Search results for: computer education tools
201 The Influence of Perinatal Anxiety and Depression on Breastfeeding Behaviours: A Qualitative Systematic Review
Authors: Khulud Alhussain, Anna Gavine, Stephen Macgillivray, Sushila Chowdhry
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Background: Estimates show that by the year 2030, mental illness will account for more than half of the global economic burden, second to non-communicable diseases. Often, the perinatal period is characterised by psychological ambivalence and a mixed anxiety-depressive condition. Maternal mental disorder is associated with perinatal anxiety and depression and affects breastfeeding behaviors. Studies also indicate that maternal mental health can considerably influence a baby's health in numerous aspects and impact the newborn health due to lack of adequate breastfeeding. However, studies reporting factors associated with breastfeeding behaviors are predominantly quantitative. Therefore, it is not clear what literature is available to understand the factors affecting breastfeeding and perinatal women’s perspectives and experiences. Aim: This review aimed to explore the perceptions and experiences of women with perinatal anxiety and depression, as well as how these experiences influence their breastfeeding behaviours. Methods: A systematic literature review of qualitative studies in line with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ). Four electronic databases (CINAHL, PsycINFO, Embase, and Google Scholar) were explored for relevant studies using a search strategy. The search was restricted to studies published in the English language between 2000 and 2022. Findings from the literature were screened using a pre-defined screening criterion and the quality of eligible studies was appraised using the Walsh and Downe (2006) checklist. Findings were extracted and synthesised based on Braun and Clark. The review protocol was registered on PROSPERO (Ref: CRD42022319609). Result: A total of 4947 studies were identified from the four databases. Following duplicate removal and screening 16 studies met the inclusion criteria. The studies included 87 pregnant and 302 post-partum women from 12 countries. The participants were from a variety of economic, regional, and religious backgrounds, mainly from the age of 18 to 45 years old. Three main themes were identified: Barriers to breastfeeding, breastfeeding facilitators, emotional disturbance, and breastfeeding. Seven subthemes emerged from the data: expectation versus reality, uncertainly about maternal competencies, body image and breastfeeding, lack of sufficient breastfeeding support for family and caregivers’ support, influences positive breastfeeding practices, breastfeeding education, and causes of mental strain among breastfeeding women. Breastfeeding duration is affected in women with mental health disorders, irrespective of their desire to breastfeed. Conclusion: There is significant empirical evidence that breastfeeding behaviour and perinatal mental disturbance are linked. However, there is a lack of evidence to apply the findings to Saudi women due to lack of empirical qualitative information. To improve the psychological well-being of mothers, it is crucial to explore and recognise any concerns with their mental, physical, and emotional well-being. Therefore, robust research is needed so that breastfeeding intervention researchers and policymakers can focus on specifically what needs to be done to help mentally distressed perinatal women and their new-born.Keywords: pregnancy, perinatal period, anxiety, depression, emotional disturbance, breastfeeding
Procedia PDF Downloads 98200 Wetland Community and Their Livelihood Opportunities in the Face of Changing Climatic Condition in Southwest Bangladesh
Authors: Mohsina Aktar, Bishawjit Mallick
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Bangladesh faces the multidimensional manifestations of climate change e.g. flood, cyclone, sea level rise, drainage congestion, salinity, etc. This study aimed at to find out the community’s perception of the perceived impact of climate change on their wetland resource based livelihood, to analyze their present livelihood scenario and to find out required institutional setup to strengthen present livelihood scenario. Therefore, this study required both quantitative analysis like quantification of wetland resources, occupation, etc. and also exploratory information like policy and institutional reform. For quantitative information 200 questionnaire survey and in some cases observation survey and for socially shareable qualitative and quantitative issues case study and focus group discussion were conducted. In-Depth interview was conducted for socially non-shareable qualitative issues. The overall findings of this study have been presented maintaining a sequence- perception about climate change effect, livelihood scenario and required institutional support of the wetland community. Flood has been ranked where cyclone effect is comparatively less disastrous in this area. Heavy rainfall comes after the cyclone. Female members responded almost same about the ranking and effects of frequently occurred and devastating effects of climate change. People are much more aware of the impact of climate change. Training of Care in RVCC project helps to increase their knowledge level. If the level of education can be increased, people can fight against calamity and poverty with more confidence. People seem to overcome the problems of water logging and thus besides involving in Hydroponics (33.3%) as prime occupation in monsoon; they are also engaged in other business related activities. January to May is the low-income season for the farmers. But some people don’t want to change their traditional occupation and their age is above 45. The young earning member wants to utilize their lean income period by alternative occupation. People who do not have own land and performing water transportation or other types of occupation are now interested about Hydroponics. People who give their land on rent are now thinking about renting their land in monsoon as through that they can earn a sound amount rather than get nothing. What they require is just seed, training, and capital. Present marketing system faces the problem of communication. So this sector needed to be developed. Involvement of women in income earning activity is very low (5.1%), and 100% women are housewives. They became inferior due to their educational level and dominance of their husband. Only one NGO named BCAS (Bangladesh Center for Advanced Studies) has been found engage training facilities and advocacy for this purpose. Upazilla agricultural extension office like other GO remains inactive to give support the community for extension and improvement of Hydroponics agriculture. If the community gets proper support and inspiration, they can fight against crisis of low-income and climate change, with the Hydroponics cultivation system successfully.Keywords: wetland community, hydroponics, climate change adaptation, livelihood
Procedia PDF Downloads 274199 Traditional Practices of Conserving Biodiversity: A Case Study around Jim Corbett National Park, Uttarakhand, India
Authors: Rana Parween, Rob Marchant
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With the continued loss of global biodiversity despite the application of modern conservation techniques, it has become crucial to investigate non-conventional methods. Accelerated destruction of ecosystems due to altered land use, climate change, cultural and social change, necessitates the exploration of society-biodiversity attitudes and links. While the loss of species and their extinction is a well-known and well-documented process that attracts much-needed attention from researchers, academics, government and non-governmental organizations, the loss of traditional ecological knowledge and practices is more insidious and goes unnoticed. The growing availability of 'indirect experiences' such as the internet and media are leading to a disaffection towards nature and the 'Extinction of Experience'. Exacerbated by the lack of documentation of traditional practices and skills, there is the possibility for the 'extinction' of traditional practices and skills before they are fully recognized and captured. India, as a mega-biodiverse country, is also known for its historical conservation strategies entwined in traditional beliefs. Indigenous communities hold skillsets, knowledge, and traditions that have accumulated over multiple generations and may play an important role in conserving biodiversity today. This study explores the differences in knowledge and attitudes towards conserving biodiversity, of three different stakeholder groups living around Jim Corbett National Park, based on their age, traditions, and association with the protected area. A triangulation designed multi-strategy investigation collected qualitative and quantitative data through a questionnaire survey of village elders, the general public, and forest officers. Following an inductive approach to analyzing qualitative data, the thematic content analysis was followed. All coding and analysis were completed using NVivo 11. Although the village elders and some general public had vast amounts of traditional knowledge, most of it was related to animal husbandry and the medicinal value of plants. Village elders were unfamiliar with the concept of the term ‘biodiversity’ albeit their way of life and attitudes ensured that they care for the ecosystem without having the scientific basis underpinning biodiversity conservation. Inherently, village elders were keen to conserve nature; the superimposition of governmental policies without any tangible benefit or consultation was seen as detrimental. Alienating villagers and consequently the village elders who are the reservoirs of traditional knowledge would not only be damaging to the social network of the area but would also disdain years of tried and tested techniques held by the elders. Forest officers advocated for biodiversity and conservation education for women and children. Women, across all groups, when questioned about nature conservation, showed more interest in learning and participation. Biodiversity not only has an ethical and cultural value, but also plays a role in ecosystem function and, thus, provides ecosystem services and supports livelihoods. Therefore, underpinning and using traditional knowledge and incorporating them into programs of biodiversity conservation should be explored with a sense of urgency.Keywords: biological diversity, mega-biodiverse countries, traditional ecological knowledge, society-biodiversity links
Procedia PDF Downloads 105198 The Contemporary Format of E-Learning in Teaching Foreign Languages
Authors: Nataliya G. Olkhovik
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Nowadays in the system of Russian higher medical education there have been undertaken initiatives that resulted in focusing on the resources of e-learning in teaching foreign languages. Obviously, the face-to-face communication in foreign languages bears much more advantages in terms of effectiveness in comparison with the potential of e-learning. Thus, we’ve faced the necessity of strengthening the capacity of e-learning via integration of active methods into the process of teaching foreign languages, such as project activity of students. Successful project activity of students should involve the following components: monitoring, control, methods of organizing the student’s activity in foreign languages, stimulating their interest in the chosen project, approaches to self-assessment and methods of raising their self-esteem. The contemporary methodology assumes the project as a specific method, which activates potential of a student’s cognitive function, emotional reaction, ability to work in the team, commitment, skills of cooperation and, consequently, their readiness to verbalize ideas, thoughts and attitudes. Verbal activity in the foreign language is a complex conception that consolidates both cognitive (involving speech) capacity and individual traits and attitudes such as initiative, empathy, devotion, responsibility etc. Once we organize the project activity by the means of e-learning within the ‘Foreign language’ discipline we have to take into consideration all mentioned above characteristics and work out an effective way to implement it into the teaching practice to boost its educational potential. We have integrated into the e-platform Moodle the module of project activity consisting of the following blocks of tasks that lead students to research, cooperate, strive to leadership, chase the goal and finally verbalize their intentions. Firstly, we introduce the project through activating self-activity of students by the tasks of the phase ‘Preparation of the project’: choose the topic and justify it; find out the problematic situation and its components; set the goals; create your team, choose the leader, distribute the roles in your team; make a written report on grounding the validity of your choices. Secondly, in the ‘Planning the project’ phase we ask students to represent the analysis of the problem in terms of reasons, ways and methods of solution and define the structure of their project (here students may choose oral or written presentation by drawing up the claim in the e-platform about their wish, whereas the teacher decides what form of presentation to prefer). Thirdly, the students have to design the visual aids, speech samples (functional phrases, introductory words, keywords, synonyms, opposites, attributive constructions) and then after checking, discussing and correcting with a teacher via the means of Moodle present it in front of the audience. And finally, we introduce the phase of self-reflection that aims to awake the inner desire of students to improve their verbal activity in a foreign language. As a result, by implementing the project activity into the e-platform and project activity, we try to widen the frameworks of a traditional lesson of foreign languages through tapping the potential of personal traits and attitudes of students.Keywords: active methods, e-learning, improving verbal activity in foreign languages, personal traits and attitudes
Procedia PDF Downloads 105197 Applying an Automatic Speech Intelligent System to the Health Care of Patients Undergoing Long-Term Hemodialysis
Authors: Kuo-Kai Lin, Po-Lun Chang
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Research Background and Purpose: Following the development of the Internet and multimedia, the Internet and information technology have become crucial avenues of modern communication and knowledge acquisition. The advantages of using mobile devices for learning include making learning borderless and accessible. Mobile learning has become a trend in disease management and health promotion in recent years. End-stage renal disease (ESRD) is an irreversible chronic disease, and patients who do not receive kidney transplants can only rely on hemodialysis or peritoneal dialysis to survive. Due to the complexities in caregiving for patients with ESRD that stem from their advanced age and other comorbidities, the patients’ incapacity of self-care leads to an increase in the need to rely on their families or primary caregivers, although whether the primary caregivers adequately understand and implement patient care is a topic of concern. Therefore, this study explored whether primary caregivers’ health care provisions can be improved through the intervention of an automatic speech intelligent system, thereby improving the objective health outcomes of patients undergoing long-term dialysis. Method: This study developed an automatic speech intelligent system with healthcare functions such as health information voice prompt, two-way feedback, real-time push notification, and health information delivery. Convenience sampling was adopted to recruit eligible patients from a hemodialysis center at a regional teaching hospital as research participants. A one-group pretest-posttest design was adopted. Descriptive and inferential statistics were calculated from the demographic information collected from questionnaires answered by patients and primary caregivers, and from a medical record review, a health care scale (recorded six months before and after the implementation of intervention measures), a subjective health assessment, and a report of objective physiological indicators. The changes in health care behaviors, subjective health status, and physiological indicators before and after the intervention of the proposed automatic speech intelligent system were then compared. Conclusion and Discussion: The preliminary automatic speech intelligent system developed in this study was tested with 20 pretest patients at the recruitment location, and their health care capacity scores improved from 59.1 to 72.8; comparisons through a nonparametric test indicated a significant difference (p < .01). The average score for their subjective health assessment rose from 2.8 to 3.3. A survey of their objective physiological indicators discovered that the compliance rate for the blood potassium level was the most significant indicator; its average compliance rate increased from 81% to 94%. The results demonstrated that this automatic speech intelligent system yielded a higher efficacy for chronic disease care than did conventional health education delivered by nurses. Therefore, future efforts will continue to increase the number of recruited patients and to refine the intelligent system. Future improvements to the intelligent system can be expected to enhance its effectiveness even further.Keywords: automatic speech intelligent system for health care, primary caregiver, long-term hemodialysis, health care capabilities, health outcomes
Procedia PDF Downloads 110196 The Integration of Apps for Communicative Competence in English Teaching
Authors: L. J. de Jager
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In the South African English school curriculum, one of the aims is to achieve communicative competence, the knowledge of using language competently and appropriately in a speech community. Communicatively competent speakers should not only produce grammatically correct sentences but also produce contextually appropriate sentences for various purposes and in different situations. As most speakers of English are non-native speakers, achieving communicative competence remains a complex challenge. Moreover, the changing needs of society necessitate not merely language proficiency, but also technological proficiency. One of the burning issues in the South African educational landscape is the replacement of the standardised literacy model by the pedagogy of multiliteracies that incorporate, by default, the exploration of technological text forms that are part of learners’ everyday lives. It foresees learners as decoders, encoders, and manufacturers of their own futures by exploiting technological possibilities to constantly create and recreate meaning. As such, 21st century learners will feel comfortable working with multimodal texts that are intrinsically part of their lives and by doing so, become authors of their own learning experiences while teachers may become agents supporting learners to discover their capacity to acquire new digital skills for the century of multiliteracies. The aim is transformed practice where learners use their skills, ideas, and knowledge in new contexts. This paper reports on a research project on the integration of technology for language learning, based on the technological pedagogical content knowledge framework, conceptually founded in the theory of multiliteracies, and which aims to achieve communicative competence. The qualitative study uses the community of inquiry framework to answer the research question: How does the integration of technology transform language teaching of preservice teachers? Pre-service teachers in the Postgraduate Certificate of Education Programme with English as methodology were purposively selected to source and evaluate apps for teaching and learning English. The participants collaborated online in a dedicated Blackboard module, using discussion threads to sift through applicable apps and develop interactive lessons using the Apps. The selected apps were entered on to a predesigned Qualtrics form. Data from the online discussions, focus group interviews, and reflective journals were thematically and inductively analysed to determine the participants’ perceptions and experiences when integrating technology in lesson design and the extent to which communicative competence was achieved when using these apps. Findings indicate transformed practice among participants and research team members alike with a better than average technology acceptance and integration. Participants found value in online collaboration to develop and improve their own teaching practice by experiencing directly the benefits of integrating e-learning into the teaching of languages. It could not, however, be clearly determined whether communicative competence was improved. The findings of the project may potentially inform future e-learning activities, thus supporting student learning and development in follow-up cycles of the project.Keywords: apps, communicative competence, English teaching, technology integration, technological pedagogical content knowledge
Procedia PDF Downloads 163195 Disability in the Course of a Chronic Disease: The Example of People Living with Multiple Sclerosis in Poland
Authors: Milena Trojanowska
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Disability is a phenomenon for which meanings and definitions have evolved over the decades. This became the trigger to start a project to answer the question of what disability constitutes in the course of an incurable chronic disease. The chosen research group are people living with multiple sclerosis.The contextual phase of the research was participant observation at the Polish Multiple Sclerosis Society, the largest NGO in Poland supporting people living with MS and their relatives. The research techniques used in the project are (in order of implementation): group interviews with people living with MS and their relatives, narrative interviews, asynchronous technique, participant observation during events organised for people living with MS and their relatives.The researcher is currently conducting follow-up interviews, as inaccuracies in the respondents' narratives were identified during the data analysis. Interviews and supplementary research techniques were used over the four years of the research, and the researcher also benefited from experience gained from 12 years of working with NGOs (diaries, notes). The research was carried out in Poland with the participation of people living in this country only.The research has been based on grounded theory methodology in a constructivist perspectivedeveloped by Kathy Charmaz. The goal was to follow the idea that research must be reliable, original, and useful. The aim was to construct an interpretive theory that assumes temporality and the processualityof social life. TheAtlas.ti software was used to collect research material and analyse it. It is a program from the CAQDAS(Computer-Assisted Qualitative Data Analysis Software) group.Several key factors influencing the construction of a disability identity by people living with multiple sclerosis was identified:-course of interaction with significant relatives,- the expectation of identification with disability (expressed by close relatives),- economic profitability (pension, allowances),- institutional advantages (e.g. parking card),- independence and autonomy (not equated with physical condition, but access to adapted infrastructure and resources to support daily functioning),- the way a person with MS construes the meaning of disability,- physical and mental state,- medical diagnosis of illness.In addition, it has been shown that making an assumption about the experience of disability in the course of MS is a form of cognitive reductionism leading to further phenomenon such as: the expectation of the person with MS to construct a social identity as a person with a disability (e.g. giving up work), the occurrence of institutional inequalities. It can also be a determinant of the choice of a life strategy that limits social and individual functioning, even if this necessity is not influenced by the person's physical or psychological condition.The results of the research are important for the development of knowledge about the phenomenon of disability. It indicates the contextuality and complexity of the disability phenomenon, which in the light of the research is a set of different phenomenon of heterogeneous nature and multifaceted causality. This knowledge can also be useful for institutions and organisations in the non-governmental sector supporting people with disabilities and people living with multiple sclerosis.Keywords: disability, multiple sclerosis, grounded theory, poland
Procedia PDF Downloads 106194 Discover Your Power: A Case for Contraceptive Self-Empowerment
Authors: Oluwaseun Adeleke, Samuel Ikan, Anthony Nwala, Mopelola Raji, Fidelis Edet
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Background: The risks associated with each pregnancy is carried almost entirely by a woman; however, the decision about whether and when to get pregnant is a subject that several others contend with her to make. The self-care concept offers women of reproductive age the opportunity to take control of their health and its determinants with or without the influence of a healthcare provider, family, and friends. DMPA-SC Self-injection (SI) is becoming the cornerstone of contraceptive self-care and has the potential to expand access and create opportunities for women to take control of their reproductive health. Methodology: To obtain insight into the influences that interfere with a woman’s capacity to make contraceptive choices independently, the Delivering Innovations in Selfcare (DISC) project conducted two intensive rounds of qualitative data collection and triangulation that included provider, client, and community mobilizer interviews, facility observations, and routine program data collection. Respondents were sampled according to a convenience sampling approach and data collected analyzed using a codebook and Atlas-TI. The research team members came together for participatory analysis workshop to explore and interpret emergent themes. Findings: Insights indicate that women are increasingly finding their voice and independently seek services to prevent a deterioration of their economic situation and achieve personal ambitions. Women who hold independent decision-making power still prefer to share decision making power with their male partners. Male partners’ influence on women’s use of family planning and self-inject was most dominant. There were examples of men’s support for women’s use of contraception to prevent unintended pregnancy, as well as men withholding support. Other men outrightly deny their partners from obtaining contraceptive services and their partners cede this sexual and reproductive health right without objection. A woman’s decision to initiate family planning is affected by myths and misconceptions, many of which have cultural and religious origins. Some tribes are known for their reluctance to use contraception and often associate stigma with the pursuit of family planning (FP) services. Information given by the provider is accepted, and, in many cases, clients cede power to providers to shape their SI user journey. A provider’s influence on a client’s decision to self-inject is reinforced by their biases and concerns. Clients are inhibited by the presence of peers during group education at the health facility. Others are motivated to seek FP services by the interest expressed by peers. There is also a growing trend in the influence of social media on FP uptake, particularly Facebook fora. Conclusion: The convenience of self-administration at home is a benefit for those that contend with various forms of social influences as well as covert users. Beyond increasing choice and reducing barriers to accessing Sexual and Reproductive Health (SRH) services, it can initiate the process of self-discovery and agency in the contraceptive user journey.Keywords: selfcare, self-empowerment, agency, DMPA-SC, contraception, family planning, influences
Procedia PDF Downloads 71193 Cross-cultural Training in International Cooperation Efforts
Authors: Shawn Baker-Garcia, Janna O. Schaeffer
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As the global and national communities and governments strive to address ongoing and evolving threats to humanity and pervasive or emerging “shared” global priorities on environmental, economic, political, and security, it is more urgent than ever before to understand each other, communicate effectively with one another, identify models of cooperation that yield improved, mutually reinforcing outcomes across and within cultures. It is within the backdrop of this reality that the presentation examines whether cultural training as we have approached it in recent decades is sufficiently meeting our current needs and what changes may be applied to foster better and more productive and sustainable intercultural interactions. Domestic and global relations face multiple challenges to peaceable cooperation. The last two years, in particular, have been defined by a travel-restricted COVID-19 pandemic yielding increased intercultural interactions over virtual platforms, polarized politics dividing nations and regions, and the commensurate rise in weaponized social and traditional media communication. These societal and cultural fissures are noticeably challenging our collective and individual abilities to constructively interact both at home and abroad. It is within this pressure cooker environment that the authors believe it is time to reexamine existing and broadly accepted inter- and cross- cultural training approaches and concepts to determine their level of effectiveness in setting conditions for optimal human understanding and relationships both in the national and international context. In order to better understand the amount and the type of intercultural training practitioners professionally engaging in international partnership building have received throughout their careers and its perceived effectiveness, a survey was designed and distributed to US and international professionals presently engaged in the fields of diplomacy, military, academia, and international business. The survey questions were deigned to address the two primary research questions investigators posed in this exploratory study. Research questions aimed to examine practitioners’ view of the role and effectiveness of current and traditional cultural training and education as a means to fostering improved communication, interactions, understanding, and cooperation among inter, cross, or multi-cultural communities or efforts.Responses were then collected and analyzed for themes present in the participants’ reflections. In their responses, the practitioners identified the areas of improvement and desired outcomes in regards to intercultural training and awareness raising curricular approaches. They also raised issues directly and indirectly pertaining to the role of foreign language proficiency in intercultural interactions and a need for a solid grasp on cultural and regional issues (regional expertise) to facilitate such an interaction. Respondents indicated knowledge, skills, abilities, and capabilities that the participants were not trained on but learned through ad hoc personal and professional intercultural interactions, which they found most valuable and wished they had acquired prior to the intercultural experience.Keywords: cultural training, improved communication, intercultural competence, international cooperation
Procedia PDF Downloads 132192 Transgressing Boundaries for Encouraging Critical Thinking: Reflections on the Integration of Active Pedagogy and Transnational Exchange into Social Work Education
Authors: Rosemary R. Carlton, Roxane Caron
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Almost three decades ago, bell hooks (1994) identified the classroom as “the most radical space of possibility in the academy”. A feminist scholar, educator, and activist, hooks urged educators to transgress the boundaries of what might be customary or considered acceptable in teaching, thus encouraging the pursuit of new ways of knowing and different strategies for sharing knowledge. This paper reflects upon a particular response to hooks’ still relevant call for transgression in teaching. Specifically, this paper reports on the design, implementation, and preliminary analysis of a social work course integrating active pedagogy and transnational exchange to encourage students’ critical thinking and autonomous learning in their development as social workers in a global context. The bachelor’s level course, Pratiques spécifiques: Projet international, was developed collaboratively across three francophone institutions of higher learning in Belgium, Canada, and France: the Haute École de Namur-Liège-Luxembourg (Hénallux); the Université de Montréal; and, the Institut d’enseignement supérieur et professionnel, l’IRTS Paris Île-de-France. The driving aims of the course are to promote autonomous learning and critical thinking through a lens of transnational understandings of social problems -competencies indispensable to students’ development as social workers. The course is offered to two paired cohorts, one addressing the subject of “migrations” (Canada/France) and the other the subject of “sexual exploitation” (Canada/Belgium). Through the adaptation of a critical pedagogy of problem-based learning, students are called upon to actively engage in acquiring and applying knowledge to respond to “real life” social issues relating to migration or sexual exploitation. At the conclusion of the course, each cohort of students is brought together for a week-long intensive period of transnational exchange either at the Université de Montréal in Canada or at Hénallux in Belgium. Extending the bounds of the classroom across international borders allows students novel opportunities to deepen and expand their understandings of issues relating to predefined social issues and to critically examine associated social work practices. The paper opens with a presentation of the social work course. Specifically, the authors will outline their adaptation of a pedagogy of problem-based learning integrating transnational exchange in the design and implementation of the course. Returning to hooks’ notion of transgression in teaching, the paper offers a preliminary analysis of how and with what effect the course provides opportunities to transgress hierarchical student-teacher relationships; transgress conventional modes of learning to explore diverse sources of knowledge and transgress the walls of the university to engage with and learn from local and global partners. The paper concludes with a consideration of the potential influence of such transgressions in teaching for students’ development of critical thinking in their practice of social work in global context.Keywords: active learning, critical pedagogy, social work intervention, transnational learning
Procedia PDF Downloads 165191 Beneath the Leisurely Surface: An Analysis of the Piano Lesson Frenzy among Chinese Middle-Class Parents
Authors: Yijie Wang, Tianyue Wang
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In the past two decades, there has been a great ‘piano lesson frenzy’ among Chinese middle-class families, with a large number of parents adding piano training to children’s extra-curriculum lists. Superficially, the frenzy reflects a rather ‘leisurely’ attitude: parents typically claim that pianos lessons are ‘just for fun’ and will hopefully render children’s life more exciting. However, a closer scrutiny reveals that there is great social-status anxiety hidden beneath this ‘leisurely’ surface. Based on pre-interviews of six Chinese middle-class parents who have enthusiastically signed their children up for piano lessons, several tentative analysis are made: 1. Owing to a series of historical and social factors, the Chinese middle-class have yet to establish their cultural norms in the past few decades, resulting in great confusion concerning how to cultivate cultural tastes in their offspring. And partly due to the fact that the middle-class status of the past Chinese generation is mostly self-acquired rather than inherited, parents are much less confident about their cultural resources—which require long-time accumulation—than material ones. Both factors combine to lead to a sort of blind, overcompensating enthusiasm in culture-related education, and the piano frenzy is but a demonstration. 2. The piano has been chosen to be the object of the frenzy partly because of its inherent characteristics as well as socially-constructed ones. Costly, large in size, imported from another culture and so forth, the piano has acquired the meaning of being exclusive, high-end and exotic, which renders it a token of top-tier status among Chinese people, and piano lessons for offspring have therefore become parents’ paths towards a kind of ‘symbolic elevation’. A child playing piano is an exhibition as well as psychological assurance of the families’ middle-class status. 3. A closer look at children’s piano training process reveals that there is much more anxiety than leisurely elements involved. Despite parents’ claim that ‘piano is mainly for kids to have fun,’ the whole process is evidently of a rather ‘ascetic’ nature, with the demands of diligence and senses of time urgency throughout, and techniques rather than flair or styles are emphasized. This either means that the apparent ‘piano-for-fun’ stance is unauthentic and is only other motives in disguise, or that the Chinese middle-class parents are not yet capable of shaking off the sense of anxiety even if they sincerely intend to. 4. When viewed in relation to Chinese formal school system as well as the job market at large, it can be said that by signing children up for piano lessons, parents are consciously or unconsciously seeking to prepare for, or reduce the risks of, their children’s future social mobility. In face of possible failures in the highly-crucial, highly-competitive formal school system, piano-playing as an extra-curriculum activity may be conveniently transferred into an alternative career path. Besides, in contemporary China, as the occupational structure goes through change, and the school-related certificates decline in value, aspects such as a person’s overall deportment, which can be gained or proved by piano-learning, have been gaining in significance.Keywords: extra-curriculum activities, middle class, piano lesson frenzy, status anxiety
Procedia PDF Downloads 245190 Re-Creating Women of the Past in Historical Series on Mexican Television: The Work of Patricia Arriaga Jordan
Authors: Maria De Los Angeles Rodriguez Cadena
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This paper discusses how the fictional versions of women of the past contribute to advance today’s ideas of social justice, personal freedom and emancipation as well as to highlight the creative challenge of constructing people and events on fictional narratives on television that incorporate multiple and simultaneous layers of meaning and complexity. This project builds on existing scholarship on audiovisual texts by exploring an influential but under-studied director. In two Mexican television series, Patricia Arriaga Jordan, an award-winning television producer, scriptwriter and director, constructs the life of two outstanding women that have played an influential role in national history and captured Mexican’s popular imagination for generations: Sor Juana Inés de la Cruz, and Malinche. Malinche (2018) tells the story of an extraordinary indigenous woman, Malintzin, during the Spanish Conquest (1511-1550) that is considered to have played a key role in the fall of the Aztec empire by acting as translator, negotiator and cultural mediator for the Spanish conquerors. Juana Ines (2016) portrays Sor Juana, a poet, essayist, playwright, theologian, philosopher, nun, of XVII century colonial Mexico, one of the brightest minds of her time, and now recognized as the first feminist of the Americas who wrote on the rights of women to an education, religious authority and feminist advocacy. Both series, as fictional narratives that recreate defining historical periods, specific events and relevant characters in the History of Mexico can be read as an example of what is called texts of cultural memory. A cultural memory text is a narrative that bonds the concepts of history, identity and belonging, and that is realized and disseminated through symbolic systems such as written documents, visual images, and dramatic representation. Cultural memory, through its narratives of historical fiction, emphasizes memory processes (historiography) and its implications and artifacts (cultural memory) mainly through the medial frameworks of remembering, which are the medial process by which memories (narratives, documents) participate in public knowledge and become collective memory. Historical fiction on television not only creates a portrayal of the past related to the real lives of protagonists, but it also significantly contributes to understand the past as an ever-evolving entity that highlights both, the necessary connection with the present as part of a developing sense of collective identity and belonging, as well as the relevance of the medium in which the past is represented and that ultimately supports the process of historical awareness. Through the emblematic recreation of national heroines and historical events in the unique context of historical drama on television, those texts constitute a venue where concepts of the past and the traditionally established ideas about history and heroines are highlighted, questioned and transformed.Keywords: cultural memory, historical fiction, Mexico, television, women directors
Procedia PDF Downloads 132189 Evaluation of Modern Natural Language Processing Techniques via Measuring a Company's Public Perception
Authors: Burak Oksuzoglu, Savas Yildirim, Ferhat Kutlu
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Opinion mining (OM) is one of the natural language processing (NLP) problems to determine the polarity of opinions, mostly represented on a positive-neutral-negative axis. The data for OM is usually collected from various social media platforms. In an era where social media has considerable control over companies’ futures, it’s worth understanding social media and taking actions accordingly. OM comes to the fore here as the scale of the discussion about companies increases, and it becomes unfeasible to gauge opinion on individual levels. Thus, the companies opt to automize this process by applying machine learning (ML) approaches to their data. For the last two decades, OM or sentiment analysis (SA) has been mainly performed by applying ML classification algorithms such as support vector machines (SVM) and Naïve Bayes to a bag of n-gram representations of textual data. With the advent of deep learning and its apparent success in NLP, traditional methods have become obsolete. Transfer learning paradigm that has been commonly used in computer vision (CV) problems started to shape NLP approaches and language models (LM) lately. This gave a sudden rise to the usage of the pretrained language model (PTM), which contains language representations that are obtained by training it on the large datasets using self-supervised learning objectives. The PTMs are further fine-tuned by a specialized downstream task dataset to produce efficient models for various NLP tasks such as OM, NER (Named-Entity Recognition), Question Answering (QA), and so forth. In this study, the traditional and modern NLP approaches have been evaluated for OM by using a sizable corpus belonging to a large private company containing about 76,000 comments in Turkish: SVM with a bag of n-grams, and two chosen pre-trained models, multilingual universal sentence encoder (MUSE) and bidirectional encoder representations from transformers (BERT). The MUSE model is a multilingual model that supports 16 languages, including Turkish, and it is based on convolutional neural networks. The BERT is a monolingual model in our case and transformers-based neural networks. It uses a masked language model and next sentence prediction tasks that allow the bidirectional training of the transformers. During the training phase of the architecture, pre-processing operations such as morphological parsing, stemming, and spelling correction was not used since the experiments showed that their contribution to the model performance was found insignificant even though Turkish is a highly agglutinative and inflective language. The results show that usage of deep learning methods with pre-trained models and fine-tuning achieve about 11% improvement over SVM for OM. The BERT model achieved around 94% prediction accuracy while the MUSE model achieved around 88% and SVM did around 83%. The MUSE multilingual model shows better results than SVM, but it still performs worse than the monolingual BERT model.Keywords: BERT, MUSE, opinion mining, pretrained language model, SVM, Turkish
Procedia PDF Downloads 146188 Using Business Simulations and Game-Based Learning for Enterprise Resource Planning Implementation Training
Authors: Carin Chuang, Kuan-Chou Chen
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An Enterprise Resource Planning (ERP) system is an integrated information system that supports the seamless integration of all the business processes of a company. Implementing an ERP system can increase efficiencies and decrease the costs while helping improve productivity. Many organizations including large, medium and small-sized companies have already adopted an ERP system for decades. Although ERP system can bring competitive advantages to organizations, the lack of proper training approach in ERP implementation is still a major concern. Organizations understand the importance of ERP training to adequately prepare managers and users. The low return on investment, however, for the ERP training makes the training difficult for knowledgeable workers to transfer what is learned in training to the jobs at workplace. Inadequate and inefficient ERP training limits the value realization and success of an ERP system. That is the need to call for a profound change and innovation for ERP training in both workplace at industry and the Information Systems (IS) education in academia. The innovated ERP training approach can improve the users’ knowledge in business processes and hands-on skills in mastering ERP system. It also can be instructed as educational material for IS students in universities. The purpose of the study is to examine the use of ERP simulation games via the ERPsim system to train the IS students in learning ERP implementation. The ERPsim is the business simulation game developed by ERPsim Lab at HEC Montréal, and the game is a real-life SAP (Systems Applications and Products) ERP system. The training uses the ERPsim system as the tool for the Internet-based simulation games and is designed as online student competitions during the class. The competitions involve student teams with the facilitation of instructor and put the students’ business skills to the test via intensive simulation games on a real-world SAP ERP system. The teams run the full business cycle of a manufacturing company while interacting with suppliers, vendors, and customers through sending and receiving orders, delivering products and completing the entire cash-to-cash cycle. To learn a range of business skills, student needs to adopt individual business role and make business decisions around the products and business processes. Based on the training experiences learned from rounds of business simulations, the findings show that learners have reduced risk in making mistakes that help learners build self-confidence in problem-solving. In addition, the learners’ reflections from their mistakes can speculate the root causes of the problems and further improve the efficiency of the training. ERP instructors teaching with the innovative approach report significant improvements in student evaluation, learner motivation, attendance, engagement as well as increased learner technology competency. The findings of the study can provide ERP instructors with guidelines to create an effective learning environment and can be transferred to a variety of other educational fields in which trainers are migrating towards a more active learning approach.Keywords: business simulations, ERP implementation training, ERPsim, game-based learning, instructional strategy, training innovation
Procedia PDF Downloads 139187 Executive Function and Attention Control in Bilingual and Monolingual Children: A Systematic Review
Authors: Zihan Geng, L. Quentin Dixon
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It has been proposed that early bilingual experience confers a number of advantages in the development of executive control mechanisms. Although the literature provides empirical evidence for bilingual benefits, some studies also reported null or mixed results. To make sense of these contradictory findings, the current review synthesize recent empirical studies investigating bilingual effects on children’s executive function and attention control. The publication time of the studies included in the review ranges from 2010 to 2017. The key searching terms are bilingual, bilingualism, children, executive control, executive function, and attention. The key terms were combined within each of the following databases: ERIC (EBSCO), Education Source, PsycINFO, and Social Science Citation Index. Studies involving both children and adults were also included but the analysis was based on the data generated only by the children group. The initial search yielded 137 distinct articles. Twenty-eight studies from 27 articles with a total of 3367 participants were finally included based on the selection criteria. The selective studies were then coded in terms of (a) the setting (i.e., the country where the data was collected), (b) the participants (i.e., age and languages), (c) sample size (i.e., the number of children in each group), (d) cognitive outcomes measured, (e) data collection instruments (i.e., cognitive tasks and tests), and (f) statistic analysis models (e.g., t-test, ANOVA). The results show that the majority of the studies were undertaken in western countries, mainly in the U.S., Canada, and the UK. A variety of languages such as Arabic, French, Dutch, Welsh, German, Spanish, Korean, and Cantonese were involved. In relation to cognitive outcomes, the studies examined children’s overall planning and problem-solving abilities, inhibition, cognitive complexity, working memory (WM), and sustained and selective attention. The results indicate that though bilingualism is associated with several cognitive benefits, the advantages seem to be weak, at least, for children. Additionally, the nature of the cognitive measures was found to greatly moderate the results. No significant differences are observed between bilinguals and monolinguals in overall planning and problem-solving ability, indicating that there is no bilingual benefit in the cooperation of executive function components at an early age. In terms of inhibition, the mixed results suggest that bilingual children, especially young children, may have better conceptual inhibition measured in conflict tasks, but not better response inhibition measured by delay tasks. Further, bilingual children showed better inhibitory control to bivalent displays, which resembles the process of maintaining two language systems. The null results were obtained for both cognitive complexity and WM, suggesting no bilingual advantage in these two cognitive components. Finally, findings on children’s attention system associate bilingualism with heightened attention control. Together, these findings support the hypothesis of cognitive benefits for bilingual children. Nevertheless, whether these advantages are observable appears to highly depend on the cognitive assessments. Therefore, future research should be more specific about the cognitive outcomes (e.g., the type of inhibition) and should report the validity of the cognitive measures consistently.Keywords: attention, bilingual advantage, children, executive function
Procedia PDF Downloads 185186 The Use of Image Analysis Techniques to Describe a Cluster Cracks in the Cement Paste with the Addition of Metakaolinite
Authors: Maciej Szeląg, Stanisław Fic
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The impact of elevated temperatures on the construction materials manifests in change of their physical and mechanical characteristics. Stresses and thermal deformations that occur inside the volume of the material cause its progressive degradation as temperature increase. Finally, the reactions and transformations of multiphase structure of cementitious composite cause its complete destruction. A particularly dangerous phenomenon is the impact of thermal shock – a sudden high temperature load. The thermal shock leads to a high value of the temperature gradient between the outer surface and the interior of the element in a relatively short time. The result of mentioned above process is the formation of the cracks and scratches on the material’s surface and inside the material. The article describes the use of computer image analysis techniques to identify and assess the structure of the cluster cracks on the surfaces of modified cement pastes, caused by thermal shock. Four series of specimens were tested. Two Portland cements were used (CEM I 42.5R and CEM I 52,5R). In addition, two of the series contained metakaolinite as a replacement for 10% of the cement content. Samples in each series were made in combination of three w/b (water/binder) indicators of respectively 0.4; 0.5; 0.6. Surface cracks of the samples were created by a sudden temperature load at 200°C for 4 hours. Images of the cracked surfaces were obtained via scanning at 1200 DPI; digital processing and measurements were performed using ImageJ v. 1.46r software. In order to examine the cracked surface of the cement paste as a system of closed clusters – the dispersal systems theory was used to describe the structure of cement paste. Water is used as the dispersing phase, and the binder is used as the dispersed phase – which is the initial stage of cement paste structure creation. A cluster itself is considered to be the area on the specimen surface that is limited by cracks (created by sudden temperature loading) or by the edge of the sample. To describe the structure of cracks two stereological parameters were proposed: A ̅ – the cluster average area, L ̅ – the cluster average perimeter. The goal of this study was to compare the investigated stereological parameters with the mechanical properties of the tested specimens. Compressive and tensile strength testes were carried out according to EN standards. The method used in the study allowed the quantitative determination of defects occurring in the examined modified cement pastes surfaces. Based on the results, it was found that the nature of the cracks depends mainly on the physical parameters of the cement and the intermolecular interactions on the dispersal environment. Additionally, it was noted that the A ̅/L ̅ relation of created clusters can be described as one function for all tested samples. This fact testifies about the constant geometry of the thermal cracks regardless of the presence of metakaolinite, the type of cement and the w/b ratio.Keywords: cement paste, cluster cracks, elevated temperature, image analysis, metakaolinite, stereological parameters
Procedia PDF Downloads 388185 Knowledge and Attitude Towards Strabismus Among Adult Residents in Woreta Town, Northwest Ethiopia: A Community-Based Study
Authors: Henok Biruk Alemayehu, Kalkidan Berhane Tsegaye, Fozia Seid Ali, Nebiyat Feleke Adimassu, Getasew Alemu Mersha
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Background: Strabismus is a visual disorder where the eyes are misaligned and point in different directions. Untreated strabismus can lead to amblyopia, loss of binocular vision, and social stigma due to its appearance. Since it is assumed that knowledge is pertinent for early screening and prevention of strabismus, the main objective of this study was to assess knowledge and attitudes toward strabismus in Woreta town, Northwest Ethiopia. Providing data in this area is important for planning health policies. Methods: A community-based cross-sectional study was done in Woreta town from April–May 2020. The sample size was determined using a single population proportion formula by taking a 50% proportion of good knowledge, 95% confidence level, 5% margin of errors, and 10% non- response rate. Accordingly, the final computed sample size was 424. All four kebeles were included in the study. There were 42,595 people in total, with 39,684 adults and 9229 house holds. A sample fraction ’’k’’ was obtained by dividing the number of the household by the calculated sample size of 424. Systematic random sampling with proportional allocation was used to select the participating households with a sampling fraction (K) of 21 i.e. each household was approached in every 21 households included in the study. One individual was selected ran- domly from each household with more than one adult, using the lottery method to obtain a final sample size. The data was collected through a face-to-face interview with a pretested and semi-structured questionnaire which was translated from English to Amharic and back to English to maintain its consistency. Data were entered using epi-data version 3.1, then processed and analyzed via SPSS version- 20. Descriptive and analytical statistics were employed to summarize the data. A p-value of less than 0.05 was used to declare statistical significance. Result: A total of 401 individuals aged over 18 years participated, with a response rate of 94.5%. Of those who responded, 56.6% were males. Of all the participants, 36.9% were illiterate. The proportion of people with poor knowledge of strabismus was 45.1%. It was shown that 53.9% of the respondents had a favorable attitude. Older age, higher educational level, having a history of eye examination, and a having a family history of strabismus were significantly associated with good knowledge of strabismus. A higher educational level, older age, and hearing about strabismus were significantly associated with a favorable attitude toward strabismus. Conclusion and recommendation: The proportion of good knowledge and favorable attitude towards strabismus were lower than previously reported in Gondar City, Northwest Ethiopia. There is a need to provide health education and promotion campaigns on strabismus to the community: what strabismus is, its’ possible treatments and the need to bring children to the eye care center for early diagnosis and treatment. it advocate for prospective research endeavors to employ qualitative study design.Additionally, it suggest the exploration of studies that investigate causal-effect relationship.Keywords: strabismus, knowledge, attitude, Woreta
Procedia PDF Downloads 62184 Cultural Competence in Palliative Care
Authors: Mariia Karizhenskaia, Tanvi Nandani, Ali Tafazoli Moghadam
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Hospice palliative care (HPC) is one of the most complicated philosophies of care in which physical, social/cultural, and spiritual aspects of human life are intermingled with an undeniably significant role in every aspect. Among these dimensions of care, culture possesses an outstanding position in the process and goal determination of HPC. This study shows the importance of cultural elements in the establishment of effective and optimized structures of HPC in the Canadian healthcare environment. Our systematic search included Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 1998 to 2023 to identify recent national literature connecting culture and palliative care delivery. The most frequently presented feature among the articles is the role of culture in the efficiency of the HPC. It has been shown frequently that including the culturespecific parameters of each nation in this system of care is vital for its success. On the other hand, ignorance about the exclusive cultural trends in a specific location has been accompanied by significant failure rates. Accordingly, implementing a culture-wise adaptable approach is mandatory for multicultural societies. The following outcome of research studies in this field underscores the importance of culture-oriented education for healthcare staff. Thus, all the practitioners involved in HPC will recognize the importance of traditions, religions, and social habits for processing the care requirements. Cultural competency training is a telling sample of the establishment of this strategy in health care that has come to the aid of HPC in recent years. Another complexity of the culturized HPC nowadays is the long-standing issue of racialization. Systematic and subconscious deprivation of minorities has always been an adversity of advanced levels of care. The last part of the constellation of our research outcomes is comprised of the ethical considerations of culturally driven HPC. This part is the most sophisticated aspect of our topic because almost all the analyses, arguments, and justifications are subjective. While there was no standard measure for ethical elements in clinical studies with palliative interventions, many research teams endorsed applying ethical principles for all the involved patients. Notably, interpretations and projections of ethics differ in varying cultural backgrounds. Therefore, healthcare providers should always be aware of the most respectable methodologies of HPC on a case-by-case basis. Cultural training programs have been utilized as one of the main tactics to improve the ability of healthcare providers to address the cultural needs and preferences of diverse patients and families. In this way, most of the involved health care practitioners will be equipped with cultural competence. Considerations for ethical and racial specifications of the clients of this service will boost the effectiveness and fruitfulness of the HPC. Canadian society is a colorful compilation of multiple nationalities; accordingly, healthcare clients are diverse, and this divergence is also translated into HPC patients. This fact justifies the importance of studying all the cultural aspects of HPC to provide optimal care on this enormous land.Keywords: cultural competence, end-of-life care, hospice, palliative care
Procedia PDF Downloads 74183 Temporal Estimation of Hydrodynamic Parameter Variability in Constructed Wetlands
Authors: Mohammad Moezzibadi, Isabelle Charpentier, Adrien Wanko, Robert Mosé
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The calibration of hydrodynamic parameters for subsurface constructed wetlands (CWs) is a sensitive process since highly non-linear equations are involved in unsaturated flow modeling. CW systems are engineered systems designed to favour natural treatment processes involving wetland vegetation, soil, and their microbial flora. Their significant efficiency at reducing the ecological impact of urban runoff has been recently proved in the field. Numerical flow modeling in a vertical variably saturated CW is here carried out by implementing the Richards model by means of a mixed hybrid finite element method (MHFEM), particularly well adapted to the simulation of heterogeneous media, and the van Genuchten-Mualem parametrization. For validation purposes, MHFEM results were compared to those of HYDRUS (a software based on a finite element discretization). As van Genuchten-Mualem soil hydrodynamic parameters depend on water content, their estimation is subject to considerable experimental and numerical studies. In particular, the sensitivity analysis performed with respect to the van Genuchten-Mualem parameters reveals a predominant influence of the shape parameters α, n and the saturated conductivity of the filter on the piezometric heads, during saturation and desaturation. Modeling issues arise when the soil reaches oven-dry conditions. A particular attention should also be brought to boundary condition modeling (surface ponding or evaporation) to be able to tackle different sequences of rainfall-runoff events. For proper parameter identification, large field datasets would be needed. As these are usually not available, notably due to the randomness of the storm events, we thus propose a simple, robust and low-cost numerical method for the inverse modeling of the soil hydrodynamic properties. Among the methods, the variational data assimilation technique introduced by Le Dimet and Talagrand is applied. To that end, a variational data assimilation technique is implemented by applying automatic differentiation (AD) to augment computer codes with derivative computations. Note that very little effort is needed to obtain the differentiated code using the on-line Tapenade AD engine. Field data are collected for a three-layered CW located in Strasbourg (Alsace, France) at the water edge of the urban water stream Ostwaldergraben, during several months. Identification experiments are conducted by comparing measured and computed piezometric head by means of the least square objective function. The temporal variability of hydrodynamic parameter is then assessed and analyzed.Keywords: automatic differentiation, constructed wetland, inverse method, mixed hybrid FEM, sensitivity analysis
Procedia PDF Downloads 163182 Voyage Analysis of a Marine Gas Turbine Engine Installed to Power and Propel an Ocean-Going Cruise Ship
Authors: Mathias U. Bonet, Pericles Pilidis, Georgios Doulgeris
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A gas turbine-powered cruise Liner is scheduled to transport pilgrim passengers from Lagos-Nigeria to the Islamic port city of Jeddah in Saudi Arabia. Since the gas turbine is an air breathing machine, changes in the density and/or mass flow at the compressor inlet due to an encounter with variations in weather conditions induce negative effects on the performance of the power plant during the voyage. In practice, all deviations from the reference atmospheric conditions of 15 oC and 1.103 bar tend to affect the power output and other thermodynamic parameters of the gas turbine cycle. Therefore, this paper seeks to evaluate how a simple cycle marine gas turbine power plant would react under a variety of scenarios that may be encountered during a voyage as the ship sails across the Atlantic Ocean and the Mediterranean Sea before arriving at its designated port of discharge. It is also an assessment that focuses on the effect of varying aerodynamic and hydrodynamic conditions which deteriorate the efficient operation of the propulsion system due to an increase in resistance that results from some projected levels of the ship hull fouling. The investigated passenger ship is designed to run at a service speed of 22 knots and cover a distance of 5787 nautical miles. The performance evaluation consists of three separate voyages that cover a variety of weather conditions in winter, spring and summer seasons. Real-time daily temperatures and the sea states for the selected transit route were obtained and used to simulate the voyage under the aforementioned operating conditions. Changes in engine firing temperature, power output as well as the total fuel consumed per voyage including other performance variables were separately predicted under both calm and adverse weather conditions. The collated data were obtained online from the UK Meteorological Office as well as the UK Hydrographic Office websites, while adopting the Beaufort scale for determining the magnitude of sea waves resulting from rough weather situations. The simulation of the gas turbine performance and voyage analysis was effected through the use of an integrated Cranfield-University-developed computer code known as ‘Turbomatch’ and ‘Poseidon’. It is a project that is aimed at developing a method for predicting the off design behavior of the marine gas turbine when installed and operated as the main prime mover for both propulsion and powering of all other auxiliary services onboard a passenger cruise liner. Furthermore, it is a techno-economic and environmental assessment that seeks to enable the forecast of the marine gas turbine part and full load performance as it relates to the fuel requirement for a complete voyage.Keywords: cruise ship, gas turbine, hull fouling, performance, propulsion, weather
Procedia PDF Downloads 165181 Treatment and Diagnostic Imaging Methods of Fetal Heart Function in Radiology
Authors: Mahdi Farajzadeh Ajirlou
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Prior evidence of normal cardiac anatomy is desirable to relieve the anxiety of cases with a family history of congenital heart disease or to offer the option of early gestation termination or close follow-up should a cardiac anomaly be proved. Fetal heart discovery plays an important part in the opinion of the fetus, and it can reflect the fetal heart function of the fetus, which is regulated by the central nervous system. Acquisition of ventricular volume and inflow data would be useful to quantify more valve regurgitation and ventricular function to determine the degree of cardiovascular concession in fetal conditions at threat for hydrops fetalis. This study discusses imaging the fetal heart with transvaginal ultrasound, Doppler ultrasound, three-dimensional ultrasound (3DUS) and four-dimensional (4D) ultrasound, spatiotemporal image correlation (STIC), glamorous resonance imaging and cardiac catheterization. Doppler ultrasound (DUS) image is a kind of real- time image with a better imaging effect on blood vessels and soft tissues. DUS imaging can observe the shape of the fetus, but it cannot show whether the fetus is hypoxic or distressed. Spatiotemporal image correlation (STIC) enables the acquisition of a volume of data concomitant with the beating heart. The automated volume accession is made possible by the array in the transducer performing a slow single reach, recording a single 3D data set conforming to numerous 2D frames one behind the other. The volume accession can be done in a stationary 3D, either online 4D (direct volume scan, live 3D ultrasound or a so-called 4D (3D/ 4D)), or either spatiotemporal image correlation-STIC (off-line 4D, which is a circular volume check-up). Fetal cardiovascular MRI would appear to be an ideal approach to the noninvasive disquisition of the impact of abnormal cardiovascular hemodynamics on antenatal brain growth and development. Still, there are practical limitations to the use of conventional MRI for fetal cardiovascular assessment, including the small size and high heart rate of the mortal fetus, the lack of conventional cardiac gating styles to attend data accession, and the implicit corruption of MRI data due to motherly respiration and unpredictable fetal movements. Fetal cardiac MRI has the implicit to complement ultrasound in detecting cardiovascular deformations and extracardiac lesions. Fetal cardiac intervention (FCI), minimally invasive catheter interventions, is a new and evolving fashion that allows for in-utero treatment of a subset of severe forms of congenital heart deficiency. In special cases, it may be possible to modify the natural history of congenital heart disorders. It's entirely possible that future generations will ‘repair’ congenital heart deficiency in utero using nanotechnologies or remote computer-guided micro-robots that work in the cellular layer.Keywords: fetal, cardiac MRI, ultrasound, 3D, 4D, heart disease, invasive, noninvasive, catheter
Procedia PDF Downloads 38180 Risks beyond Cyber in IoT Infrastructure and Services
Authors: Mattias Bergstrom
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Significance of the Study: This research will provide new insights into the risks with digital embedded infrastructure. Through this research, we will analyze each risk and its potential negation strategies, especially for AI and autonomous automation. Moreover, the analysis that is presented in this paper will convey valuable information for future research that can create more stable, secure, and efficient autonomous systems. To learn and understand the risks, a large IoT system was envisioned, and risks with hardware, tampering, and cyberattacks were collected, researched, and evaluated to create a comprehensive understanding of the potential risks. Potential solutions have then been evaluated on an open source IoT hardware setup. This list shows the identified passive and active risks evaluated in the research. Passive Risks: (1) Hardware failures- Critical Systems relying on high rate data and data quality are growing; SCADA systems for infrastructure are good examples of such systems. (2) Hardware delivers erroneous data- Sensors break, and when they do so, they don’t always go silent; they can keep going, just that the data they deliver is garbage, and if that data is not filtered out, it becomes disruptive noise in the system. (3) Bad Hardware injection- Erroneous generated sensor data can be pumped into a system by malicious actors with the intent to create disruptive noise in critical systems. (4) Data gravity- The weight of the data collected will affect Data-Mobility. (5) Cost inhibitors- Running services that need huge centralized computing is cost inhibiting. Large complex AI can be extremely expensive to run. Active Risks: Denial of Service- It is one of the most simple attacks, where an attacker just overloads the system with bogus requests so that valid requests disappear in the noise. Malware- Malware can be anything from simple viruses to complex botnets created with specific goals, where the creator is stealing computer power and bandwidth from you to attack someone else. Ransomware- It is a kind of malware, but it is so different in its implementation that it is worth its own mention. The goal with these pieces of software is to encrypt your system so that it can only be unlocked with a key that is held for ransom. DNS spoofing- By spoofing DNS calls, valid requests and data dumps can be sent to bad destinations, where the data can be extracted for extortion or to corrupt and re-inject into a running system creating a data echo noise loop. After testing multiple potential solutions. We found that the most prominent solution to these risks was to use a Peer 2 Peer consensus algorithm over a blockchain to validate the data and behavior of the devices (sensors, storage, and computing) in the system. By the devices autonomously policing themselves for deviant behavior, all risks listed above can be negated. In conclusion, an Internet middleware that provides these features would be an easy and secure solution to any future autonomous IoT deployments. As it provides separation from the open Internet, at the same time, it is accessible over the blockchain keys.Keywords: IoT, security, infrastructure, SCADA, blockchain, AI
Procedia PDF Downloads 107179 Digital Technology Relevance in Archival and Digitising Practices in the Republic of South Africa
Authors: Tashinga Matindike
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By means of definition, digital artworks encompass an array of artistic productions that are expressed in a technological form as an essential part of a creative process. Examples include illustrations, photos, videos, sculptures, and installations. Within the context of the visual arts, the process of repatriation involves the return of once-appropriated goods. Archiving denotes the preservation of a commodity for storage purposes in order to nurture its continuity. The aforementioned definitions form the foundation of the academic framework and premise of the argument, which is outlined in this paper. This paper aims to define, discuss and decipher the complexities involved in digitising artworks, whilst explaining the benefits of the process, particularly within the South African context, which is rich in tangible and intangible traditional cultural material, objects, and performances. With the internet having been introduced to the African Continent in the early 1990s, this new form of technology, in its own right, initiated a high degree of efficiency, which also resulted in the progressive transformation of computer-generated visual output. Subsequently, this caused a revolutionary influence on the manner in which technological software was developed and uterlised in art-making. Digital technology and the digitisation of creative processes then opened up new avenues of collating and recording information. One of the first visual artists to make use of digital technology software in his creative productions was United States-based artist John Whitney. His inventive work contributed greatly to the onset and development of digital animation. Comparable by technique and originality, South African contemporary visual artists who make digital artworks, both locally and internationally, include David Goldblatt, Katherine Bull, Fritha Langerman, David Masoga, Zinhle Sethebe, Alicia Mcfadzean, Ivan Van Der Walt, Siobhan Twomey, and Fhatuwani Mukheli. In conclusion, the main objective of this paper is to address the following questions: In which ways has the South African art community of visual artists made use of and benefited from technology, in its digital form, as a means to further advance creativity? What are the positive changes that have resulted in art production in South Africa since the onset and use of digital technological software? How has digitisation changed the manner in which we record, interpret, and archive both written and visual information? What is the role of South African art institutions in the development of digital technology and its use in the field of visual art. What role does digitisation play in the process of the repatriation of artworks and artefacts. The methodology in terms of the research process of this paper takes on a multifacted form, inclusive of data analysis of information attained by means of qualitative and quantitative approaches.Keywords: digital art, digitisation, technology, archiving, transformation and repatriation
Procedia PDF Downloads 52178 The Role of Intraluminal Endoscopy in the Diagnosis and Treatment of Fluid Collections in Patients With Acute Pancreatitis
Authors: A. Askerov, Y. Teterin, P. Yartcev, S. Novikov
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Introduction: Acute pancreatitis (AP) is a socially significant problem for public health and continues to be one of the most common causes of hospitalization of patients with pathology of the gastrointestinal tract. It is characterized by high mortality rates, which reaches 62-65% in infected pancreatic necrosis. Aims & Methods: The study group included 63 patients who underwent transluminal drainage (TLD) fluid collection (FC). All patients were performed transabdominal ultrasound, computer tomography of the abdominal cavity and retroperitoneal organs and endoscopic ultrasound (EUS) of the pancreatobiliary zone. The EUS was used as a final diagnostic method to determine the characteristics of FC. The indications for TLD were: the distance between the wall of the hollow organ and the FC was not more than 1 cm, the absence of large vessels on the puncture trajectory (more than 3 mm), and the size of the formation was more than 5 cm. When a homogeneous cavity with clear, even contours was detected, a plastic stent with rounded ends (“double pig tail”) was installed. The indication for the installation of a fully covered self-expanding stent was the detection of nonhomogeneous anechoic FC with hyperechoic inclusions and cloudy purulent contents. In patients with necrotic forms after drainage of the purulent cavity, a cystonasal drainage with a diameter of 7Fr was installed in its lumen under X-ray control to sanitize the cavity with a 0.05% aqueous solution of chlorhexidine. Endoscopic necrectomy was performed every 24-48 hours. The plastic stent was removed in 6 month, the fully covered self-expanding stent - in 1 month after the patient was discharged from the hospital. Results: Endoscopic TLD was performed in 63 patients. The FC corresponding to interstitial edematous pancreatitis was detected in 39 (62%) patients who underwent TLD with the installation of a plastic stent with rounded ends. In 24 (38%) patients with necrotic forms of FC, a fully covered self-expanding stent was placed. Communication with the ductal system of the pancreas was found in 5 (7.9%) patients. They underwent pancreaticoduodenal stenting. A complicated postoperative period was noted in 4 (6.3%) cases and was manifested by bleeding from the zone of pancreatogenic destruction. In 2 (3.1%) cases, this required angiography and endovascular embolization a. gastroduodenalis, in 1 (1.6%) case, endoscopic hemostasis was performed by filling the cavity with 4 ml of Hemoblock hemostatic solution. The combination of both methods was used in 1 (1.6%) patient. There was no evidence of recurrent bleeding in these patients. Lethal outcome occurred in 4 patients (6.3%). In 3 (4.7%) patients, the cause of death was multiple organ failure, in 1 (1.6%) - severe nosocomial pneumonia that developed on the 32nd day after drainage. Conclusions: 1. EUS is not only the most important method for diagnosing FC in AP, but also allows you to determine further tactics for their intraluminal drainage.2. Endoscopic intraluminal drainage of fluid zones in 45.8% of cases is the final minimally invasive method of surgical treatment of large-focal pancreatic necrosis. Disclosure: Nothing to disclose.Keywords: acute pancreatitis, fluid collection, endoscopy surgery, necrectomy, transluminal drainage
Procedia PDF Downloads 109177 Physical Activity and Nutrition Intervention for Singaporean Women Aged 50 Years and Above: A Study Protocol for a Community Based Randomised Controlled Trial
Authors: Elaine Yee Sing Wong, Jonine Jancey, Andy H. Lee, Anthony P. James
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Singapore has a rapidly aging population, where the majority of older women aged 50 years and above, are physically inactive and have unhealthy dietary habits, placing them at ‘high risk’ of non-communicable diseases. Given the multiplicity of less than optimal dietary habits and high levels of physical inactivity among Singaporean women, it is imperative to develop appropriate lifestyle interventions at recreational centres to enhance both their physical and nutritional knowledge, as well as provide them with the opportunity to develop skills to support behaviour change. To the best of our knowledge, this proposed study is the first physical activity and nutrition cluster randomised controlled trial conducted in Singapore for older women. Findings from this study may provide insights and recommendations for policy makers and key stakeholders to create new healthy living, recreational centres with supportive environments. This 6-month community-based cluster randomised controlled trial will involve the implementation and evaluation of physical activity and nutrition program for community dwelling Singaporean women, who currently attend recreational centres to promote social leisure activities in their local neighbourhood. The intervention will include dietary education and counselling sessions, physical activity classes, and telephone contact by certified fitness instructors and qualified nutritionists. Social Cognitive Theory with Motivational Interviewing will inform the development of strategies to support health behaviour change. Sixty recreational centres located in Singapore will be randomly selected from five major geographical districts and randomly allocated to the intervention (n=30) or control (n=30) cluster. A sample of 600 (intervention n=300; control n=300) women aged 50 years and above will then be recruited from these recreational centres. The control clusters will only undergo pre and post data collection and will not receive the intervention. It is hypothesised that by the end of the intervention, the intervention group participants (n = 300) compared to the control group (n = 300), will show significant improvements in the following variables: lipid profile, body mass index, physical activity and dietary behaviour, anthropometry, mental and physical health. Data collection will be examined and compared via the Statistical Package for the Social Science version 23. Descriptive and summary statistics will be used to quantify participants’ characteristics and outcome variables. Multi-variable mixed regression analyses will be used to confirm the effects of the proposed health intervention, taking into account the repeated measures and the clustering of the observations. The research protocol was approved by the Curtin University Human Research Ethics Committee (approval number: HRE2016-0366). The study has been registered with the Australian and New Zealand Clinical Trial Registry (12617001022358).Keywords: community based, healthy aging, intervention, nutrition, older women, physical activity
Procedia PDF Downloads 177176 Creation of a Trust-Wide, Cross-Speciality, Virtual Teaching Programme for Doctors, Nurses and Allied Healthcare Professionals
Authors: Nelomi Anandagoda, Leanne J. Eveson
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During the COVID-19 pandemic, the surge in in-patient admissions across the medical directorate of a district general hospital necessitated the implementation of an incident rota. Conscious of the impact on training and professional development, the idea of developing a virtual teaching programme was conceived. The programme initially aimed to provide junior doctors, specialist nurses, pharmacists, and allied healthcare professionals from medical specialties and those re-deployed from other specialties (e.g., ophthalmology, GP, surgery, psychiatry) the knowledge and skills to manage the deteriorating patient with COVID-19. The programme was later developed to incorporate the general internal medicine curriculum. To facilitate continuing medical education whilst maintaining social distancing during this period, a virtual platform was used to deliver teaching to junior doctors across two large district general hospitals and two community hospitals. Teaching sessions were recorded and uploaded to a common platform, providing a resource for participants to catch up on and re-watch teaching sessions, making strides towards reducing discrimination against the professional development of less than full-time trainees. Thus, creating a learning environment, which is inclusive and accessible to adult learners in a self-directed manner. The negative impact of the pandemic on the well-being of healthcare professionals is well documented. To support the multi-disciplinary team, the virtual teaching programme evolved to included sessions on well-being, resilience, and work-life balance. Providing teaching for learners across the multi-disciplinary team (MDT) has been an eye-opening experience. By challenging the concept that learners should only be taught within their own peer groups, the authors have fostered a greater appreciation of the strengths of the MDT and showcased the immense wealth of expertise available within the trust. The inclusive nature of the teaching and the ease of joining a virtual teaching session has facilitated the dissemination of knowledge across the MDT, thus improving patient care on the frontline. The weekly teaching programme has been running for over eight months, with ongoing engagement, interest, and participation. As described above, the teaching programme has evolved to accommodate the needs of its learners. It has received excellent feedback with an appreciation of its inclusive, multi-disciplinary, and holistic nature. The COVID-19 pandemic provided a catalyst to rapidly develop novel methods of working and training and widened access/exposure to the virtual technologies available to large organisations. By merging pedagogical expertise and technology, the authors have created an effective online learning environment. Although the authors do not propose to replace face-to-face teaching altogether, this model of virtual multidisciplinary team, cross-site teaching has proven to be a great leveler. It has made high-quality teaching accessible to learners of different confidence levels, grades, specialties, and working patterns.Keywords: cross-site, cross-speciality, inter-disciplinary, multidisciplinary, virtual teaching
Procedia PDF Downloads 170175 The Reality of Gender Equality in Universities Libraries: A Case of Pakistan
Authors: Qurat Ul Ain Saleem, Kanwal Ameen
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The library and information science discipline is universally known as a feminist profession. It is considered a suitable field for females in Pakistan like a few other fields such as teaching and healthcare. It is also reflected through the uneven enrollment at graduate levels in library schools across the country as there are more females as compared to males. However, that uneven ratio does not really translate in the profession after passing out. There are more males in the professional as compared to females, as well as males can be seen on managerial and administrative posts majorly. A few females who joined the perception remain underrated and are hardly seen at managerial or administrative positions in the academic libraries. Therefore, this study was designed to highlight the perceptions of those females who have joined the profession to identify the issues related to equality faced by them as a professional. A qualitative research design based on a semi-structured interview was selected as an appropriate method to achieve the objectives of this study. Female librarians working in the higher education commission’s recognized public and private sector universities of Punjab, Pakistan, were selected as the population for this study. Female librarians shared that inequalities and discrimination based on face value, experience, communication, and relationship with the manager are common at their workplaces. They added that managers prefer male professionals to deal with delegation or presentations though we both can do that. Female professionals from the private sector believed that library managers make final hiring and selection decisions based on job duties and gender. However, the one with strong references will be preferred for the job. Also, private-sector employees suffered more prejudice due to the non-availability of proper patterns of promotions and increments. The government personnel said there is always a proper board/procedure for hiring and promotions; therefore, it is difficult for them to identify any inequality. Participants were dissatisfied with their managers for not allowing them to attend training and conferences. The majority of participants from the private sector said they wouldn't speak up to prejudice because they are afraid of losing their jobs and their voice is lost in a male-dominated society where males hold numerous authoritative positions and females are considered less competent. Nonetheless, the discrimination and inequalities affected the work motivation and enthusiasm of employees. Therefore, organizations should not discriminate against the staff in terms of facilities and benefits. The sample may not represent the true picture of gender equality in university libraries of Pakistan due to less number of participants and limited geographical boundaries. It is also assumed that some females may refrain from disclosing factual information or some may exaggerate the facts as a large number of participants requested to become part of the study. Equal opportunities should be offered to female library professionals to uplift and involve them to mitigate the perception of gender dominance. The organizations or immediate authorities should allow their staff to participate in training opportunities to learn modern practices to better serve the community.Keywords: equality-workplace, libraries as workplace, female professionals, librarians-Pakistan
Procedia PDF Downloads 113174 Correlation between the Levels of Some Inflammatory Cytokines/Haematological Parameters and Khorana Scores of Newly Diagnosed Ambulatory Cancer Patients
Authors: Angela O. Ugwu, Sunday Ocheni
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Background: Cancer-associated thrombosis (CAT) is a cause of morbidity and mortality among cancer patients. Several risk factors for developing venous thromboembolism (VTE) also coexist with cancer patients, such as chemotherapy and immobilization, thus contributing to the higher risk of VTE in cancer patients when compared to non-cancer patients. This study aimed to determine if there is any correlation between levels of some inflammatory cytokines/haematological parameters and Khorana scores of newly diagnosed chemotherapy naïve ambulatory cancer patients (CNACP). Methods: This was a cross-sectional analytical study carried out from June 2021 to May 2022. Eligible newly diagnosed cancer patients 18 years and above (case group) were enrolled consecutively from the adult Oncology Clinics of the University of Nigeria Teaching Hospital, Ituku/Ozalla (UNTH). The control group was blood donors at UNTH Ituku/Ozalla, Enugu blood bank, and healthy members of the Medical and Dental Consultants Association of Nigeria (MDCAN), UNTH Chapter. Blood samples collected from the participants were assayed for IL-6, TNF-Alpha, and haematological parameters such as haemoglobin, white blood cell count (WBC), and platelet count. Data were entered into an Excel worksheet and were then analyzed using Statistical Package for Social Sciences (SPSS) computer software version 21.0 for windows. A P value of < 0.05 was considered statistically significant. Results: A total of 200 participants (100 cases and 100 controls) were included in the study. The overall mean age of the participants was 47.42 ±15.1 (range 20-76). The sociodemographic characteristics of the two groups, including age, sex, educational level, body mass index (BMI), and occupation, were similar (P > 0.05). Following One Way ANOVA, there were significant differences between the mean levels of interleukin-6 (IL-6) (p = 0.036) and tumor necrotic factor-α (TNF-α) (p = 0.001) in the three Khorana score groups of the case group. Pearson’s correlation analysis showed a significant positive correlation between the Khorana scores and IL-6 (r=0.28, p = 0.031), TNF-α (r= 0.254, p= 0.011), and PLR (r= 0.240, p=0.016). The mean serum levels of IL-6 were significantly higher in CNACP than in the healthy controls [8.98 (8-12) pg/ml vs. 8.43 (2-10) pg/ml, P=0.0005]. There were also significant differences in the mean levels of the haemoglobin (Hb) level (P < 0.001)); white blood cell (WBC) count ((P < 0.001), and platelet (PL) count (P = 0.005) between the two groups of participants. Conclusion: There is a significant positive correlation between the serum levels of IL-6, TNF-α, and PLR and the Khorana scores of CNACP. The mean serum levels of IL-6, TNF-α, PLR, WBC, and PL count were significantly higher in CNACP than in the healthy controls. Ambulatory cancer patients with high-risk Khorana scores may benefit from anti-inflammatory drugs because of the positive correlation with inflammatory cytokines. Recommendations: Ambulatory cancer patients with 2 Khorana scores may benefit from thromboprophylaxis since they have higher Khorana scores. A multicenter study with a heterogeneous population and larger sample size is recommended in the future to further elucidate the relationship between IL-6, TNF-α, PLR, and the Khorana scores among cancer patients in the Nigerian population.Keywords: thromboprophylaxis, cancer, Khorana scores, inflammatory cytokines, haematological parameters
Procedia PDF Downloads 82173 The Effect of Students’ Social and Scholastic Background and Environmental Impact on Shaping Their Pattern of Digital Learning in Academia: A Pre- and Post-COVID Comparative View
Authors: Nitza Davidovitch, Yael Yossel-Eisenbach
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The purpose of the study was to inquire whether there was a change in the shaping of undergraduate students’ digitally-oriented study pattern in the pre-Covid (2016-2017) versus post-Covid period (2022-2023), as affected by three factors: social background characteristics, high school, and academic background characteristics. These two-time points were cauterized by dramatic changes in teaching and learning at institutions of higher education. The data were collected via cross-sectional surveys at two-time points, in the 2016-2017 academic school year (N=443) and in the 2022-2023 school year (N=326). The questionnaire was distributed on social media and it includes questions on demographic background characteristics, previous studies in high school and present academic studies, and questions on learning and reading habits. Method of analysis: A. Statistical descriptive analysis, B. Mean comparison tests were conducted to analyze the variations in the mean score for the digitally-oriented learning pattern variable at two-time points (pre- and post-Covid) in relation to each of the independent variables. C. Analysis of variance was performed to test the main effects and the interactions. D. Applying linear regression, the research aimed to examine the combined effect of the independent variables on shaping students' digitally-oriented learning habits. The analysis includes four models. In all four models, the dependent variable is students’ perception of digitally oriented learning. The first model included social background variables; the second model included scholastic background as well. In the third model, the academic background variables were added, and the fourth model includes all the independent variables together with the variable of period (pre- and post-COVID). E. Factor analysis confirms using the principal component method with varimax rotation; the variables were constructed by a weighted mean of all the relevant statements merged to form a single variable denoting a shared content world. The research findings indicate a significant rise in students’ perceptions of digitally-oriented learning in the post-COVID period. From a gender perspective, the impact of COVID on shaping a digital learning pattern was much more significant for female students. The socioeconomic status perspective is eliminated when controlling for the period, and the student’s job is affected - more than all other variables. It may be assumed that the student’s work pattern mediates effects related to the convenience offered by digital learning regarding distance and time. The significant effect of scholastic background on shaping students’ digital learning patterns remained stable, even when controlling for all explanatory variables. The advantage that universities had over colleges in shaping a digital learning pattern in the pre-COVID period dissipated. Therefore, it can be said that after COVID, there was a change in how colleges shape students’ digital learning patterns in such a way that no institutional differences are evident with regard to shaping the digital learning pattern. The study shows that period has a significant independent effect on shaping students’ digital learning patterns when controlling for the explanatory variables.Keywords: learning pattern, COVID, socioeconomic status, digital learning
Procedia PDF Downloads 62172 An Observation of Patient-Professional Communication in the Cambodian Dental Setting
Authors: Christina Tran, Lu Khoo, Andrea Waylen
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Introduction: The evolution of the dental consultation from paternalism to partnership has been well documented in developed Western countries. Great emphasis is now placed on the importance of empowering patients to make decisions regarding their care, obtaining informed consent, and maintaining patient privacy and confidentiality. With the majority of communication occurring non-verbally, clinicians often adopt behaviours which suggest an approachable and positive attitude. However, evidence indicates that in Asia, a paternalistic model may be favored in medicine. The power imbalance occurring in doctor-patient relationships worldwide may be exacerbated by various factors in Southeast Asia: the strong hierarchical culture, and the large education gap between doctor and patient. Further insight into this matter can be gained by observing patient-dentist communication in Cambodia. The dentist:population ratio in Cambodia is approximately 1:33,000, with rural areas remaining extremely underserviced. We have carried out an observational study of communication in a voluntary dental clinic in Cambodia with the aim of describing whether the patient-dentist relationship follows a paternalistic or patient-centred model. Method: Over a period of two weeks, two clinicians provided dental care as part of a voluntary program in two Cambodian settings: a temporary, rural clinic and a permanent clinic in Phnom Penh. The clinicians independently recorded their experiences in diaries, making observations on the verbal and non-verbal communication between patients and staff. General observations such as the clinic environment were also made. The diaries were then compared and analyzed using a thematic approach. Results: The overall themes that emerged were regarding the clinic environment, verbal communication, and non-verbal communication. Regarding the clinic environment, the rural clinic was arranged in order to easily direct patients from one dentist to another, with little emphasis on continuous patient care. There was also little consideration for patient privacy: patients were often treated in the presence of many observers, including other waiting patients. However, the permanent clinic was structured to allow greater patient privacy, with continuous patient care occurring throughout the appointment. Regarding verbal communication, there was a strongly paternalistic approach to gaining consent and giving instruction. Patients rarely asked questions regarding their treatment, with dentists doing little to encourage patient involvement. Non-verbal communication between patients and dentists was generally paternalistic, with the dentist often addressing the supine patient from above. Patients often avoided making eye-contact, which may have indicated discomfort or lack of engagement. Both adult and paediatric patients rarely raised verbal concerns regarding pain during treatment, despite displaying non-verbal signs of experiencing pain. Anxious paediatric patients were sometimes managed with physical restraint by their mothers to facilitate treatment. Conclusion: Patient-professional communication in the Cambodian dental setting was observed to be generally paternalistic in nature, although more patient-centred aspects were observed in the established, urban setting. However, it should be noted that these observations are subjective in nature, and that the patients’ actual perceptions of their communication experience were unexplored. Further observations in variety of dental settings in Cambodia are needed before any definitive conclusions can be made.Keywords: patient-dentist communication, paternalism, patient-centered, non-verbal communication
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