishingly, also UK and US SMEs follow this pattern in spite of their strong and distinct liberal market economies. Though other findings show that nationality matters this research concludes that SME culture and its informal CSR agenda are strongly formative and superseding even forces of market economies, nationally cultural patterns, and language. In a world of “big business”, explicit “business case” CSR, and the mantra that “CSR must pay”, this study points to a distinctly implicit small business CSR model built on trust, physical closeness, and virtues that is largely detached from the bottom line. This pattern holds for different cultural contexts and it is concluded that SME culture is stronger than nationality leading to a supra-national, monolithic SME CSR approach. Hence, classifications of countries by their market system or capitalism, as found in the comparative capitalism literature, do not match the CSR practices in SMEs as they do not mirror the peculiarities of their business. This raises questions on the universality and generalisability of management concepts.

Keywords: CSR, comparative study, cultures of capitalism, small, medium-sized enterprises

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Authors: Linghua Kong, Xinxia Chen, Mika Gissler, Catharina Lavebratt

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Background: Prenatal exposure to preeclampsia has been associated with an increased risk of offspring attention-deficit/hyperactivity disorders (ADHD), autism spectrum disorder (ASD), and intellectual disability. However, little is known about the association between prenatal exposure to severe preeclampsia and neurodevelopmental and psychiatric disorders in offspring. Objective: This study aimed to assess the risk of maternal preeclampsia combined with perinatal problems, specifically low birth weight and prematurity, on offspring neuropsychiatric disorders. Methods: All singleton live births in Finland between 1996 and 2014 (n=1 012 723) were followed up in nation-wide registries until 2018. Main exposures included pre-eclampsia, small for gestational age, and delivery before 34 gestational weeks. Offspring neurodevelopmental and psychiatric disorders (ICD-10 codes) were examined as outcomes variables. Offspring birth year, sex, maternal age at delivery, parity, marital status at birth, mother's country of birth, maternal smoking, maternal gestational diabetes, maternal use of psychotropic medication during pregnancy, and maternal systemic inflammatory diseases were used as covariates. Risks for neurodevelopmental and psychiatric disorders were estimated using Cox proportional hazards modeling. Results: Of the 1 012 723 offspring, 25 901 (2.6%) were exposed to preeclampsia, and 93 281 (9.2%) were diagnosed with a neuropsychiatric disorder. Compared to births unexposed to preeclampsia, small for gestational age or delivery before 34 gestational weeks, those exposed to preeclampsia only had a 21% increase in the likelihood of any neuropsychiatric disorders after adjusting for potential confounding (adjusted HR=1.21, 95% CI: 1.15-1.26), while exposure to preeclampsia combined with small for gestational age or delivery before 34 gestational weeks had a more than twofold increased risk of having a child with neuropsychiatric disorders (adjusted HR=2.16, 95% CI: 2.02-2.32). The adjusted HR for neuropsychiatric disorders in offspring with small for gestational age or delivery before 34 gestational weeks only was 1.79 (95% CI: 1.73-1.83). In addition, the risk estimate in offspring exposed to both preeclampsia and perinatal problems was greater than those only exposed to preeclampsia for having personality disorders (adjusted HR=1.66; 95% CI: 1.07-2.57), intellectual disabilities (adjusted HR=3.47; 95% CI: 2.86-4.22), specific developmental disorders (adjusted HR=2.91; 95% CI: 2.69-3.15), ASD (adjusted HR=1.75; 95% CI: 1.42-2.17), ADHD and conduct disorders (adjusted HR=2.00; 95%CI: 1.76-2.27), and other behavioral and emotional disorders (adjusted HR=2.09; 95% CI: 1.84-2.37). Conclusion: In utero exposure to severe preeclampsia increased the risk of several neurodevelopmental and psychiatric disorders in offspring. Our findings are relevant to women with hypertensive disorders with regard to pregnancy consultation and management and may yield effective clues for the prevention of neurodevelopmental and psychiatric disorders in childhood.

Keywords: low birth weight, neurodevelopmental disorders, preeclampsia, prematurity, psychiatric disorders

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Authors: Camila Lemos Pinto, Juliana Alves Carneiro, Patrícia Borges Botelho, João Felipe Mota

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Sarcopenia, a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, currently affects over 50 million people and increases the risk of adverse outcomes such as physical disability, poor quality of life and death. The aim of this study was to examine the efficacy of creatine supplementation associated with resistance training on muscle mass in the elderly. A 12-week, double blind, randomized, parallel group, placebo controlled trial was conducted. Participants were randomly allocated into one of the following groups: placebo with resistance training (PL+RT, n=14) and creatine supplementation with resistance training (CR + RT, n=13). The subjects from CR+RT group received 5 g/day of creatine monohydrate and the subjects from the PL+RT group were given the same dose of maltodextrin. Participants were instructed to ingest the supplement on non-training days immediately after lunch and on training days immediately after resistance training sessions dissolved in a beverage comprising 100 g of maltodextrin lemon flavored. Participants of both groups undertook a supervised exercise training program for 12 weeks (3 times per week). The subjects were assessed at baseline and after 12 weeks. The primary outcome was muscle mass, assessed by dual energy X-ray absorptiometry (DXA). The secondary outcome included diagnose participants with one of the three stages of sarcopenia (presarcopenia, sarcopenia and severe sarcopenia) by skeletal muscle mass index (SMI), handgrip strength and gait speed. CR+RT group had a significant increase in SMI and muscle (p<0.0001), a significant decrease in android and gynoid fat (p = 0.028 and p=0.035, respectively) and a tendency of decreasing in body fat (p=0.053) after the intervention. PL+RT only had a significant increase in SMI (p=0.007). The main finding of this clinical trial indicated that creatine supplementation combined with resistance training was capable of increasing muscle mass in our elderly cohort (p=0.02). In addition, the number of subjects diagnosed with one of the three stages of sarcopenia at baseline decreased in the creatine supplemented group in comparison with the placebo group (CR+RT, n=-3; PL+RT, n=0). In summary, 12 weeks of creatine supplementation associated with resistance training resulted in increases in muscle mass. This is the first research with elderly of both sexes that show the same increase in muscle mass with a minor quantity of creatine supplementation in a short period. Future long-term research should investigate the effects of these interventions in sarcopenic elderly.

Keywords: creatine, dietetic supplement, elderly, resistance training

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Authors: Jennifer Gallup, Joel Bocanegra, Greg Callan, Abigail Vaughn

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Students with disabilities (SWD) engaged in a distance summer program delivered over multiple virtual mediums that used gaming principles to teach and practice self-regulated learning (SRL) through the process of exploring possible jobs. Gaming quests were developed to explore jobs and teach transition skills. Students completed specially designed quests that taught and reinforced SRL and problem-solving through individual, group, and teacher-led experiences. SRL skills learned were reinforced through guided job explorations over the context of MinecraftEDU, zoom with experts in the career, collaborations with a team over Marco Polo, and Zoom. The quests were developed and laid out on an accessible web page, with active learning opportunities and feedback conducted within multiple virtual mediums including MinecraftEDU. Gaming mediums actively engage players in role-playing, problem-solving, critical thinking, and collaboration. Gaming has been used as a medium for education since the inception of formal education. Games, and specifically board games, are pre-historic, meaning we had board games before we had written language. Today, games are widely used in education, often as a reinforcer for behavior or for rewards for work completion. Games are not often used as a direct method of instruction and assessment; however, the inclusion of games as an assessment tool and as a form of instruction increases student engagement and participation. Games naturally include collaboration, problem-solving, and communication. Therefore, our summer program was developed using gaming principles and MinecraftEDU. This manuscript describes a virtual learning summer program called Virtual Academy New and Exciting Transitions (VAN) that was redesigned from a face-to-face setting to a completely online setting with a focus on SWD aged 14-21. The focus of VAN was to address transition planning needs such as problem-solving skills, self-regulation, interviewing, job exploration, and communication for transition-aged youth diagnosed with various disabilities (e.g., learning disabilities, attention-deficit hyperactivity disorder, intellectual disability, down syndrome, autism spectrum disorder).

Keywords: autism, disabilities, transition, summer program, gaming, simulations

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Authors: Valeria Tatano, Francesca Guidolin, Francesca Peltrera

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The preservation of historical Italian heritage, at the urban and architectural scale, has to consider restrictions and requirements connected with conservation issues and usability needs, which are often at odds with historical heritage preservation. Recent decades have been marked by the search for increased accessibility not only of public and private buildings, but to the whole historical city, also for people with disability. Moreover, in the last years the concepts of Smart City and Healthy City seek to improve accessibility both in terms of mobility (independent or assisted) and fruition of goods and services, also for historical cities. The principles of Inclusive Design have introduced new criteria for the improvement of public urban space, between current regulations and best practices. Moreover, they have contributed to transforming “special needs” into an opportunity of social innovation. These considerations find a field of research and analysis in the historical city of Venice, which is at the same time a site of UNESCO world heritage, a mass tourism destination bringing in visitors from all over the world and a city inhabited by an aging population. Due to its conformation, Venetian urban fabric is only partially accessible: about four thousand bridges divide thousands of islands, making it almost impossible to move independently. These urban characteristics and difficulties were the base, in the last 20 years, for several researches, experimentations and solutions with the aim of eliminating architectural barriers, in particular for the usability of bridges. The Venetian Municipality with the EBA Office and some external consultants realized several devices (e.g. the “stepped ramp” and the new accessible ramps for the Venice Marathon) that should determine an innovation for the city, passing from the use of mechanical replicable devices to specific architectural projects in order to guarantee autonomy in use. This paper intends to present the state-of-the-art in bridges accessibility, through an analysis based on Inclusive Design principles and on the current national and regional regulation. The purpose is to evaluate some possible strategies that could improve performances, between limits and possibilities of interventions. The aim of the research is to lay the foundations for the development of a strategic program for the City of Venice that could successfully bring together both conservation and improvement requirements.

Keywords: accessibility of historical cities, historical heritage preservation, inclusive design, technological and social innovation

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Authors: M. Warburton

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Background: Case study examining hydrotherapy for a person with DSI. A 46 year-old lady completely deaf and blind post congenital rubella syndrome. Touch becomes the primary information gathering sense to optimise function in life. Communication is achieved via tactile finger spelling and signals onto her hand and skin. Hydrotherapy may provide a suitable mobility environment and somato-sensory input to people, and especially DSI persons. Buoyancy, warmth, hydrostatic pressure, viscosity and turbulence are elements of hydrotherapy that may offer a DSI person somato-sensory input to stimulate the mechanoreceptors, thermoreceptors and proprioceptors and offer a unique hydro-therapeutic environment. Purpose: The purpose of this case study was to establish what measurable benefits could be achieved from hydrotherapy with a DSI person. Methods: Hydrotherapy was provided for 8-weeks, 2 x week, 35-minute session duration. Pool temperature 32.5 degrees centigrade. Pool length 25-metres. Each session consisted of mobility encouragement and supervision, and activities to stimulate the somato-sensory system utilising aquatic properties of buoyancy, turbulence, viscosity, warmth and hydrostatic pressure. Somato-sensory activities focused on stimulating touch and tactile exploration including objects of various shape, size, weight, contour, texture, elasticity, pliability, softness and hardness. Outcomes were measured by the Goal Attainment Scale (GAS) and included mobility distance, attendance, and timed tactile responsiveness to varying objects. Results: Mobility distance and attendance exceeded baseline expectations. Timed tactile responsiveness to varying objects also changed positively from baseline. Average scale scores were 1.00 with an overall GAS t-score of 63.69. Conclusions: Hydrotherapy can be a quantifiable physio-therapeutic option for persons with DSI. It provides a relatively safe environment for mobility and allows the somato-sensory system to be fully engaged - important for the DSI population. Implications: Hydrotherapy can be a measurable therapeutic option for a DSI person. Physiotherapists should consider hydrotherapy for DSI people. Hydrotherapy can offer unique physical properties for the DSI population not available on land.

Keywords: chronic, disability, disease, rehabilitation

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Authors: Lauren B. Birney

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This project focuses upon the expansion of the existing "Curriculum and Community Enterprise for the Restoration of New York Harbor in New York City Public Schools" NSF EHR DRL 1440869, NSF EHR DRL 1839656 and NSF EHR DRL 1759006. This project is recognized locally as “Curriculum and Community Enterprise for Restoration Science,” or CCERS. CCERS is a comprehensive model of ecological restoration-based STEM education for urban public-school students. Following an accelerated rollout, CCERS is now being implemented in 120+ Title 1 funded NYC Department of Education middle schools, led by two cohorts of 250 teachers, serving more than 11,000 students in total. Initial results and baseline data suggest that the CCERS model, with the Billion Oyster Project (BOP) as its local restoration ecology-based STEM curriculum, is having profound impacts on students, teachers, school leaders, and the broader community of CCERS participants and stakeholders. Students and teachers report being receptive to the CCERS model and deeply engaged in the initial phase of curriculum development, citizen science data collection, and student-centered, problem-based STEM learning. The BOP CCERS Digital Platform will serve as the central technology hub for all research, data, data analysis, resources, materials and student data to promote global interactions between communities, Research conducted included qualitative and quantitative data analysis. We continue to work internally on making edits and changes to accommodate a dynamic society. The STEM Collaboratory NYC® at Pace University New York City continues to act as the prime institution for the BOP CCERS project since the project’s inception in 2014. The project continues to strive to provide opportunities in STEM for underrepresented and underserved populations in New York City. The replicable model serves as an opportunity for other entities to create this type of collaboration within their own communities and ignite a community to come together and address the notable issue. Providing opportunities for young students to engage in community initiatives allows for a more cohesive set of stakeholders, ability for young people to network and provide additional resources for those students in need of additional support, resources and structure. The project has planted more than 47 million oysters across 12 acres and 15 reef sites, with the help of more than 8,000 students and 10,000 volunteers. Additional enhancements and features on the BOP CCERS Digital Platform will continue over the next three years through funding provided by the National Science Foundation, NSF DRL EHR 1759006/1839656 Principal Investigator Dr. Lauren Birney, Professor Pace University. Early results from the data indicate that the new version of the Platform is creating traction both nationally and internationally among community stakeholders and constituents. This project continues to focus on new collaborative partners that will support underrepresented students in STEM Education. The advanced Digital Platform will allow for us connect with other countries and networks on a larger Global scale.

Keywords: STEM education, environmental restoration science, technology, citizen science

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Authors: Dana El-Mughayyar, Neil Manson, Erin Bigney, Eden Richardson, Dean Tripp, Edward Abraham

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Use of narcotics to treat pain has increased over the past two decades and is a contributing factor to the current public health crisis. Understanding the pre-operative risks of chronic narcotic use may be aided through investigation of psychological measures. The objective of the reported study is to determine predictors of narcotic use two years post-surgery in a thoracolumbar spine surgery population, including an array of psychological factors. A prospective observational study of 191 consecutively enrolled adult patients having undergone thoracolumbar spine surgery is presented. Baseline measures of interest included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, Multidimensional Scale for Perceived Social Support (MSPSS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Oswestry Disability Index (ODI), Numeric Rating Scales for back and leg pain (NRS-B/L), SF-12’s Mental Component Summary (MCS), narcotic use and demographic variables. The post-operative measure of interest is narcotic use at 2-year follow-up. Narcotic use is collapsed into binary categories of use and no use. Descriptive statistics are run. Chi Square analysis is used for categorical variables and an ANOVA for continuous variables. Significant variables are built into a hierarchical logistic regression to determine predictors of post-operative narcotic use. Significance is set at α < 0.05. Results: A total of 27.23% of the sample were using narcotics two years after surgery. The regression model included ODI, NRS-Leg, time with condition, chief complaint, pre-operative drug use, gender, MCS, PCS subscale helplessness, and CPAQ subscale pain willingness and was significant χ² (13, N=191)= 54.99; p = .000. The model accounted for 39.6% of the variance in narcotic use and correctly predicted in 79.7% of cases. Psychological variables accounted for 9.6% of the variance over and above the other predictors. Conclusions: Managing chronic narcotic usage is central to the patient’s overall health and quality of life. Psychological factors in the preoperative period are significant predictors of narcotic use 2 years post-operatively. The psychological variables are malleable, potentially allowing surgeons to direct their patients to preventative resources prior to surgery.

Keywords: narcotics, psychological factors, quality of life, spine surgery

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Authors: Samantha R. Dutra

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There are many issues that students face in college, such as academic-based struggles, financial issues, family responsibilities, and vocational problems. Students with dyslexia struggle even more with these problems compared to other students. This qualitative study examines faculty perceptions of instructing students with dyslexia. This study is important to the human services and post-secondary educational fields due to the increase in disabled students enrolled in college. This study is also substantial because of the reported bias faced by students with dyslexia and their academic failure. When students with LDs such as dyslexia experience bias, discrimination, and isolation, they are more apt to not seek accommodations, lack communication with faculty, and are more likely to drop out or fail. College students with dyslexia often take longer to complete their post-secondary education and are more likely to withdraw or drop out without earning a degree. Faculty attitudes and academic cultures are major barriers to the success and use of accommodations as well as modified instruction for students with disabilities, which leads to student success. Faculty members are often uneducated or misinformed regarding students with dyslexia. More importantly, many faculty members are unaware of the many ethical and legal implications that they face regarding accommodating students with dyslexia. Instructor expectations can generally be defined as the understanding and perceptions of students regarding their academic success. Skewed instructor expectations can affect how instructors interact with their students and can also affect student success. This is true for students with dyslexia in that instructors may have lower and biased expectations of these students and, therefore, directly impact students’ academic successes and failures. It is vital to understand how instructor attitudes affect the academic achievement of dyslexic students. This study will examine faculty perceptions of instructing students with dyslexia and faculty attitudes towards accommodations and institutional support. The literature concludes that students with dyslexia have many deficits and several learning needs. Furthermore, these are the students with the highest dropout and failure rates, as well as the lowest retention rates. Disabled students generally have many reasons why accommodations and supports just do not help. Some research suggests that accommodations do help students and show positive outcomes. Many improvements need to be made between student support service personnel, faculty, and administrators regarding providing access and adequate supports for students with dyslexia. As the research also suggests, providing more efficient and effective accommodations may increase positive student as well as faculty attitudes in college, and may improve student outcomes overall.

Keywords: dyslexia, faculty perception, higher education, learning disability

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Authors: Laura M. Hovsepyan, Gayane S. Ghazaryan, Hasmik V. Zanginyan

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Hypertension (HD) is the most common cardiovascular pathology that causes disability and mortality in the working population. Most often, heart failure (HF), which is based on myocardial remodeling, leads to death in hypertension. Recently, endothelial dysfunction (EDF) or a violation of the functional state of the vascular endothelium has been assigned a significant role in the structural changes in the myocardium and the occurrence of heart failure in patients with hypertension. It has now been established that tissues affected by inflammation form increased amounts of superoxide radical and NO, which play a significant role in the development and pathogenesis of various pathologies. They mediate inflammation, modify proteins and damage nucleic acids. The aim of this work was to study the processes of oxidative modification of proteins (OMP) and the production of nitric oxide in hypertension. In the experimental work, the blood of 30 donors and 33 patients with hypertension was used. For the quantitative determination of OMP products, the based on the reaction of the interaction of oxidized amino acid residues of proteins and 2,4-dinitrophenylhydrazine (DNPH) with the formation of 2,4-dinitrophenylhydrazones, the amount of which was determined spectrophotometrically. The optical density of the formed carbonyl derivatives of dinitrophenylhydrazones was recorded at different wavelengths: 356 nm - aliphatic ketone dinitrophenylhydrazones (KDNPH) of neutral character; 370 nm - aliphatic aldehyde dinirophenylhydrazones (ADNPH) of neutral character; 430 nm - aliphatic KDNFG of the main character; 530 nm - basic aliphatic ADNPH. Nitric oxide was determined by photometry using Grace's solution. Adsorption was measured on a Thermo Scientific Evolution 201 SF at a wavelength of 546 nm. Thus, the results of the studies showed that in patients with arterial hypertension, an increased level of nitric oxide in the blood serum is observed, and there is also a tendency to an increase in the intensity of oxidative modification of proteins at a wavelength of 270 nm and 363 nm, which indicates a statistically significant increase in aliphatic aldehyde and ketone dinitrophenylhydrazones. The increase in the intensity of oxidative modification of blood plasma proteins in the studied patients, revealed by us, actually reflects the general direction of free radical processes and, in particular, the oxidation of proteins throughout the body. A decrease in the activity of the antioxidant system also leads to a violation of protein metabolism. The most important consequence of the oxidative modification of proteins is the inactivation of enzymes.

Keywords: hypertension (HD), oxidative modification of proteins (OMP), nitric oxide (NO), oxidative stress

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Authors: Zena Tredinnick-Kirby, Anna Divinsky, Brendan Berthold, Nicole Cingolani

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Faculty members from The Pennsylvania State University, Zena Tredinnick-Kirby, Ph.D., and Anna Divinsky are at the forefront of an innovative educational approach to improve access in asynchronous online art courses. Their pioneering work weaves virtual reality (VR) technologies to construct a more equitable educational experience for students by transforming their learning and engagement. The significance of their study lies in the need to bridge the digital divide in online art courses, making them more inclusive and interactive for all distance learners. In an era where conventional classroom settings are no longer the sole means of instruction, Tredinnick-Kirby and Divinsky harness the power of instructional technologies to break down geographical barriers by incorporating an interactive VR experience that facilitates community building within an online environment transcending physical constraints. The methodology adopted by Tredinnick-Kirby, and Divinsky is centered around integrating 3D virtual spaces into their art courses. Spatial.io, a virtual world platform, enables students to develop digital avatars and engage in virtual art museums through a free browser-based program or an Oculus headset, where they can interact with other visitors and critique each other’s artwork. The goal is not only to provide students with an engaging and immersive learning experience but also to nourish them with a more profound understanding of the language of art criticism and technology. Furthermore, the study aims to cultivate critical thinking skills among students and foster a collaborative spirit. By leveraging cutting-edge VR technology, students are encouraged to explore the possibilities of their field, experimenting with innovative tools and techniques. This approach not only enriches their learning experience but also prepares them for a dynamic and ever-evolving art landscape in technology and education. One of the fundamental objectives of Tredinnick-Kirby and Divinsky is to remodel how feedback is derived through peer-to-peer art critique. Through the inclusion of 3D virtual spaces into the curriculum, students now have the opportunity to install their final artwork in a virtual gallery space and incorporate peer feedback, enabling students to exhibit their work opening the doors to a collaborative and interactive process. Students can provide constructive suggestions, engage in discussions, and integrate peer commentary into developing their ideas and praxis. This approach not only accelerates the learning process but also promotes a sense of community and growth. In summary, the study conducted by the Penn State faculty members Zena Tredinnick-Kirby, and Anna Divinsky represents innovative use of technology in their courses. By incorporating 3D virtual spaces, they are enriching the learners' experience. Through this inventive pedagogical technique, they nurture critical thinking, collaboration, and the practical application of cutting-edge technology in art. This research holds great promise for the future of online art education, transforming it into a dynamic, inclusive, and interactive experience that transcends the confines of distance learning.

Keywords: Art, community building, distance learning, virtual reality

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Authors: Vinodhini Elangovan, Jen Heng Pek

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Background: An ectopic pregnancy is defined as any pregnancy implanted outside of the endometrial cavity. Cornual pregnancy, a rare variety of ectopic pregnancies, is seen in about 2-4% of ectopic pregnancies. It develops in the interstitial portion of the fallopian tube and invades through the uterine wall. This case describes a third-trimester cornual pregnancy that resulted in a uterine rupture. Case: A 38-year old Chinese lady was brought to the Emergency Department (ED) as a standby case for hypotension. She was 30+6 weeks pregnant (Gravida 3, Parous 1). Her past obstetric history included a live birth delivered via lower segment Caesarean section due to non-reassuring fetal status in 2002 and a miscarriage in 2012. She developed generalized abdominal pain. There was no per vaginal bleeding or leaking liquor. There was also no fever, nausea, vomiting, constipation, diarrhea, or urinary symptoms. On arrival in the ED, she was pale, diaphoretic, and lethargic. She had generalized tenderness with guarding and rebound over her abdomen. Point of care ultrasound was performed and showed a large amount of intra-abdominal free fluid, and the fetal heart rate was 170 beats per minute. The point of care hemoglobin was 7.1 g/dL, and lactate was 6.8 mmol/L. The patient’s blood pressure dropped precipitously to 50/36 mmHg, and her heart rate went up to 141 beats per minute. The clinical impression was profound shock secondary to uterine rupture. Intra-operatively, there was extensive haemoperitoneum, and the fetus was seen in the abdominal cavity. The fetus was delivered immediately and handed to the neonatal team. On exploration of the uterus, the point of rupture was at the left cornual region where the placenta was attached to. Discussion: Cornual pregnancies are difficult to diagnose pre-operatively with low ultrasonographic sensitivity and hence are commonly confused with normal intrauterine pregnancies. They pose a higher risk of rupture and hemorrhage compared to other types of ectopic pregnancies. In very rare circumstances, interstitial pregnancies can result in a viable fetus. Uterine rupture resulting in hemorrhagic shock is a true obstetric emergency that can result in significant morbidity and mortality for the patient and the fetus, and early diagnosis in the emergency department is crucial. The patient in this case presented with known risk factors of multiparity, advanced maternal age, and previous lower segment cesarean section, which increased the suspicion of uterine rupture. Ultrasound assessment may be beneficial to any patient who presents with symptoms and a history of uterine surgery to assess the possibility of uterine dehiscence or rupture. Management of a patient suspected of uterine rupture should be systematic in the emergency department and follow an ABC approach. Conclusion: This case demonstrates the importance for an emergency physician to maintain the suspicion for ectopic pregnancy even at advanced gestational ages. It also highlights how even though all emergency physicians may not be qualified to do a detailed pelvic ultrasound, it is essential for them to be competent with a point of care ultrasound to make a prompt diagnosis of conditions such as uterine rupture.

Keywords: cornual ectopic , ectopic pregnancy, emergency medicine, obstetric emergencies

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Authors: Michael Picard

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This proposal offers to shed light on the changing legal geography of the global waste economy. Global waste recycling has become a multi-billion-dollar industry. NASDAQ predicts the emergence of a worldwide 1,296G$ waste management market between 2017 and 2022. Underlining this evolution, a new generation of preferential waste-trade agreements has emerged in the Pacific. In the last decade, Japan has concluded a series of bilateral treaties with Asian countries, and most recently with China. An agreement between Tokyo and Beijing was formalized on 7 May 2008, which forged an economic partnership on waste transfer and mining. The agreement set up International Recycling Zones, where certified recycling plants in China process industrial waste imported from Japan. Under the joint venture, Chinese companies salvage the embedded value from Japanese industrial discards, reprocess them and send them back to Japanese manufacturers, such as Mitsubishi and Panasonic. This circular economy is designed to convert surplus garbage into surplus value. Ever since the opening of Sino-Japanese eco-parks, millions of tons of plastic and e-waste have been exported from Japan to China every year. Yet, quite unexpectedly, China has recently closed its waste market to imports, jeopardizing Japan’s billion-dollar exports to China. China notified the WTO that, by the end of 2017, it would no longer accept imports of plastics and certain metals. Given China’s share of Japanese waste exports, a complete closure of China’s market would require Japan to find new uses for its recyclable industrial trash generated domestically every year. It remains to be seen how China will effectively implement its ban on waste imports, considering the economic interests at stake. At this stage, what remains to be clarified is whether China's ban on waste imports will negatively affect the recycling trade between Japan and China. What is clear, though, is the rapid transformation in the legal geography of waste mining in East-Asia. For decades, East-Asian waste trade had been tied up in an ‘ecologically unequal exchange’ between the Japanese core and the Chinese periphery. This global unequal waste distribution could be measured by the Environmental Stringency Index, which revealed that waste regulation was 39% weaker in the Global South than in Japan. This explains why Japan could legally export its hazardous plastic and electronic discards to China. The asymmetric flow of hazardous waste between Japan and China carried the colonial heritage of international law. The legal geography of waste distribution was closely associated to the imperial construction of an ecological trade imbalance between the Japanese source and the Chinese sink. Thus, China’s recent decision to ban hazardous waste imports is a sign of a broader ecological shift. As a global economic superpower, China announced to the world it would no longer be the planet’s junkyard. The policy change will have profound consequences on the global circulation of waste, re-routing global waste towards countries south of China, such as Vietnam and Malaysia. By the time the Berlin Conference takes place in May 2018, the presentation will be able to assess more accurately the effect of the Chinese ban on the transboundary movement of waste in Asia.

Keywords: Asia, ecological unequal exchange, global waste trade, legal geography

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Authors: Lindsay Foreman

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Introduction: Goals have become synonymous with the quest for the good life and the pursuit of happiness, with coaching and positive psychology gaining popularity as an approach in recent decades. And yet mental health is on the rise and the leading cause of disability, wellbeing is on the decline, stress is leading to 50-60% of workday absences and the need for action is indisputable and urgent. Purpose: The purpose of this study is to better understand two things we cannot see, but that play the most significant role in these outcomes - what we think and how we feel. With many working on the assumption that positive thinking and an optimistic outlook are necessary or valuable components of goal pursuit, this study uncovers the reality of the ‘inner-game’ from the coachee's perspective. Method: With a mixed methods design using a Q Method study of subjectivity to ‘make the unseen seen’. First, a wide-ranging universe of subjective thoughts and feelings experienced during goal pursuit are explored. These are generated from literature and a Qualtrics survey to create a Q-Set of 40 statements. Then 19 participants in professional and organisational settings offer their perspectives on these 40 Q-Set statements. Each rank them in a semi-forced distribution from ‘most like me’ to ‘least like me’ using Q-Sort software. From these individual perspectives, clusters of perspectives are identified using factor analysis and four distinct viewpoints have emerged. Findings: These Goal Pursuit Viewpoints offer insight into the states and self-talk experienced by coachees and may not reflect the assumption of positive thinking associated with achieving goals. The four Viewpoints are 1) the Optimistic View, 2) the Realistic View 3) The Dreamer View and 4) The Conflicted View. With only a quarter of the Dreamer View, and a third of the Optimistic view going on to achieve their goals, these assumptions need review. And with all the Realistic Views going on to achieve their goals, the role of self-doubt, overwhelm and anxiousness in goal achievement cannot be overlooked. Contribution: This study offers greater insight and understanding of people's inner experiences as they pursue goals and highlights the necessary and normal negative states associated with goal achievement. It also offers a practical tool of the Q-set statements to help coaches and coachees explore the current state and help navigate the journey towards goal achievement. It calls into question whether goals should always be part of coaching and if values, identity, and purpose may play a greater role than goals.

Keywords: coaching, goals, positive psychology, mindset, leadership, mental health, beliefs, cognition, emotional intelligence

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Authors: Matthew Conner, Leah Plocharczyk

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This study examines the role of academic libraries in support of the intellectually disabled (ID) in post-secondary education. With the growing public awareness of the ID, there has been recognition of their need for post-secondary educational opportunities. This was an unforeseen result for a population that has been associated with elementary levels of education, yet the reasons are compelling. After aging out of the school system, the ID need and deserve educational and social support as much as anyone. Moreover, the commitment to diversity in higher education rings hollow if this group is excluded. Yet, challenges remain to integrating the ID into a college curriculum. This presentation focuses on the role of academic libraries. Neglecting this vital resource for the support of the ID is not to be thought of, yet the library’s contribution is not clear. Library collections presume reading ability and libraries already struggle to meet their traditional goals with the resources available. This presentation examines how academic libraries can support post-secondary ID. For context, the presentation first examines the state of post-secondary education for the ID with an analysis of data on the United States compiled by the ThinkCollege! Project. Geographic Information Systems (GIS) and statistical analysis will show regional and methodological trends in post-secondary support of the ID which currently lack any significant involvement by college libraries. Then, the presentation analyzes a case study of a book club at the Florida Atlantic University (FAU) libraries which has run for several years. Issues such as the selection of books, effective pedagogies, and evaluation procedures will be examined. The study has found that the instruction pedagogies used by libraries can be extended through concepts of Universal Learning Design (ULD) to effectively engage the ID. In particular, student-centered, participatory methodologies that accommodate different learning styles have proven to be especially useful. The choice of text is complex and determined not only by reading ability but familiarity of subject and features of the ID’s developmental trajectory. The selection of text is not only a necessity but also promises to give insight into the ID. Assessment remains a complex and unresolved subject, but the voluntary, sustained, and enthusiastic attendance of the ID is an undeniable indicator. The study finds that, through the traditional library vehicle of the book club, academic libraries can support ID students through training in both reading and socialization, two major goals of their post-secondary education.

Keywords: academic libraries, intellectual disability, literacy, post-secondary education

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Authors: M. Petunia Tsweleng

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Statement of the Problem: Research and aid organisations report that children and adolescents orphaned due to HIV and AIDS are particularly vulnerable as they are often exposed to negative effects of both HIV and AIDS and orphanhood. Without much-needed parental love, care, and support, these children and adolescents are at risk of poor developmental outcomes. A cursory look at the available literature on AIDS-orphaned adolescents, and the quality of caregiving relationships with caregivers, shows that this is a relatively under-researched terrain. This article is a review of the literature on caregiving relationships of adolescents orphaned due to AIDS and their current primary caregivers. It aims to inform community programmes and policymakers by providing insight into the qualities of these relationships. Methodology: A comprehensive search of both peer-reviewed and non-peer-reviewed literature was conducted through EBSCOhost, SpringLINK, PsycINFO, SAGE, PubMed, Elsevier ScienceDirect, JSTOR, Wiley Online Library databases, and Google Scholar. The combination of keywords used for the search were: (caregiving relationships); (orphans OR AIDS orphaned children OR AIDS orphaned adolescents); (primary caregivers); and (quality caregiving); (orphans); (HIV and AIDS). The search took place between 24 January and 28 February 2022. Both qualitative and quantitative research studies published between 2010 and 2020 were reviewed. However, only qualitative studies were selected in the end -as they presented more profound findings concerning orphan-caregiver relationships. The following three stages of meta-synthesis analysis were used to analyse data: refutational syntheses, reciprocal syntheses, and line of argument. Results: The search resulted in a total of 2090 titles, of which 750 were duplicates and therefore subtracted. The researcher reviewed all the titles and abstracts of the remaining 1340 articles. 329 articles were identified as relevant, and full texts were reviewed. Following the review of the full texts, 313 studies were excluded for relevance and 4 for methodology. Twelve articles representing 11 studies fulfilled the inclusion criteria and were selected. These studies, representing different countries across the globe, reported similar forms of hardships experienced by caregivers economically, psychosocially, and healthwise. However, the studies also show that the majority of caregivers found contentment in caring for orphans, particularly grandmother carers, and were thus enabled to provide love, care, and support despite hardships. This resulted in positive caregiving relationships -as orphans fared well emotionally and psychosocially. Some relationships, however, were found negative due to unhealed emotional wounds suffered by both caregivers and orphans and others due to the caregiver’s lack of interest in providing care. These findings were based on self-report data from both orphans and caregivers. Conclusion: Findings suggest that intervention efforts need to be intensified to: alleviate poverty in households that are affected by HIV and AIDS pandemic, strengthen the community psychosocial support programmes for orphans and their caregivers; and integrate clinical services with community programmes for the healing of emotional and psychological wounds. Contributions: Findings inform community programmes and policymakers by providing insight into the qualities of the mentioned relationships as well as identifying factors commonly associated with high-quality caregiving and poor-quality caregiving.

Keywords: systematic review, caregiving relationships, orphans and primary caregivers, AIDS

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Authors: Monika Sobolewska, Aleksandra Majchrzak, Bartlomiej Chojnacki, Katarzyna Baruch, Adam Pilch

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The main purpose of the study is to perform the measurement and analysis of noise harmfulness in public utility facilities. The World Health Organization reports that the number of people suffering from hearing impairment is constantly increasing. The most alarming is the number of young people occurring in the statistics. The majority of scientific research in the field of hearing protection and noise prevention concern industrial and road traffic noise as the source of health problems. As the result, corresponding standards and regulations defining noise level limits are enforced. However, there is another field uncovered by profound research – leisure time. Public utility facilities such as clubs, shopping malls, sport facilities or concert halls – they all generate high-level noise, being out of proper juridical control. Among European Union Member States, the highest legislative act concerning noise prevention is the Environmental Noise Directive 2002/49/EC. However, it omits the problem discussed above and even for traffic, railway and aircraft noise it does not set limits or target values, leaving these issues to the discretion of the Member State authorities. Without explicit and uniform regulations, noise level control at places designed for relaxation and entertainment is often in the responsibility of people having little knowledge of hearing protection, unaware of the risk the noise pollution poses. Exposure to high sound levels in clubs, cinemas, at concerts and sports events may result in a progressive hearing loss, especially among young people, being the main target group of such facilities and events. The first step to change this situation and to raise the general awareness is to perform reliable measurements the results of which will emphasize the significance of the problem. This project presents the results of more than hundred measurements, performed in most types of public utility facilities in Poland. As the most suitable measuring instrument for such a research, personal noise dosimeters were used to collect the data. Each measurement is presented in the form of numerical results including equivalent and peak sound pressure levels and a detailed description considering the type of the sound source, size and furnishing of the room and the subjective sound level evaluation. In the absence of a straight reference point for the interpretation of the data, the limits specified in EU Directive 2003/10/EC were used for comparison. They set the maximum sound level values for workers in relation to their working time length. The analysis of the examined problem leads to the conclusion that during leisure time, people are exposed to noise levels significantly exceeding safe values. As the hearing problems are gradually progressing, most people underplay the problem, ignoring the first symptoms. Therefore, an effort has to be made to specify the noise regulations for public utility facilities. Without any action, in the foreseeable future the majority of Europeans will be dealing with serious hearing damage, which will have a negative impact on the whole societies.

Keywords: hearing protection, noise level limits, noise prevention, noise regulations, public utility facilities

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Authors: Tuna Şahsuvaroğlu

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The concept of disability is a concept that has been the subject of many studies in national and international literature with its social, sociological, political, anthropological, economic and social dimensions as well as with individual and social consequences. A disabled person is defined as a person who has difficulties in adapting to social life and meeting daily needs due to loss of physical, mental, spiritual, sensory and social abilities to various degrees, either from birth or for any reason later, and they are in need of protection, care, rehabilitation, counseling and support services. The industrial revolution and the rapid industrialization it brought with it led to an increase in the rate of disabilities resulting from work accidents, in addition to congenital disabilities. This increase has resulted in disabled people included in the employment policies of nations as a disadvantaged group. Although the participation of disabled individuals in the workforce is of great importance in terms of both increasing their quality of life and their integration with society and although disabled individuals are willing to participate in the workforce, they encounter with many problems. One of these problems is the negative attitudes and prejudices that develop in society towards the employment of disabled individuals. One of the most powerful ways to turn these negative attitudes and prejudices into positive ones is education. Education is a way of guiding societies and transferring existing social characteristics to future generations. This can be maintained thanks to teachers, who are one of the most dynamic parts of society and act as the locomotive of education driven by the need to give direction and transfer and basically to help and teach. For this reason, there is a strong relationship between the teaching profession and the attitudes formed in society towards the employment of disabled individuals, as they can influence each other. Therefore, the purpose of this study is to examine teacher candidates' attitudes towards the employment of disabled individuals in terms of various variables. The participants of the study consist of 665 teacher candidates studying at various departments at Marmara University Faculty of Education in the 2022-2023 academic year. The descriptive survey model of the general survey model was used in this study as it intends to determine the attitudes of teacher candidates towards the employment of disabled individuals in terms of different variables. The Attitude Scale Towards Employment of Disabled People was used to collect data. The data were analyzed according to the variables of age, gender, marital status, the department, and whether there is a disabled relative in the family, and the findings were discussed in the context of further research.

Keywords: teacher candidates, disabled, attitudes towards the employment of disabled people, attitude scale towards the employment of disabled people

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Authors: Abdreheman Seid Abdella

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This study examined instructors willingness, self-efficacy beliefs, attitudes and knowledge about provisions of instructional accommodations for students with disabilities in universities. Major concepts used in this study operationally defined and some models of disability were reviewed. Questionnaires were distributed to a total of 181 instructors from four universities and quantitative data was generated. Then to analyze the data, appropriate methods of data analysis were employed. The result indicated that on average instructors had positive willingness, strong self-efficacy beliefs and positive attitudes towards providing instructional accommodations. In addition, the result showed that the majority of participants had moderate level of knowledge about provision of instructional accommodations. Concerning the relationship between instructors background variables and dependent variables, the result revealed that location of university and awareness raising training about Inclusive Education showed statistically significant relationship with all dependent variables (willingness, self-efficacy beliefs, attitudes and knowledge). On the other hand, gender and college/faculty did not show a statistically significant relationship. In addition, it was found that among the inter-correlation of dependent variables, the correlation between attitudes and willingness to provide accommodations was the strongest. Furthermore, using multiple linear regression analysis, this study also indicated that predictor variables like self-efficacy beliefs, attitudes, knowledge and teaching methodology training made statistically significant contribution to predicting the criterion willingness. Predictor variables like willingness and attitudes made statistically significant contribution to predicting self-efficacy beliefs. Predictor variables like willingness, Special Needs Education course and self-efficacy beliefs made statistically significant contribution to predict attitudes. Predictor variables like Special Needs Education courses, the location of university and willingness made statistically significant contribution to predicting knowledge. Finally, using exploratory factor analysis, this study showed that there were four components or factors each that represent the underlying constructs of willingness and self-efficacy beliefs to provide instructional accommodations items, five components for attitudes towards providing accommodations items and three components represent the underlying constructs for knowledge about provisions of instructional accommodations items. Based on the findings, recommendations were made for improving the situation of instructional accommodations in Ethiopian universities.

Keywords: willingness, self-efficacy belief, attitude, knowledge

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Authors: Sharon Milberger, Jane Turner, Denise White-Perkins

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Michigan shares the overall U.S. national need for more highly qualified professionals who have knowledge and experience in the use of evidence-based practices to meet the special health care needs of children, adolescents, and adults with neurodevelopmental disabilities including autism spectrum disorder (DD/ASD). The Michigan Leadership Education in Neurodevelopmental Disabilities (MI-LEND) program is a consortium of six universities that spans the state of Michigan and serves more than 181,800 undergraduate, graduate, and professional students. The purpose of the MI LEND program is to improve the health of infants, children and adolescents with disabilities in Michigan by training individuals from different disciplines to assume leadership roles in their respective fields and work across disciplines. The MI-LEND program integrates “L.I.F.E.” perspectives into all training components. L.I.F.E. is an acronym for Leadership, Interdisciplinary, Family-Centered and Equity perspectives. This paper will describe how L.I.F.E. perspectives are embedded into all aspects of the MI-LEND training program including the application process, didactic training, community and clinical experiences, discussions, journaling and projects. Specific curriculum components will be described including content from a training module dedicated to Equity. Upon completion of the Equity module, trainees are expected to be able to: 1) Use a population health framework to identify key social determinants impacting families and children; 2) Explain how addressing bias and providing culturally appropriate linguistic care/services can influence patient/client health and wellbeing; and 3) Describe the impact of policy and structural/institutional factors influencing care and services for children with DD/ASD and their families. Each trainee completes two self-assessments: the Cultural and Linguistic Competence Health Practitioner Assessment and the other assessing social attitudes/implicit bias. Trainees also conduct interviews with a family with a child with DD/ASD. In addition, interdisciplinary Equity-related group activities are incorporated into face-to-face training sessions. Each MI-LEND trainee has multiple ongoing opportunities for self-reflection through discussion and journaling and completion of a L.I.F.E. project as a culminating component of the program. The poster will also discuss the challenges related to teaching and measuring successful outcomes related to diversity/equity perspectives.

Keywords: disability, diversity, equity, training

Procedia PDF Downloads 138

Authors: P. W. G. D. P. Samarasekara, S. M. K. S. Seneviratne, D. Munidasa, S. S. Williams

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Sustaining a spinal cord injury (SCI) causes severe disruption of all aspects of a person’s life, resulting in the difficult process of coping with the distressing effects of paralysis affecting their ability to lead a meaningful life. These persons are hospitalized in the acute stage of injury and subsequently for rehabilitation and the treatment of complications. The purpose of this study was to explore coping strategies used by persons with SCI during their rehabilitation period. A qualitative study was conducted among persons with SCI, undergoing rehabilitation at the Rheumatology and Rehabilitation Hospitals, Ragama and Digana Sri Lanka. Twelve participants were selected purposively to represent both males and females, with cervical, thoracic or lumbar levels of injuries due to traumatic and non-traumatic causes as well as from different socioeconomic backgrounds. Informed consent was taken from the participants. In-depth interviews were conducted using an interview guide to collect data. Probes were used to get more information and to encourage participants. Interviews were audio taped and transcribed verbatim. Qualitative content analysis was conducted. Ethical approval for this study was obtained from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya. Five themes were identified in the content analysis: social support, religious beliefs, determination, acceptance and making comparisons. Participants indicated that the support from their family members had been an essential factor in coping, after sustaining an SCI and they expressed the importance of emotional support from family members during their rehabilitation. Many participants had a strong belief towards the God, who had a personal interest in their lives, played an important role in their ability to cope with the injury. They believed that what happens to them in this life results from their actions in previous lives. They expressed that determination was essential as a factor that helps them cope with their injury. They indicated their focus on the positive aspects of the life and accepted the disability. They made comparisons to other persons who were worse off than them to help lift them out of unpleasant experience. Even some of the most severely injured and disabled participants presented evidence of using this coping strategy. Identification of coping strategies used by persons with SCI will help nurses and other health-care professionals in reinforcing the most effective coping strategies among persons with SCI. The findings recommend that engagement coping positively influences psychosocial adaptation.

Keywords: content analysis, coping strategies, rehabilitation, spinal cord injury

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

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

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

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Authors: Madalena Corte-real, João Pedro Nunes, Bernardo Fernandes, Ana Jorge Correira

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This presentation looks, from a sociological perspective, at neighboring practices in the inner city of Lisbon. The capital of Portugal, with half a million inhabitants, inserted in a metropolitan area with almost 2,9 million people, has been in the international spotlight seen as an interesting city to live in and to invest in, especially in the real estate market. This promotion emerged in the context of the financial crisis, where local authorities aimed to make Lisbon a more competitive city, calling for visitors and financial and human capital. Especially in the last decade, Portugal’s capital has been experiencing a significant increase in terms of migration from creative and entrepreneurial exiles to economic and political expats. In this context, the territory under analysis, in particular, is a mixed-used area undergoing rapid transformations in recent years marked by the presence of newcomers and non-nationals as well as social and cultural heterogeneity. It is next to one of the main arteries, considered the most multicultural part of the city, and presented in the press as one of the coolest neighborhoods in Europe. In view of these aspects, this research aims to address key-topics in current urban research: anonymity often related to big cities, socio-spatial attachment to the neighborhood, and the effects of diversity in the everyday relations of residents and shopkeepers. This case-study intends to look at particularities in local regimes differently affected by growing mobility. Against a backdrop of unidimensional generalizations and a tendency to refer to central countries and global cities, it aims to discuss national and local specificities. In methodological terms, the project comprises essentially a qualitative approach that consists of direct observation techniques and ethnographic methods as well semi-structured interviews to residents and local stakeholders whose narratives are subject to content analysis. The paper starts with a characterization of the broader context of the city of Lisbon, followed by territorial specificities regarding socio-spatial development, namely the city’s and the inner-areas morphology as well as the population’s socioeconomic profile. Following the residents and stakeholders’ narratives and practices it will assess the perception and behaviors regarding the representation of the area, relationships and experiences, routines, and sociability. Results point to a significant presence of neighborhood relations and different forms of support, in particular, among the different groups – e.g., old long-time residents, middle-class families, global creative class, and communities of economic migrants. Fieldwork reveals low levels of place-attachment although some residents refer, presently, high levels of satisfaction. Engagement with living space, this case-study suggests, reveals the social construction and lived the experience of neighboring by different groups, but also the way different and contrasting visions and desires are articulated to the profound urban, cultural and political changes that permeate the area.

Keywords: diversity, lisbon, neighboring and neighborhood, place-attachment

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Authors: Michael Josef Schwerer, Oliver Peschel

Abstract:

Background: The sense and purpose of forensic postmortem examinations are undoubtedly the same in Institutes of Legal Medicine all over the world. Cause and manner of death must be determined, persons responsible for unnatural death must be brought to justice, and accidents demand changes in the respective scenarios to avoid future mishaps. The latter particularly concerns aircraft accidents, not only regarding consequences from criminal or civil law but also in pursuance of the International Civil Aviation Authority’s regulations, which demand lessons from mishap investigations to improve flight safety. Irrespective of the distinct circumstances of a given casualty or the respective questions in subsequent death investigations, a forensic autopsy is the basis for all further casework, the clue to otherwise hidden solutions, and the crucial limitation for final success when not all possible findings have been properly collected. This also implies that the targeted work of police forces and expert witnesses strongly depends on the quality of forensic pathology practice. Deadly events in foreign countries, which lead to investigations not only abroad but also in Germany, can be challenging in this context. Frequently, second-look autopsies after the repatriation of the deceased to Germany are requested by the legal authorities to ensure proper and profound documentation of all relevant findings. Aims and Methods: To validate forensic postmortem practice abroad, a retrospective study using the findings in the corresponding second-look autopsies in the Institute of Legal Medicine Munich over the last 20 years was carried out. New findings unreported in the previous autopsy were recorded and judged for their relevance to solving the respective case. Further, the condition of the corpse at the time of the second autopsy was rated to discuss artifacts mimicking evidence or the possibility of lost findings resulting from, e.g., decomposition. Recommendations for future handling of death cases abroad and efficient autopsy practice were pursued. Results and Discussion: Our re-evaluation confirmed a high quality of autopsy practice abroad in the vast majority of cases. However, in some casework, incomplete documentation of pathology findings was revealed along with either insufficient or misconducted dissection of organs. Further, some of the bodies showed missing parts of some organs, most probably resulting from sampling for histology studies during the first postmortem. For the aeromedical evaluation of a decedent’s health status prior to an aviation mishap, particularly lost or obscured findings in the heart, lungs, and brain impeded expert testimony. Moreover, incomplete fixation of the body or body parts for repatriation was seen in several cases. This particularly involved previously dissected organs deposited back into the body cavities at the end of the first autopsy. Conclusions and Recommendations: Detailed preparation in the first forensic autopsy avoids the necessity of a second-look postmortem in the majority of cases. To limit decomposition changes during repatriation from abroad, special care must be taken to include pre-dissected organs in the chemical fixation process, particularly when they are separated from the blood vessels and just deposited back into the body cavities.

Keywords: autopsy practice, second-look autopsy, retrospective study, quality standards, decomposition changes, repatriation

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