Search results for: newly graduated nurse
Commenced in January 2007
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Edition: International
Paper Count: 1243

Search results for: newly graduated nurse

133 A Paradigm Shift into the Primary Teacher Education Program in Bangladesh

Authors: Happy Kumar Das, Md. Shahriar Shafiq

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This paper portrays an assumed change in the primary teacher education program in Bangladesh. An initiative has been taken with a vision to ensure an integrated approach to developing trainee teachers’ knowledge and understanding about learning at a deeper level, and with that aim, the Diploma in Primary Education (DPEd) program replaces the Certificate-in-Education (C-in-Ed) program in Bangladeshi context for primary teachers. The stated professional values of the existing program such as ‘learner-centered’, ‘reflective’ approach to pedagogy tend to contradict the practice exemplified through the delivery mechanism. To address the challenges, through the main two components (i) Training Institute-based learning and (ii) School-based learning, the new program tends to cover knowledge and value that underpin the actual practice of teaching. These two components are given approximately equal weighting within the program in terms of both time, content and assessment as the integration seeks to combine theoretical knowledge with practical knowledge and vice versa. The curriculum emphasizes a balance between the taught modules and the components of the practicum. For example, the theories of formative and summative assessment techniques are elaborated through focused reflection on case studies as well as observation and teaching practice in the classroom. The key ideology that is reflected through this newly developed program is teacher’s belief in ‘holistic education’ that can lead to creating opportunities for skills development in all three (Cognitive, Social and Affective) domains simultaneously. The proposed teacher education program aims to address these areas of generic skill development alongside subject-specific learning outcomes. An exploratory study has been designed in this regard where 7 Primary Teachers’ Training Institutes (PTIs) in 7 divisions of Bangladesh was used for experimenting DPEd program. The analysis was done based on document analysis, periodical monitoring report and empirical data gathered from the experimental PTIs. The findings of the study revealed that the intervention brought positive change in teachers’ professional beliefs, attitude and skills along with improvement of school environment. Teachers in training schools work together for collective professional development where they support each other through lesson study, action research, reflective journals, group sharing and so on. Although the DPEd program addresses the above mentioned factors, one of the challenges of the proposed program is the issue of existing capacity and capabilities of the PTIs towards its effective implementation.

Keywords: Bangladesh, effective implementation, primary teacher education, reflective approach

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132 Ideas for Musical Activities and Games in the Early Year (IMAGINE-Autism): A Case Study Approach

Authors: Tania Lisboa, Angela Voyajolu, Adam Ockelford

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The positive impact of music on the development of children with autism is widely acknowledged: music offers a unique channel for communication, wellbeing and self-regulation, as well as access to culture and a means of creative engagement. Yet, no coherent program exists for parents, carers and teachers to follow with their children in the early years, when the need for interventions is often most acute. Hence, research and the development of resources is urgently required. Autism is a project with children on the autism spectrum. The project aims at promoting the participants’ engagement with music through involvement in specially-designed musical activities with parents and carers. The main goal of the research is to verify the effectiveness of newly designed resources and strategies, which are based on the Sounds of Intent in the Early Years (SoI-EY) framework of musical development. This is a pilot study, comprising case studies of five children with autism in the early years. The data comprises semi-structured interviews, observations of videos, and feedback from parents on resources. Interpretative Phenomenological Analysis was chosen to analyze the interviews. The video data was coded in relation to the SoI-EY framework. The feedback from parents was used to evaluate the resources (i.e. musical activity cards). The participants’ wider development was also assessed through selected elements of the Early Years Foundation Stage (EYFS), a national assessment framework used in England: specifically, communication, language and social-emotional development. Five families of children on the autism spectrum (aged between 4-8 years) participated in the pilot. The research team visited each family 4 times over a 3-month period, during which the children were observed, and musical activities were suggested based on the child’s assessed level of musical development. Parents then trialed the activities, providing feedback and gathering further video observations of their child’s musical engagement between visits. The results of one case study will be featured in this paper, in which the evidence suggests that specifically tailored musical activity may promote communication and social engagement for a child with language difficulties on the autism spectrum. The resources were appropriate for the children’s involvement in musical activities. Findings suggest that non-specialist musical engagement with family and carers can be a powerful means to foster communication. The case study featured in this paper illustrates this with a child of limited verbal ability. There is a need for further research and development of resources that can be made available to all those working with children on the autism spectrum.

Keywords: autism, development, music education, resources

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131 Conflict Resolution in Fuzzy Rule Base Systems Using Temporal Modalities Inference

Authors: Nasser S. Shebka

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Fuzzy logic is used in complex adaptive systems where classical tools of representing knowledge are unproductive. Nevertheless, the incorporation of fuzzy logic, as it’s the case with all artificial intelligence tools, raised some inconsistencies and limitations in dealing with increased complexity systems and rules that apply to real-life situations and hinders the ability of the inference process of such systems, but it also faces some inconsistencies between inferences generated fuzzy rules of complex or imprecise knowledge-based systems. The use of fuzzy logic enhanced the capability of knowledge representation in such applications that requires fuzzy representation of truth values or similar multi-value constant parameters derived from multi-valued logic, which set the basis for the three t-norms and their based connectives which are actually continuous functions and any other continuous t-norm can be described as an ordinal sum of these three basic ones. However, some of the attempts to solve this dilemma were an alteration to fuzzy logic by means of non-monotonic logic, which is used to deal with the defeasible inference of expert systems reasoning, for example, to allow for inference retraction upon additional data. However, even the introduction of non-monotonic fuzzy reasoning faces a major issue of conflict resolution for which many principles were introduced, such as; the specificity principle and the weakest link principle. The aim of our work is to improve the logical representation and functional modelling of AI systems by presenting a method of resolving existing and potential rule conflicts by representing temporal modalities within defeasible inference rule-based systems. Our paper investigates the possibility of resolving fuzzy rules conflict in a non-monotonic fuzzy reasoning-based system by introducing temporal modalities and Kripke's general weak modal logic operators in order to expand its knowledge representation capabilities by means of flexibility in classifying newly generated rules, and hence, resolving potential conflicts between these fuzzy rules. We were able to address the aforementioned problem of our investigation by restructuring the inference process of the fuzzy rule-based system. This is achieved by using time-branching temporal logic in combination with restricted first-order logic quantifiers, as well as propositional logic to represent classical temporal modality operators. The resulting findings not only enhance the flexibility of complex rule-base systems inference process but contributes to the fundamental methods of building rule bases in such a manner that will allow for a wider range of applicable real-life situations derived from a quantitative and qualitative knowledge representational perspective.

Keywords: fuzzy rule-based systems, fuzzy tense inference, intelligent systems, temporal modalities

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130 Quantitative Analysis of the High-Value Bioactive Components of Pre-Germinated and Germinated Pigmented Rice (Oryza sativa L. Cv. Superjami and Superhongmi)

Authors: Lara Marie Pangan Lo, Soo Im Chung, Yao Cheng Zhang, Xingyue Jin, Mi Young Kang

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Being the world’s most consumed grain crop, rice (Oryza sativa L.) demands’ have increase and this prompted the development of new rice cultivars with high bio-functional properties than the commonly used white rice. Ordinary rice variety is already known to be a potential source for a number of nutritional as well as bioactive compounds. To further enhance the rice’s nutritive values, germination is done in addition to making it more tasty and palatable when cooked. Pigmented rice, on the other hand, has become increasingly popular in the recent years for their greater antioxidant potential and other nutraceutical properties which can help alleviate the occurrence of the increasing incidence of metabolic diseases. Combining these two (2) parameters, this research study is sought to quantitatively determine the pre-germinated and germinated quantities of the major bioactive compounds of South Korea’s newly developed purplish pigmented rice grain cultivar Superjami (SJ) and red pigmented rice grain Superhongmi (SH) and compare them against the non-pigmented Normal Brown (NB) rice variety. Powdered rice grain cultivars were subjected to 72-hour germination period and the quantities of GABA, γ-oryzanol, ferulic acid, tocopherol and tocotrienol homologues were compared against their pre-germinated condition using γ- amino butyric acid (GABA) analysis and High Performance Liquid Chromatography (HPLC). Results revealed the effectiveness of germination in enhancing the bioactive components in all rice samples. GABA contents in germinated rice cultivars increased by more than 10-fold following the order: SJ >SH >NB. In addition, purple rice variety (SJ) has higher total γ-oryzanol and ferulic acid contents which increased by > 2-fold after germination followed by the red cultivar SH then the control, NB. Germinated varieties also possess higher total tocotrienol content than their pre-germinated state. As for the total tocopherol content, SJ has higher quantity, but the red-pigmented SH (0.16 mg/kg) is shown to have lower total tocopherol content than the control rice NB (0.86 mg/kg). However, all tocopherol and tocotrienol homologues were present only in small amounts ( < 3.0 mg/kg) in all pre-germinated and germinated samples. In general, all of the analyzed pigmented rice cultivars were found to possess higher bioactive compounds than the control NB rice variety. Also, regardless of their strain, germinated rice samples have higher bioactive compounds than their pre-germinated counterparts. This only shows the effectiveness of germinating rice in enhancing bioactive constituents. Overall, these results suggest the potential of the pigmented rice varieties as natural source of nutraceuticals in bio-functional food development.

Keywords: bioactive compounds, germinated rice, superhongmi, superjami

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129 The Two Question Challenge: Embedding the Serious Illness Conversation in Acute Care Workflows

Authors: D. M. Lewis, L. Frisby, U. Stead

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Objective: Many patients are receiving invasive treatments in acute care or are dying in hospital without having had comprehensive goals of care conversations. Some of these treatments may not align with the patient’s wishes, may be futile, and may cause unnecessary suffering. While many staff may recognize the benefits of engaging patients and families in Serious Illness Conversations (a goal of care framework developed by Ariadne Labs in Boston), few staff feel confident and/or competent in having these conversations in acute care. Another barrier to having these conversations may be due to a lack of incorporation in the current workflow. An educational exercise, titled the Two Question Challenge, was initiated on four medical units across two Vancouver Coastal Health (VCH) hospitals in attempt to engage the entire interdisciplinary team in asking patients and families questions around goals of care and to improve the documentation of these expressed wishes and preferences. Methods: Four acute care units across two separate hospitals participated in the Two Question Challenge. On each unit, over the course of two eight-hour shifts, all members of the interdisciplinary team were asked to select at least two questions from a selection of nine goals of care questions. They were asked to pose these questions of a patient or family member throughout their shift and then asked to document their conversations in a centralized Advance Care Planning/Goals of Care discussion record in the patient’s chart. A visual representation of conversation outcomes was created to demonstrate to staff and patients the breadth of conversations that took place throughout the challenge. Staff and patients were interviewed about their experiences throughout the challenge. Two palliative approach leads remained present on the units throughout the challenge to support, guide, or role model these conversations. Results: Across four acute care medical units, 47 interdisciplinary staff participated in the Two Question Challenge, including nursing, allied health, and a physician. A total of 88 questions were asked of patients, or their families around goals of care and 50 newly documented goals of care conversations were charted. Two code statuses were changed as a result of the conversations. Patients voiced an appreciation for these conversations and staff were able to successfully incorporate these questions into their daily care. Conclusion: The Two Question Challenge proved to be an effective way of having teams explore the goals of care of patients and families in an acute care setting. Staff felt that they gained confidence and competence. Both staff and patients found these conversations to be meaningful and impactful and felt they were notably different from their usual interactions. Documentation of these conversations in a centralized location that is easily accessible to all care providers increased significantly. Application of the Two Question Challenge in non-medical units or other care settings, such as long-term care facilities or community health units, should be explored in the future.

Keywords: advance care planning, goals of care, interdisciplinary, palliative approach, serious illness conversations

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128 The Jury System in the Courts in Nineteenth Century Assam: Power Negotiations and Politics in an Institutional Rubric of a Colonial Regime

Authors: Jahnu Bharadwaj

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In the third decade of the 19th century, the political landscape of the Brahmaputra valley changed at many levels. The establishment of East India Company’s authority in ‘Assam’ was complete with the Treaty of Yandaboo. The whole phenomenon of the annexation of Assam into the British Indian Empire led to several administrative reorganizations and reforms under the new regime. British colonial rule was distinguished by new systems and institutions of governance. This paper broadly looks at the historical proceedings of the introduction of the Rule of Law and a new legal structure in the region of ‘Assam’. With numerous archival data, this paper seeks to chiefly examine the trajectory of an important element in the new legal apparatus, i.e. the jury in the British criminal courts introduced in the newly annexed region. Right from the beginning of colonial legal innovations with the establishment of the panchayats and the parallel courts in Assam, the jury became an important element in the structure of the judicial system. In both civil and criminal courts, the jury was to be formed from the learned members of the ‘native’ society. In the working of the criminal court, the jury became significantly powerful and influential. The structure meant that the judge or the British authority eventually had no compulsion to obey the verdict of the jury. However, the structure also provided that the jury had a considerable say in matters of the court proceedings, and their verdict had significant weight. This study seeks to look at certain important criminal cases pertaining to the nineteenth century and the functioning of the jury in those cases. The power play at display between the British officials, judges and the members of the jury would be helpful in highlighting the important deliberations and politics that were in place in the functioning of the British criminal legal apparatus in colonial Assam. The working and the politics of the members of the jury in many cases exerted considerable influence in the court proceedings. The interesting negotiations of the British officials or judges also present us with vital insights. By reflecting on the difficulty that the British officials and judges felt with the considerable space for opinion and difference that was provided to important members of the local society, this paper seeks to locate, with evidence, the racial politics at play within the official formulations of the legal apparatus in the colonial rule in Assam. This study seeks to argue that despite the rhetorical claims of legal equality within the Empire, racial consideration and racial politics was a reality even in the making of the structure itself. This in a way helps to enrich our ideas about the racial elements at work in numerous layers sustaining the colonial regime.

Keywords: criminal courts, colonial regime, jury, race

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127 Bulbar Conjunctival Kaposi's Sarcoma Unmasked by Immune Reconstitution Syndrome

Authors: S. Mohd Afzal, R. O'Connell

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Kaposi's sarcoma (KS) is the most common HIV-related cancer, and ocular manifestations constitute at least 25% of all KS cases. However, ocular presentations often occur in the context of systemic KS, and isolated lesions are rare. We report a unique case of ocular KS masquerading as subconjunctival haemorrhage, and only developing systemic manifestations after initiation of HIV treatment. Case: A 49-year old man with previous hypertensive stroke and newly diagnosed HIV infection presented with an acutely red left eye following repeated bouts of coughing. Given the convincing history of poorly controlled hypertension and cough, a diagnosis of subconjunctival haemorrhage was made. Over the next week, his ocular lesion began to improve and he subsequently started anti-retroviral therapy. Prior to receiving anti-retroviral therapy, his CD4+ lymphocyte count was 194 cells/mm3 with HIV viral load greater than 1 million/ml. This rapidly improved to a viral load of 150 copies/ml within 2 weeks of starting treatment. However, a few days after starting HIV treatment, his ocular lesion recurred. Ophthalmic examination was otherwise normal. He also developed widespread lymphadenopathy and multiple dark lesions on his torso. Histology and virology confirmed KS, systemically triggered by Immune Reconstitution Syndrome (KS-IRIS). The patient has since undergone chemotherapy successfully. Discussion: Kaposi's sarcoma is an atypical tumour caused by human herpesvirus 8 (HHV-8), also known as Kaposi’s sarcoma-associated herpesvirus (KSHV). In immunosuppressed patients, KSHV can also cause lymphoproliferative disorders such as primary effusion lymphoma and Castleman's disease (in our patient’s case, this was excluded through histological analysis of lymph nodes). KSHV is one of the seven currently known human oncoviruses, and its pathogenesis is poorly understood. Up to 13% of patients with HIV-related KS experience worsening of the disease after starting anti-retroviral treatment, due to a sudden increase in CD4 cell counts. Histology remains the diagnostic gold standard. Current British HIV Association (BHIVA) guidelines recommend treatment using anti-retroviral drugs, with either intralesional vinblastine for local disease or systemic chemotherapy for disseminated KS. Conclusion: This case is unique as ocular KS as initial presentation is rare and our patient's diagnosis was only made after systemic lesions were triggered by immune reconstitution. KS should be considered as an important differential diagnosis for red eyes in all patients at risk of acquiring HIV infection.

Keywords: human herpesvirus 8, human immunodeficiency virus, immune reconstitution syndrome, Kaposi’s sarcoma, Kaposi’s sarcoma-associated herpesvirus

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126 Optimal Uses of Rainwater to Maintain Water Level in Gomti Nagar, Uttar Pradesh, India

Authors: Alok Saini, Rajkumar Ghosh

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Water is nature's important resource for survival of all living things, but freshwater scarcity exists in some parts of world. This study has predicted that Gomti Nagar area (49.2 sq. km.) will harvest about 91110 ML of rainwater till 2051 (assuming constant and present annual rainfall). But 17.71 ML of rainwater was harvested from only 53 buildings in Gomti Nagar area in the year 2021. Water level will be increased (rise) by 13 cm in Gomti Nagar from such groundwater recharge. The total annual groundwater abstraction from Gomti Nagar area was 35332 ML (in 2021). Due to hydrogeological constraints and lower annual rainfall, groundwater recharge is less than groundwater abstraction. The recent scenario is only 0.07% of rainwater recharges by RTRWHs in Gomti Nagar. But if RTRWHs would be installed in all buildings then 12.39% of rainwater could recharge groundwater table in Gomti Nagar area. But if RTRWHs would be installed in all buildings then 12.39% of rainwater could recharge groundwater table in Gomti Nagar area. Gomti Nagar is situated in 'Zone–A' (water distribution area) and groundwater is the primary source of freshwater supply. Current scenario indicates only 0.07% of rainwater recharges by RTRWHs in Gomti Nagar. In Gomti Nagar, the difference between groundwater abstraction and recharge will be 735570 ML in 30 yrs. Statistically, all buildings at Gomti Nagar (new and renovated) could harvest 3037 ML of rainwater through RTRWHs annually. The most recent monsoonal recharge in Gomti Nagar was 10813 ML/yr. Harvested rainwater collected from RTRWHs can be used for rooftop irrigation, and residential kitchen and gardens (home grown fruit and vegetables). According to bylaws, RTRWH installations are required in both newly constructed and existing buildings plot areas of 300 sq. m or above. Harvested rainwater is of higher quality than contaminated groundwater. Harvested rainwater from RTRWHs can be considered water self-sufficient. Rooftop Rainwater Harvesting Systems (RTRWHs) are least expensive, eco-friendly, most sustainable, and alternative water resource for artificial recharge. This study also predicts about 3.9 m of water level rise in Gomti Nagar area till 2051, only when all buildings will install RTRWHs and harvest for groundwater recharging. As a result, this current study responds to an impact assessment study of RTRWHs implementation for the water scarcity problem in the Gomti Nagar area (1.36 sq.km.). This study suggests that common storage tanks (recharge wells) should be built for a group of at least ten (10) households and optimal amount of harvested rainwater will be stored annually. Artificial recharge from alternative water sources will be required to improve the declining water level trend and balance the groundwater table in this area. This over-exploitation of groundwater may lead to land subsidence, and development of vertical cracks.

Keywords: aquifer, aquitard, artificial recharge, bylaws, groundwater, monsoon, rainfall, rooftop rainwater harvesting system, RTRWHs water table, water level

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125 The Influence of Atmospheric Air on the Health of the Population Living in Oil and Gas Production Area in Aktobe Region, Kazakhstan

Authors: Perizat Aitmaganbet, Kerbez Kimatova, Gulmira Umarova

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As a result of medical check-up conducted in the framework of this research study an evaluation of the health status of the population living in the oil-producing regions, namely Sarkul and Kenkiyak villages in Aktobe was examined. With the help of the Spearman correlation, the connection between the level of hazard chemical elements in the atmosphere and the health of population living in the regions of oil and gas industry was estimated. Background & Objective. The oil and gas resource-extraction industries play an important role in improving the economic conditions of the Republic of Kazakhstan, especially for the oil-producing administrative regions. However, environmental problems may adversely affect the health of people living in that area. Thus, the aim of the study is to evaluate the exposure to negative environmental factors of the adult population living in Sarkul and Kenkiyak villages, the oil and gas producing areas in the Aktobe region. Methods. After conducting medical check-up among the population of Sarkul and Kenkiyak villages. A single cross-sectional study was conducted. The population consisted of randomly sampled 372 adults (181 males and 191 females). Also, atmospheric air probes were taken to measure the level of hazardous chemical elements in the air. The nonparametric method of the Spearman correlation analysis was performed between the mean concentration of substances exceeding the Maximum Permissible Concentration and the classes of newly diagnosed diseases. Selection and analysis of air samples were carried out according to the developed research protocol; the qualitative-quantitative analysis was carried out on the Gas analyzer HANK-4 apparatus. Findings. The medical examination of the population identified the following diseases: the first two dominant were diseases of the circulatory and digestive systems, in the 3rd place - diseases of the genitourinary system, and the nervous system and diseases of the ear and mastoid process were on the fourth and fifth places. Moreover, significant pollution of atmospheric air by carbon monoxide (MPC-5,0 mg/m3), benzapyrene (MPC-1mg/m3), dust (MPC-0,5 mg/m3) and phenol (МРС-0,035mg/m3) were identified in places. Correlation dependencies between these pollutants of air and the diseases of the population were established, as a result of diseases of the circulatory system (r = 0,7), ear and mastoid process (r = 0,7), nervous system (r = 0,6) and digestive organs(r = 0,6 ); between the concentration of carbon monoxide and diseases of the circulatory system (r = 0.6), the digestive system(r = 0.6), the genitourinary system (r = 0.6) and the musculoskeletal system; between nitric oxide and diseases of the digestive system (r = 0,7) and the circulatory system (r = 0,6); between benzopyrene and diseases of the digestive system (r = 0,6), the genitourinary system (r = 0,6) and the nervous system (r = 0,4). Conclusion. The positive correlation was found between air pollution and the health of the population living in Sarkul and Kenkiyak villages. To enhance the reliability of the results we are going to continue this study further.

Keywords: atmospheric air, chemical substances, oil and gas, public health

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124 Continuity Through Best Practice. A Case Series of Complex Wounds Manage by Dedicated Orthopedic Nursing Team

Authors: Siti Rahayu, Khairulniza Mohd Puat, Kesavan R., Mohammad Harris A., Jalila, Kunalan G., Fazir Mohamad

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The greatest challenge has been in establishing and maintaining the dedicated nursing team. Continuity is served when nurses are assigned exclusively for managing wound, where they can continue to build expertise and skills. In addition, there is a growing incidence of chronic wounds and recognition of the complexity involved in caring for these patients. We would like to share 4 cases with different techniques of wound management. 1st case, 39 years old gentleman with underlying rheumatoid arthritis with chronic periprosthetic joint infection of right total knee replacement presented with persistent drainage over right knee. Patient was consulted for two stage revision total knee replacement. However, patient only agreed for debridement and retention of implant. After debridement, large medial and lateral wound was treated with Instillation Negative Pressure Wound Therapy Dressings. After several cycle, the wound size reduced, and conventional dressing was applied. 2nd case, 58 years old gentleman with underlying diabetes presented with right foot necrotizing fasciitis with gangrene of 5th toe. He underwent extensive debridement of foot with rays’ amputation of 5th toe. Post debridement patient was started on Instillation Negative Pressure Wound Therapy Dressings. After several cycle of VAC, the wound bed was prepared, and he underwent split skin graft over right foot. 3 rd case, 60 years old gentleman with underlying diabetes mellitus presented with right foot necrotizing soft tissue infection. He underwent rays’ amputation and extensive wound debridement. Upon stabilization of general condition, patient was discharge with regular wound dressing by same nurse and doctor during each visit to clinic follow up. After 6 months of follow up, the wound healed well. 4th case, 38-year-old gentleman had alleged motor vehicle accident and sustained closed fracture right tibial plateau. Open reduction and proximal tibial locking plate were done. At 2 weeks post-surgery, the patient presented with warm, erythematous leg and pus discharge from the surgical site. Empirical antibiotic was started, and wound debridement was done. Intraoperatively, 50cc pus was evacuated, unhealthy muscle and tissue debrided. No loosening of the implant. Patient underwent multiple wound debridement. At 2 weeks post debridement wound healed well, but the proximal aspect was unable to close immediately. This left the proximal part of the implant to be exposed. Patient was then put on VAC dressing for 3 weeks until healthy granulation tissue closes the implant. Meanwhile, antibiotic was change according to culture and sensitivity. At 6 weeks post the first debridement, the wound was completely close, and patient was discharge home well. At 3 months post operatively, patient wound and fracture healed uneventfully and able to ambulate independently. Complex wounds are too serious to be dealt with. Team managing complex wound need continuous support through the provision of educational tools to support their professional development, engagement with local and international expert, as well as highquality products that increase efficiencies in services

Keywords: VAC (Vacuum Assisted Closure), empirical- initial antibiotics, NPWT- negative pressure wound therapy, NF- necrotizing fasciitis, gangrene- blackish discoloration due to poor blood supply

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123 Buddhist Cognitive Behavioral Therapy to Address Depression Among Elderly Population: Multi-cultural Model of Buddhist Based Cognitive Behavioral Therapy to Address Depression Among Elderly Population

Authors: Ashoke Priyadarshana Premananda

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As per the suggestions of previously conducted research in Counseling Psychology, the necessity of forming culture- friendly approaches has been strongly emphasized by a number of scholars in the field. In response to that, Multicultural-model of Buddhist Based Cognitive Behavioral Therapy (MMBCBT) has been formed as a culture-friendly therapeutic approach to address psychological disturbances (depression) in late adulthood. Elderly population in the world is on the rise by leaps and bounds, and forming a culture-based therapeutic model which is blended with Buddhist teachings has been the major objective of the study. Buddhist teachings and cultural applications, which were mapped onto Cognitive Behavioral Therapy (CBT) in the West, ultimately resulted in MMBCBT. Therefore, MMBCBT is a blend of cultural therapeutic techniques and the essence of certain Buddhist teachings extracted from five crucial suttas, which include CBT principles. In the process of mapping, MeghiyaSutta, GirimānandaSutta, SallekhaSutta, DvedhāvitakkaSutta, and Vitakka- SaṇṭhānaSutta have been taken into consideration mainly because of their cognitive behavioral content. The practical components of Vitakka- Saṇṭhānasutta (Aññanimittapabbaṃ) and Sallekhasutta (SallekhaPariyāya and CittuppādaPariyāya) have been used in the model while mindfulness of breathing was also carried out with the participants. Basically, multi-cultural therapeutic approaches of MMBCBT aim at modifying behavior (behavioral modification), whereas the rest is centered to the cognitive restructuring process. Therefore, MMBCBT is endowed with Behavioral Therapy (BT) and Cognitive Therapy(CT). In order to find out the validation of MMBCBT as a newly formed approach, it was then followed by mixed research (quantitative and qualitative research) with a sample selected from the elderly population following the purposive sampling technique. 40 individuals were selected from three elderly homes as per the purposive sampling technique. Elderly people identified to be depressed via Geriatric Depression Scale underwent MMBCBT for two weeks continuously while action research was being conducted simultaneously. Additionally, a Focus Group interview was carried out to support the action research. As per the research findings, people who identified depressed prior to the exposure to MMBCBT were found to be showing positive changes after they were exposed to the model. “Paired Sample t test” showed that the Multicultural Model of Buddhist based Cognitive Behavioral Therapy reduced depression of elderly people (The mean value (x̄) of the sample (level of depression) before the model was 10.7 whereas the mean value after the model was 7.5.). Most importantly, MMBCBT has been found to be effectively used with people from all walks of life despite religious diversities.

Keywords: buddhist psychotherapy, cognitive behavioral therapy in buddhism, counseling in cultural context, gerontology, and buddhism

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122 Reflections of Narrative Architecture in Transformational Representations on the Architectural Design Studio

Authors: M. Mortas, H. Asar, P. Dursun Cebi

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The visionary works of architectural representation in the 21st century's present situation, are practiced through the methodologies which try to expose the intellectual and theoretical essences of futurologist positions that are revealed with this era's interactions. Expansions of conceptual and contextual inputs related to one architectural design representation, depend on its deepness of critical attitudes, its interactions with the concepts such as experience, meaning, affection, psychology, perception and aura, as well as its communication with spatial, cultural and environmental factors. The purpose of this research study is to be able to offer methodological application areas for the design dimensions of experiential practices into architectural design studios, by focusing on the architectural representative narrations of 'transformation,' 'metamorphosis,' 'morphogenesis,' 'in-betweenness', 'superposition' and 'intertwine’ in which they affect and are affected by the today’s spatiotemporal hybridizations of architecture. The narrative representations and the visual theory paradigms of the designers are chosen under the main title of 'transformation' for the investigation of these visionary and critical representations' dismantlings and decodings. Case studies of this research area are chosen from Neil Spiller, Bryan Cantley, Perry Kulper and Dan Slavinsky’s transformative, morphogenetic representations. The theoretical dismantlings and decodings which are obtained from these artists’ contemporary architectural representations are tried to utilize and practice in the structural design studios as alternative methodologies when to approach architectural design processes, for enriching, differentiating, diversifying and 'transforming' the applications of so far used design process precedents. The research aims to indicate architectural students about how they can reproduce, rethink and reimagine their own representative lexicons and so languages of their architectural imaginations, regarding the newly perceived tectonics of prosthetic, biotechnology, synchronicity, nanotechnology or machinery into various experiential design workshops. The methodology of this work can be thought as revealing the technical and theoretical tools, lexicons and meanings of contemporary-visionary architectural representations of our decade, with the essential contents and components of hermeneutics, etymology, existentialism, post-humanism, phenomenology and avant-gardism disciplines to re-give meanings the architectural visual theorists’ transformative representations of our decade. The value of this study may be to emerge the superposed and overlapped atmospheres of futurologist architectural representations for the students who need to rethink on the transcultural, deterritorialized and post-humanist critical theories to create and use the representative visual lexicons of themselves for their architectural soft machines and beings by criticizing the now, to be imaginative for the future of architecture.

Keywords: architectural design studio, visionary lexicon, narrative architecture, transformative representation

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121 TeleEmergency Medicine: Transforming Acute Care through Virtual Technology

Authors: Ashley L. Freeman, Jessica D. Watkins

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TeleEmergency Medicine (TeleEM) is an innovative approach leveraging virtual technology to deliver specialized emergency medical care across diverse healthcare settings, including internal acute care and critical access hospitals, remote patient monitoring, and nurse triage escalation, in addition to external emergency departments, skilled nursing facilities, and community health centers. TeleEM represents a significant advancement in the delivery of emergency medical care, providing healthcare professionals the capability to deliver expertise that closely mirrors in-person emergency medicine, exceeding geographical boundaries. Through qualitative research, the extension of timely, high-quality care has proven to address the critical needs of patients in remote and underserved areas. TeleEM’s service design allows for the expansion of existing services and the establishment of new ones in diverse geographic locations. This ensures that healthcare institutions can readily scale and adapt services to evolving community requirements by leveraging on-demand (non-scheduled) telemedicine visits through the deployment of multiple video solutions. In terms of financial management, TeleEM currently employs billing suppression and subscription models to enhance accessibility for a wide range of healthcare facilities. Plans are in motion to transition to a billing system routing charges through a third-party vendor, further enhancing financial management flexibility. To address state licensure concerns, a patient location verification process has been integrated through legal counsel and compliance authorities' guidance. The TeleEM workflow is designed to terminate if the patient is not physically located within licensed regions at the time of the virtual connection, alleviating legal uncertainties. A distinctive and pivotal feature of TeleEM is the introduction of the TeleEmergency Medicine Care Team Assistant (TeleCTA) role. TeleCTAs collaborate closely with TeleEM Physicians, leading to enhanced service activation, streamlined coordination, and workflow and data efficiencies. In the last year, more than 800 TeleEM sessions have been conducted, of which 680 were initiated by internal acute care and critical access hospitals, as evidenced by quantitative research. Without this service, many of these cases would have necessitated patient transfers. Barriers to success were examined through thorough medical record review and data analysis, which identified inaccuracies in documentation leading to activation delays, limitations in billing capabilities, and data distortion, as well as the intricacies of managing varying workflows and device setups. TeleEM represents a transformative advancement in emergency medical care that nurtures collaboration and innovation. Not only has advanced the delivery of emergency medicine care virtual technology through focus group participation with key stakeholders, rigorous attention to legal and financial considerations, and the implementation of robust documentation tools and the TeleCTA role, but it’s also set the stage for overcoming geographic limitations. TeleEM assumes a notable position in the field of telemedicine by enhancing patient outcomes and expanding access to emergency medical care while mitigating licensure risks and ensuring compliant billing.

Keywords: emergency medicine, TeleEM, rural healthcare, telemedicine

Procedia PDF Downloads 51
120 Hydroxyapatite Based Porous Scaffold for Tooth Tissue Engineering

Authors: Pakize Neslihan Taslı, Alev Cumbul, Gul Merve Yalcın, Fikrettin Sahin

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A key experimental trial in the regeneration of large oral and craniofacial defects is the neogenesis of osseous and ligamentous interfacial structures. Currently, oral regenerative medicine strategies are unpredictable for repair of tooth supporting tissues destroyed as a consequence of trauma, chronic infection or surgical resection. A different approach combining the gel-casting method with Hydroxy Apatite HA-based scaffold and different cell lineages as a hybrid system leads to successively mimic the early stage of tooth development, in vitro. HA is widely accepted as a bioactive material for guided bone and tooth regeneration. In this study, it was reported that, HA porous scaffold preparation, characterization and evaluation of structural and chemical properties. HA is the main factor that exists in tooth and it is in harmony with structural, biological, and mechanical characteristics. Here, this study shows mimicking immature tooth at the late bell stage design and construction of HA scaffolds for cell transplantation of human Adipose Stem Cells (hASCs), human Bone Marrow Stem Cells (hBMSCs) and Gingival Epitelial cells for the formation of human tooth dentin-pulp-enamel complexes in vitro. Scaffold characterization was demonstrated by SEM, FTIR and pore size and density measurements. The biological contraction of dental tissues against each other was demonstrated by mRNA gene expressions, histopatologic observations and protein release profile by ELISA tecnique. The tooth shaped constructs with a pore size ranging from 150 to 300 µm arranged by gathering right amounts of materials provide interconnected macro-porous structure. The newly formed tissue like structures that grow and integrate within the HA designed constructs forming tooth cementum like tissue, pulp and bone structures. These findings are important as they emphasize the potential biological effect of the hybrid scaffold system. In conclusion, this in vitro study clearly demonstrates that designed 3D scaffolds shaped as a immature tooth at the late bell stage were essential to form enamel-dentin-pulp interfaces with an appropriate cell and biodegradable material combination. The biomimetic architecture achieved here is providing a promising platform for dental tissue engineering.

Keywords: tooth regeneration, tissue engineering, adipose stem cells, hydroxyapatite tooth engineering, porous scaffold

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119 Working at the Interface of Health and Criminal Justice: An Interpretative Phenomenological Analysis Exploration of the Experiences of Liaison and Diversion Nurses – Emerging Findings

Authors: Sithandazile Masuku

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Introduction: Public health approaches to offender mental health are driven by international policies and frameworks in response to the disproportionately large representation of people with mental health problems within the offender pathway compared to the general population. Public health service innovations include mental health courts in the US, restorative models in Singapore and, liaison and diversion services in Australia, the UK, and some other European countries. Mental health nurses are at the forefront of offender health service innovations. In the U.K. context, police custody has been identified as an early point within the offender pathway where nurses can improve outcomes by offering assessments and share information with criminal justice partners. This scope of nursing practice has introduced challenges related to skills and support required for nurses working at the interface of health and the criminal justice system. Parallel literature exploring experiences of nurses working in forensic settings suggests the presence of compassion fatigue, burnout and vicarious trauma that may impede risk harm to the nurses in these settings. Published research explores mainly service-level outcomes including monitoring of figures indicative of a reduction in offending behavior. There is minimal research exploring the experiences of liaison and diversion nurses who are situated away from a supportive clinical environment and engaged in complex autonomous decision-making. Aim: This paper will share qualitative findings (in progress) from a PhD study that aims to explore the experiences of liaison and diversion nurses in one service in the U.K. Methodology: This is a qualitative interview study conducted using an Interpretative Phenomenological Analysis to gain an in-depth analysis of lived experiences. Methods: A purposive sampling technique was used to recruit n=8 mental health nurses registered with the UK professional body, Nursing and Midwifery Council, from one UK Liaison and Diversion service. All participants were interviewed online via video call using semi-structured interview topic guide. Data were recorded and transcribed verbatim. Data were analysed using the seven steps of the Interpretative Phenomenological Analysis data analysis method. Emerging Findings Analysis to date has identified pertinent themes: • Difficulties of meaning-making for nurses because of the complexity of their boundary spanning role. • Emotional burden experienced in a highly emotive and fast-changing environment. • Stress and difficulties with role identity impacting on individual nurses’ ability to be resilient. • Challenges to wellbeing related to a sense of isolation when making complex decisions. Conclusion Emerging findings have highlighted the lived experiences of nurses working in liaison and diversion as challenging. The nature of the custody environment has an impact on role identity and decision making. Nurses left feeling isolated and unsupported are less resilient and may go on to experience compassion fatigue. The findings from this study thus far point to a need to connect nurses working in these boundary spanning roles with a supportive infrastructure where the complexity of their role is acknowledged, and they can be connected with a health agenda. In doing this, the nurses would be protected from harm and the likelihood of sustained positive outcomes for service users is optimised.

Keywords: liaison and diversion, nurse experiences, offender health, staff wellbeing

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118 Eucalyptus camaldulensis Leaves Attacked by the Gall Wasp Leptocybe invasa: A Phyto-Volatile Constituents Study

Authors: Maged El-Sayed Mohamed

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Eucalyptus camaldulensis is one on the most well-known species of the genus Eucalyptus in the Middle east, its importance relay on the high production of its unique volatile constituents which exhibits many medicinal and pharmacological activities. The gall-forming wasp (Leptocybe invasa) has recently come into sight as the main pest attacking E. camaldulensis and causing severe injury. The wasp lays its eggs in the petiole and midrib of leaves and stems of young shoots of E. camaldulensis, which leads to gall formation. Gall formation by L. invasa damages growing shoot and leaves of Eucalyptus, resulting in abscission of leaves and drying. AIM: This study is an attempt to investigate the effect of the gall wasp (Leptocybe invasa) attack on the volatile constitutes of E. camaldulensis. This could help in the control of this wasp through stimulating plant defenses or production of a new allelochemicals or insecticide. The study of volatile constitutes of Eucalyptus before and after attack by the wasp can help the re-use and recycle of the infected Eucalyptus trees for new pharmacological and medicinal activities. Methodology: The fresh gall wasp-attacked and healthy leaves (100 g each) were cut and immediately subjected to hydrodistillation using Clevenger-type apparatus for 3 hours. The volatile fractions isolated were analyzed using Gas chromatography/mass spectrometry (GC/MS). Kovat’s retention indices (RI) were calculated with respect to a set of co-injected standard hydrocarbons (C10-C28). Compounds were identified by comparing their spectral data and retention indices with Wiley Registry of Mass Spectral Data 10th edition (April 2013), NIST 11 Mass Spectral Library (NIST11/2011/EPA/NIH) and literature data. Results: Fifty-nine components representing 89.13 and 88.60% of the total volatile fraction content respectively were quantitatively analyzed. Twenty-six major compounds at an average concentration greater than 0.1 ± 0.02% have been used for the statistical comparison. From those major components, twenty-one were found in both the attacked and healthy Eucalyptus leaves’ fractions in different concentration and five components, mono terpene p-Mentha-2-4(8) diene and the sesquiterpenes δ-elemene, β-elemene, E-caryophyllene and Bicyclogermacrene, were unique and only produced in the attacked-leaves’ fraction. CONCLUSION: Newly produced components or those commonly found in the volatile fraction and changed in concentration could represent a part of the plant defense mechanisms or might be an element of the plant allelopathic and communication mechanisms. Identification of the components of the gall wasp-damaged leaves can help in their recycling for different physiological, pharmacological and medicinal uses.

Keywords: Eucalyptus camaldulensis, eucalyptus recycling, gall wasp, Leptocybe invasa, plant defense mechanisms, Terpene fraction

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117 Organizational Ideologies and Their Embeddedness in Fashion Show Productions in Shanghai and London Fashion Week: International-Based-Chinese Independent Designers' Participatory Behaviors in Different Fashion Cities

Authors: Zhe Wang

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The fashion week, as a critical international fashion event in shaping world fashion cities, is one of the most significant world events that serves as the core medium for designers to stage new collections. However, its role in bringing about and shaping design ideologies of major fashion cities have long been neglected from a fashion ecosystem perspective. With the expanding scale of international fashion weeks in terms of culture and commerce, the organizational structures of these fashion weeks are becoming more complex. In the emerging fashion city, typified by Shanghai, a newly-formed 'hodgepodge' transforming the current global fashion ecosystem. A city’s legitimate fashion institutions, typically the organizers of international fashion weeks, have cultivated various cultural characteristics via rules and regulations pertaining to international fashion weeks. Under these circumstances, designers’ participatory behaviors, specifically show design and production, are influenced by the cultural ideologies of official organizers and institutions. This research compares international based Chinese (IBC) independent designers’ participatory behavior in London and Shanghai Fashion Weeks: specifically, the way designers present their clothing and show production. both of which are found to be profoundly influenced by cultural and design ideologies of fashion weeks. They are, to a large degree, manipulated by domestic institutions and organizers. Shanghai fashion week has given rise to a multiple, mass-ended entertainment carnival design and cultural ideology in Shanghai, thereby impacting the explicit cultural codes or intangible rules that IBC designers must adhere to when designing and producing fashion shows. Therefore, influenced by various cultural characteristics in the two cities, IBC designers’ show design and productions, in turn, play an increasingly vital role in shaping the design characteristic of an international fashion week. Through researching the organizational systems and design preferences of organizers of London and Shanghai fashion weeks, this paper demonstrates the embeddedness of design systems in the forming of design ideologies under various cultural and institutional contexts. The core methodology utilized in this research is ethnography. As a crucial part of a Ph.D. project on innovations in fashion shows under a cross-cultural context run by Edinburgh College of Art, School of Design, the fashion week’s organizational culture in various cultural contexts is investigated in London and Shanghai for approximately six months respectively. Two IBC designers, Angel Chen and Xuzhi Chen were followed during their participation of London and Shanghai Fashion Weeks from September 2016 to June 2017, during which two consecutive seasons were researched in order to verify the consistency of design ideologies’ associations with organizational system and culture.

Keywords: institutional ideologies, international fashion weeks, IBC independent designers; fashion show

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116 Architecture, Politics and Religion Synthesis: Political Legitimacy in Early Islamic Iran

Authors: Fahimeh Ghorbani, Alam Saleh

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Ideology, politics and art have always been omnipresent patterns of Islam since its early age. The Islamic empire, expanded from China to Andalusia, has instrumentalized art and architecture to enhance political legitimacy of different dynasties or states throughout its history. Quranic verses utilized to convey ideological messages in the major mosques and mausoleums. Iranians had already been employing art and architecture to propagate their political legitimacy prior to Islam. The land of Iran and its art with strong civilizational pre-Islamic history has been profoundly politicized since the rise of Islam in the region. Early Islamic period in Iran has witnessed introduction of a new architectural language, new formulas for spatial configuration in built spaces, as well as new system of architectural decoration. Studying Iran’s Early Islamic architecture helps in better understanding the process of socio-political identity making of Iranian-Islamic culture, and thus art and architecture. This period also set the stage for formation of glorious architectural movements through Persianate world in later periods. During the Early Islamic period in Iran, the innovative combination of Islamic ideology and Iranian Architecture created formidable ideological tools in politicizing art in the region and beyond. As such, this paper aims to investigate the political history and architectural legacy from late Sassanid to Early Islamic period, delves into the ways in which Early Islamic architecture played role in transforming Persian concepts of kingship, administration, and social organization. In so doing, the study focuses on the Perso-Islamic architectural synthesis under the Samanids and Seljuk dynasty as case studies. The paper also explores how the newly introduced Islamic architecture has been employed to address the question of political legitimacy and to propagate states’ political agenda in early Islamic Iran (650-1250). As for the existing literature, despite its uniqueness and significance, Early Islamic architecture of Iran has received little scholarly attention. However, there exists a sizeable body of scholarship on socio-historic condition of the land of Iran during Early Islamic period which provide a solid base for the project. Methodologically speaking, the authors look into the subject through various lenses. They will conduct historic and archival research in libraries, private collections, and archives in Iran and the related neighbouring countries in Persian, Arabic and English. The methods of visual and formal analysis are applied to examine architectural features of the period. There are also a high number of intriguing, yet poorly examined, published and unpublished documents, old plans, drawings and photos of monuments preserved in Cultural Heritage of Iran Organization which will be consulted.

Keywords: Iran, Islamic architecture, early Islamic Iran, early Islamic architecture, politicized art, political legitimacy, propaganda, aesthetics

Procedia PDF Downloads 98
115 Analytical Solutions of Josephson Junctions Dynamics in a Resonant Cavity for Extended Dicke Model

Authors: S.I.Mukhin, S. Seidov, A. Mukherjee

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The Dicke model is a key tool for the description of correlated states of quantum atomic systems, excited by resonant photon absorption and subsequently emitting spontaneous coherent radiation in the superradiant state. The Dicke Hamiltonian (DH) is successfully used for the description of the dynamics of the Josephson Junction (JJ) array in a resonant cavity under applied current. In this work, we have investigated a generalized model, which is described by DH with a frustrating interaction term. This frustrating interaction term is explicitly the infinite coordinated interaction between all the spin half in the system. In this work, we consider an array of N superconducting islands, each divided into two sub-islands by a Josephson Junction, taken in a charged qubit / Cooper Pair Box (CPB) condition. The array is placed inside the resonant cavity. One important aspect of the problem lies in the dynamical nature of the physical observables involved in the system, such as condensed electric field and dipole moment. It is important to understand how these quantities behave with time to define the quantum phase of the system. The Dicke model without frustrating term is solved to find the dynamical solutions of the physical observables in analytic form. We have used Heisenberg’s dynamical equations for the operators and on applying newly developed Rotating Holstein Primakoff (HP) transformation and DH we have arrived at the four coupled nonlinear dynamical differential equations for the momentum and spin component operators. It is possible to solve the system analytically using two-time scales. The analytical solutions are expressed in terms of Jacobi's elliptic functions for the metastable ‘bound luminosity’ dynamic state with the periodic coherent beating of the dipoles that connect the two double degenerate dipolar ordered phases discovered previously. In this work, we have proceeded the analysis with the extended DH with a frustrating interaction term. Inclusion of the frustrating term involves complexity in the system of differential equations and it gets difficult to solve analytically. We have solved semi-classical dynamic equations using the perturbation technique for small values of Josephson energy EJ. Because the Hamiltonian contains parity symmetry, thus phase transition can be found if this symmetry is broken. Introducing spontaneous symmetry breaking term in the DH, we have derived the solutions which show the occurrence of finite condensate, showing quantum phase transition. Our obtained result matches with the existing results in this scientific field.

Keywords: Dicke Model, nonlinear dynamics, perturbation theory, superconductivity

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114 A Discourse Analysis of Syrian Refugee Representations in Canadian News Media

Authors: Pamela Aimee Rigor

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This study aims to examine the representation of Syrian refugees resettled in Vancouver and the Lower Mainland in local community and major newspapers. While there is strong support for immigration in Canada, public opinion towards refugees and asylum seekers is a bit more varied. Concerns about the legitimacy of refugee claims are among the common concerns of Canadians, and hateful or negative narratives are still present in Canadian media discourse which affects how people view refugees. To counter the narratives, these Syrian refugees must publicly declare how grateful they are because they are resettled in Canada. The dominant media discourse is that these refugees should be grateful as they have been graciously accepted by Canada and Canadians, once again upholding the image of Canada being a generous and humanitarian nation. The study examined the representation of Syrian refugees and the Syrian refugee resettlement in Canadian newspapers from September 2015 to October 2017 – around the time Prime Minister Trudeau came into power up until the present. Using a combination of content and discourse analysis, it aimed to uncover how local community and major newspapers in Vancouver covered the Syrian refugee ‘crisis’ – more particularly, the arrival and resettlement of the refugees in the country. Using the qualitative data analysis software Nvivo 12, the newspapers were analyzed and sorted into themes. Based on the initial findings, the discourse of Canada being a humanitarian country and Canadians being generous, as well as the idea of Syrian refugees having to publicly announce how grateful they are, is still present in the local community newspapers. This seems to be done to counter the hateful narratives of citizens who might view them as people who are abusing help provided by the community or the services provided by the government. However, compared to the major and national newspapers in Canada, many these local community newspapers are very inclusive of Syrian refugee voices. Most of the News and Community articles interview Syrian refugees and ask them their personal stories of plight, survival, resettlement and starting a ‘new life’ in Canada. They are not seen as potential threats nor are they dismissed – the refugees were named and were allowed to share their personal experiences in these news articles. These community newspapers, even though their representations are far from perfect, actually address some aspects of the refugee resettlement issue and respond to their community’s needs. There are quite a number of news articles that announce community meetings and orientations about the Syrian refugee crisis, ways to help in the resettlement process, as well as community fundraising activities to help sponsor refugees or resettle newly arrived refugees. This study aims to promote awareness of how these individuals are socially constructed so we can, in turn, be aware of the certain biases and stereotypes present, and its implications on refugee laws and public response to the issue.

Keywords: forced migration and conflict, media representations, race and multiculturalism, refugee studies

Procedia PDF Downloads 218
113 Experiences of Pediatric Cancer Patients and Their Families: A Focus Group Interview

Authors: Bu Kyung Park

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Background: The survival rate of pediatric cancer patients has been increased. Thus, the needs of long-term management and follow-up education after discharge continue to grow. Purpose: The purpose of this study was to explore the experiences of pediatric cancer patients and their families from first diagnosis to returning their social life. The ultimate goal of this study was to assess which information and intervention did pediatric cancer patients and their families required and needed, so that this could provide fundamental information for developing educational content of web-based intervention program for pediatric cancer patients. Research Approach: This study was based on a descriptive qualitative research design using semi-structured focus group interview. Participants: Twelve pediatric cancer patients and 12 family members participated in a total six focus group interview sessions. Methods: All interviews were audiotaped after obtaining participants’ approval. The recordings were transcribed. Qualitative Content analysis using the inductive coding approach was performed on the transcriptions by three coders. Findings: Eighteen categories emerged from the six main themes: 1) Information needs, 2) Support system, 3) Barriers to treatment, 4) Facilitators to treatment, 5) Return to social life, 6) Healthcare system issues. Each theme had both pediatric cancer patients’ codes and their family members’ codes. Patients and family members had high information needs through the whole process of treatment, not only the first diagnosis but also after completion of treatment. Hospitals provided basic information on chemo therapy, medication, and various examinations. However, they were more likely to rely on information from other patients and families by word of mouth. Participants’ information needs were different according to their treatment stage (e.g., first admitted patients versus cancer survivors returning to their social life). Even newly diagnosed patients worried about social adjustment after completion of all treatment, such as return to school and diet and physical activity at home. Most family members had unpleasant experiences while they were admitted in hospitals and concerned about healthcare system issues, such as medical error and patient safety. Conclusions: In conclusion, pediatric cancer patients and their family members wanted information source which can provide tailored information based on their needs. Different information needs with patients and their family members based on their diagnosis, progress, stage of treatment were identified. Findings from this study will be used to develop a patient-centered online health intervention program for pediatric cancer patients. Pediatric cancer patients and their family members had variety fields of education needs and soak the information from various sources. Web-based health intervention program for them is required to satisfy their inquiries to provide reliable information.

Keywords: focus group interview, family caregivers, pediatric cancer patients, qualitative content analysis

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112 Securing Communities to Bring Sustainable Development, Building Peace and Community Safety: the Ethiopian Community Policing in Amhara National Regional State of Ethiopia

Authors: Demelash Kassaye

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The Ethiopia case study reveals a unique model of community policing that has developed from a particular political context in which there is a history of violent political transition, a political structure characterized by ethnic federalism and a political ideology that straddles liberal capitalism and democracy on the one hand, and state-led development and centralized control on the other. The police see community policing as a way to reduce crime. Communities speak about community policing as an opportunity to take on policing responsibilities themselves. Both of these objectives are brought together in an overarching rhetoric of community policing as a way of ‘mobilizing for development’ – whereby the community cooperate with the police to reduce crime, which otherwise inhibits development progress. Community policing in Amhara has primarily involved the placement of Community Police Officers at the kebele level across the State. In addition, a number of structures have also been established in the community, including Advisory Councils, Conflict Resolving Committees, family police and the use of shoe shiner’s and other trade associations as police informants. In addition to these newly created structures, community policing also draws upon pre-existing customary actors, such as militia and elders. Conflict Resolving Committees, Community Police Officers and elders were reported as the most common first ports of call when community members experience a crime. The analysis highlights that the model of community policing in Amhara increased communities’ access to policing services, although this is not always attended by increased access to justice. Community members also indicate that public perceptions of the police have improved since the introduction of community policing, in part due to individual Community Police Officers who have, with limited resources, innovated some impressive strategies to improve safety in their neighborhoods. However, more broadly, community policing has provided the state with more effective surveillance of the population – a potentially oppressive function in the current political context. Ultimately, community policing in Amhara is anything but straightforward. It has been a process of attempting to demonstrate the benefits of newfound (and controversial) ‘democracy’ following years of dictatorship, drawing on generations of customary dispute resolution, providing both improved access to security for communities and an enhanced surveillance capacity for the state. For external actors looking to engage in community policing, this case study reveals the importance of close analysis in assessing potential merits, risks and entry points of programming. Factors found to be central in shaping the nature of community policing in the Amhara case include the structure of the political system, state-society relations, cultures dispute resolution and political ideology.

Keywords: community policing, community, militias, ethiopia

Procedia PDF Downloads 88
111 Damage-Based Seismic Design and Evaluation of Reinforced Concrete Bridges

Authors: Ping-Hsiung Wang, Kuo-Chun Chang

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There has been a common trend worldwide in the seismic design and evaluation of bridges towards the performance-based method where the lateral displacement or the displacement ductility of bridge column is regarded as an important indicator for performance assessment. However, the seismic response of a bridge to an earthquake is a combined result of cyclic displacements and accumulated energy dissipation, causing damage to the bridge, and hence the lateral displacement (ductility) alone is insufficient to tell its actual seismic performance. This study aims to propose a damage-based seismic design and evaluation method for reinforced concrete bridges on the basis of the newly developed capacity-based inelastic displacement spectra. The capacity-based inelastic displacement spectra that comprise an inelastic displacement ratio spectrum and a corresponding damage state spectrum was constructed by using a series of nonlinear time history analyses and a versatile, smooth hysteresis model. The smooth model could take into account the effects of various design parameters of RC bridge columns and correlates the column’s strength deterioration with the Park and Ang’s damage index. It was proved that the damage index not only can be used to accurately predict the onset of strength deterioration, but also can be a good indicator for assessing the actual visible damage condition of column regardless of its loading history (i.e., similar damage index corresponds to similar actual damage condition for the same designed columns subjected to very different cyclic loading protocols as well as earthquake loading), providing a better insight into the seismic performance of bridges. Besides, the computed spectra show that the inelastic displacement ratio for far-field ground motions approximately conforms to the equal displacement rule when structural period is larger than around 0.8 s, but that for near-fault ground motions departs from the rule in the whole considered spectral regions. Furthermore, the near-fault ground motions would lead to significantly greater inelastic displacement ratio and damage index than far-field ground motions and most of the practical design scenarios cannot survive the considered near-fault ground motion when the strength reduction factor of bridge is not less than 5.0. Finally, the spectrum formula is presented as a function of structural period, strength reduction factor, and various column design parameters for far-field and near-fault ground motions by means of the regression analysis of the computed spectra. And based on the developed spectrum formula, a design example of a bridge is presented to illustrate the proposed damage-based seismic design and evaluation method where the damage state of the bridge is used as the performance objective.

Keywords: damage index, far-field, near-fault, reinforced concrete bridge, seismic design and evaluation

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110 Stability Analysis of Hossack Suspension Systems in High Performance Motorcycles

Authors: Ciro Moreno-Ramirez, Maria Tomas-Rodriguez, Simos A. Evangelou

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A motorcycle's front end links the front wheel to the motorcycle's chassis and has two main functions: the front wheel suspension and the vehicle steering. Up to this date, several suspension systems have been developed in order to achieve the best possible front end behavior, being the telescopic fork the most common one and already subjected to several years of study in terms of its kinematics, dynamics, stability and control. A motorcycle telescopic fork suspension model consists of a couple of outer tubes which contain the suspension components (coil springs and dampers) internally and two inner tubes which slide into the outer ones allowing the suspension travel. The outer tubes are attached to the frame through two triple trees which connect the front end to the main frame through the steering bearings and allow the front wheel to turn about the steering axis. This system keeps the front wheel's displacement in a straight line parallel to the steering axis. However, there exist alternative suspension designs that allow different trajectories of the front wheel with the suspension travel. In this contribution, the authors investigate an alternative front suspension system (Hossack suspension) and its influence on the motorcycle nonlinear dynamics to identify and reduce stability risks that a new suspension systems may introduce in the motorcycle dynamics. Based on an existing high-fidelity motorcycle mathematical model, the front end geometry is modified to accommodate a Hossack suspension system. It is characterized by a double wishbone design that varies the front end geometry on certain maneuverings and, consequently, the machine's behavior/response. It consists of a double wishbone structure directly attached to the chassis. In here, the kinematics of this system and its impact on the motorcycle performance/stability are analyzed and compared to the well known telescopic fork suspension system. The framework of this research is the mathematical modelling and numerical simulation. Full stability analyses are performed in order to understand how the motorcycle dynamics may be affected by the newly introduced front end design. This study is carried out by a combination of nonlinear dynamical simulation and root-loci methods. A modal analysis is performed in order to get a deeper understanding of the different modes of oscillation and how the Hossack suspension system affects them. The results show that different kinematic designs of a double wishbone suspension systems do not modify the general motorcycle's stability. The normal modes properties remain unaffected by the new geometrical configurations. However, these normal modes differ from one suspension system to the other. It is seen that the normal modes behaviour depends on various important dynamic parameters, such as the front frame flexibility, the steering damping coefficient and the centre of mass location.

Keywords: nonlinear mechanical systems, motorcycle dynamics, suspension systems, stability

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109 Synthesis of Methanol through Photocatalytic Conversion of CO₂: A Green Chemistry Approach

Authors: Sankha Chakrabortty, Biswajit Ruj, Parimal Pal

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Methanol is one of the most important chemical products and intermediates. It can be used as a solvent, intermediate or raw material for a number of higher valued products, fuels or additives. From the last one decay, the total global demand of methanol has increased drastically which forces the scientists to produce a large amount of methanol from a renewable source to meet the global demand with a sustainable way. Different types of non-renewable based raw materials have been used for the synthesis of methanol on a large scale which makes the process unsustainable. In this circumstances, photocatalytic conversion of CO₂ into methanol under solar/UV excitation becomes a viable approach to give a sustainable production approach which not only meets the environmental crisis by recycling CO₂ to fuels but also reduces CO₂ amount from the atmosphere. Development of such sustainable production approach for CO₂ conversion into methanol still remains a major challenge in the current research comparing with conventional energy expensive processes. In this backdrop, the development of environmentally friendly materials, like photocatalyst has taken a great perspective for methanol synthesis. Scientists in this field are always concerned about finding an improved photocatalyst to enhance the photocatalytic performance. Graphene-based hybrid and composite materials with improved properties could be a better nanomaterial for the selective conversion of CO₂ to methanol under visible light (solar energy) or UV light. The present invention relates to synthesis an improved heterogeneous graphene-based photocatalyst with improved catalytic activity and surface area. Graphene with enhanced surface area is used as coupled material of copper-loaded titanium oxide to improve the electron capture and transport properties which substantially increase the photoinduced charge transfer and extend the lifetime of photogenerated charge carriers. A fast reduction method through H₂ purging has been adopted to synthesis improved graphene whereas ultrasonication based sol-gel method has been applied for the preparation of graphene coupled copper loaded titanium oxide with some enhanced properties. Prepared photocatalysts were exhaustively characterized using different characterization techniques. Effects of catalyst dose, CO₂ flow rate, reaction temperature and stirring time on the efficacy of the system in terms of methanol yield and productivity have been studied in the present study. The study shown that the newly synthesized photocatalyst with an enhanced surface resulting in a sustained productivity and yield of methanol 0.14 g/Lh, and 0.04 g/gcat respectively, after 3 h of illumination under UV (250W) at an optimum catalyst dosage of 10 g/L having 1:2:3 (Graphene: TiO₂: Cu) weight ratio.

Keywords: renewable energy, CO₂ capture, photocatalytic conversion, methanol

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108 Fields of Power, Visual Culture, and the Artistic Practice of Two 'Unseen' Women of Central Brazil

Authors: Carolina Brandão Piva

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In our visual culture, images play a newly significant role in the basis of a complex dialogue between imagination, creativity, and social practice. Insofar as imagination has broken out of the 'special expressive space of art' to become a part of the quotidian mental work of ordinary people, it is pertinent to recognize that visual representation can no longer be assumed as if in a domain detached from everyday life or exclusively 'centered' within the limited frame of 'art history.' The approach of Visual Culture as a field of study is, in this sense, indispensable to comprehend that not only 'the image,' but also 'the imagined' and 'the imaginary' are produced in the plurality of social interactions; crucial enough, this assertion directs us to something new in contemporary cultural processes, namely both imagination and image production constitute a social practice. This paper starts off with this approach and seeks to examine the artistic practice of two women from the State of Goiás, Brazil, who are ordinary citizens with their daily activities and narratives but also dedicated to visuality production. With no formal training from art schools, branded or otherwise, Maria Aparecida de Souza Pires deploys 'waste disposal' of daily life—from car tires to old work clothes—as a trampoline for art; also adept at sourcing raw materials collected from her surroundings, she manipulates raw hewn wood, tree trunks, plant life, and various other pieces she collects from nature giving them new meaning and possibility. Hilda Freire works with sculptures in clay using different scales and styles; her art focuses on representations of women and pays homage to unprivileged groups such as the practitioners of African-Brazilian religions, blue-collar workers, poor live-in housekeepers, and so forth. Although they have never been acknowledged by any mainstream art institution in Brazil, whose 'criterion of value' still favors formally trained artists, Maria Aparecida de Souza Pires, and Hilda Freire have produced visualities that instigate 'new ways of seeing,' meriting cultural significance in many ways. Their artworks neither descend from a 'traditional' medium nor depend on 'canonical viewing settings' of visual representation; rather, they consist in producing relationships with the world which do not result in 'seeing more,' but 'at least differently.' From this perspective, the paper finally demonstrates that grouping this kind of artistic production under the label of 'mere craft' has much more to do with who is privileged within the fields of power in art system, who we see and who we do not see, and whose imagination of what is fed by which visual images in Brazilian contemporary society.

Keywords: visual culture, artistic practice, women's art in the Brazilian State of Goiás, Maria Aparecida de Souza Pires, Hilda Freire

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107 Fabrication of Highly Conductive Graphene/ITO Transparent Bi-Film through Chemical Vapor Deposition (CVD) and Organic Additives-Free Sol-Gel Techniques

Authors: Bastian Waduge Naveen Harindu Hemasiri, Jae-Kwan Kim, Ji-Myon Lee

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Indium tin oxide (ITO) remains the industrial standard transparent conducting oxides with better performances. Recently, graphene becomes as a strong material with unique properties to replace the ITO. However, graphene/ITO hybrid composite material is a newly born field in the electronic world. In this study, the graphene/ITO composite bi-film was synthesized by a two steps process. 10 wt.% tin-doped, ITO thin films were produced by an environmentally friendly aqueous sol-gel spin coating technique with economical salts of In(NO3)3.H2O and SnCl4 without using organic additives. The wettability and surface free energy (97.6986 mJ/m2) enhanced oxygen plasma treated glass substrates were used to form voids free continuous ITO film. The spin-coated samples were annealed at 600 0C for 1 hour under low vacuum conditions to obtained crystallized, ITO film. The crystal structure and crystalline phases of ITO thin films were analyzed by X-ray diffraction (XRD) technique. The Scherrer equation was used to determine the crystallite size. Detailed information about chemical composition and elemental composition of the ITO film were determined by X-ray photoelectron spectroscopy (XPS) and energy dispersive X-ray spectroscopy (EDX) coupled with FE-SEM respectively. Graphene synthesis was done under chemical vapor deposition (CVD) method by using Cu foil at 1000 0C for 1 min. The quality of the synthesized graphene was characterized by Raman spectroscopy (532nm excitation laser beam) and data was collected at room temperature and normal atmosphere. The surface and cross-sectional observation were done by using FE-SEM. The optical transmission and sheet resistance were measured by UV-Vis spectroscopy and four point probe head at room temperature respectively. Electrical properties were also measured by using V-I characteristics. XRD patterns reveal that the films contain the In2O3 phase only and exhibit the polycrystalline nature of the cubic structure with the main peak of (222) plane. The peak positions of In3d5/2 (444.28 eV) and Sn3d5/2 (486.7 eV) in XPS results indicated that indium and tin are in the oxide form only. The UV-visible transmittance shows 91.35 % at 550 nm with 5.88 x 10-3 Ωcm specific resistance. The G and 2D band in Raman spectroscopy of graphene appear at 1582.52 cm-1 and 2690.54 cm-1 respectively when the synthesized CVD graphene on SiO2/Si. The determined intensity ratios of 2D to G (I2D/IG) and D to G (ID/IG) were 1.531 and 0.108 respectively. However, the above-mentioned G and 2D peaks appear at 1573.57 cm-1 and 2668.14 cm-1 respectively when the CVD graphene on the ITO coated glass, the positions of G and 2D peaks were red shifted by 8.948 cm-1 and 22.396 cm-1 respectively. This graphene/ITO bi-film shows modified electrical properties when compares with sol-gel derived ITO film. The reduction of sheet resistance in the bi-film was 12.03 % from the ITO film. Further, the fabricated graphene/ITO bi-film shows 88.66 % transmittance at 550 nm wavelength.

Keywords: chemical vapor deposition, graphene, ITO, Raman Spectroscopy, sol-gel

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106 Graphic Procession Unit-Based Parallel Processing for Inverse Computation of Full-Field Material Properties Based on Quantitative Laser Ultrasound Visualization

Authors: Sheng-Po Tseng, Che-Hua Yang

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Motivation and Objective: Ultrasonic guided waves become an important tool for nondestructive evaluation of structures and components. Guided waves are used for the purpose of identifying defects or evaluating material properties in a nondestructive way. While guided waves are applied for evaluating material properties, instead of knowing the properties directly, preliminary signals such as time domain signals or frequency domain spectra are first revealed. With the measured ultrasound data, inversion calculation can be further employed to obtain the desired mechanical properties. Methods: This research is development of high speed inversion calculation technique for obtaining full-field mechanical properties from the quantitative laser ultrasound visualization system (QLUVS). The quantitative laser ultrasound visualization system (QLUVS) employs a mirror-controlled scanning pulsed laser to generate guided acoustic waves traveling in a two-dimensional target. Guided waves are detected with a piezoelectric transducer located at a fixed location. With a gyro-scanning of the generation source, the QLUVS has the advantage of fast, full-field, and quantitative inspection. Results and Discussions: This research introduces two important tools to improve the computation efficiency. Firstly, graphic procession unit (GPU) with large amount of cores are introduced. Furthermore, combining the CPU and GPU cores, parallel procession scheme is developed for the inversion of full-field mechanical properties based on the QLUVS data. The newly developed inversion scheme is applied to investigate the computation efficiency for single-layered and double-layered plate-like samples. The computation efficiency is shown to be 80 times faster than unparalleled computation scheme. Conclusions: This research demonstrates a high-speed inversion technique for the characterization of full-field material properties based on quantitative laser ultrasound visualization system. Significant computation efficiency is shown, however not reaching the limit yet. Further improvement can be reached by improving the parallel computation. Utilizing the development of the full-field mechanical property inspection technology, full-field mechanical property measured by non-destructive, high-speed and high-precision measurements can be obtained in qualitative and quantitative results. The developed high speed computation scheme is ready for applications where full-field mechanical properties are needed in a nondestructive and nearly real-time way.

Keywords: guided waves, material characterization, nondestructive evaluation, parallel processing

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105 Tuberculosis Outpatient Treatment in the Context of Reformation of the Health Care System

Authors: Danylo Brindak, Viktor Liashko, Olexander Chepurniy

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Despite considerable experience in implementation of the best international approaches and services within response to epidemy of multi-drug resistant tuberculosis, the results of situation analysis indicate the presence of faults in this area. In 2014, Ukraine (for the first time) was included in the world’s five countries with the highest level of drug-resistant tuberculosis. The effectiveness of its treatment constitutes only 35% in the country. In this context, the increase in allocation of funds to control the epidemic of multidrug-resistant tuberculosis does not produce perceptible positive results. During 2001-2016, only the Global Fund to fight AIDS, Tuberculosis, and Malaria allocated to Ukraine more than USD 521,3 million for programs of tuberculosis and HIV/AIDS control. However, current conditions in post-Semashko system create little motivation for rational use of resources or cost control at inpatient TB facilities. There is no motivation to reduce overdue hospitalization and to target resources to priority sectors of modern tuberculosis control, including a model of care focused on the patient. In the presence of a line-item budget at medical institutions, based on the input factors as the ratios of beds and staff, there is a passive disposal of budgetary funds by health care institutions and their employees who have no motivation to improve quality and efficiency of service provision. Outpatient treatment of tuberculosis is being implemented in Ukraine since 2011 and has many risks, namely creation of parallel systems, low consistency through dependence on funding for the project, reduced the role of the family doctor, the fragmentation of financing, etc. In terms of reforming approaches to health system financing, which began in Ukraine in late 2016, NGO Infection Control in Ukraine conducted piloting of a new, motivating method of remuneration of employees in primary health care. The innovative aspect of this funding mechanism is cost according to results of treatment. The existing method of payment on the basis of the standard per inhabitant (per capita ratio) was added with motivating costs according to results of work. The effectiveness of such treatment of TB patients at the outpatient stage is 90%, while in whole on the basis of a current system the effectiveness of treatment of newly diagnosed pulmonary TB with positive swab is around 60% in the country. Even though Ukraine has 5.24 TB beds per 10 000 citizens. Implemented pilot model of ambulatory treatment will be used for the creation of costs system according to results of activities, the integration of TB and primary health and social services and their focus on achieving results, the reduction of inpatient treatment of tuberculosis.

Keywords: health care reform, multi-drug resistant tuberculosis, outpatient treatment efficiency, tuberculosis

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104 Evaluating Urban City Indices: A Study for Investigating Functional Domains, Indicators and Integration Methods

Authors: Fatih Gundogan, Fatih Kafali, Abdullah Karadag, Alper Baloglu, Ersoy Pehlivan, Mustafa Eruyar, Osman Bayram, Orhan Karademiroglu, Wasim Shoman

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Nowadays many cities around the world are investing their efforts and resources for the purpose of facilitating their citizen’s life and making cities more livable and sustainable by implementing newly emerged phenomena of smart city. For this purpose, related research institutions prepare and publish smart city indices or benchmarking reports aiming to measure the city’s current ‘smartness’ status. Several functional domains, various indicators along different selection and calculation methods are found within such indices and reports. The selection criteria varied for each institution resulting in inconsistency in the ranking and evaluating. This research aims to evaluate the impact of selecting such functional domains, indicators and calculation methods which may cause change in the rank. For that, six functional domains, i.e. Environment, Mobility, Economy, People, Living and governance, were selected covering 19 focus areas and 41 sub-focus (variable) areas. 60 out of 191 indicators were also selected according to several criteria. These were identified as a result of extensive literature review for 13 well known global indices and research and the ISO 37120 standards of sustainable development of communities. The values of the identified indicators were obtained from reliable sources for ten cities. The values of each indicator for the selected cities were normalized and standardized to objectively investigate the impact of the chosen indicators. Moreover, the effect of choosing an integration method to represent the values of indicators for each city is investigated by comparing the results of two of the most used methods i.e. geometric aggregation and fuzzy logic. The essence of these methods is assigning a weight to each indicator its relative significance. However, both methods resulted in different weights for the same indicator. As a result of this study, the alternation in city ranking resulting from each method was investigated and discussed separately. Generally, each method illustrated different ranking for the selected cities. However, it was observed that within certain functional areas the rank remained unchanged in both integration method. Based on the results of the study, it is recommended utilizing a common platform and method to objectively evaluate cities around the world. The common method should provide policymakers proper tools to evaluate their decisions and investments relative to other cities. Moreover, for smart cities indices, at least 481 different indicators were found, which is an immense number of indicators to be considered, especially for a smart city index. Further works should be devoted to finding mutual indicators representing the index purpose globally and objectively.

Keywords: functional domain, urban city index, indicator, smart city

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