Search results for: leadership demographics

Authors: Jayita Mukhopadhyay

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Even though more than six decades has passed since the death of India’s iconic thinker and mass leader Mahatma Gandhi, the world besieged by terrorism may still take a leaf out of his philosophical discourse on non-violence and attempt to turn his theory into praxis to save mankind. The greatest soul world has ever produced, a man of divine fire, an apostle of peace and non-violence, a revolutionary, a visionary, a social reformer and deliverer of the downtrodden, Father of the nation, these and numerous other epithets have been used by eminent personalities and scholars while describing Mahatma Gandhi. Gandhi was a relentless fighter and mass mobiliser who awakened a sleeping giant, the common men and women of India, shook them out of their docile, fatalistic mould, invigorated them with his doctrine of ahimsa and satyagraha (non violence and strict adherence to truth), instilled in them nationalist zeal and patriotic fervour and turned them into determined, steadfast freedom fighters. Under his leadership, the national liberation movement got a new life and ultimately succeeded in ending the era of foreign domination. And he did all these while resisting a natural tendency of his people to respond violently to unspeakable violence and atrocities unleashed by the colonial British administration desperate to keep India in its empire. In this paper, an attempt will be made to unravel Gandhi’s elucidation of the concept of non-violent resistance, along with non-cooperation and civil disobedience and their actual application through political practices which succeeded in capturing the imagination of not only India’s teeming millions but the entire world. The methodology of analytical study will be used as Gandhi’s own writings and those by noted scholars on Gandhi will be examined extensively to establish contemporary relevance of his thought, his invaluable guidelines about how to cope with poverty, inequality, exploitation, repression and marginalization of some sections of society and resultant radicalization of some disturbed members of human race, the very conditions which spawn terrorism in today’s world.

Keywords: India, non cooperation, non violence, terrorism

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Authors: Priya Nangia, Sanchita Bansal

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As fashion cycles become more rapid, some segments of the fashion industry have adopted increasingly unsustainable production processes to keep up with demand and enhance profit margins. The growing threat to environmental and social wellbeing posed by unethical fast fashion practices and the need to integrate the targets of SDGs into this industry necessitates a shift in the fashion industry's unsustainable nature, which can only be accomplished in the long run if consumers support sustainable fashion by purchasing it. Fast fashion is defined as low-cost, trendy apparel that takes inspiration from the catwalk or celebrity culture and rapidly transforms it into garments at high-street stores to meet consumer demand. Given the importance of identity formation to many consumers, the desire to be “fashionable” often outweighs the desire to be ethical or sustainable. This paradox exemplifies the tension between the human drive to consume and the will to do so in moderation. Previous research suggests that there is an attitude-behavior gap when it comes to determining consumer purchasing behavior, but to the best of our knowledge, no study has analysed how to encourage customers to shift from fast to slow fashion. Against this backdrop, the aim of this study is twofold: first, to identify and examine the factors that impact consumers' decisions to engage in sustainable fashion, and second, the authors develop a comprehensive framework for conceptualizing and encouraging researchers and practitioners to foster sustainable consumer behavior. This study used a systematic approach to collect data and analyse literature. The approach included three key steps: review planning, review execution, and findings reporting. Authors identified the keywords “sustainable consumption” and “sustainable fashion” and retrieved studies from the Web of Science (WoS) (126 records) and Scopus database (449 records). To make the study more specific, the authors refined the subject area to management, business, and economics in the second step, retrieving 265 records. In the third step, the authors removed the duplicate records and manually reviewed the articles to examine their relevance to the research issue. The final 96 research articles were used to develop this study's systematic scheme. The findings indicate that societal norms, demographics, positive emotions, self-efficacy, and awareness all have an effect on customers' decisions to purchase sustainable apparel. The authors propose a framework, denoted by the acronym SHIFT, in which consumers are more likely to engage in sustainable behaviors when the message or context leverages the following factors: (s)social influence, (h)habit formation, (i)individual self, (f)feelings, emotions, and cognition, and (t)tangibility. Furthermore, the authors identify five broad challenges that encourage sustainable consumer behavior and use them to develop novel propositions. Finally, the authors discuss how the SHIFT framework can be used in practice to drive sustainable consumer behaviors. This research sought to define the boundaries of existing research while also providing new perspectives on future research, with the goal of being useful for the development and discovery of new fields of study, thereby expanding knowledge.

Keywords: consumer behavior, fast fashion, sustainable consumption, sustainable fashion, systematic literature review

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Authors: Pablo Ampuero, Claudia Labarca

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The current research paper assesses how the narrative of Chilean businesspeople about China shapes a new Orientalism Analyses on the role of non-state actors in foreign policy that have hitherto theorized about Orientalism as a narrative of hegemonic power. Hence, it has been instrumental to the efforts of imperialist powers to justify their mission civilisatrice. However, such conceptualization can seldom explain new complexities of international interactions at the height of globalization. Hence, we assessed the case of Chile, a small Latin American country, and its relationship with China, its largest trading partner. Through a discourse analysis of interviews with Chilean businesspeople engaged in the Chinese market, we could determine that Chile is building an Orientalist image of China. This new business Orientalism reinforces a relation of alterity based on commercial opportunities, traditional values, and natural dispositions. Hence, the perception of the Chinese Other amongst Chilean business people frames a new set of representations as part of the essentially commercial nature of current bilateral relations. It differs from previous frames, such as the racial bias frame of the early 20^th century, or the anti-communist frame in reaction to Mao’s leadership. As in every narrative of alterity, there is not only a construction of the Other but also a definition of the Self. Consequently, this analysis constitutes a relevant case of the role of non-state actors in asymmetrical bilateral relations, where the non-state actors of the minor power build and act upon an Orientalist frame, which is not representative of its national status in the relation. This study emerges as a contribution on the relation amongst non-state actors in asymmetrical relations, where the smaller power’s business class acts on a negative prejudice of its interactions with its counterpart. The research builds upon the constructivist approach to international relations, linking the idea of Nation Branding with Orientalism in the case of Chile-China relations.

Keywords: new business Orientalism, small power, framing, Chile-China relations

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Authors: Galih Imaduddin

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Knowledge has been viewed as one of the most important resources in organizations, including those that operate in the healthcare sector. On that basis, Knowledge Management (KM) is crucial for healthcare organizations to improve their productivity and ensure effective utilization of their resources. Despite the growing interests to understand how KM might work for healthcare organizations, there is only a modest amount of empirical inquiries which have specifically focused on the tools and initiatives to share knowledge. Hence, the main purpose of this paper is to investigate the way healthcare organizations, particularly public sector ones, utilize knowledge sharing tools and initiatives for the benefit of patient-care. Employing a qualitative method, 13 (thirteen) Community Health Centers (CHCs) from a high-performing district health setting in Indonesia were observed. Data collection and analysis involved a repetition of document retrievals and interviews (n=41) with multidisciplinary health professionals who work in these CHCs. A single case study was cultivated reflecting on the means that were used to share knowledge, along with the factors that inhibited the exchange of knowledge among those health professionals. The study discovers that all of the thirteen CHCs exhibited and applied knowledge sharing means which included knowledge documents, virtual communication channels (i.e. emails and chatting applications), and social learning forums such as staff meetings, morning briefings, and communities of practices. However, the intensity of utilization was different among these CHCs, in which organizational culture, leadership, professional boundaries, and employees’ technological aptitude were presumed to be the factors that inhibit knowledge sharing processes. Making a distance with the KM literature of other sectors, this study denounces the primacy of technology-based tools, suggesting that socially-based initiatives could be more reliable for sharing knowledge. This suggestion is largely due to the nature of healthcare work which is still predominantly based on the tacit form of knowledge.

Keywords: knowledge management, knowledge sharing, knowledge sharing tools and initiatives, knowledge sharing inhibitors, primary health care organizations

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Authors: Ana M. G. Sperandio, Adriana A. C. Rosa, Jussara C. Guarnieri

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This study consists of a research of the Post Occupancy Assessment (POA) of Medicinal Gardens' project of Urban Social Center’s square, in the city of 'Santa Barbara d'Oeste', located in the interior of Sao Paulo, Brazil. In view of the fact that community gardens, as well as medicinal gardens, are based on innumerable functions. The addition to the pedagogical function rescues people from their origins through (re)contact with the land, as a vehicle for social integration. Bearing in mind the project has the potential to fight hunger among the low-income population, to treat some diseases, also works as a strategy of environmental recovery especially of idle land. Such as very often only accumulate weeds and garbage, and therefore, must be considered in the Municipal Master Plan for the activity to be regulated. Objective: Identify on implantation the medicinal plants' value and principles for the promotion of a healthy city. Methodology: Application of the walkthrough, where it is possible to affirm that this instrument has three routes: one officer applied within the urban social center and two complementary ones, one being about 3 miles and the other being almost 5,5 miles. Results: Through a dialogical course, one can observe the benefits that the community medicinal gardens bring to the local population. In addition, it is consistent with the proposal for the community to be enabled to access collective care with home orientations that rescue the local and regional culture making the physical environment. This project aims at promoting more pleasant and inclusive through the actions of the caregiver, local leadership and the co-participation of local government. Although with the aim of increasing the supply value and improving the living conditions of social groups and interrelationship. Conclusion: This type of urban intervention, which articulates social participation, rescue of medicinal cultures and local knowledge, intersectoriality, social inclusion, among other premises connected with health promotion, and the city presents a potential for reverberation of practices in social networks with the objective of meeting the healthy city strategies.

Keywords: healthy city, healthy urban planning, medicinal gardens, social participation

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Authors: Balbasatu Ibrahim

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In the 19th century, Hausaland an Islamic revolution known as the Sokoto Jihad took place that led to the establishment of the Sokoto Caliphate in 1804 under the leadership of the famous Sheik Uthman Bn Fodiye. Before the Jihad movement in Hausaland (now Northern Nigeria), women were left in ignorance and were used and dumped like old kitchen utensils. The sheik and his followers did their best to actualising women’s right to education by using their female family members as role models who were highly educated and renowned scholars. After the Jihad with the establishment of an Islamic state, the women scholars initiated different strategies to teach the generality of the women. The most efficient strategy was the ‘Yantaru Movement founded by Nana Asma’u the daughter of Sheikh Uthman Bn Fodiye in collaboration with her sisters around 1840. The ‘Yantaru movement is a women’s educational movement aimed at enlightening women in rural and urban areas. The move helped in massively mobilizing women for education. In addition to town pupils, women from villages and throughout the nooks and crannies of metropolitan Sokoto participated in the movement in the search for knowledge. Thus, the birth of the ‘Yantaru system of women’s education. The ‘Yantaru operates the three-tier system at village, town and the metropolitan capital of Sokoto. ‘Yantaru functions include imparting knowledge to elderly women and young girls. Step down enlightenment program on returning home. The most effective medium of communication in the ‘Yantaru movement was through poetry where scholars composed educational poems which were memorized by the ‘Yantaru, who on return recite it to fellow women at home. Through this system, many women were educated. This paper translated and examines one of such educative poems written by the second leader of the ‘Yantaru Movement Maryam Bn Uthman Bn Fodiye in 1855.

Keywords: English, Hausa language, public enlightenment, Maryam Bint Uthman Ibn Foduye

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Authors: Moet Moet Myint lay

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Professional learning communities provide ongoing professional development for teachers, where they become learning leaders and actively participate in school improvement. The development of professional knowledge requires a significant focus on professional competence in the work of teachers, and a solid foundation of professional knowledge and skills is necessary for members of society to become intelligent members. Continuing professional development (CPD) plays a vital role in improving educational outcomes, as its importance has been proven over the years. This article explores the need for CPD for teachers in Myanmar and the utility of professional learning communities in improving teacher quality. This study aims to explore a comprehensive understanding of professional learning communities to support the continuing professional development of teacher educators in improving the quality of education. The research questions are: (1) How do teacher educators in Myanmar understand the concept of professional learning communities for continuing professional development? (2) What CPD training is required for all teachers in teachers' colleges? Quantitative research methods were used in this study. Survey data were collected from 50 participants (teacher trainers) from five educational institutions. The analysis shows that professional learning communities when done well, can have a lasting impact on teacher quality. Furthermore, the creation of professional learning communities is the best indicator of professional development in existing education systems. Some research suggests that teacher professional development is closely related to teacher professional skills and school improvement. As a result of the collective learning process, teachers gain a deeper understanding of the subject matter, increase their knowledge, and develop their professional teaching skills. This will help improve student performance and school quality in the future. The lack of clear understanding and knowledge about PLC among school leaders and leads teachers to believe that PLC activities are not beneficial. Lack of time, teacher accountability, leadership skills, and negative attitudes of participating teachers were the most frequently cited challenges in implementing PLCs. As a result of these findings, educators and stakeholders can use them to implement professional learning communities.

Keywords: professional learning communities, continuing professional development, teacher education, competence, school improvement

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Authors: Hassan Abbas, Rehmat Ali, Muhammad Akbar

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This study has been conducted in Sassi-Haramosh conservancy District Gilgit, Gilgit-Baltistan of Pakistan, under the Conservation Leadership Programme of Fauna and Flora International. The main objectives of the study were to assess the socio-economic impact of community-based conservation in Sassi-Haramosh conservancy and identify effects of trophy hunting on the conservation of wildlife in the area. The first trophy hunting program of Astor Markhor was held in year February 21, 2015, and the second on February 21, 2016. The community received a share of 49200 USD and 52400 USD from the first and second hunting, and the total earning was 101600 USD which are Rs. 10,871,200 in Pak Rs. The amounts from the trophy hunting are being managed by the Wildlife Conservation and Social Development Organization (WCSDO) Sassi. The village-based organization WCSDO is spending 50% of the trophy hunting amount in the protection of wildlife, its habitat and other natural resources, 30% in developmental sectors of the village and 20% of the amount in the office expenses. Several developmental projects, like construction of 300 KVA hydropower stations, purchase of 8 acres of land for agriculture, potable water supply project, construction of treks, and other social welfare activities have been carried in the village utilizing the trophy hunting grant. These developmental activities have uplifted the socio-economic conditions of the conservancy. Furthermore, trophy hunting program has positive impacts on the wildlife in the area, as the population of Markhor and Ibex has been increased, results in increasing number of other carnivores in the area. The WCSDO has banned any illegal activities in the habitat of wildlife and grazing of livestock in the core habitats. The program raised the level of awareness in communities and reduced poaching, illegal hunting, cutting of shrubs and extraction of Artemisia species from the pastures.

Keywords: Markhor, trophy hunting, Sassi-Haramosh, Gilgit

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Authors: Armando T. Zúñiga

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

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

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Authors: Amaraporn Puraya, Roongtiva Boonpracom, Somsak Thojampa, Sirikanok Klankhajhon, Kittisak Kumpeera

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The objective of this qualitative research was to study the elderly health care process by community participation. Data were collected by quality research methods, including secondary data study, observation, in-depth interviews, and focus group discussions and analyzed by content analysis, reflection and review of information. The research results pointed out that the important elderly health care process by community participation consisted of 2 parts, namely the community participation development process in elderly health care and the outcomes from the participation development process. The community participation development process consisted of 4 steps as follows: 1) Building the leadership team, an important social capital of the community, which started from searching for both formal and informal leaders by giving the opportunity for public participation and creating clear agreements defining roles, duties and responsibilities; 2) investigating the problems and the needs of the community, 3) designing the elderly health care activities under the concept of self-care potential development of the elderly through participation in community forums and meetings to exchange knowledge with common goals, plans and operation and 4) the development process of sustainable health care agreement at the local level, starting from opening communication channels to create awareness and participation in various activities at both individual and group levels as well as pushing activities/projects into the community development plan consistent with the local administration policy. The outcomes from the participation development process were as follows. 1) There was the integration of the elderly for doing the elderly health care activities/projects in the community managed by the elderly themselves. 2) The service system was changed from the passive to the proactive one, focusing on health promotion rather than treating diseases or illnesses. 3) The registered nurses / the public health officers can provide care for the elderly with chronic illnesses through the implementation of activities/projects of elderly health care so that the elderly can access the services more. 4) The local government organization became the main mechanism in driving the elderly health care process by community participation.

Keywords: elderly health care process, community participation, elderly, Thailand

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Authors: Maria L. Ulloa, Ruth M. Crawford, Stephanie Kelly, Joey Domdom

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In recent decades health and social service delivery have become more collaborative and interdisciplinary. Emerging trends suggest the need for an integrative and interprofessional approach to meet the challenges faced by professionals navigating the complexities of health and social service practice environments. Terms such as multidisciplinary practice, interprofessional collaboration, interprofessional education and transprofessional practice have become the common language used across a range of social services and health providers in western democratic systems. In Aotearoa New Zealand, one example of an interprofessional collaborative approach to curriculum design and delivery in health and social service is the development of an innovative Masters of Professional Practice programme. This qualification is the result of a strategic partnership between two tertiary institutions – Whitireia New Zealand (NZ) and the Wellington Institute of Technology (Weltec) in Wellington. The Master of Professional Practice programme was designed and delivered from the perspective of a collaborative, interprofessional and relational approach. Teachers and students in the programme come from a diverse range of cultural, professional and personal backgrounds and are engaged in courses using a blended learning approach that incorporates the values and pedagogies of interprofessional education. Students are actively engaged in professional practice while undertaking the programme. This presentation describes the themes of exploratory qualitative formative observations of engagement in class and online, student assessments, student research projects, as well as qualitative interviews with the programme teaching staff. These formative findings reveal the development of critical practice skills around the common themes of the programme: research and evidence based practice, education, leadership, working with diversity and advancing critical reflection of professional identities and interprofessional practice. This presentation will provide evidence of enhanced learning experiences in higher education and learning in multi-disciplinary contexts.

Keywords: diversity, exploratory research, interprofessional education, professional identity

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Authors: Elise Machline

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Policy instruments have been developed worldwide to reduce the energy demand of buildings. Two types of such instruments have been green building rating systems and energy efficiency standards for buildings -such as Green Star (Australia), LEED (United States, Leadership in Energy and Environmental Design), Energy Star (United States), and BREEAM (United Kingdom, Building Research Establishment Environmental Assessment Method). The popularity of the idea of sustainable development has allowed the actors to consider the potential value generated by the environmental performance of buildings, labeled “green value” in the literature. Sustainable performances of buildings are expected to improve their attractiveness, increasing their value. A growing number of empirical studies demonstrate that green buildings yield rental/sale premia, as well as higher occupancy rates and thus higher asset values. The results suggest that green buildings are not affordable to all and that their construction tends to have a gentrifying effect. An increasing number of countries are institutionalizing green strategies for affordable housing. In that sense, making green buildings affordable to all will depend on government policies. That research aims to investigate whether green building fosters inequality in Israel, under the banner of sustainability. The method is comparison (of the market value). This method involves comparing the green buildings sale prices with non-certified buildings of the same type that have undergone recent transactions. The “market value” is deduced from those sources by analogy. The results show that, in Israel, green building projects are usually addressed to the middle to upper classes. The green apartment’s sale premium is about 19% (comparing to non-certified dwelling). There is a link between energy and/or environmental performance and the financial value of the dwellings. Moreover, price differential is much higher than the value of energy savings. This perpetuates socio-spatial and socio-economic inequality as well as ecological vulnerability for the poor and other socially marginal groups. Moreover, there are no green affordable housings and the authorities do not subsidy green building or retrofitting.

Keywords: green building, gentrification, social housing, green value, green building certification

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Authors: Amenah Dhannoon, Ciaran Martin Hurley, Laura Wrafter, Podraic J. Regan

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Introduction: The COVID-19 pandemic continues to present unprecedented challenges for healthcare systems. This has resulted in the pragmatic shift in the practice of plastic surgery units worldwide. During this period, many units reported a significant fall in urgent melanoma referrals, leading to patients presenting with advanced disease requiring more extensive surgery and inferior outcomes. Our objective was to evaluate our unit's experience with both non-invasive and invasive melanoma during the COVID-19 pandemic and characterize our experience and contrast it to that experienced by our neighbors in the UK, mainland Europe and North America. Methods: a retrospective chart review was performed on all patients diagnosed with invasive and non-invasive cutaneous melanoma between March to December of 2019 (control) compared to 2020 (COVID-19 pandemic) in a single plastic surgery unit in Ireland. Patient demographics, referral source, surgical procedures, tumour characteristics, radiological findings, oncological therapies and follow-up were recorded. All data were anonymized and stored in Microsoft Excel. Results: A total of 589 patients were included in the study. Of these, 314 (53%) with invasive melanoma, compared to 275 (47%) with the non-invasive disease. Overall, more patients were diagnosed with both invasive and non-invasive melanoma in 2020 than in 2019 (p<0.05). However, significantly longer waiting times in 2020 (64 days) compared to 2019 (28 days) (p<0.05), with the majority of the referral being from GP in 2019 (83%) compared to 61% in 2020. Positive sentinel lymph node were higher in 2019 at 56% (n=28) compared to 24% (n=22) in 2020. There was no statistically significant difference in the tutor characteristics or metastasis status. Discussion: While other countries have noticed a fall in the melanoma diagnosis. Our units experienced a higher number of disease diagnoses. This can be due to multiple reasons. In Ireland, the government reached an early agreement with the private sector to continue elective surgery on an urgent basis in private hospitals. This allowed access to local anesthetic procedures and local skin cancer cases were triaged to non-COVID-19 provider centers. Our unit also adapted a fast, effective and minimal patient contact strategy for triaging skin cancer based on telemedicine. Thirdly, a skin cancer nurse specialist maintained patient follow-ups and triaging a dedicated email service. Finally, our plastic surgery service continued to maintain a virtual complex skin cancer multidisciplinary team meeting during the pandemic, ensuring local clinical governance has adhered to each clinical case. Conclusion: Our study highlights that with the prompt efficient restructuring of services, we could reserve successful management of skin cancer even in the most devastating times. It is important to reflect on the success during the pandemic and emphasize the importance of preparation for a potentially difficult future

Keywords: malignant melanoma, skin cancer, COVID-19, triage

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Authors: Sofia Nilsson, Alicia Ohlsson, Linda-Marie Lundqvist, Aida Alvinius, Peder Hyllengren, Gerry Larsson

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In irregular warfare contexts, military personnel are often presented with morally ambiguous situations where they are aware of the morally correct choice but may feel prevented to follow through with it due to organizational demands. Moral stress and/or injury can be the outcome of the individual’s experienced dissonance. These types of challenges put a large demand on the individual to manage their own emotions and the emotions of others, particularly in the case of a leader. Both the ability and inability for emotional regulation can result in different combinations of short and long term reactions after morally stressful events, which can be either positive or negative. Our study analyzed the combination of these reactions based upon the types of morally challenging events that were described by the subjects. 1)What institutionalized norms concerning emotion regulation are favorable in short-and long-term perspectives after a morally stressful event? 2)What individual emotion-focused coping strategies are favorable in short-and long-perspectives after a morally stressful? To address these questions, we conducted a quantitative study in military contexts in Sweden and Norway on upcoming or current military officers (n=331). We tested a theoretical model built upon a recently developed qualitative study. The data was analyzed using factor analysis, multiple regression analysis and subgroup analyses. The results indicated that an individual’s restriction of emotion in order to achieve an organizational goal, which results in emotional dissonance, can be an effective short term strategy for both the individual and the organization; however, it appears to be unfavorable in a long-term perspective which can result in negative reactions. Our results are intriguing because they showed an increased percentage of reported negative long term reactions (13%), which indicated PTSD-related symptoms in comparison to previous Swedish studies which indicated lower PTSD symptomology.

Keywords: emotion culture, emotion coping, emotion management, military

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Authors: Anudeep Appe, Bhanu Poluparthi, Lakshmi Kasivajjula, Udai Mv, Sobha Bagadi, Punya Modi, Aditya Singh, Hemanth Gunupudi, Spenser Troiano, Jeff Paul, Justin Stovall, Justin Yamamoto

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The necessity of data-driven decisions in healthcare strategy formulation is rapidly increasing. A reliable framework which helps identify factors impacting a healthcare provider facility or a hospital (from here on termed as facility) market share is of key importance. This pilot study aims at developing a data-driven machine learning-regression framework which aids strategists in formulating key decisions to improve the facility’s market share which in turn impacts in improving the quality of healthcare services. The US (United States) healthcare business is chosen for the study, and the data spanning 60 key facilities in Washington State and about 3 years of historical data is considered. In the current analysis, market share is termed as the ratio of the facility’s encounters to the total encounters among the group of potential competitor facilities. The current study proposes a two-pronged approach of competitor identification and regression approach to evaluate and predict market share, respectively. Leveraged model agnostic technique, SHAP, to quantify the relative importance of features impacting the market share. Typical techniques in literature to quantify the degree of competitiveness among facilities use an empirical method to calculate a competitive factor to interpret the severity of competition. The proposed method identifies a pool of competitors, develops Directed Acyclic Graphs (DAGs) and feature level word vectors, and evaluates the key connected components at the facility level. This technique is robust since its data-driven, which minimizes the bias from empirical techniques. The DAGs factor in partial correlations at various segregations and key demographics of facilities along with a placeholder to factor in various business rules (for ex. quantifying the patient exchanges, provider references, and sister facilities). Identified are the multiple groups of competitors among facilities. Leveraging the competitors' identified developed and fine-tuned Random Forest Regression model to predict the market share. To identify key drivers of market share at an overall level, permutation feature importance of the attributes was calculated. For relative quantification of features at a facility level, incorporated SHAP (SHapley Additive exPlanations), a model agnostic explainer. This helped to identify and rank the attributes at each facility which impacts the market share. This approach proposes an amalgamation of the two popular and efficient modeling practices, viz., machine learning with graphs and tree-based regression techniques to reduce the bias. With these, we helped to drive strategic business decisions.

Keywords: competition, DAGs, facility, healthcare, machine learning, market share, random forest, SHAP

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Authors: Laith F. Gulli, Nicole M. Mallory

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The undertaking to develop a psychometric instrument is monumental. Understanding the relationship between variables and events is important in structural and exploratory design of psychometric instruments. Considering this, we describe a method used to group, pair and combine multiple Philosophical Assumption statements that assisted in development of a 13 item psychometric screening instrument. We abbreviated our Philosophical Assumptions (PA)s and added parameters, which were then condensed and mathematically modeled in a specific process. This model produced clusters of combinatorics which was utilized in design and development for 1) information retrieval and categorization 2) item development and 3) estimation of interactions among variables and likelihood of events. The psychometric screening instrument measured Knowledge, Assessment (education) and Beliefs (KAB) of New Addictions Research (NAR), which we called KABNAR. We obtained an overall internal consistency for the seven Likert belief items as measured by Cronbach’s α of .81 in the final study of 40 Clinicians, calculated by SPSS 14.0.1 for Windows. We constructed the instrument to begin with demographic items (degree/addictions certifications) for identification of target populations that practiced within Outpatient Substance Abuse Counseling (OSAC) settings. We then devised education items, beliefs items (seven items) and a modifiable “barrier from learning” item that consisted of six “choose any” choices. We also conceptualized a close relationship between identifying various degrees and certifications held by Outpatient Substance Abuse Therapists (OSAT) (the demographics domain) and all aspects of their education related to EB-NAR (past and present education and desired future training). We placed a descriptive (PA)1tx in both demographic and education domains to trace relationships of therapist education within these two domains. The two perceptions domains B1/b1 and B2/b2 represented different but interrelated perceptions from the therapist perspective. The belief items measured therapist perceptions concerning EB-NAR and therapist perceptions using EB-NAR during the beginning of outpatient addictions counseling. The (PA)s were written in simple words and descriptively accurate and concise. We then devised a list of parameters and appropriately matched them to each PA and devised descriptive parametric (PA)s in a domain categorized information grid. Descriptive parametric (PA)s were reduced to simple mathematical symbols. This made it easy to utilize parametric (PA)s into algorithms, combinatorics and clusters to develop larger information grids. By using matching combinatorics we took paired demographic and education domains with a subscript of 1 and matched them to the column with each B domain with subscript 1. Our algorithmic matching formed larger information grids with organized clusters in columns and rows. We repeated the process using different demographic, education and belief domains and devised multiple information grids with different parametric clusters and geometric arrays. We found benefit combining clusters by different geometric arrays, which enabled us to trace parametric variables and concepts. We were able to understand potential differences between dependent and independent variables and trace relationships of maximum likelihoods.

Keywords: psychometric, parametric, domains, grids, therapists

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Authors: Patrice Conner

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Nanotechnologies have enormous potential to contribute to human flourishing in responsible and sustainable ways. They are rapidly developing field of science, technology and innovation. As enabling technologies, their full scope of applications is potentially very wide. Major implications are expected in many areas, e.g. healthcare, information and communication technologies, energy production and storage, materials science/chemical engineering, manufacturing, environmental protection, consumer products, etc. However, nanotechnologies are unlikely to realize their full potential unless their associated societal and ethical issues are adequately attended. Namely nanotechnologies and nanoparticles may expose humans and the environment to new health risks, possibly involving quite different mechanisms of interference with the physiology of human and environmental species. One of the building blocks of the ‘safe, integrated and responsible’ approach is standardization. Both the Economic and Social Committee and the European Parliament have highlighted the importance to be attached to standardization as a means to accompany the introduction on the market of nanotechnologies and nanomaterials, and a means to facilitate the implementation of regulation. ISO and CEN have respectively started in 2005 and 2006 to deal with selected topics related to this emerging and enabling technology. In the beginning of 2010, EC DG ‘Enterprise and Industry’ addressed the mandate M/461 to CEN, CENELEC and ETSI for standardization activities regarding nanotechnologies and nanomaterials. Thus CEN/TC 352 ‘Nanotechnologies’ has been asked to take the leadership for the coordination in the execution of M/461 (46 topics to be standardized) and to contact relevant European and International Technical committees and interested stakeholders as appropriate (56 structures have been identified). Prior requests from M/461 deal with characterization and exposure of nanomaterials and any matters related to Health, Safety and Environment. Answers will be given to: - What are the structures and how they work? - Where are we right now and how work is going from now onwards? - How CEN’s work and targets deal with and interact with global matters in this field?

Keywords: characterization, environmental protection, exposure, health risks, nanotechnologies, responsible and sustainable ways, safety

Procedia PDF Downloads 168

Authors: Barbara P. Ewerling, Bernadete M. Voichcoski, Alexandre J. Miziara

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Highly skilled and motivated employees, supported by the leadership through investments in development and by a healthy organizational environment, while performing their duties, produce a considerable amount of intellectual capital, which constitutes part of the intangible wealth that is not explicitly mentioned in accounting reports. The customer relationship is built subtly through three components of intellectual capital: human, structural, and relational capital. The indispensable skill is to understand what employees need in order to shape a favorable environment to the creation and gathering of this capital, given that a dissatisfied employee may intoxicate the environments he or she is part of. This research aims at instigating the reader to understand how the development of intellectual capital occurs within organizations; what are the near-ideal conditions for the process to be as rich and enjoyable as possible, where employees can feel belonging to a group and be motivated to evolve, which supports the idea that the recompense for work goes beyond financial rewards. The study explains how human capital and structural capital — comprised by management philosophy, corporate culture, and management processes — when combined with each other aiming at becoming a robust ecosystem, and how that ecosystem becomes the basis for a competitive advantage when viewed as a principle value-generating principle for the company. Psychometrics proved to be a great method for evaluating potential; however, during the studies, it was observed that due to the complexity of human capital and its relationships with the environment, it is also necessary to consider a set of intrinsic characteristics of each individual which is difficult to measure. Structural capital, shaped by innovation, process, and organizational capital, reflects a company's ability to reinvent itself for longevity, making room for new ideas, organize itself for better profits, and optimize its processes to prevent wasting of time. Considering the findings during the study, it is understood that investing in organizational health and quality of life at work to create a healthy environment encourages good actions from both sides, the company, and the employees, and both are equally responsible for establishing this healthy environment.

Keywords: human value development, intellectual capital, organizational health, structural capital

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Authors: Norhan Anwar Elshikh

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The study aimed to identify the extent of rural women’s awareness of gender issues and discrimination against women. The study also investigated the relationship between the extent of that awareness and the social and economic characteristics of the surveyed women. The study aimed to find both the related factors and the affecting factors of the surveyed women's awareness of gender issues and the discrimination against them. The study then proposed some recommendations that can raise rural women's ability to understand gender issues and discrimination against women. To achieve the study goals, a field study was conducted in the Al-Buhaira governorate. Abu Homs township was chosen as one of the traditional rural areas closest in its characteristics to most rural areas in Egypt, and the Abu Homs township consists of one town and seven rural local units. The local unit of Baraka Ghattas was chosen, as it is considered on average level in human development. Baraka Ghattas local unit includes five villages. Alherfah village and Barakat Ghatas village were chosen to conduct the study as they represent the high and the low levels of human development, respectively. The study included households of women who were in their fertile period in the sample’s villages. The volume of the sample was divided among the two villages according to the number of families in each village, so that each village is represented in the sample space by the same percentage of its presence in the original community. The size of the sample was determined, which is 385 women, According to the Crijsey and Morgen equation. To execute the study, a questionnaire was designed and collected through personal interviews. The results showed that the independent variables most influencing the dependent variable are, from high to low, the economic level of the respondent's family, the number of children of the respondent, the level of formal education of the husband, then leadership ability and the level of ambition, respectively. These variables are responsible for explaining 52% of the change in the extent of rural women's awareness of gender issues and discrimination against women. The study was concluded by providing suggestions and recommendations to improve rural women's awareness of gender issues and discrimination against women.

Keywords: gender, rural women, discrimination, discrimination against women

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Authors: Javier E. García-Gallo, Nelson J. Fonseca-Ruiz, John F. Duitama-Munoz

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Sepsis is a syndrome that occurs with physiological and biochemical abnormalities induced by severe infection and carries a high mortality and morbidity, therefore the severity of its condition must be interpreted quickly. After patient admission in an intensive care unit (ICU), it is necessary to synthesize the large volume of information that is collected from patients in a value that represents the severity of their condition. Traditional severity of illness scores seeks to be applicable to all patient populations, and usually assess in-hospital mortality. However, the use of machine learning techniques and the data of a population that shares a common characteristic could lead to the development of customized mortality prediction scores with better performance. This study presents the development of a score for the one-year mortality prediction of the patients that are admitted to an ICU with a sepsis diagnosis. 5650 ICU admissions extracted from the MIMICIII database were evaluated, divided into two groups: 70% to develop the score and 30% to validate it. Comorbidities, demographics and clinical information of the first 24 hours after the ICU admission were used to develop a mortality prediction score. LASSO (least absolute shrinkage and selection operator) and SGB (Stochastic Gradient Boosting) variable importance methodologies were used to select the set of variables that make up the developed score; each of this variables was dichotomized and a cut-off point that divides the population into two groups with different mean mortalities was found; if the patient is in the group that presents a higher mortality a one is assigned to the particular variable, otherwise a zero is assigned. These binary variables are used in a logistic regression (LR) model, and its coefficients were rounded to the nearest integer. The resulting integers are the point values that make up the score when multiplied with each binary variables and summed. The one-year mortality probability was estimated using the score as the only variable in a LR model. Predictive power of the score, was evaluated using the 1695 admissions of the validation subset obtaining an area under the receiver operating characteristic curve of 0.7528, which outperforms the results obtained with Sequential Organ Failure Assessment (SOFA), Oxford Acute Severity of Illness Score (OASIS) and Simplified Acute Physiology Score II (SAPSII) scores on the same validation subset. Observed and predicted mortality rates within estimated probabilities deciles were compared graphically and found to be similar, indicating that the risk estimate obtained with the score is close to the observed mortality, it is also observed that the number of events (deaths) is indeed increasing as the outcome go from the decile with the lowest probabilities to the decile with the highest probabilities. Sepsis is a syndrome that carries a high mortality, 43.3% for the patients included in this study; therefore, tools that help clinicians to quickly and accurately predict a worse prognosis are needed. This work demonstrates the importance of customization of mortality prediction scores since the developed score provides better performance than traditional scoring systems.

Keywords: intensive care, logistic regression model, mortality prediction, sepsis, severity of illness, stochastic gradient boosting

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Authors: Emily Moore, Andrew Gaukroger, Matthew Solan, Lucy Bailey, Alexandra Boxall, Andrew Carne, Chintu Gadamsetty, Charlotte Morley, Katy Western, Iwona Kolodziejczyk

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Introduction: Rupture of the Achilles tendon is common and has a long recovery period. Most cases are managed non-operatively. Foot and Ankle Surgeons advise an ultrasound scan to check the gap between the torn ends. A large gap (with the ankle in equinus) is a relative indication for surgery. The definitive decision regarding surgical versus non-operative management can only be made once an ultrasound scan is undertaken and the patient is subsequently reviewed by a Foot and Ankle surgeon. To get to this point, the patient journey involves several hospital departments. In nearby trusts, patients reattend for a scan and go to the plaster room both before and after the ultrasound for removal and re-application of the cast. At a third visit to the hospital, the surgeon and patient discuss options for definitive treatment. It may take 2-3 weeks from the initial Emergency Department visit before the final treatment decision is made. This “wasted time” is ultimately added to the recovery period for the patient. In this hospital, Achilles rupture patients are seen in a weekly multidisciplinary OneStop Heel Pain clinic. This pathway was already efficient but subject to occasional frustrating delays if a key staff member was absent. A new pathway was introduced with the goal to reduce delays to a definitive treatment plan. Method: A retrospective series of Achilles tendon ruptures managed according to the 2019 protocol was identified. Time taken from the Emergency Department to have both an ultrasound scan and specialist Foot and Ankle surgical review were calculated. 30 consecutive patients were treated with our new pathway and prospectively followed. The time taken for a scan and for specialist review were compared to the 30 consecutive cases from the 2019 (pre-COVID) cohort. The new pathway includes 1. A new contoured splint applied to the front of the injured limb held with a bandage. This can be removed and replaced (unlike a plaster cast) in the ultrasound department, removing the need for plaster room visits. 2. Urgent triage to a Foot and Ankle specialist. 3. Ultrasound scan for assessment of rupture gap and deep vein thrombosis check. 4. Early decision regarding surgery. Transfer to weight bearing in a prosthetic boot in equinuswithout waiting for the once-a-week clinic. 5. Extended oral VTE prophylaxis. Results: The time taken for a patient to have both an ultrasound scan and specialist review fell > 50%. All patients in the new pathway reached a definitive treatment decision within one week. There were no significant differences in patient demographics or rates of surgical vs non-operative treatment. The mean time from Emergency Department visit to specialist review and ultrasound scan fell from 8.7 days (old protocol) to 2.9 days (new pathway). The maximum time for this fell from 23 days (old protocol) to 6 days (new pathway). Conclusion: Teamwork and innovation have improved the experience for patients with an Achilles tendon rupture. The new pathway brings many advantages - reduced time in the Emergency Department, fewer hospital visits, less time using crutches and reduced overall recovery time.

Keywords: orthopaedics, achilles rupture, ultrasound, innovation

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Authors: Jakub Vávra, Milan Valenta, Petr Kosek

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This article presents a perspective on the conduct of the dramatherapy process with persons with addictive behaviours with regard to the directiveness of the process. Although drama therapy as one of the creative arts approaches is rather non-directive in nature, depending on the clientele, there may be a need to structure the process more and, depending on the needs of the clients, to guide the process more directive. The specificity for people with addictive behaviours is discussed through the prism of the dramatherapeutic perspective, where we can find both a psychotherapeutic component as well as a component touching on expression and art, which is rather non-directive in nature. Within the context of practice with clients, this theme has repeatedly emerged and dramatherapists themselves have sought to find ways of coping with clients' demands and needs for structure and guidance within the dramatherapy process. Some of the outcomes from the supervision work also guided the research. Based on this insight, the research questions were approached. The first research question asks: in what ways is directive in dramatherapy manifested and manifested in the process? The second research question then complements the first and asks: to which phenomena are directivity in dramatherapy linked? In relation to the research questions, data were collected using focus groups and field notes. The qualitative approach of Content analysis and Relational analysis was chosen as the methodology. For analyzing qualitative research, we chose an Inductive coding scheme: Open coding, Axial coding, Pattern matching, Member checking, and Creating a coding scheme. In the presented partial research results, we find recurrent schemes related to directive coding in drama therapy. As an important element, directive leadership emerges in connection with safety for the client group, then in connection with the clients' order and also the department of the facility, and last but not least, to the personality of the drama therapist. By careful analysis and looking for patterns in the research results, we can see connections that are impossible to interpret at this stage but already provide clues to our understanding of the topic and open up further avenues for research in this area.

Keywords: dramatherapy, directivity, personal approach, aims of dramatherapy process, safetyness

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Authors: Sarah Hazelwood, Janice Hay

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Methoxyflurane is an inhaled analgesic administered via a disposable inhaler, which has been used in Australia for 40 years for the management of pain in children & adults. However, there is a lack of data for methoxyflurane as a frontline analgesic medication within the emergency department (ED). This study will investigate the usefulness of methoxyflurane in a private inner-city ED. The study concluded that the inclusion of all key stakeholders in the prescribing, administering & use of this new process led to comprehensive uptake & vastly positive outcomes for consumer & health professionals. Method: A 12-week prospective pilot study was completed utilizing patients presenting to the ED in pain (numeric pain rating score > 4) that fit the requirement of methoxyflurane use (as outlined in the Australian Prescriber information package). Nurses completed a formatted spreadsheet for each interaction where methoxyflurane was used. Patient demographics, day, time, initial numeric pain score, analgesic response time, the reason for use, staff concern (free text), & patient feedback (free text), & discharge time was documented. When clinical concern was raised, the researcher retrieved & reviewed patient notes. Results: 140 methoxyflurane inhalers were used. 60% of patients were 31 years of age & over (n=82) with 16% aged 70+. The gender split; 51% male: 49% female. Trauma-related pain (57%) saw the highest use of administration, with the evening hours (1500-2259) seeing the greatest numbers used (39%). Tuesday, Thursday & Sunday shared the highest daily use throughout the study. A minimum numerical pain score of 4/10 (n=13, 9%), with the ranges of 5 - 7/10 (moderate pain) being given by almost 50% of patients. Only 3 instances of pain scores increased post use of methoxyflurane (all other entries showed pain score < initial rating). Patients & staff noted obvious analgesic response within 3 minutes (n= 96, 81%, of administration). Nurses documented a change in patient vital signs for 4 of the 15 patient-related concerns; the remaining concerns were due to “gagging” on the taste, or “having a coughing episode”; one patient tried to leave the department before the procedure was attended (very euphoric state). Upon review of the staff concerns – no adverse events occurred & return to therapeutic vitals occurred within 10 minutes. Length of stay for patients was compared with similar presentations (such as dislocated shoulder or ankle fracture) & saw an average 40-minute decrease in time to discharge. Methoxyflurane treatment was rated “positively” by > 80% of patients – with remaining feedback related to mild & transient concerns. Staff similarly noted a positive response to methoxyflurane as an analgesic & as an added tool for frontline analgesic purposes. Conclusion: Methoxyflurane should be used on suitable patient presentations requiring immediate, short term pain relief. As a highly portable, non-narcotic avenue to treat pain this study showed obvious therapeutic benefit, positive feedback, & a shorter length of stay in the ED. By partnering with key stake holders, this study determined methoxyflurane use decreased work load, decreased wait time to analgesia, and increased patient satisfaction.

Keywords: analgesia, benefits, emergency, methoxyflurane

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Authors: Kaleb Shiferaw, Berhanu Geberemedhin

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Ethiopian farmers have a long tradition of beekeeping and the country has huge potential for honey production. However traditional mode of production still dominates the sub sector which negatively affect the total production and productivity. A number of studies have been conducted to better understand the working honey production, however, none of them systematically investigate the extent of technical efficiency of the sub-sector. This paper uses Stochastic Frontier production model to quantifying the extent of technical efficiency and identify exogenous determinant of inefficiency. The result showed that consistent with other studies traditional practice dominate small scale honey production in Ethiopia. The finding also revealed that use of purchased inputs such as bee forage and other supplement is very limited among honey producers indicating that natural bee forage is the primary source of bee forage. The immediate consequence of all these is low production and productivity. The number of hives the household owns, whether the household used improved apiculture technologies, availability of natural forest which is the primary sources of nectar for bees and amount of land owned by the households were found to have a significant influence on the amount of honey produced by beekeeper. Our result further showed that the mean technical efficiency of honey producers is 0.79 implying that, on average honey producer produce 80 percent of the maximum output. The implication is that 20 percent of the potential output is lost due to technical inefficiency. Number of hives owned by a honey produces, distance to district town-a proxy to market access, household wealth, and whether the household head has a leadership role in the PA affect the technical efficiency of honey producers. The finding suggest that policies that aim to expand the use of improved hives is expected to increase the honey production at household level. The result also suggest that investment on rural infrastructure would be instrumental in improving technical efficiency of honey producer.

Keywords: small-scale honey producer, Ethiopia, technical efficiency in apiculture, stochastic frontier analysis

Procedia PDF Downloads 210

Authors: Fabio Rodriguez Sanchez, Josef Bruers, Iciar Arteagoitia, Carlos Rodriguez Andres

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Background: Oral implants are a routine treatment to replace lost teeth. Although they have a high rate of success, implant failures do occur. Perioperative antibiotics have been suggested to prevent postoperative infections and dental implant failures, but they remain a controversial treatment among healthy patients. The objective of this study was to determine whether antibiotic prophylaxis is a common treatment in the Netherlands among general dentists, maxillofacial-surgeons, periodontists and implantologists in conjunction with oral implant surgery among healthy patients and to assess the nature of antibiotics prescriptions in order to evaluate whether any consensus has been reached and the current recommendations are being followed. Methodology: Observational cross-sectional study based on a web-survey reported according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines. A validated questionnaire, developed by Deeb et al. (2015), was translated and slightly adjusted to circumstances in the Netherlands. It was used with the explicit permission of the authors. This questionnaire contained both close-ended and some open-ended questions in relation to the following topics: demographics, qualification, antibiotic type, prescription-duration and dosage. An email was sent February 2018 to a sample of 600 general dentists and all 302 oral implantologists, periodontists and maxillofacial surgeons who were recognized by the Dutch Association of Oral Implantology (NVOI) as oral health care providers placing oral implants. The email included a brief introduction about the study objectives and a link to the web questionnaire, which could be filled in anonymously. Overall, 902 questionnaires were sent. However, 29 questionnaires were not correctly received due to an incorrect email address. So a total number of 873 professionals were reached. Collected data were analyzed using SPSS (IBM Corp., released 2012, Armonk, NY). Results: The questionnaire was sent back by a total number of 218 participants (response rate=24.2%), 45 female (20.8%) and 171 male (79.2%). Two respondents were excluded from the study group because they were not currently working as oral health providers. Overall 151 (69.9%) placed oral implants on regular basis. Approximately 79 (52.7%) of these participants prescribed antibiotics only in determined situations, 66 (44.0%) prescribed antibiotics always and 5 dentists (3.3%) did not prescribe antibiotics at all when placing oral implants. Overall, 83 participants who prescribed antibiotics, did so both pre- and postoperatively (58.5%), 12 exclusively postoperative (8.5%), and 47 followed an exclusive preoperative regime (33.1%). A single dose of 2,000 mg amoxicillin orally 1-hour prior treatment was the most prescribed preoperative regimen. The most frequent prescribed postoperative regimen was 500 mg amoxicillin three times daily for 7 days after surgery. On average, oral health professionals prescribed 6,923 mg antibiotics in conjunction with oral implant surgery, varying from 500 to 14,600 mg. Conclusions: Antibiotic prophylaxis in conjunction with oral implant surgery is prescribed in the Netherlands on a rather large scale. Dutch professionals might prescribe antibiotics more cautiously than in other countries and there seems to be a lower range on the different antibiotic types and regimens being prescribed. Anyway, recommendations based on last-published evidence are frequently not being followed.

Keywords: clinical decision making, infection control, antibiotic prophylaxis, dental implants

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Authors: Hayden R Schott, John M Felder III

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Introduction: Chronic lower extremity wounds in the diabetic and vasculopathic populations are associated with a high degree of morbidity.When wounds require more extensive treatment than can be offered by wound care centers, more aggressive solutions involve local tissue transfer and microsurgical free tissue transfer for achieving definitive soft tissue coverage. These procedures of autologous tissue transfer (ATT) offer resilient, soft tissue coverage of limb-threatening wounds and confer promising limb salvage rates. However, chronic osteomyelitis and recalcitrant soft tissue infections are common in severe diabetic foot wounds and serve to significantly complicate ATT procedures. Stimulan is a resorbable calcium sulfate antibiotic carrier. The use of stimulan antibiotic beads to treat chronic osteomyelitis is well established in the orthopedic and plastic surgery literature. In these procedures, the beads are placed beneath the skin flap to directly deliver antibiotics to the infection site. The purpose of this study was to quantify the success of Stimulan antibiotic beads in treating recalcitrant infections in patients with diabetic foot wounds receiving ATT. Methods: A retrospective review of clinical and demographic information was performed on patients who underwent ATT with the placement of Stimulan antibiotic beads for attempted limb salvage from 2018-21. Patients were analyzed for preoperative wound characteristics, demographics, infection recurrence, and adverse outcomes as a result of product use. The primary endpoint was 90 day infection recurrence, with secondary endpoints including 90 day complications. Outcomes were compared using basic statistics and Fisher’s exact tests. Results: In this time span, 14 patients were identified. At the time of surgery, all patients exhibited clinical signs of active infection, including positive cultures and erythema. 57% of patients (n=8) exhibited chronic osteomyelitis prior to surgery, and 71% (n=10) had exposed bone at the wound base. In 57% of patients (n=8), Stimulan beads were placed beneath a free tissue flap and beneath a pedicle tissue flap in 42% of patients (n=6). In all patients, Stimulan beads were only applied once. Recurrent infections were observed in 28% of patients (n=4) at 90 days post-op, and flap nonadherence was observed in 7% (n=1). These were the only Stimulan related complications observed. Ultimately, lower limb salvage was successful in 85% of patients (n=12). Notably, there was no significant association between the preoperative presence of osteomyelitis and recurrent infections. Conclusions: The use of Stimulanantiobiotic beads to treat recalcitrant infections in patients receiving definitive skin coverage of diabetic foot wounds does not appear to demonstrate unnecessary risk. Furthermore, the lack of significance between the preoperative presence of osteomyelitis and recurrent infections indicates the successful use of Stimulan to dampen infection in patients with osteomyelitis, as is consistent with the literature. Further research is needed to identify Stimulan as the significant contributor to infection treatment using future cohort and case control studies with more patients. Nonetheless, the use of Stimulan antibiotic beads in patients with diabetic foot wounds demonstrates successful infection suppression and maintenance of definitive soft tissue coverage.

Keywords: wound care, stimulan antibiotic beads, free tissue transfer, plastic surgery, wound, infection

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Authors: Ahmed Makhoukh

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Quality assurance (QA) has recently become a common practice, which is endorsed by most Higher Education (HE) institutions worldwide, due to the pressure of internal and external forces. One of the aims of this quality movement is to make the contribution of university education to socio-economic development highly significant. This entails that graduates are currently required have a high-quality profile, i.e., to be competent and master the 21st-century skills needed in the labor market. This wave of change, mostly imposed by globalization, has the effect that university education should be learner-centered in order to satisfy the different needs of students and meet the expectations of other stakeholders. Such a shift of focus on the student learning outcomes has led HE institutions to reconsider their strategic planning, their mission, the curriculum, the pedagogical competence of the academic staff, among other elements. To ensure that the overall institutional performance is on the right way, a QA system should be established to assume this task of checking regularly the extent to which the set of standards of evaluation are strictly respected as expected. This operation of QA has the advantage of proving the accountability of the institution, gaining the trust of the public with transparency and enjoying an international recognition. This is the case of Doha Institute (DI) for Graduate Studies, in Qatar, the object of the present study. The significance of this contribution is to show that the conception of quality has changed in this digital age, and the need to integrate a department responsible for QA in every HE institution to ensure educational quality, enhance learners and achieve academic leadership. Thus, to undertake the issue of QA in DI for Graduate Studies, an elite university (in the academic sense) that focuses on a small and selected number of students, a qualitative method will be adopted in the description and analysis of the data (document analysis). In an attempt to investigate the extent to which QA is achieved in Doha Institute for Graduate Studies, three broad indicators will be evaluated (input, process and learning outcomes). This investigation will be carried out in line with the UK Quality Code for Higher Education represented by Quality Assurance Agency (QAA).

Keywords: accreditation, higher education, quality, quality assurance, standards

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Authors: O. Fatemi

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Considering growing building construction industry in developing countries and sustainable development concept, as well as the importance of taking care of the future generations, codifying buildings scoring system based on environmental criteria, has always been a subject for discussion. The existing systems cannot be used for all the regions due to several reasons, including but not limited to variety in regional variables. In this article, the most important common LEED (Leadership in Energy and Environmental Design) and BREEAM (Building Research Establishment Environmental Assessment Method) common and Global environmental scoring systems, used in UK, USA, and Japan, respectively, have been discussed and compared with a special focus on CASBEE (Comprehensive Assessment System for Built Environment Efficiency), to credit assigning field (weighing and scores systems) as well as sustainable development criteria in each system. Then, converging and distinct fields of the foregoing systems are examined considering National Iranian Building Code. Furthermore, the common credits in the said systems not mentioned in National Iranian Building Code have been identified. These credits, which are generally included in well-known fundamental principles in sustainable development, may be considered as offered options for the Iranian building environmental scoring system. It is suggested that one of the globally and commonly accepted systems is chosen considering national priorities in order to offer an effective method for buildings environmental scoring, and then, a part of credits is added and/or removed, or a certain credit score is changed, and eventually, a new scoring system with a new title is developed for the country. Evidently, building construction industry highly affects the environment, economy, efficiency, and health of the relevant occupants. Considering the growing trend of cities and construction, achieving building scoring systems based on environmental criteria has always been a matter of discussion. The existing systems cannot be used for all the regions due to several reasons, including but not limited to variety in regional variables.

Keywords: scoring system, sustainability assessment, water efficiency, national Iranian building code

Procedia PDF Downloads 149

Authors: Stephanie J. Sedberry, William J. Gerace, Ian D. Beatty, Michael J. Kane

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Increasing the number of US university students who attain degrees in STEM and enter the STEM workforce is a national priority. Demographic groups vary in their rates of participation in STEM, and the US produces just 10% of the world’s science and engineering degrees (2014 figures). To address these gaps, we have developed and tested a practical, 30-minute, single-session classroom-based intervention to improve students’ self-efficacy and academic performance in University STEM courses. Self-efficacy is a psychosocial construct that strongly correlates with academic success. Self-efficacy is a construct that is internal and relates to the social, emotional, and psychological aspects of student motivation and performance. A compelling body of research demonstrates that university students’ self-efficacy beliefs are strongly related to their selection of STEM as a major, aspirations for STEM-related careers, and persistence in science. The development of an intervention to increase students’ self-efficacy is motivated by research showing that short, social-psychological interventions in education can lead to large gains in student achievement. Our intervention addresses STEM self-efficacy via two strong, but previously separate, lines of research into attitudinal/affect variables that influence student success. The first is ‘attributional retraining,’ in which students learn to attribute their successes and failures to internal rather than external factors. The second is ‘mindset’ about fixed vs. growable intelligence, in which students learn that the brain remains plastic throughout life and that they can, with conscious effort and attention to thinking skills and strategies, become smarter. Extant interventions for both of these constructs have significantly increased academic performance in the classroom. We developed a 34-item questionnaire (Likert scale) to measure STEM Self-efficacy, Perceived Academic Control, and Growth Mindset in a University STEM context, and validated it with exploratory factor analysis, Rasch analysis, and multi-trait multi-method comparison to coded interviews. Four iterations of our 42-week research protocol were conducted across two academic years (2017-2018) at three different Universities in North Carolina, USA (UNC-G, NC A&T SU, and NCSU) with varied student demographics. We utilized a quasi-experimental prospective multiple-group time series research design with both experimental and control groups, and we are employing linear modeling to estimate the impact of the intervention on Self-Efficacy,wth-Mindset, Perceived Academic Control, and final course grades (performance measure). Preliminary results indicate statistically significant effects of treatment vs. control on Self-Efficacy, Growth-Mindset, Perceived Academic Control. Analyses are ongoing and final results pending. This intervention may have the potential to increase student success in the STEM classroom—and ownership of that success—to continue in a STEM career. Additionally, we have learned a great deal about the complex components and dynamics of self-efficacy, their link to performance, and the ways they can be impacted to improve students’ academic performance.

Keywords: academic performance, affect variables, growth mindset, intervention, perceived academic control, psycho-social variables, self-efficacy, STEM, university classrooms

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Authors: Sagar Mahendrakar

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Testers' roles have changed dramatically as automation continues to revolutionise the software development lifecycle. There's a general belief that manual testing is becoming outdated with the introduction of advanced testing frameworks and tools. This abstract, however, disproves that notion by examining the complex and dynamic role that testers play in automated environments. In this work, we explore the complex duties that testers have when everything is automated. We contend that although automation increases productivity and simplifies monotonous tasks, it cannot completely replace the cognitive abilities and subject-matter knowledge of human testers. Rather, testers shift their focus to higher-value tasks like creating test strategies, designing test cases, and delving into intricate scenarios that are difficult to automate. We also emphasise the critical role that testers play in guaranteeing the precision, thoroughness, and dependability of automated testing. Testers verify the efficacy of automated scripts and pinpoint areas for improvement through rigorous test planning, execution, and result analysis. They play the role of quality defenders, using their analytical and problem-solving abilities to find minute flaws that computerised tests might miss. Furthermore, the abstract emphasises how testing in automated environments is a collaborative process. In order to match testing efforts with business objectives, improve test automation frameworks, and rank testing tasks according to risk, testers work closely with developers, automation engineers, and other stakeholders. Finally, we discuss how testers in the era of automation need to possess a growing skill set. To stay current, testers need to develop skills in scripting languages, test automation tools, and emerging technologies in addition to traditional testing competencies. Soft skills like teamwork, communication, and flexibility are also essential for productive cooperation in cross-functional teams. This abstract clarifies the ongoing importance of testers in automated settings. Testers can use automation to improve software quality and provide outstanding user experiences by accepting their changing role as strategic partners and advocates for quality.

Keywords: testing, QA, automation, leadership

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