Search results for: emotional focused couple therapy
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6860

Search results for: emotional focused couple therapy

5630 Resilience among Children with and without Hearing Loss: A Comparative Study in Pakistan

Authors: Bushra Akram, Amina Tariq

Abstract:

Objective: This cross-sectional descriptive study aimed to compare the level of resilience among children with and without hearing loss. Methodology: In this descriptive cross sectional study total 500 children (with hearing loss = 250 and without hearing loss = 250) were recruited conveniently. Children with hearing loss were recruited from the special schools whereas children without hearing loss were selected from regular schools located in cities of Gujrat and Jhelum of Pakistan. Respondents’ age ranged from 9-14 years. Resiliency scale named RSCA (Resiliency Scales for children and adolescents) developed by Sandra Prince Embury (2006) was used. RSCA consist of three core theoretical areas: MAS (Sense of Mastery Scale), REL (Sense of Relatedness Scale) and REA (Emotional Reactivity Scale). Results: Findings indicated that there was a significant difference in the resilience level of participants with and without hearing loss. The mean comparison showed that the children with hearing loss showed lower scores on MAS (X̅ = 43.32, SD = 7.55) as well as on REL (X̅ = 49.96, SD = 7.65) as compared to their counterparts on MAS (X̅ = 53.96, SD = 9.90, t= -7.31***) and on REL (X̅ = 68.43, SD = 14.57,t= -10.18***). However children with hearing loss showed higher scores on REA (X̅ = 42.12, SD = 5.84) as compared to hearing participants (X̅ = 28.84, SD = 13.97, t = -8.20***). The findings revealed no significance difference in the resilience level of hearing and deaf children on the basis of their gender and age. Research Outcomes and Future Scope: Children with hearing loss showed a lower level of resilience, therefore, needs a program to develop resilience for better social-emotional adjustment and enhancement of their psychological well-being. In the end, the researcher gave recommendations for future research.

Keywords: children with hearing loss, psychological Wellbeing, resiliency scales for children and adolescents, resilience

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5629 Upconversion Nanoparticle-Mediated Carbon Monoxide Prodrug Delivery System for Cancer Therapy

Authors: Yaw Opoku-Damoah, Run Zhang, Hang Thu Ta, Zhi Ping Xu

Abstract:

Gas therapy is still at an early stage of research and development. Even though most gasotransmitters have proven their therapeutic potential, their handling, delivery, and controlled release have been extremely challenging. This research work employs a versatile nanosystem that is capable of delivering a gasotransmitter in the form of a photo-responsive carbon monoxide-releasing molecule (CORM) for targeted cancer therapy. The therapeutic action was mediated by upconversion nanoparticles (UCNPs) designed to transfer bio-friendly low energy near-infrared (NIR) light to ultraviolet (UV) light capable of triggering carbon monoxide (CO) from a water-soluble amphiphilic manganese carbonyl complex CORM incorporated into a carefully designed lipid drug delivery system. Herein, gaseous CO that plays a role as a gasotransmitter with cytotoxic and homeostatic properties was investigated to instigate cellular apoptosis. After successfully synthesizing the drug delivery system, the ability of the system to encapsulate and mediate the sustained release of CO after light excitation was demonstrated. CO fluorescence probe (COFP) was successfully employed to determine the in vitro drug release profile upon NIR light irradiation. The uptake of nanoparticles enhanced by folates and its receptor interaction was also studied for cellular uptake purposes. The anticancer potential of the final lipid nanoparticle Lipid/UCNPs/CORM/FA (LUCF) was also determined by cell viability assay. Intracellular CO release and a subsequent therapeutic action involving ROS production, mitochondrial damage, and CO production was also evaluated. In all, this current project aims to use in vitro studies to determine the potency and efficiency of a NIR-mediated CORM prodrug delivery system.

Keywords: carbon monoxide-releasing molecule, upconversion nanoparticles, site-specific delivery, amphiphilic manganese carbonyl complex, prodrug delivery system.

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5628 Story of Alex: Sociology of Gender

Authors: Karen V. Lee

Abstract:

The significance of this study involves autoethnographic research about a music teacher learning about the socialization of gender issues in teaching. Mentorship involving intervention helps with the consequences influencing a transgendered music teacher. Basic storytelling methodology involves the qualitative method of research as a theoretical framework where the author provides a storied reflection about political issues surrounding teachers and the sociology of gender. Sub-themes involve counseling, adult education to ensure students and teachers receive social, emotional, physical, spiritual, and educational resources that evoke visceral, emotional responses from the audience. Major findings share how stories are helpful resources for others who struggle with the socialization of gender. It is hoped the research dramatizes an episodic yet incomplete story that highlights the circumstances surrounding the protagonist having his sex reassignment surgery during his undergraduate education degree. In conclusion, the research is a reflexive storied framework that embraces a positive outlook about a transgendered teacher during his masectomy. The sensory experience seeks verisimilitude by evoking lifelike and believable feelings from others. Thus, the scholarly importance of the sociology of gender and society provides transformative aspects that contributes to social change. Overall, the surgery surrounding the story about transgendered issues are not uncommon in society. Thus, continued education supports the moral mission to help teachers overcome and understand issues of gender that can socially impacts their professional lives as teachers.

Keywords: sociology of gender, transgender, music teachers, story, autoethnography as research, ideology

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5627 A Problem on Homogeneous Isotropic Microstretch Thermoelastic Half Space with Mass Diffusion Medium under Different Theories

Authors: Devinder Singh, Rajneesh Kumar, Arvind Kumar

Abstract:

The present investigation deals with generalized model of the equations for a homogeneous isotropic microstretch thermoelastic half space with mass diffusion medium. Theories of generalized thermoelasticity Lord-Shulman (LS) Green-Lindsay (GL) and Coupled Theory (CT) theories are applied to investigate the problem. The stresses in the considered medium have been studied due to normal force and tangential force. The normal mode analysis technique is used to calculate the normal stress, shear stress, couple stresses and microstress. A numerical computation has been performed on the resulting quantity. The computed numerical results are shown graphically.

Keywords: microstretch, thermoelastic, normal mode analysis, normal and tangential force, microstress force

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5626 A Phenomenological Method Based on Professional Descriptions of Community-of-Practice Members to Scientifically Determine the Level of Child Psycho-Social-Emotional Development

Authors: Gianni Jacucci

Abstract:

Alfred Schutz (1932), at the very turning towards phenomenology, of the attention for the social sciences, stated that successful communication of meanings requires the sharing of “sedimenta-tions “ of previous meanings. Börje Langefors (1966), at the very beginning of the social studies of information systems, stated that a common professional basis is required for a correct sharing of meanings, e. g., “standardised accounting data among accountants”. Harold Garfinkel (1967), at the very beginning of ethnomethodology, stated that the accounting of social events must be carried out in the same language used by the actors of those events in managing their practice. Community of practice: we advocate professional descriptions of the community of practice members to scientifically determine the level of child psycho social emotional development. Our approach consists of an application to Human Sciences of Husserl’s Phenomenological Philosophy using a method reminder of Giorgi’s DPM in Psychology. Husserl’s requirement of "Epoché," which involves eliminating prejudices from the minds of observers, is met through "concept cleaning," achieved by consistently sharing disciplinary concepts within their community of practice. Mean-while, the absence of subjective bias is ensured by the meticulous attention to detail in their professional expertise. Our approach shows promise in accurately assessing many other properties through detailed professional descriptions of the community of practice members.

Keywords: scientific rigour, descriptive phenomenological method, sedimentation of meanings, community of practice

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5625 Early Education Assessment Methods

Authors: Anantdeep Kaur, Sharanjeet Singh

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Early childhood education and assessment of children is a very essential tool that helps them in their growth and development. Techniques should be developed, and tools should be created in this field as it is a very important learning phase of life. Some information and sources are included for student assessment to provide a record of growth in all developmental areas cognitive, physical, Language, social-emotional, and approaches to learning. As an early childhood educator, it is very important to identify children who need special support and counseling to improve them because they are not mentally mature to discuss with the teacher their problems and needs. It is the duty and responsibility of the educator to assess children from their body language, behavior, and their routine actions about their skills that can be improved and which can take them forward in their future life. And also, children should be assessed with their weaker points because this is the right time to correct them, and they be improved with certain methods and tools by working on them constantly. Observing children regularly with all their facets of development, including intellectual, linguistic, social-emotional, and physical development. Every day, a physical education class should be regulated to check their physical growth activities, which can help to assess their physical activeness and motor abilities. When they are outside on the playgrounds, it is very important to instill environmental understanding among them so that they should know that they are very part of this nature, and it will help them to be one with the universe rather than feeling themselves individually. This technique assists them in living their childhood full of energy all the time. All types of assessments have unique purposes. It is important first to determine what should be measured, then find the program that best assesses those.

Keywords: special needs, motor ability, environmental understanding, physical development

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5624 The Effects of Family Economic Situation (Poverty) on the Domestic Violence

Authors: Fatemeh Noughani, Seyd Mehdi Sadat

Abstract:

Violence against women as a global problem is not confined to any geographical and cultural area. The thoughts and opinions propagating the violence are seen in many cultural beliefs of societies. However, the shape, type and nature of it is different in different cultures. Also, many Iranian women have experienced different dimensions of domestic violence in their lives. This experience may vary with the family economic situation and poverty. Therefore, this research had studied the effects of family economic situation (poverty) on the increase of domestic violence against women. The sample of this study includes 126 married women older than 8 years old and they were selected by stratified and quota sampling method. The results showed that there is a direct and significant between the family economic situation and employment situation of women and domestic violence against women. More precisely, having economic capital, financial ability, affects the couple’s relationship and will solve their many social problems and perhaps, it seem that in terms of economic violence, the men who have higher economic capital, exert the lowest level of economic violence against their wives.

Keywords: economic situation , domestic violence, poverty, Iran

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5623 Circle of Learning Using High-Fidelity Simulators Promoting a Better Understanding of Resident Physicians on Point-of-Care Ultrasound in Emergency Medicine

Authors: Takamitsu Kodama, Eiji Kawamoto

Abstract:

Introduction: Ultrasound in emergency room has advantages of safer, faster, repeatable and noninvasive. Especially focused Point-Of-Care Ultrasound (POCUS) is used daily for prompt and accurate diagnoses, for quickly identifying critical and life-threatening conditions. That is why ultrasound has demonstrated its usefulness in emergency medicine. The true value of ultrasound has been once again recognized in recent years. It is thought that all resident physicians working at emergency room should perform an ultrasound scan to interpret signs and symptoms of deteriorating patients in the emergency room. However, a practical education on ultrasound is still in development. To resolve this issue, we established a new educational program using high-fidelity simulators and evaluated the efficacy of this course. Methods: Educational program includes didactic lectures and skill stations in half-day course. Instructor gives a lecture on POCUS such as Rapid Ultrasound in Shock (RUSH) and/or Focused Assessment Transthoracic Echo (FATE) protocol at the beginning of the course. Then, attendees are provided for training of scanning with cooperation of normal simulated patients. In the end, attendees learn how to apply focused POCUS skills at clinical situation using high-fidelity simulators such as SonoSim® (SonoSim, Inc) and SimMan® 3G (Laerdal Medical). Evaluation was conducted through surveillance questionnaires to 19 attendees after two pilot courses. The questionnaires were focused on understanding course concept and satisfaction. Results: All attendees answered the questionnaires. With respect to the degree of understanding, 12 attendees (number of valid responses: 13) scored four or more points out of five points. High-fidelity simulators, especially SonoSim® was highly appreciated to enhance learning how to handle ultrasound at an actual practice site by 11 attendees (number of valid responses: 12). All attendees encouraged colleagues to take this course because the high level of satisfaction was achieved. Discussion: Newly introduced educational course using high-fidelity simulators realizes the circle of learning to deepen the understanding on focused POCUS by gradual stages. SonoSim® can faithfully reproduce scan images with pathologic findings of ultrasound and provide experimental learning for a growth number of beginners such as resident physicians. In addition, valuable education can be provided if it is used combined with SimMan® 3G. Conclusions: Newly introduced educational course using high-fidelity simulators is supposed to be effective and helps in providing better education compared with conventional courses for emergency physicians.

Keywords: point-of-care ultrasound, high-fidelity simulators, education, circle of learning

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5622 Hypertensive Response to Maximal Exercise Test in Young and Middle Age Hypertensive on Blood Pressure Lowering Medication: Monotherapy vs. Combination Therapy

Authors: James Patrick A. Diaz, Raul E. Ramboyong

Abstract:

Background: Hypertensive response during maximal exercise test provides important information on the level of blood pressure control and evaluation of treatment. Method: A single center retrospective descriptive study was conducted among 117 young (aged 20 to 40) and middle age (aged 40 to 65) hypertensive patients, who underwent treadmill stress test. Currently on maintenance frontline medication either monotherapy (Angiotensin-converting enzyme inhibitor/Angiotensin receptor blocker [ACEi/ARB], Calcium channel blocker [CCB], Diuretic - Hydrochlorthiazide [HCTZ]) or combination therapy (ARB+CCB, ARB+HCTZ), who attained a maximal exercise on treadmill stress test (TMST) with hypertensive response (systolic blood pressure: male >210 mm Hg, female >190 mm Hg, diastolic blood pressure >100 mmHg, or increase of >10 mm Hg at any time during the test), on Bruce and Modified Bruce protocol. Exaggerated blood pressure response during exercise (systolic [SBP] and diastolic [DBP]), peak exercise blood pressure (SBP and DBP), recovery period (SBP and DBP) and test for ischemia and their antihypertensive medication/s were investigated. Analysis of variance and chi-square test were used for statistical analysis. Results: Hypertensive responses on maximal exercise test were seen mostly among female population (P < 0.000) and middle age (P < 0.000) patients. Exaggerated diastolic blood pressure responses were significantly lower in patients who were taking CCB (P < 0.004). A longer recovery period that showed a delayed decline in SBP was observed in patients taking ARB+HCTZ (P < 0.036). There were no significant differences in the level of exaggerated systolic blood pressure response and during peak exercise (both systolic and diastolic) in patients using either monotherapy or combination antihypertensives. Conclusion: Calcium channel blockers provided lower exaggerated diastolic BP response during maximal exercise test in hypertensive middle age patients. Patients on combination therapy using ARB+HCTZ exhibited a longer recovery period of systolic blood pressure.

Keywords: antihypertensive, exercise test, hypertension, hyperytensive response

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5621 Long Term Examination of the Profitability Estimation Focused on Benefits

Authors: Stephan Printz, Kristina Lahl, René Vossen, Sabina Jeschke

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Strategic investment decisions are characterized by high innovation potential and long-term effects on the competitiveness of enterprises. Due to the uncertainty and risks involved in this complex decision making process, the need arises for well-structured support activities. A method that considers cost and the long-term added value is the cost-benefit effectiveness estimation. One of those methods is the “profitability estimation focused on benefits – PEFB”-method developed at the Institute of Management Cybernetics at RWTH Aachen University. The method copes with the challenges associated with strategic investment decisions by integrating long-term non-monetary aspects whilst also mapping the chronological sequence of an investment within the organization’s target system. Thus, this method is characterized as a holistic approach for the evaluation of costs and benefits of an investment. This participation-oriented method was applied to business environments in many workshops. The results of the workshops are a library of more than 96 cost aspects, as well as 122 benefit aspects. These aspects are preprocessed and comparatively analyzed with regards to their alignment to a series of risk levels. For the first time, an accumulation and a distribution of cost and benefit aspects regarding their impact and probability of occurrence are given. The results give evidence that the PEFB-method combines precise measures of financial accounting with the incorporation of benefits. Finally, the results constitute the basics for using information technology and data science for decision support when applying within the PEFB-method.

Keywords: cost-benefit analysis, multi-criteria decision, profitability estimation focused on benefits, risk and uncertainty analysis

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5620 Prevalence and Factors Associated With Concurrent Use of Herbal Medicine and Anti-retroviral Therapy Among HIV/Aids Patients Attending Selected HIV Clinics in Wakiso District

Authors: Nanteza Rachel

Abstract:

Background: Worldwide, there were 36.7 million people living with Human Immunodeficiency Virus (HIV) in 2015, up from 35 million at the end of 2013. Wakiso district is one of the hotspots for the Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) infection in Uganda, with the prevalence of 8.1 %. Herbal medicine has gained popularity among Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) patients as adjuvant therapy to reduce the adverse effects of ART. Regardless of the subsidized and physical availability of the Anti-Retroviral Therapy (ART), majority of Africans living with Human Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS) resort to adding to their ART traditional medicine. Result found out from a pilot observation made by the PI that indicate 13 out of 30 People Living with AIDS(PLWA) who are attending Human Immunodeficiency Virus (HIV) clinics in Wakiso district reported to be using herbal preparations despite the fact that they were taking Anti Retro Viral (ARVs) this prompted this study to be done. Purpose of the study: To determine the prevalence and factors associated with concurrent use of herbal medicine and anti-retroviral therapy among HIV/AIDS patients attending selected HIV clinics in Wakiso district. Methodology: This was a cross sectional study with both quantitative data collection (use of a questionnaire) and qualitative data collection (key informants’ interviews). A mixed method of sampling was used, that is, purposive and random sampling. Purposive sampling was based on the location in the district and used to select 7 health facilities basing on the 7 health sub districts from Wakiso. Simple random sampling was used to select one HIV clinic from each of the 7 health sub districts. Furthermore, the study units were enrolled in to the study as they entered into the HIV clinics, and 105 respondents were interviewed. Both manual and computer packages (SPSS) were used to analyze the data Results: The prevalence of concurrent use of herbal medicine and ART was 38 (36.2%). Commonly HIV symptom treated with herbs was fever 27(71.1%), diarrhea 3(7.9%) and cough 2(5.3%). Commonly used herbs for fever (Omululuza (Vernonica amydalina), Ekigagi (Aloe sp), Nalongo (Justicia betonica Linn) while for diarrhea was Ntwatwa. The side effects also included; too much pain, itchy pain of HIV, aneamia,felt sick, loss/gain appetite, joint pain and bad dreams. Herbs used to sooth the side effects were; for aneamia was avocado leaves Parea Americana mill The significant factors associated with concurrent use of herbal medicine were being familiar with herbs and conventional medicine for management HIV symptoms being expensive. The other significant factor was exhibiting hostility to patients by health personnel providing HIV care. Conclusion: Herbal medicine is widely used by clients in HIV/AIDS care. Patients being familiar with herbs and conventional medicine being expensive were associated with concurrent use of herbal medicine and ART. The exhibition of hostility to the HIV/AIDS patients by the health care providers was also associated with concurrent use of herbal medicine and ART among HIV/AIDS patients.

Keywords: HIV patients, herbal medicine, antiretroviral therapy, factors associated

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5619 Neutron Contamination in 18 MV Medical Linear Accelerator

Authors: Onur Karaman, A. Gunes Tanir

Abstract:

Photon radiation therapy used to treat cancer is one of the most important methods. However, photon beam collimator materials in Linear Accelerator (LINAC) head generally contains heavy elements is used and the interaction of bremsstrahlung photon with such heavy nuclei, the neutron can be produced inside the treatment rooms. In radiation therapy, neutron contamination contributes to the risk of secondary malignancies in patients, also physicians working in this field. Since the neutron is more dangerous than photon, it is important to determine neutron dose during radiotherapy treatment. In this study, it is aimed to analyze the effect of field size, distance from axis and depth on the amount of in-field and out-field neutron contamination for ElektaVmat accelerator with 18 MV nominal energy. The photon spectra at the distance of 75, 150, 225, 300 cm from target and on the isocenter of beam were scored for 5x5, 10x10, 20x20, 30x30 and 40x40 cm2 fields. Results demonstrated that the neutron spectra and dose are dependent on field size and distances. Beyond 225 cm of isocenter, the dependence of the neutron dose on field size is minimal. As a result, it is concluded that as the open field increases, neutron dose determined decreases. It is important to remember that when treating with high energy photons, the dose from contamination neutrons must be considered as it is much greater than the photon dose.

Keywords: radiotherapy, neutron contamination, linear accelerators, photon

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5618 Marriage, Foundation of Family Strength and the Best Opportunity for Human Existence and Relationships

Authors: Tamriko Pavliashvili

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Marriage is such an important institution of family law, which is an indicator of the development of society. Although a family can be created by the birth of a child between an unmarried couple, marriage is still the main basis for the creation of a family, during which the rights and duties imposed require legal regulation. At present, in the conditions of globalization, there are different types of marriage, although, in the main countries, it is still a union of a woman and a man, which involves voluntary cohabitation and assuming and fulfilling the norms and responsibilities established on the basis of the law. Modern society is at the stage where there is a need to create a family, and therefore marriage provides the best opportunity for relationships and existence between people. The mentioned paper about the state institution - of marriage gives us the opportunity to get more information about the existing habits and legal norms from ancient times to the modern period in Georgia, and also through comparison, we will see what the differences and commonalities were and are in the marriage law of the countries of the world and Georgia.

Keywords: marriage, family law, the union of man and woman, church law, concubinage, registered marriage, impeding circumstances, positive and negative conditions of marriage

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5617 Ambivalence as Ethical Practice: Methodologies to Address Noise, Bias in Care, and Contact Evaluations

Authors: Anthony Townsend, Robyn Fasser

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While complete objectivity is a desirable scientific position from which to conduct a care and contact evaluation (CCE), it is precisely the recognition that we are inherently incapable of operating objectively that is the foundation of ethical practice and skilled assessment. Drawing upon recent research from Daniel Kahneman (2021) on the differences between noise and bias, as well as different inherent biases collectively termed “The Elephant in the Brain” by Kevin Simler and Robin Hanson (2019) from Oxford University, this presentation addresses both the various ways in which our judgments, perceptions and even procedures can be distorted and contaminated while conducting a CCE, but also considers the value of second order cybernetics and the psychodynamic concept of ‘ambivalence’ as a conceptual basis to inform our assessment methodologies to limit such errors or at least better identify them. Both a conceptual framework for ambivalence, our higher-order capacity to allow for the convergence and consideration of multiple emotional experiences and cognitive perceptions to inform our reasoning, and a practical methodology for assessment relying on data triangulation, Bayesian inference and hypothesis testing is presented as a means of promoting ethical practice for health care professionals conducting CCEs. An emphasis on widening awareness and perspective, limiting ‘splitting’, is demonstrated both in how this form of emotional processing plays out in alienating dynamics in families as well as the assessment thereof. In addressing this concept, this presentation aims to illuminate the value of ambivalence as foundational to ethical practice for assessors.

Keywords: ambivalence, forensic, psychology, noise, bias, ethics

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5616 Effect of He-Ne Laser Therapy on the Testis and Serum Testosterone Level in Adult Rats

Authors: Nadeem H. Meikha , Nazad H. Qader, Basheer M. Hasafa

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The trial was conducted to examine the effect of He-Ne laser therapy on the testis and serum testosterone level in adult rats. Thirty five albino Western adult male rats aged 3-4 months and weighing approximately 250-300 g were used and divided into three treatments. Testicular tissue of rats in the first and second treatments were exposed once daily for three successively days to a dose of irradiation 1.02 j/cm2 (40 second), and to 2.03 j/cm2 (80 second) respectively, while the third group left without any treatments (control). The results showed that the process of irradiation adversely affected on the level of serum testosterone concentration of the irradiated rats in the first and second treatment comparing to the normal level in the control group. While the histological examination showed that decrease in number of germ cells with 40 second of irradiation at day three, with 80 second of irradiation the decreased started at day two and three. The spermatids number decreased in rate low, medium, high respectively for three days of 40 second of irradiation, while the spermatids number were adversely affected by dropping in a rate of medium, large and very large for three days of 80 second of irradiation, respectively. In conclusion our study revealed that any reduction in sertoli cells causes adverse affect on both spermatids and germinal cells which increase with the increasing of duration and repetition of irradiation.

Keywords: He-Ne laser, rats, testosterone, spermatids

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5615 The Role of Personality and Attitude on Marital Conflict

Authors: Hajar Mohafezatkar Abadi

Abstract:

The family foundation is formed by marriage, and each couple, with their unique attitudes and personalities, takes a step into marriage. The more efficient and flexible these variables are, the more stable the marriage will be predicted. This group of couples sees their conflicts as an opportunity for growth, not as a threat to their shared life. Regarding family issue importance, a lot of research has been done around this topic which can be an effective step toward improving couples' life quality. The aim of the present study was to determine the role of personality and attitude on marital conflict. 306 couples (153 females, 153 males) were selected using multistage cluster sampling. The participants completed the personality Questionnaire (16PF, Cattell, 1975), marital conflict Questionnaire (MCQ-R, Sanaee Zaker, 1387), and dysfunctional attitude Questionnaire (DAS-26, Weissman & beck. 1987). The regression analysis results indicated that some personality traits and dysfunctional attitudes had a significant positive correlation with marital conflict.

Keywords: marital conflict, dysfunctional attitude, personality, personality questionnaire (16PF)

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5614 Classical Improvisation Facilitating Enhanced Performer-Audience Engagement and a Mutually Developing Impulse Exchange with Concert Audiences

Authors: Pauliina Haustein

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Improvisation was part of Western classical concert culture and performers’ skill sets until early 20th century. Historical accounts, as well as recent studies, indicate that improvisatory elements in the programme may contribute specifically towards the audiences’ experience of enhanced emotional engagement during the concert. This paper presents findings from the author’s artistic practice research, which explored re-introducing improvisation to Western classical performance practice as a musician (cellist and ensemble partner/leader). In an investigation of four concert cycles, the performer-researcher sought to gain solo and chamber music improvisation techniques (both related to and independent of repertoire), conduct ensemble improvisation rehearsals, design concerts with an improvisatory approach, and reflect on interactions with audiences after each concert. Data was collected through use of reflective diary, video recordings, measurement of sound parameters, questionnaires, a focus group, and interviews. The performer’s empirical experiences and findings from audience research components were juxtaposed and interrogated to better understand the (1) rehearsal and planning processes that enable improvisatory elements to return to Western classical concert experience and (2) the emotional experience and type of engagement that occur throughout the concert experience for both performer and audience members. This informed the development of a concert model, in which a programme of solo and chamber music repertoire and improvisations were combined according to historically evidenced performance practice (including free formal solo and ensemble improvisations based on audience suggestions). Inspired by historical concert culture, where elements of risk-taking, spontaneity, and audience involvement (such as proposing themes for fantasies) were customary, this concert model invited musicians to contribute to the process personally and creatively at all stages, from programme planning, and throughout the live concert. The type of democratic, personal, creative, and empathetic collaboration that emerged, as a result, appears unique in Western classical contexts, rather finding resonance in jazz ensemble, drama, or interdisciplinary settings. The research identified features of ensemble improvisation, such as empathy, emergence, mutual engagement, and collaborative creativity, that became mirrored in audience’s responses, generating higher levels of emotional engagement, empathy, inclusivity, and a participatory, co-creative experience. It appears that duringimprovisatory moments in the concert programme, audience members started feeling more like active participants in za\\a creative, collaborative exchange and became stakeholders in a deeper phenomenon of meaning-making and narrativization. Examining interactions between all involved during the concert revealed that performer-audience impulse exchange occurred on multiple levels of awareness and seemed to build upon each other, resulting in particularly strong experiences of both performer and audience’s engagement. This impact appeared especially meaningful for audience members who were seldom concertgoers and reported little familiarity with classical music. The study found that re-introducing improvisatory elements to Western classical concert programmes has strong potential in increasing audience’s emotional engagement with the musical performance, enabling audience members to connect more personally with the individual performers, and in reaching new-to-classical-music audiences.

Keywords: artistic research, audience engagement, audience experience, classical improvisation, ensemble improvisation, emotional engagement, improvisation, improvisatory approach, musical performance, practice research

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5613 A Quantitative Investigation of the Relation between Gender and Different Types of Loneliness among Adults in Flanders, Belgium

Authors: J. De Witte, W. Schepers, L. Heylen, T. Van Regenmortel

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Loneliness is increasingly considered a major public health threat. Feelings of severe loneliness negatively affect the social network, physical and mental health, mortality, and quality of life. Although loneliness is generally associated with old age, loneliness is of all ages, and young adults often have the highest risk of loneliness. Further, it is crucial to take the specific types of loneliness into account when studying and developing loneliness interventions. At the moment, little is known about how age interacts with this specific relation while taking into account various dimensions of loneliness (social, emotional and existential) among adults of all ages. Nevertheless, it is crucial to take the life course perspective into account when studying the relationship between loneliness and gender because several characteristics of the life course depend on gender. Therefore, this study investigates the relation between gender and different types of loneliness (social, emotional and existential) among adults of all ages in Flanders, Belgium, while taking into account its interaction with age. In this respect, we make use of a representative large-scale survey conducted in the period of May-July 2024 among adults (18+) living in the Flemish Region, Belgium, which could be completed both online (via QR code or website) and in writing. We wrote to 15,000 residents of the Flemish Region, who - after approval by the National Register - were randomly selected by Statbel. Next, ‘MAS Research’ wrote to those individuals via a written invitation letter and again via two reminders to complete this survey. After data cleansing, we retained 3756 questionnaires, which were at least 90% completed, or a response rate of 25.1%. A total of 2700 questionnaires were completed online (71.9%) and 1056 in writing (28.1%). The analyses use a weighting factor, which was calculated to account for over- and under-representation of certain groups with regard to age and gender. Preliminary results show that the relationship between gender and loneliness depends on the specific type of loneliness. For the youngest age group (18-25 years), we find, for example, no difference between men and women with respect to social loneliness, but women are significantly more emotionally lonely at that age period than men. Further, we find that there is no association between gender and loneliness for all age groups, except for young adults (25-34 years), where men are significantly more lonely than women, which is entirely explained by men being significantly more socially lonely than women. Knowledge about the specific relationship between gender and the different types of loneliness, which is dependent on age, is crucial when setting up interventions that aim to prevent or alleviate loneliness. Policymakers should always take into account the different types of loneliness when setting up loneliness interventions for a specific target group, and hereby take into account differences in life stages for young men and women.

Keywords: adults, emotional loneliness, gender, loneliness, social loneliness

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5612 Development of a Novel Nanobiosystem for the Selective Nanophotothermolysis of Meticilin Resistant Staphyloccocous Aureus Using Anti-MRSA Antibody Functionalized Gold Nanoparticles

Authors: Lucian Mocan, Cristian Matea, Flaviu A. Tabaran, Teodora Mocan, Cornel Iancu

Abstract:

Introduction: Due to antibiotic resistance, systemic infections caused by Meticilin resistant Staphyloccocous Aureus (MRSA) are the main cause of millions of deaths each year. Development of new active biomolecules that are highly effective and refractory to antibiotic resistance may open new avenues in the field of antimicrobial therapy. In this research, we have focused on the development of a novel nanobiosystem with high affinity for MRSA microorganism to mediate its selective laser thermal ablation. Materials and Methods: Gold nanoparticles (15nm in diameter) linked to a specific antibody against MRSA surface were selectively delivered (at various concentrations and incubation times) and internalized into MRSA microorganism following the treatment these multidrug-resistant bacteria were irradiated using a 2w, 808 nm LASER. Results and Discussions: The post-irradiation necrotic rate ranged from 51.2% (for 1 mg/L) to 87.3% (for 50 mg/L) at 60 seconds (p<0.001), while at 30 minute the necrotic rate increased from 64.3% (1 mg/L) to 92.1% (50 mg/L), p value<0.001. Significantly lower apoptotic rates were obtained in irradiated MRSA treated with GNPs only (control) treated for 60 seconds and 30 minutes at concentrations ranging from 1 mg/L to 50 mg/L. We show here that the optimal LASER mediated the necrotic effect of MRSA after incubation with anti-MRSA-Ab was obtained at a concentration of 50 mg/L. Conclusion: In the presented research, we obtained a very efficacious pulse laser mode treatment of individual MRSA agents with minimal effects on the surrounding medium, providing highly localized destruction only for MRSA microorganism.

Keywords: MRSA, photothermolysis, antibiotic resistance, gold nanoparticles

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5611 Static and Dynamic Analysis of Timoshenko Microcantilever Using the Finite Element Method

Authors: Mohammad Tahmasebipour, Hosein Salarpour

Abstract:

Micro cantilevers are one of the components used in the manufacture of micro-electromechanical systems. Epoxy microcantilevers have a variety of applications in the manufacture of micro-sensors and micro-actuators. In this paper, the Timoshenko Micro cantilever was statically and dynamically analyzed using the finite element method. First, all boundary conditions and initial conditions governing micro cantilevers were considered. The effect of size on the deflection, angle of rotation, natural frequencies, and mode shapes were then analyzed and evaluated under different frequencies. It was observed that an increased micro cantilever thickness reduces the deflection, rotation, and resonant frequency. A good agreement was observed between our results and those obtained by the couple stress theory, the classical theory, and the strain gradient elasticity theory.

Keywords: microcantilever, microsensor; epoxy, dynamic behavior, static behavior, finite element method

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5610 Impact of Individual Resilience on Organizational Resilience: An Exploratory Study

Authors: Mitansha, Suzanne Wilkinson, Regan Potangaroa

Abstract:

The built environment is designed, maintained, operated, and decommissioned by construction organisations, which play a significant role in providing physical resources and rebuilding infrastructures during major crises and disasters. It is evident that enhancing the resilience of construction organisations allows better responding ability and speedy recovery from disasters and acts as a boon for the nation in the face of significant disruptions. As individuals are the integral component of any organisation, hence, individual resilience is considered a critical aspect, which may boost organisational resilience of construction sector. It has been observed that individual resilience is indirectly supported by organisation’s citizenship behaviour, job performance, and career success. Not only this, it also tends to hold a directly proportional relation with job satisfaction, physical and emotional well-being affected by organisation’s work culture, whereas the resilience of organisation increases as a result of positive adaption, growth and collective learning of the employees as an entity. Moreover, indicators like Situation awareness in staff and crisis related issues, effective vulnerability management, organisational leadership and culture ensured by approachable, encouraging and people-oriented leaders, are prominent for achieving organisational resilience. It, thus, becomes perceptible that both, organisational and individual resiliencies have the potential to influence each other. Consequently, it arises a major question that how these characteristics are associated and tend to behave with respect to each other The study, thus, aims to explore the overlapping dimensions of organisational and individual resilience to determine the impact boundaries. The research methodology of the paper would be based on systematic literature review specifically focused on the resilience of construction industry. This would provide a direct comparison of characteristics influencing individual and organisational resilience and will present the most significant indicators of individual resilience, that can eventually help to enhance the resilience of construction organisations amidst any disaster or crisis.

Keywords: construction industry, individual resilience, organizational resilience, overlapping dimension

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5609 Psychological Characteristic Patients with Takotsubo - Etiology of Stress and Family Functioning

Authors: Treder Natalia, Siemiński Mariusz

Abstract:

Takotsubo cardiomyopathy (TC) is a recently defined clinical entity. First described by Japanese researchers, today is diagnosed worldwide in 1-2% of patients admitted with the preliminary diagnosis of Acute Coronary Syndrome. The etiology of takotsubo cardiomyopathy remains still largely unknown. Currently, the most likely cause of takotsubo is direct cytotoxicity caused by catecholamine surge triggered by emotional stress. There is a strong relation between recent severe emotional stress and TC. The aim of this study was to analysis the role of stress and personality as a risk factor of TT. The presented research involves 35 people who are diagnosed TC. All patients were women, mean age 60 years. The methods used in the research are popular psychological tests: Perceived Stress Scale, DS14 scale to measure type D personality, The Neo-Five Factor Inventory of Personality and psychological interview. The obtained results prove that stress events may directly precede or even release TC. The stressful events occurred directly before the symptoms in 75% examined. 65% assessed their family life as very stressful. Examiners have also a high level of experienced stress. Only 25% of the TC were classified as having type D personality but they have a high level of negative affectivity. The subjects had a high level of extraversion, openness to experiences and an average level of neuroticism. The results suggested that such a type of personality profile may predispose to the development of takotsubo cardiomyopathy. Patients with TT are the individuals who reveal joint tendency to the experience of negative emotions and very stressful family life.

Keywords: stress, personality trails, familiar problems, Takotsubo cardiomyopathy

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5608 Semi-Transparent Dye-Sensitized Solar Panels for Energy Autonomous Greenhouses

Authors: A. Mourtzikou, D. Sygkridou, T. Georgakopoulos, G. Katsagounos, E. Stathatos

Abstract:

Over 60% highly transparent quasi-solid-state dye-sensitized solar cells (DSSCs) with dimension of 50x50 cm2 were fabricated via inkjet printing process using nanocomposite inks as raw materials and tested under outdoor illumination conditions. The cells were electrically characterized, and their possible application to the shell of greenhouses was also examined. The panel design was in Z-interconnection, where the working electrode was inkjet printed on one conductive glass and the counter electrode on a second glass in a sandwich configuration. Silver current collective fingers were printed on the glasses to make the internal electrical connections. In that case, the adjacent cells were connected in series via silver fingers and finally insulated using a UV curing resin to protect them from the corrosive (I-/I3-) redox couple of the electrolyte.

Keywords: Dye-sensitized solar panels, inkjet printing, quasi-solid state electrolyte, semi-transparency, scale up

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5607 Role of Endonuclease G in Exogenous DNA Stability in HeLa Cells

Authors: Vanja Misic, Mohamed El-Mogy, Yousef Haj-Ahmad

Abstract:

Endonuclease G (EndoG) is a well conserved mitochondrio-nuclear nuclease with dual lethal and vital roles in the cell. The aim of our study was to examine whether EndoG exerts its nuclease activity on exogenous DNA substrates such as plasmid DNA (pDNA), considering their importance in gene therapy applications. The effects of EndoG knockdown on pDNA stability and levels of encoded reporter gene expression were evaluated in the cervical carcinoma HeLa cells. Transfection of pDNA vectors encoding short-hairpin RNAs (shRNAs) reduced levels of EndoG mRNA and nuclease activity in HeLa cells. In physiological circumstances, EndoG knockdown did not have an effect on the stability of pDNA or the levels of encoded transgene expression as measured over a four day time-course. However, when endogenous expression of EndoG was induced by an extrinsic stimulus, targeting of EndoG by shRNA improved the perceived stability and transgene expression of pDNA vectors. Therefore, EndoG is not a mediator of exogenous DNA clearance, but in non-physiological circumstances it may non-specifically cleave intracellular DNA regardless of its origin. These findings make it unlikely that targeting of EndoG is a viable strategy for improving the duration and level of transgene expression from non-viral DNA vectors in gene therapy efforts.

Keywords: EndoG, silencing, exogenous DNA stability, HeLa cells

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5606 Microdosimetry in Biological Cells: A Monte Carlo Method

Authors: Hamidreza Jabal Ameli, Anahita Movahedi

Abstract:

Purpose: In radionuclide therapy, radioactive atoms are coupled to monoclonal antibodies (mAbs) for treating cancer tumor while limiting radiation to healthy tissues. We know that tumoral and normal tissues are not equally sensitive to radiation. In fact, biological effects such as cellular repair processes or the presence of less radiosensitive cells such as hypoxic cells should be taken account. For this reason, in this paper, we want to calculate biological effect dose (BED) inside tumoral area and healthy cells around tumors. Methods: In this study, deposited doses of a radionuclide, gold-198, inside cells lattice and surrounding healthy tissues were calculated with Monte Carlo method. The elemental compositions and density of malignant and healthy tissues were obtained from ICRU Report 44. For reaching to real condition of oxygen effects, the necrosis and hypoxia area inside tumors has been assessed. Results: With regard to linear-quadratic expression which was defined in Monte Carlo, results showed that a large amount of BED is deposited in the well-oxygenated part of the hypoxia area compared to necrosis area. Moreover, there is a significant difference between the curves of absorbed dose with BED and without BED.

Keywords: biological dose, monte carlo, hypoxia, radionuclide therapy

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5605 Photoelectrical Stimulation for Cancer Therapy

Authors: Mohammad M. Aria, Fatma Öz, Yashar Esmaeilian, Marco Carofiglio, Valentina Cauda, Özlem Yalçın

Abstract:

Photoelectrical stimulation of cells with semiconductor organic polymers have been shown promising applications in neuroprosthetics such as retinal prosthesis. Photoelectrical stimulation of the cell membranes can be induced through a photo-electric charge separation mechanism in the semiconductor materials, and it can alter intracellular calcium level through both stimulation of voltage-gated ion channels and increase of intracellular reactive oxygen species (ROS) level. On the other hand, targeting voltage-gated ion channels in cancer cells to induce cell apoptosis through calcium signaling alternation is an effective mechanism which has been explained before. In this regard, remote control of the voltage-gated ion channels aimed to alter intracellular calcium by using photo-active organic polymers can be novel technology in cancer therapy. In this study, we used P (ITO/Indium thin oxide)/P3HT(poly(3-hexylthiophene-2,5-diyl)) and PN (ITO/ZnO/P3HT) photovoltaic junctions to stimulate MDA-MB-231 breast cancer cells. We showed that the photo-stimulation of breast cancer cells through photo capacitive current generated by the photovoltaic junctions are able to excite the cells and alternate intracellular calcium based on the calcium imaging (at 8mW/cm² green light intensity and 10-50 ms light durations), which has been reported already to safety stimulate neurons. The control group did not undergo light treatment and was cultured in T-75 flasks. We detected 20-30% cell death for ITO/P3HT and 51-60% cell death for ITO/ZnO/P3HT samples in the light treated MDA-MB-231 cell group. Western blot analysis demonstrated poly(ADP-ribose) polymerase (PARP) activated cell death in the light treated group. Furthermore, Annexin V and PI fluorescent staining indicated both apoptosis and necrosis in treated cells. In conclusion, our findings revealed that the photoelectrical stimulation of cells (through long time overstimulation) can induce cell death in cancer cells.

Keywords: Ca²⁺ signaling, cancer therapy, electrically excitable cells, photoelectrical stimulation, voltage-gated ion channels

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5604 Critical Dialogue: Anti-Racism Teacher Education in Predominantly White Schools

Authors: Claire M. Hollocou, Denise Johnson

Abstract:

As racism permeates the foundation of America's educational system, educators hold a level of responsibility to address racism and the power of white privilege in the classroom by implementing anti-racist practices. This study aims to discuss the practices of anti-racist education across two predominantly affluent white schools. It offers our perspectives as white and black female teachers committed to implementing and reflecting on our antiracist work. Through communities of practice and the critical dialogue framework, we will provide an environment for one another to share our experiences implementing anti-racist education. We will spend a couple of months engaging in dialogue together to support our praxis. With critical reflection, we will look for themes that emerge through the conversations as well as develop a protocol for building an antiracist community of practice. This study is a work in progress.

Keywords: anti-racism, critical dialogue, race and racism, teacher education

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5603 A Disappearing Radiolucency of the Mandible Caused by Inadvertent Trauma Following IMF Screw Placement

Authors: Anna Ghosh, Dominic Shields, Ceri McIntosh, Stephen Crank

Abstract:

A 29-year-old male was a referral to the maxillofacial unit following a referral from his general dental practitioner via a routine pathway regarding a large periapical lesion on the LR4 with root resorption. The patient was asymptomatic, the LR4 vital and unrestored, and this was an incidental finding at a routine check-up. The patient's past medical history was unremarkable. Examination revealed no extra or intra-oral pathology and non-mobile teeth. No focal neurology was detected. An orthopantogram demonstrated a well-defined unilocular corticated radiolucency associated with the LR4. The root appeared shortened with the radiolucency between the root and a radio-opacity, possibly representing the displacement of the apical tip of the tooth. It was recommended that the referring general practitioner should proceed with orthograde root canal therapy, after which time exploration, enucleation, and retrograde root filling of the LR4 would be carried out by a maxillofacial unit. The patient was reviewed six months later where, due to the COVID-19 pandemic, the patient had been unable to access general dental services for the root canal treatment. He was still entirely asymptomatic. A one-year review was planned in the hope this would allow time for the orthograde root canal therapy to be completed. At this review, the orthograde root canal therapy had still not been completed. Interestingly, a repeat orthopantogram revealed a significant reduction in size with good bony infill and a significant reduction in the size of the lesion. Due to the ongoing delays with primary care dental therapy, the patient was subsequently internally referred to the restorative dentistry department for care. The patient was seen again by oral and maxillo-facial surgery in mid-2022 where he still reports this tooth as asymptomatic with no focal neurology. The patient's history was fully reviewed, and noted that 15 years previously, the patient underwent open reduction and internal fixation of a left angle of mandible fracture. Temporary IMF involving IMF screws and fixation wires were employed to maintain occlusion during plating and subsequently removed post-operatively. It is proposed that the radiolucency was, as a result of the IMF screw placement, penetrating the LR4 root resulting in resorption of the tooth root and development of a radiolucency. This case highlights the importance of careful screw size and physical site location, and placement of IMF screws, as there can be permeant damage to a patient’s dentition.

Keywords: facial trauma, inter-maxillary fixation, mandibular radiolucency, oral and maxillo-facial surgery

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5602 An Artistic-Narrative Process for Reducing Suicide Risk Among Minority Stressed Individuals

Authors: Lewis Mehl-Madrona, Barbara Mainguy, Patrick McFarlane

Abstract:

Introduction: There are many risk factors for attempting suicide, including young age, “minority stress,” which would include Transgender and Gender Diverse orientations (TGD). The rate of TGD youths for suicide attempts is 3 times higher than heterosexual cis-gender youth. Half of TGD youth have seriously contemplated taking their own lives; of those, about half attempted suicide; and 18% of the TGD teenagers reported suicidal thoughts linked to their gender identity. Native American TGD have a six times higher suicide attempt rate. Conventional mental health has not generally helped these individuals. Stigma and discrimination contribute to healthcare disparities. Storytelling plays a crucial role in the development of human culture and individual identities. Sharing narrative artwork, creative writing, and personal stories allow people to build trust and to share their vulnerabilities. This helps people become aware of themselves in relation to others and gain a sense of comfort that their stories are similar; they may also be transformed in the process. Art provides a means to reach people who are otherwise difficult to engage in services. Methods: TGD individuals are recruited through a snowballing procedure. Following a life story interview, participants complete a scale of gender dysphoria, identification with conventional masculinity, patient-reported anxiety, and depression measure, and a quality-of-life scale. The interview completes the Columbia Suicide Scale. Following this, an artist and a therapist works with the participant to create a story related to their gender identity using the six-part story method. This story is then rendered to an artists’ book, which combines narrative with art (drawings, collage, computer images, etc.) and can take the form of a graphic novella, a zine, or a comic book. The pages can range from plain to ornate, as can the covers. Participants describe their process of making the books as the work unfolds and then participate in an exit interview at the completion of their book, remarking on what has changed for them and how the process affected them. Results: Preliminary results show high levels of suicidal thoughts among this population, as expected. Participants participate enthusiastically in the life story interview process and in the construction of a story related to gender identity. They enthusiastically participate in the studio process of putting their story into the form of a graphic novel, zine, or comic book. Participants reported feeling more comfortable with their TGD identity after the process and more able to resist negative judgments of family members and society. Suicidal thoughts diminish, and participants reported improved emotional wellbeing. Quantitative analysis of questionnaire data is underway Conclusions: A process in which narrative therapy is combined with art therapy shows promise for attracting and helping TGD individuals to reduce their risk for suicide without the stigma of going for mental health treatment. This process can be done outside of conventional mental health settings, on college and University campuses. This can provide an exciting alternative pathway for minority stressed and stigmatized individuals to engage in reflective, psychotherapeutic work without the trappings of psychotherapy or mental health treatment.

Keywords: minority stress, narrative process, artists' books, life story interview

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5601 Illness Roles and Coping Strategies in Aged Patients on Hemodialysis in Lahore

Authors: Zainab Bashir

Abstract:

There has been a lot of quantitative research on end-stage renal disease (ESRD), its implications, psychological effects and so on across the world, however little qualitative information is available on coping strategies and illness role adaptations specific to renal failure. This article attempts to learn about illness roles and coping strategies specific to aged ESRD patients on hemodialysis in Lahore. The patients were interviewed on a structured schedule and were asked questions on tasks and coping related to physical, psychological, and social consequences of renal failure. Standardised techniques and methods of grounded theory were used to analyse and code the information in this small-scale, in-depth study. An analysis of tasks faced by the ESRD patients and coping they employ to fulfill or overcome those tasks were done. This analysis was based on three different types of data: experiential accounts of ESRD patients with respect to tasks and strategies for coping, coping styles and illness roles typologies, and monographs of coping styles. In the information gathered using interviews with respondents, three styles of problem focused coping, and two styles of emotion focused coping could be identified. Problem focused coping included making physical adjustments to suit the requirements of the health condition, including dialysis and medical regime as integral part of patients’ lives, and altering future plans according to the course of the disease. Emotion focused coping included seeking help to manage stress/anxiety and resenting the disease condition and giving up. These coping styles are linked to the illness roles assigned to the respondents. In conclusion, there is no single formula to deal with the disease, however, some typologies can be established. In most of the cases discussed in the paper, adjustment to a regular dialysis routine, restriction in bodily function, inability to work and negative impacts on family life, especially spousal relationships have come to fore as common problems. A large part of coping with these problems had to do with mentally accepting the disease and carrying on despite. These cannot be seen as deviant adaptations to the depressive situation arising from renal failure, but more of patterned ways in which patients can approximate a close to normal lifestyle despite the terminal disease.

Keywords: coping strategies, ESRD patients, hemodialysis, illness roles

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