Search results for: systematic%20review
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1761

Search results for: systematic%20review

591 Smallholder Farmers’ Adaptation Strategies and Socioeconomic Determinants of Climate Variability in Boset District, Oromia, Ethiopia

Authors: Hurgesa Hundera, Samuel Shibeshibikeko, Tarike Daba, Tesfaye Ganamo

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The study aimed at examining the ongoing adaptation strategies used by smallholder farmers in response to climate variability in Boset district. It also assessed the socioeconomic factors that influence the choice of adaptation strategies of smallholder farmers to climate variability risk. For attaining the objectives of the study, both primary and secondary sources of data were employed. The primary data were obtained through a household questionnaire, key informant interviews, focus group discussions, and observations, while secondary data were acquired through desk review. Questionnaires were distributed and filled by 328 respondents, and they were identified through systematic random sampling technique. Descriptive statistics and binary logistic regression model were applied in this study as the main analytical methods. The findings of the study reveal that the sample households have utilized multiple adaptation strategies in response to climate variability, such as cropping early mature crops, planting drought resistant crops, growing mixed crops on the same farm lands, and others. The results of the binary logistic model revealed that education, sex, age, family size, off farm income, farm experience, access to climate information, access to farm input, and farm size were significant and key factors determining farmers’ choice of adaptation strategies to climate variability in the study area. To enable effective adaptation measures, Ministry of Agriculture and Natural Resource, with its regional bureaus and offices and concerned non–governmental organizations, should consider climate variability in their planning and budgeting in all levels of decision making.

Keywords: adaptation strategies, boset district, climate variability, smallholder farmers

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590 Changing Pedagogy from Segregation to Inclusion: A Phenomenological Case Study of Ten Special Educators

Authors: Monique Somma

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As special education service delivery models are shifting in order to better meet the academic and social rights of students with exceptionalities, teaching practices must also align with these goals. This phenomenological case study explored the change experiences of special education teachers who have transitioned from teaching in a self-contained special education class to an inclusive class setting. Ten special educators who had recently changed their teaching roles to inclusive classrooms, completed surveys and participated in a focus group. Of the original ten educators, five chose to participate further in individual interviews. Data collected from the three methods was examined and compared for common themes. Emergent themes included, support and training, attitudes and perceptions, inclusive practice, growth and change, and teaching practice. The overall findings indicated that despite their special education training, these educators were challenged by their own beliefs and expectations, the attitudes of others and systematic barriers in the education system. They were equally surprised by the overall social and academic performance of students with exceptionalities in inclusive classes, as well as, the social and academic growth and development of the other students in the class. Over the course of their careers, they all identified an overall personal pedagogical shift, to some degree or another, which they contributed to the successful experiences of inclusion they had. They also recognized that collaborating with others was essential for inclusion to be successful. The findings from this study suggest several implications for professional development and training needs specific to special education teachers moving into inclusive settings. Maximizing the skills of teachers with special education experience in a Professional Learning Community (PLC) and mentorship opportunities would be beneficial to all staffs working toward creating inclusive classrooms and schools.

Keywords: attitudes and perceptions, inclusion of students with exceptionalities, special education teachers, teacher change

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589 Symbolic Status of Architectural Identity: Example of Famagusta Walled City

Authors: Rafooneh Mokhtarshahi Sani

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This study explores how the residents of a conserved urban area have used goods and ideas as resources to maintain an enviable architectural identity. Whereas conserved urban quarters are seen as role model for maintaining architectural identity, the article describes how their residents try to give a contemporary modern image to their homes. It is argued that despite the efforts of authorities and decision makers to keep and preserve the traditional architectural identity in conserved urban areas, people have already moved on and have adjusted their homes with their preferred architectural taste. Being through such conflict of interests, have put the future of architectural identity in such places at risk. The thesis is that, on the one hand, such struggle over a desirable symbolic status in identity formation is taking place, and, on the other, it is continuously widening the gap between the real and ideal identity in the built environment. The study then analytically connects the concept of symbolic status to current identity debates. As an empirical research, this study uses systematic social and physical observation methods to describe and categorize the characteristics of settlements in Walled City of Famagusta, which symbolically represent the modern houses. The Walled City is a cultural heritage site, which most of its urban context has been conserved. Traditional houses in this area demonstrate the identity of North Cyprus architecture. The conserved residential buildings, however, either has been abandoned or went through changes by their users to present the ideal image of contemporary life. In the concluding section, the article discusses the differences between the symbolic status of people and authorities in defining a culturally valuable contemporary home. And raises the question of whether we can talk at all about architectural identity in terms of conserving the traditional style, and how we may do so on the basis of dynamic nature of identity and the necessity of its acceptance by the users.

Keywords: symbolic status, architectural identity, conservation, facades, Famagusta walled city

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588 The Impact of Bim Technology on the Whole Process Cost Management of Civil Engineering Projects in Kenya

Authors: Nsimbe Allan

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The study examines the impact of Building Information Modeling (BIM) on the cost management of engineering projects, focusing specifically on the Mombasa Port Area Development Project. The objective of this research venture is to determine the mechanisms through which Building Information Modeling (BIM) facilitates stakeholder collaboration, reduces construction-related expenses, and enhances the precision of cost estimation. Furthermore, the study investigates barriers to execution, assesses the impact on the project's transparency, and suggests approaches to maximize resource utilization. The study, selected for its practical significance and intricate nature, conducted a Systematic Literature Review (SLR) using credible databases, including ScienceDirect and IEEE Xplore. To constitute the diverse sample, 69 individuals, including project managers, cost estimators, and BIM administrators, were selected via stratified random sampling. The data were obtained using a mixed-methods approach, which prioritized ethical considerations. SPSS and Microsoft Excel were applied to the analysis. The research emphasizes the crucial role that project managers, architects, and engineers play in the decision-making process (47% of respondents). Furthermore, a significant improvement in cost estimation accuracy was reported by 70% of the participants. It was found that the implementation of BIM resulted in enhanced project visibility, which in turn optimized resource allocation and facilitated the process of budgeting. In brief, the study highlights the positive impacts of Building Information Modeling (BIM) on collaborative decision-making and cost estimation, addresses challenges related to implementation, and provides solutions for the efficient assimilation and understanding of BIM principles.

Keywords: cost management, resource utilization, stakeholder collaboration, project transparency

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587 A Taxonomic Study on Cephalopods (Mollusca: Cephalopoda) from the Northern Bay of Bengal

Authors: Foyezunnesa Setu, S. M. Sharifuzzaman

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Cephalopods, belonging to the taxonomic class Cephalopoda under the phylum Mollusca, have a global distribution and are particularly common in the coastal waters of Bangladesh, specifically in the southeast and southwest regions. Identifying them can be difficult due to their pliable anatomical characteristics. Due to the presence of concealed cephalopod species within the orders Sepioidea, Teuthoidea, and Octopoda, these groupings of invertebrates, which share common characteristics, are frequently misidentified as distinct entities. Until now, cephalopods have been ignored because there is not enough knowledge about the specific species and the necessary preliminary research has not been done. This study offers a systematic description of various cephalopod species found along the south eastern coast of Bangladesh. A combined total of 25 cuttlefish specimens, four squid specimens, and five octopus specimens were gathered from the shores of Saint Martin's Island and Cox's Bazar. Based on morphological analysis, a total of 14 cephalopod species are identified. These species include Sepia aculeata, Sepia esculenta, Sepia pharaonis, Sepia prashadi, Sepiella inermis, Sepiella japonica, Uroteuthis duvauceli, Doryteuthis singhalensis, Sepioteuthis sepioidea, Eupryma stenodactyla, Amphioctopus aegina, Callistoctopus macropus, Octopus ceynea, and Octopus vulgaris. Six newly discovered species, including Sepia prashadi, Sepiella japonica, Sepioteuthis sepioidea, Eupryma stenodactyla, Callistoctopus macropus, and Octopus ceynea, have been identified in Bangladesh. Taxonomically, the identification of cephalopods is difficult due to the significant resemblance between species and the scarcity of information and preparatory research. This study offers significant insights about the cephalopod fauna found in the northern region of the Bay of Bengal.

Keywords: cephalopods, new records, northern bay of bengal, taxonomic identification

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586 Systematic Review and Meta-Analysis of Mid-Term Survival, and Recurrent Mitral Regurgitation for Robotic-Assisted Mitral Valve Repair

Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

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585 Knowledge, Perception and Practice of Deworming among Mothers of Under-Five Children in Rural Communities of Lafia Local Government Area, North Central Nigeria

Authors: Bahago I. N., Oyewole O. E.

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Nigeria has the second highest prevalence of intestinal worms globally, which has not declined since the 1970s, especially in rural communities. Identifying the gaps in self-care practice will pave a way for a suitable intervention. This study investigated the knowledge, perception, and practice of deworming among mothers of under-five children in rural communities of Lafia Local Government Area, Nasarawa State. This study was descriptive cross-sectional and involved 419 mothers selected by systematic sampling technique. Information was obtained using a valid interviewer-questionnaire. Knowledge, perception, and practice was measured using a 10-point scale for each variable, respectively. Scores of 0-4, >4-6, and >6 were categorised as poor, average/fair, and good, respectively, at p<0.05 level of significance. Respondents’ age was 30.3±9.2 years; 46.5% were into trading, 26.7% were unemployed, 9.3% were skilled labour, and 7.4% were farmers. On literacy, secondary school (25.5%) while 9.1% above secondary school. Many (51.1%) had 2-3 children, while 42.2% had 5 or more children. Most of the respondents (96.2%) had good knowledge of deworming, and 3.8% had fair knowledge. Using multivariate model, Mothers between the ages of 25-34 years were 20 times likely to be more knowledgeable, given they have access to health information (O.R 2.39 -164.31). Most (62.3%) had good perception scores, 33.2% had fair scores, while 4.5% had poor perception scores. Majority (66.4%) had a good deworming practice of deworming, 66.4% had good, 28.4% had fair, and 5.3% had poor practice. The test of association between Parent's literacy level, religion, and age were significantly associated with the level of knowledge of deworming. Knowledge of deworming was above average; perception and practice was good. Women of ages 25-34 years could be trained as community volunteers to propagate the right information about deworming in rural communities, especially among young women of ages 13-19 years. Preferred channels to obtaining health information identified in the study should be explored.

Keywords: deworming, mothers of under-five, intestinal worms, rural communities

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584 Challenges of eradicating neglected tropical diseases

Authors: Marziye Hadian, Alireza Jabbari

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Background: Each year, tropical diseases affect large numbers of tropical or subtropical populations and give rise to irreparable financial and human damage. Among these diseases, some are known as Neglected Tropical Disease (NTD) that may cause unusual dangers; however, they have not been appropriately accounted for. Taking into account the priority of eradication of the disease, this study explored the causes of failure to eradicate neglected tropical diseases. Method: This study was a systematized review that was conducted in January 2021 on the articles related to neglected tropical diseases on databases of Web of Science, PubMed, Scopus, Science Direct, Ovid, Pro-Quest, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as well as Critical Appraisal Skills Program (CASP) for articles and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) for grey literature (provides five criteria for judging the quality of grey information) were integrated. Finding: The challenges in controlling and eradicating neglected tropical diseases in four general themes are as follows: shortcomings in disease management policies and programs, environmental challenges, executive challenges in policy disease and research field and 36 sub-themes. Conclusion: To achieve the goals of eradicating forgotten tropical diseases, it seems indispensable to free up financial, human and research resources, proper management of health infrastructure, attention to migrants and refugees, clear targeting, prioritization appropriate to local conditions and special attention to political and social developments. Reducing the number of diseases should free up resources for the management of neglected tropical diseases prone to epidemics as dengue, chikungunya and leishmaniasis. For the purpose of global support, targeting should be accurate.

Keywords: neglected tropical disease, NTD, preventive, eradication

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583 Digital Content Strategy (DCS) Detailed Review of the Key Content Components

Authors: Oksana Razina, Shakeel Ahmad, Jessie Qun Ren, Olufemi Isiaq

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The modern life of businesses is categorically reliant on their established position online, where digital (and particularly website) content plays a significant role as the first point of information. Digital content, therefore, becomes essential – from making the first impression to the building and development of client relationships. Despite a number of valuable papers suggesting a strategic approach when dealing with digital data, other sources often do not view or accept the approach to digital content as a holistic or continuous process. Associations are frequently made with merely a one-off marketing campaign or similar. The challenge is to establish an agreed definition for the notion of Digital Content Strategy, which currently does not exist, as DCS is viewed from an excessive number of different angles. A strategic approach to content, nonetheless, is required, both practically and contextually. The researchers, therefore, aimed at attempting to identify the key content components comprising a digital content strategy to ensure all the aspects were covered and strategically applied – from the company’s understanding of the content value to the ability to display flexibility of content and advances in technology. This conceptual project evaluated existing literature on the topic of Digital Content Strategy (DCS) and related aspects, using the PRISMA Systematic Review Method, Document Analysis, Inclusion and Exclusion Criteria, Scoping Review, Snow-Balling Technique and Thematic Analysis. The data was collected from academic and statistical sources, government and relevant trade publications. Based on the suggestions from academics and trading sources related to the issues discussed, the researchers revealed the key actions for content creation and attempted to define the notion of DCS. The major finding of the study presented Key Content Components of Digital Content Strategy and can be considered for implementation in a business retail setting.

Keywords: digital content strategy, key content components, websites, digital marketing strategy

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582 Post-Discharge Oral Nutritional Supplements Following Gastric Cancer Surgery: A systematic Review

Authors: Mohammad Mohammadi, Mohammad Pashmchi

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Background: Malnutrition commonly develops and worsens following gastric cancer surgery, particularly after discharge, which is associated with adverse outcomes. Former studies have primarily focused on patients during their hospital stay period, and there is limited evidence regarding the recommendation of nutritional interventions for patients after discharge from the hospital following gastric cancer surgery. This review is aimed to evaluate the efficiency of post-discharge dietary counseling with oral nutritional supplements (ONS), and dietary counseling alone on post-surgical nutritional outcomes in patients undergoing gastric cancer surgery. Methods: The four databases of Embase, PubMed, web of science, and google scholar were searched up to November 2022 for relevant randomized controlled trials. The Cochrane Collaboration’s assessment tool for randomized trials was used to evaluate the quality of studies. Results: Compared to patients who only received dietary counseling, patients who received both dietary counseling and ONS had considerably higher SMI, BMI, and less weight loss and sarcopenia occurrence rate. The patients who had received dietary counseling and ONS had significantly lower risk of chemotherapy intolerance. No differences in the readmission rate between the two groups was found. In terms of the quality of life, concomitant dietary advice and ONS significantly was associated with lower appetite loss and fatigue rate, but there was no difference in the other outcomes between the two groups. Conclusions: Post-discharge dietary advice with ONS following gastric cancer surgery may improve skeletal muscle maintenance, nutritional outcomes, quality of life variables, and chemotherapy tolerance. This evidence supports the recommendation of post-discharge dietary advice with ONS for patients who underwent gastric cancer surgery.

Keywords: gastric cancer surgery, oral nutritional supplements, malnutrition, gastric cancer

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581 Democratic Action as Insurgency: On Claude Lefort's Concept of the Political Regime

Authors: Lorenzo Buti

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This paper investigates the nature of democratic action through a critical reading of Claude Lefort’s notion of the democratic ‘regime’. Lefort provides one of the most innovative accounts of the essential features of a democratic regime. According to him, democracy is a political regime that acknowledges the indeterminacy of a society and stages it as a contestation between competing political actors. As such, democracy provides the symbolic markers of society’s openness towards the future. However, despite their democratic features, the recent decades in late capitalist societies attest to a sense of the future becoming fixed and predetermined. This suggests that Lefort’s conception of democracy harbours a misunderstanding of the character and experience of democratic action. This paper examines this underlying tension in Lefort’s work. It claims that Lefort underestimates how a democratic regime, next to its symbolic function, also takes a materially constituted form with its particular dynamics of power relations. Lefort’s systematic dismissal of this material dimension for democratic action can lead to the contemporary paradoxical situation where democracy’s symbolic markers are upheld (free elections, public debate, dynamic between government and opposition in parliament,…) but the room for political decision-making is constrained due to a myriad of material constraints (e.g., market pressures, institutional inertias). The paper draws out the implications for the notion of democratic action. Contra Lefort, it argues that democratic action necessarily targets the material conditions that impede the capacity for decision-making on the basis of equality and liberty. This analysis shapes our understanding of democratic action in two ways. First, democratic action takes an asymmetrical, insurgent form, as a contestation of material power relations from below. Second, it reveals an ambivalent position vis-à-vis the political regime: democratic action is symbolically made possible by the democratic dispositive, but it contests the constituted form that the democratic regime takes.

Keywords: Claude Lefort, democratic action, material constitution, political regime

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580 Novel Wound Healing Biodegradable Patch of Bioactive

Authors: Abhay Asthana, Shally Toshkhani, Gyati Shilakari

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The present research was aimed to develop a biodegradable dermal patch formulation for wound healing in a novel, sustained and systematic manner. The goal is to reduce the frequency of dressings with improved drug delivery and thereby enhance therapeutic performance. In present study optimized formulation was designed using component polymers and excipients (e.g. Hydroxypropyl methyl cellulose, Ethylcellulose, and Gelatin) to impart significant folding endurance, elasticity and strength. Gelatin was used to get a mixture using ethylene glycol. Chitosan dissolved in suitable medium was mixed with stirring to gelatin mixture. With continued stirring to the mixture Curcumin was added in optimized ratio to get homogeneous dispersion. Polymers were dispersed with stirring in final formulation. The mixture was sonicated casted to get the film form. All steps were carried out under under strict aseptic conditions. The final formulation was a thin uniformly smooth textured film with dark brown-yellow color. The film was found to have folding endurance was around 20 to 21 times without a crack in an optimized formulation at RT (23C). The drug content was in range 96 to 102% and it passed the content uniform test. The final moisture content of the optimized formulation film was NMT 9.0%. The films passed stability study conducted at refrigerated conditions (4±0.2C) and at room temperature (23 ± 2C) for 30 days. Further, the drug content and texture remained undisturbed with stability study conducted at RT 23±2C for 45 and 90 days. Percentage cumulative drug release was found to be 80% in 12 h and matched the biodegradation rate as drug release with correlation factor R2 > 0.9. The film based formulation developed shows promising results in terms of stability and release profiles.

Keywords: biodegradable, patch, bioactive, polymer

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579 Historical Analysis of Two Types of Urbanization Changing Both the Aspect and Identity of a Town in Transylvania, Romania

Authors: Ágota Ladó

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Miercurea Ciuc is a town in the historical region of Szeklerland in Transylvania, Romania, with a predominantly Hungarian population (its name in Hungarian being Csíkszereda) having an urban landscape and environment that has been shaped dramatically by different perceptions of urbanization during the history. The town has been part of Hungary and the Austro-Hungarian Empire before the First World War. It even got an important role, becoming in 1876 the seat and administrative center of the historical Csík county. This marks the beginning of the first urbanization process: new administrative buildings, railways, a railway station, a hospital, a Redoute and new schools have been built, new streets have been opened. However, not only the public facilities have changed: the center of the town with its private houses has also transformed, new, modern decorative and lifestyle elements have appeared. One of the streets from the town center, Kossuth street, has been featured on many postcards of the time; even a novel has mentioned it as a symbol of modern urbanization. Right after the First World War, the town became part of Romania and aside from a short interruption (between 1940 and 1944), it is still part of it. The beginning of the second major urbanization process – exactly one hundred years later - is marked by the visit of the communist leader Nicolae Ceaușescu in Miercurea Ciuc on the 6th of October 1976. In the upcoming years, he decided and started to demolish the old Kossuth street and to construct a new avenue with tall blocks of flats according to the principles of socialist urbanization. No other Transylvanian settlement has gone through such systematic abolition of its historical center and urban history during the Communist era. Not only the urban landscape has been affected. The collective memory and contemporary identity of the locals are also violated by this recent transformation of the town: important spaces, buildings, venues of activities and events simply cannot be localized, thus understood - by the younger generations.

Keywords: communist era, historical urban landscape, urban identity, urbanization

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578 Open Reading Frame Marker-Based Capacitive DNA Sensor for Ultrasensitive Detection of Escherichia coli O157:H7 in Potable Water

Authors: Rehan Deshmukh, Sunil Bhand, Utpal Roy

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We report the label-free electrochemical detection of Escherichia coli O157:H7 (ATCC 43895) in potable water using a DNA probe as a sensing molecule targeting the open reading frame marker. Indium tin oxide (ITO) surface was modified with organosilane and, glutaraldehyde was applied as a linker to fabricate the DNA sensor chip. Non-Faradic electrochemical impedance spectroscopy (EIS) behavior was investigated at each step of sensor fabrication using cyclic voltammetry, impedance, phase, relative permittivity, capacitance, and admittance. Atomic force microscopy (AFM) and scanning electron microscopy (SEM) revealed significant changes in surface topographies of DNA sensor chip fabrication. The decrease in the percentage of pinholes from 2.05 (Bare ITO) to 1.46 (after DNA hybridization) suggested the capacitive behavior of the DNA sensor chip. The results of non-Faradic EIS studies of DNA sensor chip showed a systematic declining trend of the capacitance as well as the relative permittivity upon DNA hybridization. DNA sensor chip exhibited linearity in 0.5 to 25 pg/10mL for E. coli O157:H7 (ATCC 43895). The limit of detection (LOD) at 95% confidence estimated by logistic regression was 0.1 pg DNA/10mL of E. coli O157:H7 (equivalent to 13.67 CFU/10mL) with a p-value of 0.0237. Moreover, the fabricated DNA sensor chip used for detection of E. coli O157:H7 showed no significant cross-reactivity with closely and distantly related bacteria such as Escherichia coli MTCC 3221, Escherichia coli O78:H11 MTCC 723 and Bacillus subtilis MTCC 736. Consequently, the results obtained in our study demonstrated the possible application of developed DNA sensor chips for E. coli O157:H7 ATCC 43895 in real water samples as well.

Keywords: capacitance, DNA sensor, Escherichia coli O157:H7, open reading frame marker

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577 Decision Making in Medicine and Treatment Strategies

Authors: Kamran Yazdanbakhsh, Somayeh Mahmoudi

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Three reasons make good use of the decision theory in medicine: 1. Increased medical knowledge and their complexity makes it difficult treatment information effectively without resorting to sophisticated analytical methods, especially when it comes to detecting errors and identify opportunities for treatment from databases of large size. 2. There is a wide geographic variability of medical practice. In a context where medical costs are, at least in part, by the patient, these changes raise doubts about the relevance of the choices made by physicians. These differences are generally attributed to differences in estimates of probabilities of success of treatment involved, and differing assessments of the results on success or failure. Without explicit criteria for decision, it is difficult to identify precisely the sources of these variations in treatment. 3. Beyond the principle of informed consent, patients need to be involved in decision-making. For this, the decision process should be explained and broken down. A decision problem is to select the best option among a set of choices. The problem is what is meant by "best option ", or know what criteria guide the choice. The purpose of decision theory is to answer this question. The systematic use of decision models allows us to better understand the differences in medical practices, and facilitates the search for consensus. About this, there are three types of situations: situations certain, risky situations, and uncertain situations: 1. In certain situations, the consequence of each decision are certain. 2. In risky situations, every decision can have several consequences, the probability of each of these consequences is known. 3. In uncertain situations, each decision can have several consequences, the probability is not known. Our aim in this article is to show how decision theory can usefully be mobilized to meet the needs of physicians. The decision theory can make decisions more transparent: first, by clarifying the data systematically considered the problem and secondly by asking a few basic principles should guide the choice. Once the problem and clarified the decision theory provides operational tools to represent the available information and determine patient preferences, and thus assist the patient and doctor in their choices.

Keywords: decision making, medicine, treatment strategies, patient

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576 Effect of Tool Size and Cavity Depth on Response Characteristics during Electric Discharge Machining on Superalloy Metal - An Experimental Investigation

Authors: Sudhanshu Kumar

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Electrical discharge machining, also known as EDM, process is one of the most applicable machining process for removal of material in hard to machine materials like superalloy metals. EDM process utilizes electrical energy into sparks to erode the metals in presence of dielectric medium. In the present investigation, superalloy, Inconel 718 has been selected as workpiece and electrolytic copper as tool electrode. Attempt has been made to understand the effect of size of tool with varying cavity depth during drilling of hole through EDM process. In order to systematic investigate, tool size in terms of tool diameter and cavity depth along with other important electrical parameters namely, peak current, pulse-on time and servo voltage have been varied at three different values and the experiments has been designed using fractional factorial (Taguchi) method. Each experiment has been repeated twice under the same condition in order to understand the variability within the experiments. The effect of variations in parameters has been evaluated in terms of material removal rate, tool wear rate and surface roughness. Results revel that change in tool diameter during machining affects the response characteristics significantly. Larger tool diameter yielded 13% more material removal rate than smaller tool diameter. Analysis of the effect of variation in cavity depth is notable. There is no significant effect of cavity depth on material removal rate, tool wear rate and surface quality. This indicates that number of experiments can be performed to analyze other parameters effect even at smaller depth of cavity which can reduce the cost and time of experiments. Further, statistical analysis has been carried out to identify the interaction effect between parameters.

Keywords: EDM, Inconel 718, material removal rate, roughness, tool wear, tool size

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575 Expert Solutions to Affordable Housing Finance Challenges in Developing Economies

Authors: Timothy Akinwande, Eddie C. M. Hui

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Housing the urban poor has remained a challenge for many years across the world, especially in developing economies, despite the apparent research attention and policy interventions. It is apt to investigate the prevalent affordable housing (AH) provision challenges using unconventional approaches. It is pragmatic to thoroughly examine housing experts to provide supply-side solutions to AH challenges and investigate informal settlers to deduce solutions from AH demand viewpoints. This study being the supply-side investigation of an ongoing research, interrogated housing experts to determine significant expert solutions. Focus group discussions and in-depth interviews were conducted with housing experts in Nigeria. Through descriptive, content, and systematic thematic analyses of data, major findings are that deliberate finance models designed for the urban poor are the most significant housing finance solution in developing economies. Other findings are that adequately implemented rent control policies, deliberate PPP approaches like inclusionary housing and land-value capture, and urban renewal programmes to enlighten and tutor the urban poor on how to earn more, spend wisely, and invest in their own better housing will effectively solve AH finance challenges. Study findings are informative for the best approaches to achieve effective, affordable housing finance for the urban poor in Nigeria, which is indispensable for the achievement of sustainable development goals. This research’s originality lies in the exploration of experts’ opinions in relation to AH finance to produce an equation model of critical solutions to AH finance challenges. Study data are useful resources for future pro-poor housing studies. This study makes housing policy-oriented recommendations toward effective, affordable housing for the urban poor in developing countries.

Keywords: affordable housing, effective affordable housing, housing policy, housing research, sustainable development, urban poor

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574 The Potential of Southern Malang as Geotourism Site: The Distribution of Geodiversity and Geotrek in Southern Malang, Indonesia

Authors: Arda Bagus M, Yehezkiel Festian P, Budianto Santoso

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The Tourism Area of Southern Malang is administratively located in the Regency of Malang, East Java Province, Indonesia and geographically is in a position between 112o17' - 112o57' E dan 7o44' - 8o26' S. Southern Malang consists of several sub-districts that directly borders with the Indian Ocean, such as Donomulyo, Bantur, Gedangan, Sumbermanjing, Tirto Yudo, and Ampel Gading. This area has a high geotourism potential because of the existence of geodiversity such as beaches, waterfalls, caves, and karst area. However, to the best of the authors’ knowledge, there is still no systematic data that informs the geotourism potentials to the public. The aim of this research is to complete the lack of data and then arrange it systematically so it can be used for both tourism and research purposes. Research methods such as field observation, literature study, and depth interview to local people have been implemented. Aspects reviewed by visiting the field are accommodation, transportation, and the feasibility of a place to be geotourism object. The primary data was taken in Sumbermanjing, Gedangan, Bantur, and Donomulyo sub-district. A literature study is needed to determine the regional geology of Southern Malang and as a comparison to new data obtained in the field. The results of the literature study show that southern Malang consists of three formations: Wonosari Formation, Mandalaka Formation, and River-swamps Sediment Formation with the age range of Oligocene to Quaternary. Depth interviews have been conducted by involving local people with the aim of knowing cultural-history in the research area. From this research, the geotourism object distribution map has been made. The map also includes Geotrek and basic geological information of each object. The results of this research can support the development of geotourism in Southern Malang.

Keywords: geodiversity, geology, geotourism, geotrek, southern Malang

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573 Factors Affecting Long-Term and Permanent Contraceptive Uptake among Immediate Post-Partum Mothers at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia: A Cross-Sectional Study

Authors: Lemi Tolu

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Background: Postpartum family planning (PPFP) focuses on the prevention of unintended and closely spaced pregnancies through the first 12 months following childbirth. Objective: This study assesses the barriers to uptake of long-term and permanent family planning methods among immediate post-partum mothers at Saint Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. Methodology: An institution-based cross-sectional study was conducted from January 1 to June 30, 2017. The six months of study were used as strata, and systematic sampling used to select participants in each month. Post-partum mothers were interviewed using pretested structured questionnaires. Data entry and analysis were done using SPSS version 17. Bivariate and multivariable logistic regressions were fitted to identify determinants of post-partum family planning uptake. An OR with 95% CIs was calculated, and p values set at 005 were used to determine the statistical significance of associations. Results: Four hundred and twenty-two post-partum women were interviewed. Two hundred sixty-eight (63%) women received counselling on family planning, and 241 (66.8 %) got information about contraception. One hundred and fifty-two (45%) of the women accepted long-term and permanent contraception on their immediate postpartum period before discharge. Contraceptive counselling (OR = 2.13, 95% CI 1.004-3.331), getting information from the health facility (OR = 15.15, 95% CI 1.848-19.242), and partner support (OR = 1.367, 95% CI 1.175-2.771) were significantly associated with long-term and permanent contraception uptake. Conclusion: Postpartum counselling on family planning and provision of contraception information improve immediate postpartum FP acceptance, and, hence postpartum programs need to strengthen such services.

Keywords: contraception, immediate postpartum, long-term family planning, post-partum family planning

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572 A Systematic Categorization of Arguments against the Vision Zero Goal: A Literature Review

Authors: Henok Girma Abebe

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The Vision Zero is a long-term goal of preventing all road traffic fatalities and serious injuries which was first adopted in Sweden in 1997. It is based on the assumption that death and serious injury in the road system is morally unacceptable. In order to approach this end, vision zero has put in place strategies that are radically different from the traditional safety work. The vision zero, for instance, promoted the adoption of the best available technology to promote safety, and placed the ultimate responsibility for traffic safety on system designers. Despite Vision Zero’s moral appeal and its expansion to different safety areas and also parts of the world, important philosophical concerns related to the adoption and implementation of the vision zero remain to be addressed. Moreover, the vision zero goal has been criticized on different grounds. The aim of this paper is to identify and systematically categorize criticisms that have been put forward against vision zero. The findings of the paper are solely based on a critical analysis of secondary sources and snowball method is employed to identify the relevant philosophical and empirical literatures. Two general categories of criticisms on the vision zero goal are identified. The first category consists of criticisms that target the setting of vision zero as a ‘goal’ and some of the basic assumptions upon which the goal is based. Among others, the goal of achieving zero fatalities and serious injuries, together with vision zero’s lexicographical prioritization of safety has been criticized as unrealistic. The second category consists of criticisms that target the strategies put in place to achieve the goal of zero fatalities and serious injuries. For instance, Vision zero’s responsibility ascription for road safety and its rejection of cost-benefit analysis in the formulation and adoption of safety measures has both been criticized as counterproductive. In this category also falls the criticism that Vision Zero safety measures tend to be too paternalistic. Significant improvements have been recorded in road safety work since the adoption of vision zero, however, for the vision zero to even succeed more, it is important that issues and criticisms of philosophical nature associated with it are identified and critically dealt with.

Keywords: criticisms, systems approach, traffic safety, vision zero

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571 A Self-Study of the Facilitation of Science Teachers’ Action Research

Authors: Jawaher A. Alsultan, Allen Feldman

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With the rapid switch to remote learning due to the COVID-19 pandemic, science teachers were suddenly required to teach their classes online. This breakneck shift to eLearning raised the question of how teacher educators could support science teachers who wanted to use reform-based methods of instruction while using virtual technologies. In this retrospective self-study, we, two science teacher educators, examined our practice as we worked with science teachers to implement inquiry, discussion, and argumentation [IDA] through eLearning. Ten high school science teachers from a large school district in the southeastern US participated virtually in the COVID-19 Community of Practice [COVID-19 CoP]. The CoP met six times from the end of April through May 2020 via Zoom. Its structure was based on a model of action research called enhanced normal practice [ENP], which includes exchanging stories, trying out ideas, and systematic inquiry. Data sources included teacher educators' meeting notes and reflective conversations, audio recordings of the CoP meetings, teachers' products, and post-interviews of the teachers. Findings included a new understanding of the role of existing relationships, shared goals, and similarities in the participants' situations, which helped build trust in the CoP, and the effects of our paying attention to the science teachers’ needs led to a well-functioning CoP. In addition, we became aware of the gaps in our knowledge of how the teachers already used apps in their practice, which they then shared with all of us about how they could be used for online teaching using IDA. We also identified the need to pay attention to feelings about tensions between the teachers and us around the expectations for final products and the project's primary goals. We found that if we are to establish relationships between us as facilitators and teachers that are honest, fair, and kind, we must express those feelings within the collective, dialogical processes that can lead to learning by all members of the CoP, whether virtual or face-to-face.

Keywords: community of practice, facilitators, self-study, action research

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570 Molecular Detection of Tuberculosis in Dogs in the Three North-Eastern States Assam, Mizoram and Nagaland of India

Authors: A. G. Barua, Uttam Rajkhowa, Pranjal Moni Nath, Nur Abdul Kadir

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Mycobacterium tuberculosis (MTB) is one of the most closely-related intracellular bacterial pathogens, grouped as the M. tuberculosis complex (MTC). MTB, the primary agent of human tuberculosis (TB), can develop clinical TB in animals as 75 percent of canine mycobacterial infection is caused by close contact with an infected human being. In the present study, molecular detection of TB in dogs in three North-eastern states of India, Assam Mizoram, and Nagaland was carried out. So far, there has been a lack of systematic study in these regions, hampered by slow diagnostic methods and poor infrastructure. In an attempt to rectify this situation, molecular epidemiology was carried out for nine months to detect canine TB in a sample of 340 dogs. Isolation of DNA was done with swabs (throat/nasal), nodules of lungs and fluids from 100 suspected dogs and the molecular study were carried out with the help of conventional and real-time PCR. Post-mortem study was also carried out. Our results showed that the prevalence of clinical TB in dogs from a high-risk setting was 1 percent. However, the prevalence of immunological sensitization to M. tuberculosis antigen in dogs living in contact with sputum smeared positive TB cases was almost 50 percent. The latter setting had the maximum impact in terms of TB transmission. During the study period, a survey with a standard questionnaire was carried out in the TB hospitals to study reverse zoonosis. It was observed that an infected human being was one of the major risk factors for dogs to contract the infection. This observation was drawn by examining the probable airborne transmission from humans to their pets or strays. The present study helped to discover the nuances of TB transmission more clearly and systematically as compared to other sporadic tests to detect MTB in canine.

Keywords: Assam and Nagaland, canine TB, India, molecular detection, tuberculosis

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569 Research on Localized Operations of Multinational Companies in China

Authors: Zheng Ruoyuan

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With the rapid development of economic globalization and increasingly fierce international competition, multinational companies have carried out investment strategy shifts and innovations, and actively promoted localization strategies. Localization strategies have become the main trend in the development of multinational companies. Large-scale entry of multinational companies China has a history of more than 20 years. With the sustained and steady growth of China's economy and the optimization of the investment environment, multinational companies' investment in China has expanded rapidly, which has also had an important impact on the Chinese economy: promoting employment, foreign exchange reserves, and improving the system. etc., has brought a lot of high-tech and advanced management experience; but it has also brought challenges and survival pressure to China's local enterprises. In recent years, multinational companies have gradually regarded China as an important part of their global strategies and began to invest in China. Actively promote localization strategies, including production, marketing, scientific research and development, etc. Many multinational companies have achieved good results in localized operations in China. Not only have their benefits continued to improve, but they have also established a good corporate image and brand in China. image, which has greatly improved their competitiveness in the international market. However, there are also some multinational companies that have difficulties in localized operations in China. This article will closely follow the background of economic globalization and comprehensively use the theory of multinational companies and strategic management theory and business management theory, using data and facts as the entry point, combined with typical cases of representative significance for analysis, to conduct a systematic study of the localized operations of multinational companies in China. At the same time, for each specific link of the operation of multinational companies, we provide multinational enterprises with some inspirations and references.

Keywords: localization, business management, multinational, marketing

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568 The Role of Metaphor in Communication

Authors: Fleura Shkëmbi, Valbona Treska

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In elementary school, we discover that a metaphor is a decorative linguistic device just for poets. But now that we know, it's also a crucial tactic that individuals employ to understand the universe, from fundamental ideas like time and causation to the most pressing societal challenges today. Metaphor is the use of language to refer to something other than what it was originally intended for or what it "literally" means in order to suggest a similarity or establish a connection between the two. People do not identify metaphors as relevant in their decisions, according to a study on metaphor and its effect on decision-making; instead, they refer to more "substantive" (typically numerical) facts as the basis for their problem-solving decision. Every day, metaphors saturate our lives via language, cognition, and action. They argue that our conceptions shape our views and interactions with others and that concepts define our reality. Metaphor is thus a highly helpful tool for both describing our experiences to others and forming notions for ourselves. In therapeutic contexts, their shared goal appears to be twofold. The cognitivist approach to metaphor regards it as one of the fundamental foundations of human communication. The benefits and disadvantages of utilizing the metaphor differ depending on the target domain that the metaphor portrays. The challenge of creating messages and surroundings that affect customers' notions of abstract ideas in a variety of industries, including health, hospitality, romance, and money, has been studied for decades in marketing and consumer psychology. The aim of this study is to examine, through a systematic literature review, the role of the metaphor in communication and in advertising. This study offers a selected analysis of this literature, concentrating on research on customer attitudes and product appraisal. The analysis of the data identifies potential research questions. With theoretical and applied implications for marketing, design, and persuasion, this study sheds light on how, when, and for whom metaphoric communications are powerful.

Keywords: metaphor, communication, advertising, cognition, action

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567 Developing Urban Design and Planning Approach to Enhance the Efficiency of Infrastructure and Public Transportation in Order to Reduce GHG Emissions

Authors: A. Rostampouryasouri, A. Maghoul, S. Tahersima

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The rapid growth of urbanization and the subsequent increase in population in cities have resulted in the destruction of the environment to cater to the needs of citizens. The industrialization of urban life has led to the production of pollutants, which has significantly contributed to the rise of air pollution. Infrastructure can have both positive and negative effects on air pollution. The effects of infrastructure on air pollution are complex and depend on various factors such as the type of infrastructure, location, and context. This study examines the effects of infrastructure on air pollution, drawing on a range of empirical evidence from Iran and China. Our paper focus for analyzing the data is on the following concepts: 1. Urban design and planning principles and practices 2. Infrastructure efficiency and optimization strategies 3. Public transportation systems and their environmental impact 4. GHG emissions reduction strategies in urban areas 5. Case studies and best practices in sustainable urban development This paper employs a mixed methodology approach with a focus on developmental and applicative purposes. The mixed methods approach combines both quantitative and qualitative research methods to provide a more comprehensive understanding of the research topic. A group of 20 architectural specialists and experts who are proficient in the field of research, design, and implementation of green architecture projects were interviewed in a systematic and purposeful manner. The research method was based on content analysis using MAXQDA2020 software. The findings suggest that policymakers and urban planners should consider the potential impacts of infrastructure on air pollution and take measures to mitigate negative effects while maximizing positive ones. This includes adopting a nature-based approach to urban planning and infrastructure development, investing in information infrastructure, and promoting modern logistic transport infrastructure.

Keywords: GHG emissions, infrastructure efficiency, urban development, urban design

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566 Harnessing Community Benefits; Case Study of REDD+ in Ghana

Authors: Abdul-Razak Saeed

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Addressing the climate change crisis that this generation faces has evolved to include the consideration of a policy mechanism referred to as reduced emissions from deforestation and forest degradation with plus components of conservation, sustainable forest management and enhancement of forest carbon stocks (REDD+). REDD+ emerged from the International level of UNFCCC but its implementation is by developing countries. It challenges the development paradigm of nations that depend on the unsustainable clearing of forests and land use change for economic development whilst posing as an opportunity or risk for forest community livelihoods, institutions and their interaction with the forest resources. As a novel policy mechanism, it is imperative to gain global insight into local contexts of its implementation and to understand local level mobilization of their agency for institutional sustainability as reconfigured by new carbon economy initiatives like REDD+. Using a systematic review process, as the initial stages of this study, secondary data of REDD+ projects across the globe were evaluated to pick up gaps in research and that of on ground REDD+ implementation. Primary data was gathered from 30 actors in the government, NGO, private sector and traditional authorities using face-to-face semi structured interviews in Ghana; participation in meetings and workshops and policy and strategy document reviews. Preliminary findings of the study include REDD+ knowledge being a key determinant of power distribution and affects who shapes the process; in Ghana, informal relationships are playing key roles in advancing REDD+ unlike in traditional forestry and a subjectivity shift of local communities from an 'emotive-link' of environmental care to one of 'economic self-seeking and enriching' domain of thought.

Keywords: climate change, communities, forests, REDD+

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565 Speech Anxiety in Higher Education Students-Retention of an Ancestral Trait: A Study into the Students' Perspective of Communication Anxiety with Suggestions on How to Minimise Student Distress

Authors: Paul D. Facey, Claire Morgan

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Speech anxiety is thought to be deep-seated within the human evolutionary lineage.As a result, almost all people display high levels of anxiety when asked to communicate in front of an audience.However, proficiency in oral communication is considered as an essential skill for a graduate career and significant emphasis is placed on developing these skills in many degree programs.Because of this, many degree schemes incorporate some form of assessed dialogic presentation. Yet, a student’s anxiety over public speaking, especially if severe, can be so great that at worst it can cause the student to withdraw from their study. This study investigated how students perceive their own levels of anxiety when faced with public speaking using the Personal Report of Public Speaking Anxiety (PRPSA) questionnaire developed by McCroskey. Additionally, students were asked to provide examples of adjustments that could be implemented that they felt would alleviate some/all of their anxiety. The results of the study indicated that the majority of the students experienced a moderate level of anxiety. However, further analysis showed that of those who were in the moderate anxiety’ group, 43% fell into the higher range suggesting that overall more students experience higher levels of anxiety when faced with public speaking than maybe first envisaged. Thus, it is essential that steps are taken to address student anxiety in order that students engage with presentations, are motivated and encouraged and do not avoid such assignments. The feedback from our students indicated a need to implement systematic desensitization programs where students learn to overcome their anxiety through a series of sessions that gradually increase their anxiety levels. Furthermore, these sessions should be run in parallel with skills sessions in order for students to be better prepared and allow self-reflection and self-analysis.This study highlights the paucity of these sessions on many degree schemes and suggests that they should form an integral part of a students’ early academic learning.

Keywords: student anxiety, communication anxiety, public speaking, higher education, desensitisation

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564 Comparison of the Anthropometric Obesity Indices in Prediction of Cardiovascular Disease Risk: Systematic Review and Meta-analysis

Authors: Saeed Pourhassan, Nastaran Maghbouli

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Statement of the problem: The relationship between obesity and cardiovascular diseases has been studied widely(1). The distribution of fat tissue gained attention in relation to cardiovascular risk factors during lang-time research (2). American College of Cardiology/American Heart Association (ACC/AHA) is widely and the most reliable tool to be used as a cardiovascular risk (CVR) assessment tool(3). This study aimed to determine which anthropometric index is better in discrimination of high CVR patients from low risks using ACC/AHA score in addition to finding the best index as a CVR predictor among both genders in different races and countries. Methodology & theoretical orientation: The literature in PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched by two independent investigators using the keywords "anthropometric indices," "cardiovascular risk," and "obesity." The search strategy was limited to studies published prior to Jan 2022 as full-texts in the English language. Studies using ACC/AHA risk assessment tool as CVR and those consisted at least 2 anthropometric indices (ancient ones and novel ones) are included. Study characteristics and data were extracted. The relative risks were pooled with the use of the random-effect model. Analysis was repeated in subgroups. Findings: Pooled relative risk for 7 studies with 16,348 participants were 1.56 (1.35-1.72) for BMI, 1.67(1.36-1.83) for WC [waist circumference], 1.72 (1.54-1.89) for WHR [waist-to-hip ratio], 1.60 (1.44-1.78) for WHtR [waist-to-height ratio], 1.61 (1.37-1.82) for ABSI [A body shape index] and 1.63 (1.32-1.89) for CI [Conicity index]. Considering gender, WC among females and WHR among men gained the highest RR. The heterogeneity of studies was moderate (α²: 56%), which was not decreased by subgroup analysis. Some indices such as VAI and LAP were evaluated just in one study. Conclusion & significance: This meta-analysis showed WHR could predict CVR better in comparison to BMI or WHtR. Some new indices like CI and ABSI are less accurate than WHR and WC. Among women, WC seems to be a better choice to predict cardiovascular disease risk.

Keywords: obesity, cardiovascular disease, risk assessment, anthropometric indices

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563 Signed Language Phonological Awareness: Building Deaf Children's Vocabulary in Signed and Written Language

Authors: Lynn Mcquarrie, Charlotte Enns

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The goal of this project was to develop a visually-based, signed language phonological awareness training program and to pilot the intervention with signing deaf children (ages 6 -10 years/ grades 1 - 4) who were beginning readers to assess the effects of systematic explicit American Sign Language (ASL) phonological instruction on both ASL vocabulary and English print vocabulary learning. Growing evidence that signing learners utilize visually-based signed language phonological knowledge (homologous to the sound-based phonological level of spoken language processing) when reading underscore the critical need for further research on the innovation of reading instructional practices for visual language learners. Multiple single-case studies using a multiple probe design across content (i.e., sign and print targets incorporating specific ASL phonological parameters – handshapes) was implemented to examine if a functional relationship existed between instruction and acquisition of these skills. The results indicated that for all cases, representing a variety of language abilities, the visually-based phonological teaching approach was exceptionally powerful in helping children to build their sign and print vocabularies. Although intervention/teaching studies have been essential in testing hypotheses about spoken language phonological processes supporting non-deaf children’s reading development, there are no parallel intervention/teaching studies exploring hypotheses about signed language phonological processes in supporting deaf children’s reading development. This study begins to provide the needed evidence to pursue innovative teaching strategies that incorporate the strengths of visual learners.

Keywords: American sign language phonological awareness, dual language strategies, vocabulary learning, word reading

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562 Development of Nursing Service System Integrated Case Manager Concept for the Patients with Epilepsy at the Tertiary Epilepsy Clinic of Thailand

Authors: C. Puangsawat, C. Limotai, P. Srikhachin

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Bio-psycho-social caring was required for promoting the quality of life of the patients with epilepsy (PWE), despite controlled seizures. Multifaceted issues emerge at the epilepsy clinic. Unpredicted seizures, antiepileptic drug compliance problems/adverse effects, psychiatric, and social problems are all needed to be explored and managed. The Nursing Service System (NSS) at the tertiary epilepsy clinic (TEC) was consequently developed for improving the clinical care for PWE. Case manager concept was integrated as the framework guiding the processes and strategies used for developing the NSS as well as the roles of the multidisciplinary team at the clinic. This study aimed to report the outcomes of the developed NSS integrated case manager concept. The processes of our developed NSS program included 1) screening for patient’s problems using questionnaire prior to seeing epileptologists i.e., assessing the patient’s risk to develop acute seizures at the clinic, issues related to medication use, and uncovered psychiatric and social problems; and 2) assigning the patients at risk to be evaluated and managed by appropriate team. Nurses specializing in epilepsy in coordination with the multidisciplinary team implemented the NSS to promote coordinated work among the team which consists of epileptologists, nurses, pharmacists, psychologists, and social workers. Determination of the role of each person and their responsibilities along with joint care plan were clearly established. One year after implementation, the rate of acute seizure occurrence at the clinic was decreased, and satisfactory feedback from the patients was received. In order to achieve an optimal goal to promote self-management behaviors in PWE, continuing the NSS and systematic assessment of its effectiveness is required.

Keywords: case manager concept, nursing service system, patients with epilepsy, quality of life

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