Search results for: healthcare coordination
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2159

Search results for: healthcare coordination

1199 Analysis of Urban Slum: Case Study of Korail Slum, Dhaka

Authors: Sanjida Ahmed Sinthia

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Bangladesh is one of the poorest countries in the world. There are several reasons for this insufficiency and uncontrolled population growth is one of the prime reasons. Others include low economic progress, imbalanced resource management, unemployment and underemployment, urban migration and natural catastrophes etc. As a result, the rate of urban poor is increasing inevitably in every sphere of urban cities in Bangladesh and Dhaka is the most affected one. Besides there is scarcity of urban land, housing, urban infrastructure and amenities which create pressure on urban cities and mostly encroach the open space, wetlands that causes environmental degradation. Government has no or limited control over these due to poor government policy and management, political pressure and lack of resource management. Unfortunately, over centralization and bureaucracy creates unnecessary delay and interruptions in any government initiations. There is also no coordination between government and private sector developer to solve the problem of urban Poor. To understand the problem of these huge populations this paper analyzes one of the single largest slum areas in Dhaka, Korail Slum. The study focuses on socio demographic analysis, morphological pattern and role of different actors responsible for the improvements of the area and recommended some possible steps for determining the potential outcomes.

Keywords: demographic analysis, environmental degradation, government policy, housing and land management policy

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1198 The Contribution of the Lomé Charter to Combating Trafficking in Persons at Sea: Nigerian and South African Legal Perspective

Authors: Obinna Emmanuel Nkomadu

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A major maritime problem in the African continent is the widespread proliferation of threats to maritime security, and one of which is the traffic in persons (TIP) at sea, which victims are sometimes assaulted, injured, killed, and in many cases go missing. The South African and Nigerian law on TIP at sea is the Prevention and Combating of Trafficking in Persons Act and the Trafficking in Persons (Prohibition) Enforcement and Administration Act, respectively. These legislation prohibits TIP at sea but does not provides effective and efficient national coordination structures and international cooperation measures against traffickers who engage on human trafficking on the African maritime domain. As a result of the limitations on the maritime security laws of most African States and the maritime security threats on the continent, the African Union in 2016 adopted the African Charter on Maritime Security and Safety and Development in Africa (Lome Charter). The Lomé Charter provides mechanisms for national and international cooperation on maritime security threats, including TIP at sea. However, the Charter is yet to come into force due to the number of States required to accede or ratify the Charter. This paper identifies gaps on existing instruments on TIP at sea by those States and justify on South Africa and Nigeria should adopt the Charter. The justification flow from analysing relevant international law instruments, as well as legislation on human trafficking.

Keywords: cooperation against trafficking in persons at sea, lomé charter, maritime security, Nigerian legislation on trafficking in persons, South African legislation on trafficking in person, and trafficking in persons at sea

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1197 Pulmonary Disease Identification Using Machine Learning and Deep Learning Techniques

Authors: Chandu Rathnayake, Isuri Anuradha

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Early detection and accurate diagnosis of lung diseases play a crucial role in improving patient prognosis. However, conventional diagnostic methods heavily rely on subjective symptom assessments and medical imaging, often causing delays in diagnosis and treatment. To overcome this challenge, we propose a novel lung disease prediction system that integrates patient symptoms and X-ray images to provide a comprehensive and reliable diagnosis.In this project, develop a mobile application specifically designed for detecting lung diseases. Our application leverages both patient symptoms and X-ray images to facilitate diagnosis. By combining these two sources of information, our application delivers a more accurate and comprehensive assessment of the patient's condition, minimizing the risk of misdiagnosis. Our primary aim is to create a user-friendly and accessible tool, particularly important given the current circumstances where many patients face limitations in visiting healthcare facilities. To achieve this, we employ several state-of-the-art algorithms. Firstly, the Decision Tree algorithm is utilized for efficient symptom-based classification. It analyzes patient symptoms and creates a tree-like model to predict the presence of specific lung diseases. Secondly, we employ the Random Forest algorithm, which enhances predictive power by aggregating multiple decision trees. This ensemble technique improves the accuracy and robustness of the diagnosis. Furthermore, we incorporate a deep learning model using Convolutional Neural Network (CNN) with the RestNet50 pre-trained model. CNNs are well-suited for image analysis and feature extraction. By training CNN on a large dataset of X-ray images, it learns to identify patterns and features indicative of lung diseases. The RestNet50 architecture, known for its excellent performance in image recognition tasks, enhances the efficiency and accuracy of our deep learning model. By combining the outputs of the decision tree-based algorithms and the deep learning model, our mobile application generates a comprehensive lung disease prediction. The application provides users with an intuitive interface to input their symptoms and upload X-ray images for analysis. The prediction generated by the system offers valuable insights into the likelihood of various lung diseases, enabling individuals to take appropriate actions and seek timely medical attention. Our proposed mobile application has significant potential to address the rising prevalence of lung diseases, particularly among young individuals with smoking addictions. By providing a quick and user-friendly approach to assessing lung health, our application empowers individuals to monitor their well-being conveniently. This solution also offers immense value in the context of limited access to healthcare facilities, enabling timely detection and intervention. In conclusion, our research presents a comprehensive lung disease prediction system that combines patient symptoms and X-ray images using advanced algorithms. By developing a mobile application, we provide an accessible tool for individuals to assess their lung health conveniently. This solution has the potential to make a significant impact on the early detection and management of lung diseases, benefiting both patients and healthcare providers.

Keywords: CNN, random forest, decision tree, machine learning, deep learning

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1196 Training Can Increase Knowledge and Skill of Teacher's on Measurement and Assessment Nutritional Status Children

Authors: Herawati Tri Siswati, Nurhidayat Ana Sıdık Fatimah

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The Indonesia Basic Health Research, 2013 showed that prevalence of stunting of 6–12 children years old was 35,6%, wasting was 12,2% and obesiy was 9,2%. The Indonesian Goverment have School Health Program, held in coordination, plans, directing and responsible, developing and implement health student. However, it's implementation still under expected, while Indonesian Ministry of Health has initiated the School Health Program acceleration. This aimed is to know the influencing of training to knowledge and skill of elementary school teacher about measurement and assesment nutrirional status children. The research is quasy experimental with pre-post design, in Sleman disctrict, Yogyakarta province, Indonesia, 2015. Subject was all of elementary school teacher’s who responsible in School Health Program in Gamping sub-district, Sleman, Yogyakarta, i.e. 32 persons. The independent variable is training, while the dependent variable are teacher’s klowledge and skill on measurement and assesment nutrirional status children. The data was analized by t-test. The result showed that the knowledge score before training is 31,6±9,7 and after 56,4±12,6, with an increase 24,8±15,7, and p=0.00. The skill score before training is 46,6±11,1 and after 61,7±13, with an increase 15,2±14,2, p = 0.00. Training can increase the teacher’s klowledge and skill on measurement and assesment nutrirional status.

Keywords: training, school health program, nutritional status, children.

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1195 Liquid-Liquid Extraction of Uranium (VI) from Aqueous Solution Using 1-Hydroxyalkylidene-1,1-Diphosphonic Acids

Authors: Mustapha Bouhoun Ali, Ahmed Yacine Badjah Hadj Ahmed, Mouloud Attou, Abdel Hamid Elias, Mohamed Amine Didi

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The extraction of uranium(VI) from aqueous solutions has been investigated using 1-hydroxyhexadecylidene-1,1-diphosphonic acid (HHDPA) and 1-hydroxydodecylidene-1,1-diphosphonic acid (HDDPA), which were synthesized and characterized by elemental analysis and by FT-IR, 1H NMR, 31P NMR spectroscopy. In this paper, we propose a tentative assignment for the shifts of those two ligands and their specific complexes with uranium(VI). We carried out the extraction of uranium(VI) by HHDPA and HDDPA from [carbon tetrachloride + 2-octanol (v/v: 90%/10%)] solutions. Various factors such as contact time, pH, organic/aqueous phase ratio and extractant concentration were considered. The optimum conditions obtained were: contact time = 20 min, organic/aqueous phase ratio = 1, pH value = 3.0 and extractant concentration = 0.3M. The extraction yields are more significant in the case of the HHDPA which is equipped with a hydrocarbon chain, longer than that of the HDDPA. Logarithmic plots of the uranium(VI) distribution ratio vs. pHeq and the extractant concentration showed that the ratio of extractant to extracted uranium(VI) (ligand/metal) is 2:1. The formula of the complex of uranium(VI) with the HHDPA and the DHDPA is UO2(H3L)2 (HHDPA and DHDPA are denoted as H4L). A spectroscopic analysis has showed that coordination of uranium(VI) takes place via oxygen atoms.

Keywords: liquid-liquid extraction, uranium(VI), 1-hydroxyalkylidene-1, 1-diphosphonic acids, HHDPA, HDDPA, aqueous solution

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1194 Maximizing Bidirectional Green Waves for Major Road Axes

Authors: Christian Liebchen

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Both from an environmental perspective and with respect to road traffic flow quality, planning so-called green waves along major road axes is a well-established target for traffic engineers. For one-way road axes (e.g. the Avenues in Manhattan), this is a trivial downstream task. For bidirectional arterials, the well-known necessary condition for establishing a green wave in both directions is that the driving times between two subsequent crossings must be an integer multiple of half of the cycle time of the signal programs at the nodes. In this paper, we propose an integer linear optimization model to establish fixed-time green waves in both directions that are as long and as wide as possible, even in the situation where the driving time condition is not fulfilled. In particular, we are considering an arterial along whose nodes separate left-turn signal groups are realized. In our computational results, we show that scheduling left-turn phases before or after the straight phases can reduce waiting times along the arterial. Moreover, we show that there is always a solution with green waves in both directions that are as long and as wide as possible, where absolute priority is put on just one direction. Compared to optimizing both directions together, establishing an ideal green wave into one direction can only provide suboptimal quality when considering prioritized parts of a green band (e.g., first few seconds).

Keywords: traffic light coordination, synchronization, phase sequencing, green waves, integer programming

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1193 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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1192 Investigating the Effects of Managerial Competencies on Organizational Performance through the Mediating Role of Entrepreneurship and Social Capital

Authors: Nader Chavoshi Boroujeni, Naser Chavoshi Boroujeni

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Considering the importance of managerial competencies on organizational performance as well as the role of social capital and entrepreneurship as mediator parameters affecting organizational performance, this study attempts to examine the impact carefully. In this regard, Isfahan Science and Technology Town (ISTT) as an effective and knowledge generator company that has a great effect on improving organizational performances of many other companies such as Knowledge-Based Companies (KBCs) activing in the ISTT's site was selected as statistical population. According to coordination with the Department of Development and Technology of ISTT, all employees of ISTT and active KBCs were selected as sample. Then, to analyze the variables a standard and self-made questionnaire containing 98 questions was designed and distributed. Of the 350 questionnaires distributed, 319 questionnaires were collected that 313 cases were confirmed and analyzed. To confirm the reliability of questionnaire, the Leader professor and two other professors approved it. Cronbach's alpha coefficient was used to validate the questionnaire that all coefficient was between 0/7 and 0/95. So, the validity was confirmed. After descriptive study population, the normality of distribution was investigated with Kolmogorov-Smirnov test. Finally, the results obtained from the questionnaires were analyzed by Amos software that all hypotheses were confirmed.

Keywords: managerial competencies, personnel organizational performance, entrepreneurship, social capital

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1191 Observer-Based Leader-Following Consensus of Nonlinear Fractional-Order Multi-Agent Systems

Authors: Ali Afaghi, Sehraneh Ghaemi

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The coordination of the multi-agent systems has been one of the interesting topic in recent years, because of its potential applications in many branches of science and engineering such as sensor networks, flocking, underwater vehicles and etc. In the most of the related studies, it is assumed that the dynamics of the multi-agent systems are integer-order and linear and the multi-agent systems with the fractional-order nonlinear dynamics are rarely considered. However many phenomena in nature cannot be described within integer-order and linear characteristics. This paper investigates the leader-following consensus problem for a class of nonlinear fractional-order multi-agent systems based on observer-based cooperative control. In the system, the dynamics of each follower and leader are nonlinear. For a multi-agent system with fixed directed topology firstly, an observer-based consensus protocol is proposed based on the relative observer states of neighboring agents. Secondly, based on the property of the stability theory of fractional-order system, some sufficient conditions are presented for the asymptotical stability of the observer-based fractional-order control systems. The proposed method is applied on a five-agent system with the fractional-order nonlinear dynamics and unavailable states. The simulation example shows that the proposed scenario results in the good performance and can be used in many practical applications.

Keywords: fractional-order multi-agent systems, leader-following consensus, nonlinear dynamics, directed graphs

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1190 Community Re-Integrated Soldiers’ Perceptions of Barriers and Facilitators to A Home-Based Physical Rehabilitation Programme Following Lower-Limb Amputation

Authors: Ashan Wijekoon, Abi Beane, Subashini Jayawardana

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Background: Soldiers' physical rehabilitation and long term health status has been hindered due to limited investment in and access to rehabilitation services. Home-based rehabilitation programmes could offer a potentially feasible alternative to facilitate long-term recovery. Objectives: To explore Sri Lankan soldiers' perceptions of barriers and facilitators to a home-based physical rehabilitation programme.Methods and Materials: We conducted qualitative semi-structured interviews with community re-integrated army veterans who had undergone unilateral lower limb amputation following war related trauma. Veterans were identified from five districts of Sri Lanka, based on a priori knowledge of veteran community settlements (Disabled Category Registry) obtained from Directorate of Rehabilitation, MoD, Sri Lanka. Individuals were stratified for purposive selection. The interview guide was developed from existing methods and adapted for context. Verbatim transcripts of interviews were analyzed for emerging themes using an inductive approach. Following consent, participants met the researcher (AW- a trained physiotherapist fluent in Sinhalese). Results: Twenty-five Interviews were conducted, totaling 7.2 hours of new data (Mean±SD: 0.28±0.11). All participants were male, aged 30-55 years (Mean±SD: 46.1±7.4), and had experienced traumatic amputation as a result of conflict. Twenty-four sub themes were identified. Inadequate space for exercises, absence of equipment and assistance to conduct the exercises at home, alongside absence of community healthcare services were all barriers. Burden of comorbidities, including chronic pain and disability level, were also barriers. Social support systems, including soldier societies, family, and kinship with other amputees, were seen as facilitators to an at-home programme. Motivation for independence was a strong indicator of engagement. Conclusion: Environment, chronic pain, and absence of well-established community health services were key barriers. Family and soldier support was a facilitator. Engagement with community healthcare providers (physiotherapist and primary care physicians) will be essential to the success of an at-home rehabilitation program.

Keywords: physical rehabilitation, home-based, soldiers, disability, lower-limb amputation, qualitative

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1189 Emotion Processing Differences Between People

Authors: Elif Unveren, Ozlem Bozkurt

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Emotion processing happens when someone has a negative, stressful experience and gets over it in time, and it is a different experience for every person. As to look into emotion processing can be categorised by intensity, awareness, coordination, speed, accuracy and response. It may vary depending on people’s age, sex and conditions. Each emotion processing shows different activation patterns in different brain regions. Activation is significantly higher in the right frontal areas. The highest activation happens in extended frontotemporal areas during the processing of happiness, sadness and disgust. Those emotions also show widely disturbed differences and get produced earlier than anger and fear. For different occasions, listed variables may have less or more importance. A borderline personality disorder is a condition that creates an unstable personality, sudden mood swings and unpredictability of actions. According to a study that was made with healthy people and people who had BPD, there were significant differences in some categories of emotion processing, such as intensity, awareness and accuracy. According to another study that was made to show the emotional processing differences between puberty and was made for only females who were between the ages of 11 and 17, it was perceived that for different ages and hormone levels, different parts of the brain are used to understand the given task. Also, in the different study that was made for kids that were between the age of 4 and 15, it was observed that the older kids were processing emotion more intensely and expressing it to a greater extent. There was a significant increase in fear and disgust in those matters. To sum up, we can say that the activity of undertaking negative experiences is a unique thing for everybody for many different reasons.

Keywords: age, sex, conditions, brain regions, emotion processing

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1188 School Emergency Drills Evaluation through E-PreS Monitoring System

Authors: A. Kourou, A. Ioakeimidou, V. Avramea

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Planning for natural disasters and emergencies is something every school or educational institution must consider, regardless of its size or location. Preparedness is the key to save lives if a disaster strikes. School disaster management mirrors individual and family disaster prevention, and wider community disaster prevention efforts. This paper presents the usage of E-PreS System as a helpful, managerial tool during the school earthquake drill, in order to support schools in developing effective disaster and emergency plans specific to their local needs. The project comes up with a holistic methodology using real-time evaluation involving different categories of actors, districts, steps and metrics. The main outcomes of E-PreS project are the development of E-PreS web platform that host the needed data of school emergency planning; the development of E-PreS System; the implementation of disaster drills using E-PreS System in educational premises and local schools; and the evaluation of E-PreS System. Taking into consideration that every disaster drill aims to test and valid school plan and procedures; clarify and train personnel in roles and responsibilities; improve interagency coordination; identify gaps in resources; improve individual performance; and identify opportunities for improvement, E-PreS Project was submitted and approved by the European Commission (EC).

Keywords: disaster drills, earthquake preparedness, E-PreS System, school emergency plans

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1187 Technology Transfer of Indigenous Technologies: Emerging Aid to Indian Health Sector

Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

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India is battling with the issues of accessibility, affordability and availability of quality health to the masses. Indian medical heritage which dated back to 3000 BC unveils the rich knowledge pool which has undergone a perceptible change over years, such as eradication of many communicable diseases, increasing individual awareness of quality health and import driven medical device market etc. Despite a slew of initiatives the holistic slogan of ‘health for all’ remains elusive and a concern for the nation. The 21st-century projects a myriad of challenges like cultural diversity, large population, demographic dividend and geographical segmentation leading to varied needs of people as per their regional conditions of climate, disease prevalence, nutrition and sanitation. But these challenges are also opportunities for the development of indigenous, low cost and accessible technologies to tackle them. This requires reinforcing the potential of indigenous technologies in coordination with prevailing health issues in various regions of country. This paper emphasis on the strategy for exploring the indigenous technologies with entrusted up-scaling to meet the diverse needs of the people. This review proposes to adopt technology transfer as a strategy to establish a vibrant ecosystem for identifying and up-scaling the indigenous medical technologies with diligent hand-holding for public health.

Keywords: health, indigenous, medical technology, technology transfer

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1186 Confirming the Factors of Professional Readiness in Athletic Training

Authors: Philip A. Szlosek, M. Susan Guyer, Mary G. Barnum, Elizabeth M. Mullin

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In the United States, athletic training is a healthcare profession that encompasses the prevention, examination, diagnosis, treatment, and rehabilitation of injuries and medical conditions. Athletic trainers work under the direction of or in collaboration with a physician and are recognized by the American Medical Association as allied healthcare professionals. Internationally, this profession is often known as athletic therapy. As healthcare professionals, athletic trainers must be prepared for autonomous practice immediately after graduation. However, new athletic trainers have been shown to have clinical areas of strength and weakness.To better assess professional readiness and improve the preparedness of new athletic trainers, the factors of athletic training professional readiness must be defined. Limited research exists defining the holistic aspects of professional readiness needed for athletic trainers. Confirming the factors of professional readiness in athletic training could enhance the professional preparation of athletic trainers and result in more highly prepared new professionals. The objective of this study was to further explore and confirm the factors of professional readiness in athletic training. Authors useda qualitative design based in grounded theory. Participants included athletic trainers with greater than 24 months of experience from a variety of work settings from each district of the National Athletic Trainer’s Association. Participants took the demographic questionnaire electronically using Qualtrics Survey Software (Provo UT). After completing the demographic questionnaire, 20 participants were selected to complete one-on-one interviews using GoToMeeting audiovisual web conferencing software. IBM Statistical Package for the Social Sciences (SPSS, v. 21.0) was used to calculate descriptive statistics for participant demographics. The first author transcribed all interviews verbatim and utilized a grounded theory approach during qualitative data analysis. Data were analyzed using a constant comparative analysis and open and axial coding. Trustworthiness was established using reflexivity, member checks, and peer reviews. Analysis revealed four overarching themes, including management, interpersonal relations, clinical decision-making, and confidence. Management was categorized as athletic training services not involving direct patient care and was divided into three subthemes, including administration skills, advocacy, and time management. Interpersonal Relations was categorized as the need and ability of the athletic trainer to properly interact with others. Interpersonal relations was divided into three subthemes, including personality traits, communication, and collaborative practice. Clinical decision-making was categorized as the skills and attributes required by the athletic trainer whenmaking clinical decisions related to patient care. Clinical decision-making was divided into three subthemes including clinical skills, continuing education, and reflective practice. The final theme was confidence. Participants discussed the importance of confidence regarding relationships building, clinical and administrative duties, and clinical decision-making. Overall, participants explained the value of a well-rounded athletic trainer and emphasized that athletic trainers need communication and organizational skills, the ability to collaborate, and must value self-reflection and continuing education in addition to having clinical expertise. Future research should finalize a comprehensive model of professional readiness for athletic training, develop a holistic assessment instrument for athletic training professional readiness, and explore the preparedness of new athletic trainers.

Keywords: autonomous practice, newly certified athletic trainer, preparedness for professional practice, transition to practice skills

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1185 The Impact of Physical Activity for Recovering Cancer Patients

Authors: Martyn Queen, Diane Crone, Andrew Parker, Saul Bloxham

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Rationale: There is a growing body of evidence that supports the use of physical activity during and after cancer treatment. However, activity levels for patients remain low. As more cancer patients are treated successfully, and treatment costs continue to escalate, physical activity may be a promising adjunct to a person-centred healthcare approach to recovery. Aim: The aim was to further understand how physical activity may enhance the recovery process for a group of mixed-site cancer patients. Objectives: The research investigated longitudinal changes in physical activity and perceived the quality of life between two and six month’s post-exercise interventions. It also investigated support systems that enabled patients to sustain these perceived changes. Method: The respondent cohort comprised 14 mixed-site cancer patients aged 43-70 (11 women, 3 men), who participated in a two-phase physical activity intervention that took place at a university in the South West of England. Phase 1 consisted of an eight-week structured physical activity programme; Phase 2 consisted of four months of non-supervised physical activity. Semi-structured interviews took place three times over six months with each participant. Grounded theory informed the data collection and analysis which, in turn, facilitated theoretical development. Findings: Our findings propose three theories on the impact of physical activity for recovering cancer patients: 1) Knowledge gained through a structured exercise programme can enable recovering cancer patients to independently sustain physical activity to four-month follow-up. 2) Sustaining physical activity for six months promotes positive changes in the quality of life indicators of chronic fatigue, self-efficacy, the ability to self-manage and energy levels. 3) Peer support from patients facilitates adherence to a structured exercise programme and support from a spouse, or life partner facilitates independently sustained physical activity to four-month follow-up. Conclusions: This study demonstrates that qualitative research can provide an evidence base that could be used to support future care plans for cancer patients. Findings also demonstrate that a physical activity intervention can be effective at helping cancer patients recover from the side effects of their treatment, and recommends that physical activity should become an adjunct therapy alongside traditional cancer treatments.

Keywords: physical activity, health, cancer recovery, quality of life, support systems, qualitative, grounded theory, person-centred healthcare

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1184 Socioeconomic Burden of a Diagnosis of Cervical Cancer in Women in Rural Uganda: Findings from a Phenomenological Study

Authors: Germans Natuhwera, Peter Ellis, Acuda Wilson, Anne Merriman, Martha Rabwoni

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Objective: The aim of the study was to diagnose the socio-economic burden and impact of a diagnosis of cervical cancer (CC) in rural women in the context of low-resourced country Uganda, using a phenomenological enquiry. Methods: This was a multi-site phenomenological inquiry, conducted at three hospice settings; Mobile Hospice Mbarara in southwestern, Little Hospice Hoima in Western, and Hospice Africa Uganda Kampala in central Uganda. A purposive sample of women with a histologically confirmed diagnosis of CC was recruited. Data was collected using open-ended audio-recorded interviews conducted in the native languages of participants. Interviews were transcribed verbatim in English, and Braun and Clarke’s (2019) framework of thematic analysis was used. Results: 13 women with a mean age of 49.2 and age range 29-71 participated in the study. All participants were of low socioeconomic status. The majority (84.6%) had advanced disease at diagnosis. A fuller reading of transcripts produced four major themes clustered under; (1) socioeconomic characteristics of women, (2) impact of CC on women’s relationships, (3) disrupted and impaired activities of daily living (ADLs), and (4) economic disruptions. Conclusions: A diagnosis of CC introduces significant socio-economic disruptions in a woman’s and her family’s life. CC causes disability, impairs the woman and her family’s productivity hence exacerbating levels of poverty in the home. High and expensive out-of-pocket expenditure on treatment, investigations, and transport costs further compound the socio-economic burden. Decentralizing cancer care services to regional centers, scaling up screening services, subsidizing costs of cancer care services, or making cervical cancer care treatment free of charge, strengthening monitoring mechanisms in public facilities to curb the vice of healthcare workers soliciting bribes from patients, increased mass awareness campaigns about cancer, training more healthcare professionals in cancer investigation and management, and palliative care, and introducing an introductory course on gynecologic cancers into all health training institutions are recommended.

Keywords: activities of daily living, cervical cancer, out-of-pocket, expenditure, phenomenology, socioeconomic

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1183 Best Practice for Post-Operative Surgical Site Infection Prevention

Authors: Scott Cavinder

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Surgical site infections (SSI) are a known complication to any surgical procedure and are one of the most common nosocomial infections. Globally it is estimated 300 million surgical procedures take place annually, with an incidence of SSI’s estimated to be 11 of 100 surgical patients developing an infection within 30 days after surgery. The specific purpose of the project is to address the PICOT (Problem, Intervention, Comparison, Outcome, Time) question: In patients who have undergone cardiothoracic or vascular surgery (P), does implementation of a post-operative care bundle based on current EBP (I) as compared to current clinical agency practice standards (C) result in a decrease of SSI (O) over a 12-week period (T)? Synthesis of Supporting Evidence: A literature search of five databases, including citation chasing, was performed, which yielded fourteen pieces of evidence ranging from high to good quality. Four common themes were identified for the prevention of SSI’s including use and removal of surgical dressings; use of topical antibiotics and antiseptics; implementation of evidence-based care bundles, and implementation of surveillance through auditing and feedback. The Iowa Model was selected as the framework to help guide this project as it is a multiphase change process which encourages clinicians to recognize opportunities for improvement in healthcare practice. Practice/Implementation: The process for this project will include recruiting postsurgical participants who have undergone cardiovascular or thoracic surgery prior to discharge at a Northwest Indiana Hospital. The patients will receive education, verbal instruction, and return demonstration. The patients will be followed for 12 weeks, and wounds assessed utilizing the National Healthcare Safety Network//Centers for Disease Control (NHSN/CDC) assessment tool and compared to the SSI rate of 2021. Key stakeholders will include two cardiovascular surgeons, four physician assistants, two advance practice nurses, medical assistant and patients. Method of Evaluation: Chi Square analysis will be utilized to establish statistical significance and similarities between the two groups. Main Results/Outcomes: The proposed outcome is the prevention of SSIs in the post-op cardiothoracic and vascular patient. Implication/Recommendation(s): Implementation of standardized post operative care bundles in the prevention of SSI in cardiovascular and thoracic surgical patients.

Keywords: cardiovascular, evidence based practice, infection, post-operative, prevention, thoracic, surgery

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1182 Study of Trend, Dimension and Effect of Organizational Politics on Workers Performance in Public Organizations

Authors: Eniola Simbiat Ibude

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Work politics could be referred to as office politics or organizational politics. Work place politics take different form, direction, and dimensions. Studies of these features of organizational politics have been conducted in the private sector and much has been left to be studied on the other side of the fence, namely in larger bureaucracies and in public sector system. This is the gap the study tried to fill. This study also focuses on the negative effects that perceptions of politics seem to have on job attitudes (i.e., job satisfaction, organizational commitment) and on affective performance. This was with a view to understanding the relevance of its effects on job performance. The descriptive survey research design of the ex-post facto type was adopted for this study since the variables being studied had already occurred and were, therefore, not manipulated. Data were analyzed using the descriptive and inferential statistics of frequency counts, simple percentages, ANOVA, and multiple regression. Findings show that the joint and relative effect of organizational politics on workers performance, planning, coordination and supervision of work (B 0.71), delaying information for carrying out work (B 0.67), criticizing and wasting time for work done (B 0.56) has contributed to workers performance. The effect could be seen as negative on workers performance. Conclusively, every employee will not react to organizational politics the same way. The 'social arsenal' or the 'social skills' of the individual are a good buffer against the potential aftermaths of organizational politics. Also, from this study, it could be concluded that the perceptions of politics have a more complex relationship with job performance, a relationship that may be different for various types of employees.

Keywords: bureaucracies, dimension, politics, trend

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1181 SAFECARE: Integrated Cyber-Physical Security Solution for Healthcare Critical Infrastructure

Authors: Francesco Lubrano, Fabrizio Bertone, Federico Stirano

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Modern societies strongly depend on Critical Infrastructures (CI). Hospitals, power supplies, water supplies, telecommunications are just few examples of CIs that provide vital functions to societies. CIs like hospitals are very complex environments, characterized by a huge number of cyber and physical systems that are becoming increasingly integrated. Ensuring a high level of security within such critical infrastructure requires a deep knowledge of vulnerabilities, threats, and potential attacks that may occur, as well as defence and prevention or mitigation strategies. The possibility to remotely monitor and control almost everything is pushing the adoption of network-connected devices. This implicitly introduces new threats and potential vulnerabilities, posing a risk, especially to those devices connected to the Internet. Modern medical devices used in hospitals are not an exception and are more and more being connected to enhance their functionalities and easing the management. Moreover, hospitals are environments with high flows of people, that are difficult to monitor and can somehow easily have access to the same places used by the staff, potentially creating damages. It is therefore clear that physical and cyber threats should be considered, analysed, and treated together as cyber-physical threats. This means that an integrated approach is required. SAFECARE, an integrated cyber-physical security solution, tries to respond to the presented issues within healthcare infrastructures. The challenge is to bring together the most advanced technologies from the physical and cyber security spheres, to achieve a global optimum for systemic security and for the management of combined cyber and physical threats and incidents and their interconnections. Moreover, potential impacts and cascading effects are evaluated through impact propagation models that rely on modular ontologies and a rule-based engine. Indeed, SAFECARE architecture foresees i) a macroblock related to cyber security field, where innovative tools are deployed to monitor network traffic, systems and medical devices; ii) a physical security macroblock, where video management systems are coupled with access control management, building management systems and innovative AI algorithms to detect behavior anomalies; iii) an integration system that collects all the incoming incidents, simulating their potential cascading effects, providing alerts and updated information regarding assets availability.

Keywords: cyber security, defence strategies, impact propagation, integrated security, physical security

Procedia PDF Downloads 157
1180 Determinants of Youth Engagement with Health Information on Social Media Platforms in United Arab Emirates

Authors: Niyi Awofeso, Yunes Gaber, Moyosola Bamidele

Abstract:

Since most social media platforms are accessible anytime and anywhere where Internet connections and smartphones are available, the invisibility of the reader raises questions about accuracy, appropriateness and comprehensibility of social media communication. Furthermore, the identity and motives of individuals and organizations who post articles on social media sites are not always transparent. In the health sector, through socially networked platforms constitute a common source of health-related information, given their purported wealth of information. Nevertheless, fake blogs and sponsored postings for marketing 'natural cures' pervade most commonly used social media platforms, thus complicating readers’ abilities to access and understand trustworthy health-related information. This purposive sampling study of 120 participants aged 18-35 year in UAE was conducted between September and December 2017, and explored commonly used social media platforms, frequency of use of social media for accessing health related information, and approaches for assessing the trustworthiness of health information on social media platforms. Results indicate that WhatsApp (95%), Instagram (87%) and Youtube (82%) were the most commonly used social media platforms among respondents. Majority of respondents (81%) indicated that they regularly access social media to get health-associated information. More than half of respondents (55%) with non-chronic health status relied on unsolicited messages to obtain health-related information. Doctors’ health blogs (21%) and social media sites of international healthcare organizations (20%) constitute the most trusted source of health information among respondents, with UAE government health agencies’ social media accounts trusted by 15% of respondents. Cardiovascular diseases, diabetes, and hypertension were the most commonly searched topics on social media (29%), followed by nutrition (20%) and skin care (16%). Majority of respondents (41%) rely on reliability of hits on Google search engines, 22% check for health information only from 'reliable' social media sites, while 8% utilize 'logic' to ascertain reliability of health information. As social media has rapidly become an integral part of the health landscape, it is important that health care policy makers, healthcare providers and social media companies collaborate to promote the positive aspects of social media for young people, whilst mitigating the potential negatives. Utilizing popular social media platforms for posting reader-friendly health information will achieve high coverage. Improving youth digital literacy will facilitate easier access to trustworthy information on the internet.

Keywords: social media, United Arab Emirates, youth engagement, digital literacy

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1179 Status of Communication and Swallowing Therapy in Patient with a Tracheostomy

Authors: Ya-Hui Wang

Abstract:

Lower speech therapy rate of tracheostomized patient was noted in comparison with previous researches. This study is aim to shed light on the referral status of speech therapy in those patients in Taiwan. This study developed an analysis for the size and key characteristics of the population of tracheostomized in-patient in the Taiwan. Method: We analyzed National Healthcare Insurance data (The Collaboration Center of Health Information Application, CCHIA) from Jan 1 2010 to Dec 31 2010. Result: over ages 3, number of tracheostomized in-patient is directly proportional to age. A high service loading was observed in North region in comparison with other regions. Only 4.87% of the tracheostomized in-patients were referred for speech therapy, and 1.9% for swallow examination, 2.5% for communication evaluation.

Keywords: refer, speech therapy, training, rehabilitation

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1178 Participation of Juvenile with Driven of Tobacco Control in Education Institute: Case Study of Suan Sunandha Rajabhat University

Authors: Sakapas Saengchai

Abstract:

This paper studied the participation of juvenile with driven of tobacco control in education institute: case study of Suan Sunandha Rajabhat University is qualitative research has objective to study participation of juvenile with driven of tobacco control in University, as guidance of development participation of juvenile with driven of tobacco control in education institute the university is also free-cigarette university. There are qualitative researches on collection data of participation observation, in-depth interview of group conversation and agent of student in each faculty and college and exchange opinion of student. Result of study found that participation in tobacco control has 3 parts; 1) Participation in campaign of tobacco control, 2) Academic training and activity of free-cigarette of university and 3) As model of juvenile in tobacco control. For guidelines on youth involvement in driven tobacco control is universities should promote tobacco control activities. Reduce smoking campaign continues include a specific area for smokers has living room as sign clearly, staying in the faculty / college and developing network of model students who are non-smoking. This is a key role in the coordination of university students driving to the free cigarette university. Including the strengthening of community in the area and outside the area as good social and quality of country.

Keywords: participation, juvenile, tobacco control, institute

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1177 Going Horizontal: Confronting the Challenges When Transitioning to Cloud

Authors: Harvey Hyman, Thomas Hull

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As one of the largest cancer treatment centers in the United States, we continuously confront the challenge of how to leverage the best possible technological solutions, in order to provide the highest quality of service to our customers – the doctors, nurses and patients at Moffitt who are fighting every day for the prevention and cure of cancer. This paper reports on the transition from a vertical to a horizontal IT infrastructure. We discuss how the new frameworks and methods such as public, private and hybrid cloud, brokering cloud services are replacing the traditional vertical paradigm for computing. We also report on the impact of containers, micro services, and the shift to continuous integration/continuous delivery. These impacts and changes in delivery methodology for computing are driving how we accomplish our strategic IT goals across the enterprise.

Keywords: cloud computing, IT infrastructure, IT architecture, healthcare

Procedia PDF Downloads 377
1176 The Leadership Criterion: Challenges in Pursuing Excellence in the Jordanian Public Sector

Authors: Shaker Aladwan, Paul Forrester

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This paper explores the challenges that face leaders when implementing business excellence programmes in the Jordanian public sector. The study adopted a content analysis approach to analyse the excellence assessment reports that have been produced by the King Abdullah II Centre for Excellence (KACE). The sample comprises ten public organisations which have participated in the King Abdullah Award for Excellence (KAA) more than once and acknowledge in their reports that they have failed to achieve satisfactory results. The key challenges to the implementation of leadership criteria in the public sector in Jordan were found to be poor strategic planning, lack of employee empowerment, weaknesses in benchmarking performance, a lack of financial resources, poor integration and coordination, and poor measurement system: This study proposes a conceptual model for the as assessment of challenges that face managers when seeking to implement excellence in leadership in the Jordanian public sector. Theoretically, this paper fills context gaps in the excellence literature in general and organisational excellence in the public sector in particular. Leadership challenges in the public sector are generally widely studied, but it is important to gain a better understanding of how these challenges can be overcome. In comparison to many existing studies, this research has provided specific and detailed insights these organisational excellence challenges in the public sector and provides a conceptual model for use by other researchers into the future.

Keywords: leadership criterion, organisational excellence, challenges, quality awards, public sector, Jordan

Procedia PDF Downloads 383
1175 The Influence of Ligands Molecular Structure on the Antibacterial Activity of Some Metal Complexes

Authors: Sanja O. Podunavac-Kuzmanović, Lidija R. Jevrić, Strahinja Z. Kovačević

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In last decade, metal-organic complexes have captured intensive attention because of their wide range of biological activities such as antibacterial, antifungal, anticancerous, antimicrobial and antiHIV. Therefore, it is of great importance for the development of coordination chemistry to explore the assembly of functional organic ligands with metal ion and to investigate the relationship between the structure and property. In view of our studies, we reasoned that benzimidazoles complexed to metal ions could act as a potent antibacterial agents. Thus, we have bioassayed the inhibitory potency of benzimidazoles and their metal salts (Co or Ni) against Gram negative bacteria Escherichia coli. In order to validate our in vitro study, we performed in silico studies using molecular docking software’s. The investigated compounds and their metal complexes (Co, Ni) showed good antibacterial activity against Escherichia coli. In silico docking studies of the synthesized compounds suggested that complexed benzimidazoles have a greater binding affinity and enhanced antibacterial activity in comparison with noncomplexed ligands. In view of their enhanced inhibitory properties we propose that the studied complexes can be used as potential pharmaceuticals. This study is financially supported by COST action CM1306 and the project No. 114-451-347/2015-02, financially supported by the Provincial Secretariat for Science and Technological Development of Vojvodina.

Keywords: benzimidazoles, complexes, antibacterial, Escherichia coli, metal

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1174 An Analytic Cross-Sectional Study on the Association between Social Determinants of Health, Maternal and Child Health-Related Knowledge and Attitudes, and Utilization of Maternal, Newborn, Child Health and Nutrition Strategy-Prescribed Services for M

Authors: Rafael Carlos C. Aniceto, Bryce Abraham M. Anos, Don Christian A. Cornel, Marjerie Brianna S. Go, Samantha Nicole U. Roque, Earl Christian C. Te

Abstract:

Indigenous peoples (IPs) in the Philippines are a vulnerable, marginalized group in terms of health and overall well-being due to social inequities and cultural differences. National standards regarding maternal healthcare are geared towards facility-based delivery with modern medicine, health services, and skilled birth attendants. Standards and procedures of care for pregnant mothers do not take into account cultural differences between indigenous people and the majority of the population. There do exist, however, numerous other factors that cause relatively poorer health outcomes among indigenous peoples (IPs). This analytic cross-sectional study sought to determine the association between social determinants of health (SDH), focusing on status as indigenous peoples, and maternal health-related knowledge and attitudes (KA), and health behavior of the Dumagat-Agta indigenous people of Barangay Catablingan and Barangay San Marcelino, General Nakar, Quezon Province, and their utilization of health facilities for antenatal care, facility-based delivery and postpartum care, which would affect their health outcomes (that were not within the scope of this study). To quantitatively measure the primary/secondary exposures and outcomes, a total of 90 face-to-face interviews with IP and non-IP mothers were done. For qualitative information, participant observation among 6 communities (5 IP and 1 non-IP), 11 key informant interviews (traditional and modern health providers) and 4 focused group discussions among IP mothers were conducted. Primary quantitative analyses included chi-squared, T-test and binary logistic regression, while secondary qualitative analyses involved thematic analysis and triangulation. The researchers spent a total of 15 days in the community to learn the culture and participate in the practices of the Dumagat-Agta more intensively and deeply. Overall, utilization of all MNCHN services measured in the study was lower for IP mothers compared to their non-IP counterparts. After controlling for confounders measured in the study, IP status (primary exposure) was found to be significantly correlated with utilization of and adherence to two MNCHN-prescribed services: number of antenatal care check-ups and place of delivery (secondary outcomes). Findings show that being an indigenous mother leads to unfavorable social determinants of health, and if compounded by a difference in knowledge and attitudes, would then lead to poor levels of utilization of MNCHN-prescribed services. Key themes from qualitative analyses show that factors that affected utilization were: culture, land alienation, social discrimination, socioeconomic status, and relations between IPs and non-IPs, specifically with non-IP healthcare providers. The findings of this study aim to be used to help and guide in policy-making, to provide healthcare that is not only adequate and of quality, but more importantly, that addresses inequities stemming from various social determinants, and which is socio-culturally acceptable to indigenous communities. To address the root causes of health problems of IPs, there must be full recognition and exercise of their collective rights to communal assets, specifically land, and self-determination. This would improve maternal and child health outcomes to one of the most vulnerable and neglected sectors in society today.

Keywords: child health, indigenous people, knowledge-attitudes-practices, maternal health, social determinants of health

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1173 RACK1 Integrates Light and Brassinosteroid Signaling to Coordinate Cell Division During Root Soil Penetration

Authors: Liang Jiansheng, Zhu Wei

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Light and brassinosteroids are essential external and internal cues for plant survival. Although the coordination of light with phytohormone signals is crucial for plant growth and development, the molecular connection between light and brassinosteroid signaling during root soil penetration remains elusive. Here, we reveal that light-stabilized RACK1 couples a brassinosteroid signaling cascade to drive cell division in root meristems. RACK1 family scaffold proteins positively regulate light-induced the promotion of root elongation during soil penetration. Under the light condition, RACK1A interacts with both phyB and SPA1, then reinforces the phyB-SPA1 association to accumulate its abundance in roots. In response to brassinosteroid signals, RACK1A competes with BKI1 to attenuate the BRI1-BKI1 interaction, thereby leading to activating BRI1 actions in root development. Furthermore, RACK1A binds to BES1 to repress its DNA binding activity toward the target gene CYCD3;1. This ultimately allows to release the inhibition of CYCD3;1 transcription, and promotes cell division during root growth. Our study illustrates a new mechanistic model of how plants engage scaffold proteins in transducing light information to facilitate brassinosteroid signaling for root growth in the soil.

Keywords: root growth, cell division, light signaling, brassinosteroid signaling, soil penetration, scaffold protein, RACK1

Procedia PDF Downloads 75
1172 Analyzing the Economic Impact and Stakeholder Perception of Destination Promotion: A Case Study of the First City on the Mississippi as 'True North'

Authors: Kelly La Venture

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Destination promotion has become increasingly important to economic development in the United States. Key stakeholders of the First City on the Mississippi recognizes the importance of the visitor economy and decided to invest in destination promotion of the city as ‘True North’. The purpose of the study was to analyze the economic impact and stakeholder perceptions of destination promotion of the First City on the Mississippi as ‘True North’ using the case study method. Using a semi-structured guide consisting of 8 questions and additional probing questions, investigators engaged in 30-90 minute interviews with 20 key stakeholders. Data captured was then subjected to thematic analysis and interpretation. Through a review of literature and interview analysis, data indicate(1) there is increasing value in the visitor economy of the First City on the Mississippi,(2) the visitor economy warrants investments in destination promotion,(3) economic development can be more effective through coordination of destination promotion of as ‘True North’ and,(4) destination promotion fuels development across the entire economic spectrum. As a result, the First City on the Mississippi should prioritize marketing efforts of as ‘True North’ and coordinate these efforts with economic development initiatives. The destination promotion of the First City on the Mississippi as ‘True North’ may raise the communities profile and open doors to increased tourism, business relocation, business expansion, and entrepreneurs ready to start up a new organization.

Keywords: case study method, destination promotion, economic development, leisure and business travel

Procedia PDF Downloads 289
1171 Content Analysis of Images Shared on Twitter during 2017 Iranian Protests

Authors: Maryam Esfandiari, Bohdan Fridrich

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On December 28, 2017, a wave of protests erupted in several Iranian cities. Protesters demonstrated against the president, Hasan Rohani, and theocratical nature of the regime. Iran has a recent history with protest movements, such as Green Movement responsible for demonstrations after 2009 Iranian presidential election. However, the 2017/2018 protests differ from the previous ones in terms of organization and agenda. The events show little to no central organization and seem as being sparked by grass root movements and by citizens’ fatigue of government corruption, authoritarianism, and economic problems of the country. Social media has played important role in communicating the protests to the outside world and also in general coordination. By using content analyses, this paper analyzes the visual content of Twitter posts published during the protests. It aims to find the correlation between their decentralized nature and nature of the tweets – either emotionally arousing or efficiency-elicit. Pictures are searched by hashtags and coded by their content, such as ‘crowds,’ ‘protest activities,’ ‘symbols of unity,’ ‘violence,’ ‘iconic figures,’ etc. The study determines what type of content prevails and what type is the most impactful in terms of reach. This study contributes to understanding the role of social media both as a tool and a space in protest organization and portrayal in countries with limited Internet access.

Keywords: twitter, Iran, collective action, protest

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1170 The Link Between Collaboration Interactions and Team Creativity Among Nursing Student Teams in Taiwan: A Moderated Mediation Model

Authors: Hsing Yuan Liu

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Background: Considerable theoretical and empirical work has identified a relationship between collaboration interactions and creativity in an organizational context. The mechanisms underlying this link, however, are not well understood in healthcare education. Objectives: The aims of this study were to explore the impact of collaboration interactions on team creativity and its underlying mechanism and to verify a moderated mediation model. Design, setting, and participants: This study utilized a cross-sectional, quantitative, descriptive design. The survey data were collected from 177 nursing students who enrolled in 18-week capstone courses of small interdisciplinary groups collaborating to design healthcare products in Taiwan during 2018 and 2019. Methods: Questionnaires assessed the nursing students' perceptions about their teams' swift trust (of cognition- and affect-based), conflicts (of task, process, and relationship), interaction behaviors (constructive controversy, helping behaviors, and spontaneous communication), and creativity. This study used descriptive statistics to compare demographics, swift trust scores, conflict scores, interaction behavior scores, and creativity scores for interdisciplinary teams. Data were analyzed using Pearson’s correlation coefficient and simple and hierarchical multiple regression models. Results: Pearson’s correlation analysis showed the cognition-based team swift trust was positively correlated with team creativity. The mediation model indicated constructive controversy fully mediated the effect of cognition-based team swift trust on student teams’ creativity. The moderated mediation model indicated that task conflict negatively moderates the mediating effect of the constructive controversy on the link between cognition-based team swift trust and team creativity. Conclusion: Our findings suggest nursing student teams’ interaction behaviors and task conflict are crucial mediating and moderated mediation variables on the relationship between collaboration interactions and team creativity, respectively. The empirical data confirms the validity of our proposed moderated mediation models of team creativity. Therefore, this study's validated moderated mediation model could provide guidance for nursing educators to improve collaboration interaction outcomes and creativity on nursing student teams.

Keywords: team swift trust, team conflict, team interaction behavior, moderated mediating effects, interdisciplinary education, nursing students

Procedia PDF Downloads 181