Search results for: theory of number “0”

Authors: Johnson C. Y. Pang, Bo Peng, Kara K. L. Reeves, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding is potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26 ± 5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms, and quality of life (QOL), were analyzed by repeated measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: ultrasound-guided dry needling, dry needling, knee osteoarthritis, physiotheraphy

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Authors: Mei-Hui Liu

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This paper reports the progression of language teachers’ learning to assess students’ speech act performance via online videos in a cross-tier professional growth community. This yearlong research project collected multiple data sources from several stakeholders, including 12 preservice and 4 inservice English as a foreign language (EFL) teachers, 4 English professionals, and 82 high school students. Data sources included surveys, (focus group) interviews, online reflection journals, online video-based assessment items/scores, and artifacts related to teacher professional learning. The major findings depicted the effectiveness of this proposed learning module on language teacher development in pragmatic assessment as well as its impact on student learning experience. All these teachers appreciated this professional learning experience which enhanced their knowledge in assessing students’ pragmalinguistic and sociopragmatic performance in an English speech act (i.e., making refusals). They learned how to design online video-based assessment items by attending to specific linguistic structures, semantic formula, and sociocultural issues. They further became aware of how to sharpen pragmatic instructional skills in the near future after putting theories into online assessment and related classroom practices. Additionally, data analysis revealed students’ achievement in and satisfaction with the designed online assessment. Yet, during the professional learning process most participating teachers encountered challenges in reaching a consensus on selecting appropriate video clips from available sources to present the sociocultural values in English-speaking refusal contexts. Also included was to construct test items which could testify the influence of interlanguage transfer on students’ pragmatic performance in various conversational scenarios. With pedagogical implications and research suggestions, this study adds to the increasing amount of research into integrating preservice and inservice EFL teacher education in pragmatic assessment and relevant instruction. Acknowledgment: This research project is sponsored by the Ministry of Science and Technology in the Republic of China under the grant number of MOST 106-2410-H-029-038.

Keywords: cross-tier professional development, inservice EFL teachers, pragmatic assessment, preservice EFL teachers, student learning experience

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Authors: Carlos V. Gonzalez

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Background: Providers of in-home and community based services strive for the elimination of preventable harm to the people under their care as well as to the employees who support them. Traditional models of safety and protection from harm have assumed that the absence of incidents of harm is a good indicator of safe practices. However, this model creates an illusion of safety that is easily shaken by sudden and inadvertent harmful events. As an alternative, we have developed and implemented an evidence-based resilient model of safety known as C.O.P.E. (Caring, Observing, Predicting and Evaluating). Within this model, safety is not defined by the absence of harmful incidents, but by the presence of continuous monitoring, anticipation, learning, and rapid response to events that may lead to harm. Objective: The objective was to evaluate the effectiveness of the C.O.P.E. model for the reduction of harm to individuals with mental disabilities who receive home and community based services. Methods: Over the course of 2 years we counted the number of incidents of harm and near misses. We trained employees on strategies to eliminate incidents before they fully escalated. We trained employees to track different levels of patient status within a scale from 0 to 10. Additionally, we provided direct support professionals and supervisors with customized smart phone applications to track and notify the team of changes in that status every 30 minutes. Finally, the information that we collected was saved in a private computer network that analyzes and graphs the outcome of each incident. Result and conclusions: The use of the COPE model resulted in: A reduction in incidents of harm. A reduction the use of restraints and other physical interventions. An increase in Direct Support Professional’s ability to detect and respond to health problems. Improvement in employee alertness by decreasing sleeping on duty. Improvement in caring and positive interaction between Direct Support Professionals and the person who is supported. Developing a method to globally measure and assess the effectiveness of prevention from harm plans. Future applications of the COPE model for the reduction of harm to people who receive home and community based services are discussed.

Keywords: harm, patients, resilience, safety, mental illness, disability

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Authors: Fuad Hamsyah

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Since last two decades, major disasters have happened in the Philippines and Indonesia as two countries that are located in the pacific ring of fire territory. While in Southeast Asian countries, the process of psychosocial support provision is facing various constraints such as limited number of mental health professionals and the limited knowledge about the provision of psychosocial support for disaster survivors. Yet after the tsunami disaster in 2004, many Asian countries begin to develop policies about the provision of psychosocial interventions as an effort for future disasters preparedness. In addition, mental health professionals have to consider the local cultural values and beliefs in order to provide people with effective psychosocial support since cultural values and beliefs play a significant role in the diversity of psychological distress that forms symptoms formation, and people’s way to seek for psychological assistance. This study is a critical literature review on 130 relevant selected documents and literatures. IASC MHPSS guideline is used as the research framework in doing critical analysis. The purpose of this study is to conduct a critical analysis on the mental health and psychosocial support provision in the Philippines and Indonesia with three main objectives: 1) To describe strengths, weaknesses, and challenges in the process of psychosocial supports given by public and private organizations in emergency settings of disaster in the Philippines and Indonesia, 2) To compare psychosocial support practices between the Philippines and Indonesia, and to identify the good practices among these countries, 3) To learn how cultural values influence the implementation of psychosocial supports in emergency settings of disaster. This research indicated that almost every function from IASC MHPSS guidelines has been implemented effectively in the Philippines and Indonesia, yet not in every detail of IASC MHPSS guidelines. Several similarities and differences are indicated in this study also based on the IASC MHPSS guidelines as the analysis framework. Further, both countries have some good practices that can be useful as an example of a comprehensive psychosocial support implementation. Apart from the IASC MHPSS guideline, cultural values and beliefs in the Philippines such as kanya-kanya syndrome, pakikipakapwa, utang na loob, bahala na, pagkaya are indicated as several cultural values that have strong influences towards people’s attitude and behavior in disaster situations. While in Indonesia, several cultural values such as sabar and nrimo become two important attitudes to cope disaster situations.

Keywords: disaster, Indonesia, psychosocial support, Philippines

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Authors: Sachi Matsuoka

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This study aimed at implicating a current community health in South India focusing on a Vaidya, a non-codified traditional doctor, based on long-term field works. As the prevalence of colonic diseases is increasing in all over the world, it is needed to know the potential of non-codified medicines and how they can effectively take in a part in community health. Describing the people’s treatment seeking behaviours in a suburban village which is susceptible to modernization can give us a new insight for studying Indian medicines, that is included not only non-codified but also codified traditional ones, affected by global, national and local communities. Both qualitative and quantitative data were gathered via participatory fieldworks and open-ended interviews to a Vaidya and his 97 patients and 31 individuals who lived in a community near the Vaidya’s station. It was found that the community members seldom consulted the Vaidya while a number of patients outside the village (mainly from urban nearby area) daily visited the Vaidya. Thus, the role of the Vaidya as the community’ s primary health care provider had nearly disappeared. Nonetheless, the Vaidya was deeply respected as one of the community’ s leaders by its members because of the spiritual and financial support he provided to them. The reasons for choosing the Vaidya for the patients from urban area are characterized by several social factors of the patients such as their religious belief, seriousness, occupation and medical history. Meanwhile, not only the Vaidya but also other codified traditional medicines, e.g., Ayurveda, were less popular among the community members. It sounds paradoxical given that the traditional Indian medical system has been becoming popular as an alternative medicine in societies outside of India, such as in Europe. The community members who are less educated and engaged in religious activities in daily life preferred to allopathy, the biomedicine in Indian context. It is thus concluded that roles of non-codified medicine has changed depending on its cultural and social contexts, even though its medical system is not authorized by the government. Nowadays, traditional medical effectiveness is recognized as evidenced by scientific survey and the codified medical doctors treats diseases rather than people. However, this study implicated that people’s treatment seeking behaviors are likely based on the social context in which people live their lives even though evidenced based codified medicine is provided in their community.

Keywords: medical pluralism, non-codified medicine, south india, treatment-seeking behaviours

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Authors: Prasad Urvashi, Wynn Yezarni, Williams Shehan, Ravindran Arun

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Introduction: Primary health services are often the first point of contact that patients with mental illness have with the healthcare system. A number of tools have been developed to increase detection of depression in the context of primary care. However, one challenge amongst many includes utilizing these tools within the limited primary care consultation timeframe. Therefore, short questionnaires that screen for depression that are just as effective as more comprehensive diagnostic tools may be beneficial in improving detection rates of patients visiting a primary care setting. Objective: To develop and determine the sensitivity and specificity of a 2-Question Questionnaire (2-QQ) to screen for depression in in a suburban primary care clinic in Ragama, Sri Lanka. The purpose is to develop a short screening tool for depression that is culturally adapted in order to increase the detection of depression in the Sri Lankan patient population. Methods: This was a cross-sectional study involving two steps. Step one: verbal administration of 2-QQ to patients by their primary care physician. Step two: completion of the Peradeniya Depression Scale, a validated diagnostic tool for depression, the patient after their consultation with the primary care physician. The results from the PDS were then correlated to the results from the 2-QQ for each patient to determine sensitivity and specificity of the 2-QQ. Results: A score of 1/+ on the 2-QQ was most sensitive but least specific. Thus, setting the threshold at this level is effective for correctly identifying depressed patients, but also inaccurately captures patients who are not depressed. A score of 6 on the 2-QQ was most specific but least sensitive. Setting the threshold at this level is effective for correctly identifying patients without depression, but not very effective at capturing patients with depression. Discussion: In the context of primary care, it may be worthwhile setting the 2-QQ screen at a lower threshold for positivity (such as a score of 1 or above). This would generate a high test sensitivity and thus capture the majority of patients that have depression. On the other hand, by setting a low threshold for positivity, patients who do not have depression but score higher than 1 on the 2-QQ will also be falsely identified as testing positive for depression. However, the benefits of identifying patients who present with depression may outweigh the harms of falsely identifying a non-depressed patient. It is our hope that the 2-QQ will serve as a quick primary screen for depression in the primary care setting and serve as a catalyst to identify and treat individuals with depression.

Keywords: depression, primary care, screening tool, Sri Lanka

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Authors: V. Reyes, P. Ferreira

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In response to high levels of competitiveness, industrial systems have evolved to improve productivity. As a consequence, a rapid increase in volume production and simultaneously, a customization process require lower costs, more variety, and accurate quality of products. Reducing time-cycle production, enabling customizability, and ensure continuous quality improvement are key features in advance intelligent industry. In this scenario, customers and producers will be able to participate in the ongoing production life cycle through real-time interaction. To achieve this vision, transparency, predictability, and adaptability are key features that provide the industrial systems the capability to adapt to customer demands modifying the manufacturing process through an autonomous response and acting preventively to avoid errors. The industrial system incorporates a diversified number of components that in advanced industry are expected to be decentralized, end to end communicating, and with the capability to make own decisions through feedback. The evolving process towards advanced intelligent industry defines a set of stages to empower components of intelligence and enhancing efficiency to achieve the decision-making stage. The integrated system follows an industrial cyber-physical system (CPS) architecture whose real-time integration, based on a set of enabler technologies, links the physical and virtual world generating the digital twin (DT). This instance allows incorporating sensor data from real to virtual world and the required transparency for real-time monitoring and control, contributing to address important features of the advanced intelligent industry and simultaneously improve sustainability. Assuming the industrial CPS as the core technology toward the latest advanced intelligent industry stage, this paper reviews and highlights the correlation and contributions of the enabler technologies for the operationalization of each stage in the path toward advanced intelligent industry. From this research, a real-time integration architecture for a cyber-physical system with applications to collaborative robotics is proposed. The required functionalities and issues to endow the industrial system of adaptability are identified.

Keywords: cyber-physical systems, digital twin, sensor data, system integration, virtual model

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Authors: Saeidreza Radpour, Md. Alam Mondal, Amit Kumar

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Market penetration of high energy efficiency technologies has key impacts on energy consumption and GHG mitigation. Also, it will be useful to manage the policies formulated by public or private organizations to achieve energy or environmental targets. Energy intensity in residential sector of Alberta was 148.8 GJ per household in 2012 which is 39% more than the average of Canada 106.6 GJ, it was the highest amount among the provinces on per household energy consumption. Energy intensity by appliances of Alberta was 15.3 GJ per household in 2012 which is 14% higher than average value of other provinces and territories in energy demand intensity by appliances in Canada. In this research, a framework has been developed to analyze the market penetration and market share of high energy efficiency technologies in residential sector. The overall methodology was based on development of data-intensive models’ estimation of the market penetration of the appliances in the residential sector over a time period. The developed models were a function of a number of macroeconomic and technical parameters. Developed mathematical equations were developed based on twenty-two years of historical data (1990-2011). The models were analyzed through a series of statistical tests. The market shares of high efficiency appliances were estimated based on the related variables such as capital and operating costs, discount rate, appliance’s life time, annual interest rate, incentives and maximum achievable efficiency in the period of 2015 to 2050. Results show that the market penetration of refrigerators is higher than that of other appliances. The stocks of refrigerators per household are anticipated to increase from 1.28 in 2012 to 1.314 and 1.328 in 2030 and 2050, respectively. Modelling results show that the market penetration rate of stand-alone freezers will decrease between 2012 and 2050. Freezer stock per household will decline from 0.634 in 2012 to 0.556 and 0.515 in 2030 and 2050, respectively. The stock of dishwashers per household is expected to increase from 0.761 in 2012 to 0.865 and 0.960 in 2030 and 2050, respectively. The increase in the market penetration rate of clothes washers and clothes dryers is nearly parallel. The stock of clothes washers and clothes dryers per household is expected to rise from 0.893 and 0.979 in 2012 to 0.960 and 1.0 in 2050, respectively. This proposed presentation will include detailed discussion on the modelling methodology and results.

Keywords: appliances efficiency improvement, energy star, market penetration, residential sector

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Authors: Vanita Singh

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In developing countries, there are conflicting political agendas; policy makers have to prioritize issues from a list of issues competing for the limited resources. Thus, it is imperative to understand how some issues gain attention, and others lose in the policy circles. Multiple-Streams Theory of Kingdon (1984) is among the influential theories that help to understand the public policy process and is utilitarian for health policy makers to understand how certain health issues emerge on the policy agendas. The issue of maternal mortality was long standing in India and was linked with high birth rate thus the focus of maternal health policy was on family planning since India’s independence. However, a paradigm shift was noted in the maternal health policy in the year 1992 with the launch of Safe Motherhood Programme and then in the year 2005, when the agenda of maternal health policy became universalizing institutional deliveries and phasing-out of Traditional Birth Attendants (TBAs) from the health system. There were many solutions proposed by policy communities other than universalizing of institutional deliveries, including training of TBAs and improving socio-economic conditions of pregnant women. However, Government of India favored medical community, which was advocating for the policy of universalizing institutional delivery, and neglected the solutions proposed by other policy communities. It took almost 15 years for the advocates of institutional delivery to transform their proposed solution into a program - the Janani Suraksha Yojana (JSY), a safe-motherhood program promoting institutional delivery through cash incentives to pregnant women. Thus, the case of safe motherhood policy in India is worth studying to understand how certain issues/problems gain political attention and how advocacy work in policy circles. This paper attempts to understand the factors that favored the agenda of safe-motherhood in the policy circle in India, using John Kingdon’s Multiple-Stream model of agenda-setting. Through document analysis and literature review, the paper traces the evolution of safe motherhood program and maternal health policy. The study has used open source documents available on the website of Ministry of Health and Family Welfare, media reports (Times of India Archive) and related research papers. The documents analyzed include National health policy-1983, National Health Policy-2002, written reports of Ministry of Health and Family Welfare Department, National Rural Health Mission (NRHM) document, documents related to Janani Suraksha Yojana and research articles related to maternal health programme in India. The study finds that focusing events and credible indicators coupled with media attention has the potential to recognize a problem. The political elites favor clearly defined and well-accepted solutions. The trans-national organizations affect the agenda-setting process in a country through conditional resource provision. The closely-knit policy communities and political entrepreneurship are required for advocating solutions high on agendas. The study has implications for health policy makers in identifying factors that have the potential to affect the agenda-setting process for a desired policy agenda and identify the challenges in generating political priorities.

Keywords: agenda-setting, focusing events, Kingdon’s model, safe motherhood program India

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Authors: Sanjay Rathee, Arti Kashyap

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Extraction of useful information from large datasets is one of the most important research problems. Association rule mining is one of the best methods for this purpose. Finding possible associations between items in large transaction based datasets (finding frequent patterns) is most important part of the association rule mining. There exist many algorithms to find frequent patterns but Apriori algorithm always remains a preferred choice due to its ease of implementation and natural tendency to be parallelized. Many single-machine based Apriori variants exist but massive amount of data available these days is above capacity of a single machine. Therefore, to meet the demands of this ever-growing huge data, there is a need of multiple machines based Apriori algorithm. For these types of distributed applications, MapReduce is a popular fault-tolerant framework. Hadoop is one of the best open-source software frameworks with MapReduce approach for distributed storage and distributed processing of huge datasets using clusters built from commodity hardware. However, heavy disk I/O operation at each iteration of a highly iterative algorithm like Apriori makes Hadoop inefficient. A number of MapReduce-based platforms are being developed for parallel computing in recent years. Among them, two platforms, namely, Spark and Flink have attracted a lot of attention because of their inbuilt support to distributed computations. Earlier we proposed a reduced- Apriori algorithm on Spark platform which outperforms parallel Apriori, one because of use of Spark and secondly because of the improvement we proposed in standard Apriori. Therefore, this work is a natural sequel of our work and targets on implementing, testing and benchmarking Apriori and Reduced-Apriori and our new algorithm ReducedAll-Apriori on Apache Flink and compares it with Spark implementation. Flink, a streaming dataflow engine, overcomes disk I/O bottlenecks in MapReduce, providing an ideal platform for distributed Apriori. Flink's pipelining based structure allows starting a next iteration as soon as partial results of earlier iteration are available. Therefore, there is no need to wait for all reducers result to start a next iteration. We conduct in-depth experiments to gain insight into the effectiveness, efficiency and scalability of the Apriori and RA-Apriori algorithm on Flink.

Keywords: apriori, apache flink, Mapreduce, spark, Hadoop, R-Apriori, frequent itemset mining

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Authors: Magdalena Barbara Kaziuk

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Introduction: In December 2019, the first case of an acute infectious disease of the respiratory system caused by the SARS-CoV-2 virus was recorded in Wuhan in Central China. On March 11, 2020, the World Health Organization restrictions, among others, in the travel industry. Aim: The aim of the study was the assessment of the preparedness of European cultural institutions and catering establishments within the sanitary and epidemiological dimension during the COVID-19 pandemic by Polish tourists and their sense of safety in selected destinations. Material and methods: The study involved 300 Polish tourists (125 females, 175 males, age 46.5+/-12.9 years) who traveled during the COVID-19 pandemic to Southern European countries. 5 most popular travel destinations were selected: Italy, Austria, Greece, Croatia, and Mediterranean islands. The tourists assessed cultural institutions and catering establishments with the use of a proprietary questionnaire which concerned the preparedness regarding the sanitary and epidemiological requirements and the tourists' sense of safety. The number of respondents was deliberate - 60 persons per each country. Results: The more stringent sanitary regimes, the higher the sense of safety in the study group of females aged 45-50 (p<0.005), while the more stringent sanitary and epidemiological issues are implemented, the shorter the stay (p<0.001). Less stringent restrictions resulted in increased sense of freedom and mental rest in the group of studied males (p<0.005). Conclusions: The respondents' opinions revealed that the highest level of safety with regard to sanitary and epidemiological requirements (masks covering mouth and nose worn by both personnel and society, the necessity to present the COVID passport, the possibility to disinfect hands) was observed in Austria and Italy, while shorter length of the stay in these countries resulted from high prices, particularly in catering establishments. According to the respondents, less stringent restrictions, among others lack of the necessity to own the COVID passport, were linked to Croatia and Mediterranean islands. The sense of safety was satisfying, while the sense of freedom and mental rest was high. declared a string of COVID-19 cases a pandemic. Most countries implemented numerous sanitary and epidemiological

Keywords: sanitary and epidemiological regimes, tourist facilities, COVID-19 pandemic, sense of safety

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Authors: Marius Sebastian Secula, Mihaela Darie, Gabriela Carja

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Ibuprofen is a non-steroidal anti-inflammatory drug (NSAIDs) and is among the most frequently detected pharmaceuticals in environmental samples and among the most widespread drug in the world. Its concentration in the environment is reported to be between 10 and 160 ng L-1. In order to improve the abatement efficiency of this compound for water source prevention and reclamation, the development of innovative technologies is mandatory. AOPs (advanced oxidation processes) are known as highly efficient towards the oxidation of organic pollutants. Among the promising combined treatments, photo-Fenton processes using layered double hydroxides (LDHs) attracted significant consideration especially due to their composition flexibility, high surface area and tailored redox features. This work presents the self-supported Fe, Mn or Ti on ZnFeAl LDHs obtained by co-precipitation followed by reconstruction method as novel efficient photo-catalysts for Fenton-like catalysis. Fe, Mn or Ti/ZnFeAl LDHs nano-hybrids were tested for the degradation of a model pharmaceutical agent, the anti-inflammatory agent ibuprofen, by photocatalysis and photo-Fenton catalysis, respectively, by means of a lab-scale system consisting of a batch reactor equipped with an UV lamp (17 W). The present study presents comparatively the degradation of Ibuprofen in aqueous solution UV light irradiation using four different types of LDHs. The newly prepared Ti/ZnFeAl 4:1 catalyst results in the best degradation performance. After 60 minutes of light irradiation, the Ibuprofen removal efficiency reaches 95%. The slowest degradation of Ibuprofen solution occurs in case of Fe/ZnFeAl 4:1 LDH, (67% removal efficiency after 60 minutes of process). Evolution of Ibuprofen degradation during the photo Fenton process is also studied using Ti/ZnFeAl 2:1 and 4:1 LDHs in the presence and absence of H2O2. It is found that after 60 min the use of Ti/ZnFeAl 4:1 LDH in presence of 100 mg/L H2O2 leads to the fastest degradation of Ibuprofen molecule. After 120 min, both catalysts Ti/ZnFeAl 4:1 and 2:1 result in the same value of removal efficiency (98%). In the absence of H2O2, Ibuprofen degradation reaches only 73% removal efficiency after 120 min of degradation process. Acknowledgements: This work was supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNCS - UEFISCDI, project number PN-II-RU-TE-2014-4-0405.

Keywords: layered double hydroxide, advanced oxidation process, micropollutant, heterogeneous Fenton

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Authors: Joseph Kimuli Balikuddembe

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Road traffic incidents (RTIs) continue to be a serious public health and development burden around the globe. Compared to high-income countries (HICs), the low and middle-income countries (LMICs) bear the heaviest brunt of RTIs. Like other LMICs, Uganda, a country located in Eastern Africa, has been experiencing a worryingly high burden of RTIs and their associated impacts. Over the years, the highest number of all the total registered RTIs in Uganda has taken place in the Greater Kampala Metropolitan Area (GKMA). This places a tremendous demand on the few existing emergency medical services (EMS) to adequately respond to those affected. In this regard, the overall objective of the study was to risk map RTIs in the GKMA so as to help in the better planning of EMS for the victims of RTIs. Other objectives included: (i) identifying the factors affecting the exposure, vulnerability and EMS capacity for the victims of RTIs; (ii) identifying the RTI prone-areas and estimating their associated risk factors; (iii) identifying the weaknesses and capacities which affect the EMS systems for RTIs; and (iv) determining the strategies and priority actions that can help to improve the EMS response for RTI victims in the GKMA. To achieve these objectives, a mixed methodological approach was used in four phrases for approximately 15 months. It employed a systematic review based on the preferred reporting items for systematic reviews and meta-data analysis guidelines; a Delphi panel technique; retrospective data analysis; and a cross-sectional method. With Uganda progressing forward as envisaged in its 'Vision 2040', the GKMA, which is the country’s political and socioeconomic epicenter, is experiencing significant changes in terms of population growth, urbanization, infrastructure development, rapid motorization and other factors. Unless appropriate actions are taken, these changes are likely to worsen the already alarming rate of RTIs in Uganda, and in turn also to put pressure on the few existing EMS and facilities to render care for those affected. Therefore, road safety vis-à-vis injury prevention measures, which are needed to reduce the burden of RTIs, should be multifaceted in nature so that they closely correlate with the ongoing dynamics that contribute to RTIs, particularly in the GKMA and Uganda as a whole.

Keywords: emergency medical services, Kampala, risk mapping, road traffic incidents

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Authors: Camila Lemos Pinto, Juliana Alves Carneiro, Patrícia Borges Botelho, João Felipe Mota

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Sarcopenia, a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, currently affects over 50 million people and increases the risk of adverse outcomes such as physical disability, poor quality of life and death. The aim of this study was to examine the efficacy of creatine supplementation associated with resistance training on muscle mass in the elderly. A 12-week, double blind, randomized, parallel group, placebo controlled trial was conducted. Participants were randomly allocated into one of the following groups: placebo with resistance training (PL+RT, n=14) and creatine supplementation with resistance training (CR + RT, n=13). The subjects from CR+RT group received 5 g/day of creatine monohydrate and the subjects from the PL+RT group were given the same dose of maltodextrin. Participants were instructed to ingest the supplement on non-training days immediately after lunch and on training days immediately after resistance training sessions dissolved in a beverage comprising 100 g of maltodextrin lemon flavored. Participants of both groups undertook a supervised exercise training program for 12 weeks (3 times per week). The subjects were assessed at baseline and after 12 weeks. The primary outcome was muscle mass, assessed by dual energy X-ray absorptiometry (DXA). The secondary outcome included diagnose participants with one of the three stages of sarcopenia (presarcopenia, sarcopenia and severe sarcopenia) by skeletal muscle mass index (SMI), handgrip strength and gait speed. CR+RT group had a significant increase in SMI and muscle (p<0.0001), a significant decrease in android and gynoid fat (p = 0.028 and p=0.035, respectively) and a tendency of decreasing in body fat (p=0.053) after the intervention. PL+RT only had a significant increase in SMI (p=0.007). The main finding of this clinical trial indicated that creatine supplementation combined with resistance training was capable of increasing muscle mass in our elderly cohort (p=0.02). In addition, the number of subjects diagnosed with one of the three stages of sarcopenia at baseline decreased in the creatine supplemented group in comparison with the placebo group (CR+RT, n=-3; PL+RT, n=0). In summary, 12 weeks of creatine supplementation associated with resistance training resulted in increases in muscle mass. This is the first research with elderly of both sexes that show the same increase in muscle mass with a minor quantity of creatine supplementation in a short period. Future long-term research should investigate the effects of these interventions in sarcopenic elderly.

Keywords: creatine, dietetic supplement, elderly, resistance training

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Authors: Ammar Y. Alqahtani

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In order to minimize the negative impact on the environment, it is essential to manage the waste that generated from the premature disposal of end-of-life (EOL) products properly. Consequently, government and international organizations introduced new policies and regulations to minimize the amount of waste being sent to landfills. Moreover, the consumers’ awareness regards environment has forced original equipment manufacturers to consider being more environmentally conscious. Therefore, manufacturers have thought of different ways to deal with waste generated from EOL products viz., remanufacturing, reusing, recycling, or disposing of EOL products. The rate of depletion of virgin natural resources and their dependency on the natural resources can be reduced by manufacturers when EOL products are treated as remanufactured, reused, or recycled, as well as this will cut on the amount of harmful waste sent to landfills. However, disposal of EOL products contributes to the problem and therefore is used as a last option. Number of EOL need to be estimated in order to fulfill the components demand. Then, disassembly process needs to be performed to extract individual components and subassemblies. Smart products, built with sensors embedded and network connectivity to enable the collection and exchange of data, utilize sensors that are implanted into products during production. These sensors are used for remanufacturers to predict an optimal warranty policy and time period that should be offered to customers who purchase remanufactured components and products. Sensor-provided data can help to evaluate the overall condition of a product, as well as the remaining lives of product components, prior to perform a disassembly process. In this paper, a multi-period disassembly-to-order (DTO) model is developed that takes into consideration the different system uncertainties. The DTO model is solved using Nonlinear Programming (NLP) in multiple periods. A DTO system is considered where a variety of EOL products are purchased for disassembly. The model’s main objective is to determine the best combination of EOL products to be purchased from every supplier in each period which maximized the total profit of the system while satisfying the demand. This paper also addressed the impact of sensor embedded products on the cost of warranties. Lastly, this paper presented and analyzed a case study involving various simulation conditions to illustrate the applicability of the model.

Keywords: closed-loop supply chains, environmentally conscious manufacturing, product recovery, reverse logistics

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Authors: Lorand Ujhazi

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The vast majority of existing canonical studies about migration are focused on examining the general pastoral and legal regulations of the Catholic Church. The weakness of this approach is that it ignores a number of important factors; like the financial, legal and personal circumstances of a particular church or the canonical position of certain organizations which actually look after the immigrants. This paper is a case study, which analyses the current and historical migration related policies and activities of the Catholic Church in Hungary. To achieve this goal the study uses canon law, historical publications, various instructions and communications issued by church superiors, Hungarian and foreign media reports and the relevant Hungarian legislation. The paper first examines how the Hungarian Catholic Church assisted migrants like Armenians fleeing from the Ottoman Empire, Poles escaping during the Second World War, East German and Romanian citizens in the 1980s and refugees from the former Yugoslavia in the 1990s. These events underline the importance of past historical experience in the development of contemporary pastoral and humanitarian policy of the Catholic Church in Hungary. Then the paper turns to the events of the ongoing crisis by describing the unique challenges faced by churches in transit countries like Hungary. Then the research contrasts these findings with the typical responsibilities of churches in countries which are popular destinations for immigrants. The next part of the case study focuses on the changes to the pre-crisis legal and canonical framework which influenced the actions of hierarchical and charity organizations in Hungary. Afterwards, the paper illustrates the dangers of operating in an unclear legal environment, where some charitable activities of the church like a fundraising campaign may be interpreted as a national security risk by state authorities. Then the paper presents the reactions of Hungarian academics to the current migration crisis and finally it offers some proposals how to improve parts of Canon Law which govern immigration. The conclusion of the paper is that during the formulation of the central refugee policy of the Catholic Church decision makers must take into consideration the peculiar circumstances of its particular churches. This approach may prevent disharmony between the existing central regulations, the policy of the Vatican and the operations of the local church organizations.

Keywords: canon law, Catholic Church, civil law, Hungary, immigration, national security

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Authors: M. Gomez, A. Molina

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The concept of brand equity in the wine tourism area is an interesting topic to explore the factors that determine it. The aim of this study is to address this gap by investigating wine tourism destinations brand equity, and understanding the impact that the denomination of origin (DO) brand image and the destination image have on brand equity. Managing and monitoring the branding of wine tourism destinations is crucial to attract tourist arrivals. The multiplicity of stakeholders involved in the branding process calls for research that, unlike previous studies, adopts a broader perspective and incorporates an internal and an external perspective. Therefore, this gap by comparing managers’ and visitors’ approaches to wine tourism destination brand equity has been addressed. A survey questionnaire for data collection purposes was used. The hypotheses were tested using winery managers and winery visitors, each leading a different position relative to the wine tourism destination brand equity. All the interviews were conducted face-to-face. The survey instrument included several scales related to DO brand image, destination image, and wine tourism destination brand equity. All items were measured on seven-point Likert scales. Partial least squares was used to analyze the accuracy of scales, the structural model, and multi-group analysis to identify the differences in the path coefficients and to test the hypotheses. The results show that the positive influence of DO brand image on wine tourism destination brand equity is stronger for wineries than for visitors, but there are no significant differences between the two groups. However, there are significant differences in the positive effect of destination brand image on both wine tourism destination brand equity and DO brand image. The results of this study are important for consultants, practitioners, and policy makers. The gap between managers and visitors calls for the development of a number of campaigns to enhance the image that visitors hold and, thus, increase tourist arrivals. Events such as wine gatherings and gastronomic symposiums held at universities and culinary schools and participation in business meetings can enhance the perceptions and in turn, the added value, brand equity of the wine tourism destinations. The images of destinations and DOs can help strengthen the brand equity of the wine tourism destinations, especially for visitors. Thus, the development and reinforcement of favorable, strong, and unique destination associations and DO associations are important to increase that value. Joint campaigns are advisable to enhance the images of destinations and DOs and, as a consequence, the value of the wine tourism destination brand.

Keywords: brand equity, managers, visitors, wine tourism

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Authors: May Fadheel Estephan, Richard Perks

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Context: Cancer is a serious health concern that affects millions of people worldwide. Early detection and treatment are essential for improving patient outcomes. However, current methods for cancer detection have limitations, such as low sensitivity and specificity. Research Aim: The aim of this study was to develop an optical sensor for cancer detection using elastic light scattering spectroscopy (ELSS). ELSS is a noninvasive optical technique that can be used to characterize the size and concentration of particles in a solution. Methodology: An optical probe was fabricated with a 100-μm-diameter core and a 132-μm centre-to-centre separation. The probe was used to measure the ELSS spectra of polystyrene spheres with diameters of 2, 0.8, and 0.413 μm. The spectra were then analysed to determine the size and concentration of the spheres. Findings: The results showed that the optical probe was able to differentiate between the three different sizes of polystyrene spheres. The probe was also able to detect the presence of polystyrene spheres in suspension concentrations as low as 0.01%. Theoretical Importance: The results of this study demonstrate the potential of ELSS for cancer detection. ELSS is a noninvasive technique that can be used to characterize the size and concentration of cells in a tissue sample. This information can be used to identify cancer cells and assess the stage of the disease. Data Collection: The data for this study were collected by measuring the ELSS spectra of polystyrene spheres with different diameters. The spectra were collected using a spectrometer and a computer. Analysis Procedures: The ELSS spectra were analysed using a software program to determine the size and concentration of the spheres. The software program used a mathematical algorithm to fit the spectra to a theoretical model. Question Addressed: The question addressed by this study was whether ELSS could be used to detect cancer cells. The results of the study showed that ELSS could be used to differentiate between different sizes of cells, suggesting that it could be used to detect cancer cells. Conclusion: The findings of this research show the utility of ELSS in the early identification of cancer. ELSS is a noninvasive method for characterizing the number and size of cells in a tissue sample. To determine cancer cells and determine the disease's stage, this information can be employed. Further research is needed to evaluate the clinical performance of ELSS for cancer detection.

Keywords: elastic light scattering spectroscopy, polystyrene spheres in suspension, optical probe, fibre optics

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Authors: Carmen García Sánchez

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The UN's 17 Sustainable Development Goals – specifically the nº 3 and nº 11- urgently call for new architectural design solutions at different design scales to increase human contact with nature in the health and wellbeing promotion of primarily urban communities. The discipline of Interior Design offers an important alternative to large-scale nature-inclusive actions which are not always possible due to space limitations. These circumstances provide an immense opportunity to integrate biophilic design, a complex emerging and under-developed approach that pursues sustainable design strategies for increasing the human-nature connection through the experience of the built environment. Biophilic design explores the diverse ways humans are inherently inclined to affiliate with nature, attach meaning to and derive benefit from the natural world. It represents a biological understanding of architecture which categorization is still in progress. The internationally renowned Danish domestic architecture built in the 1950´s and early 1960´s - a golden age of Danish modern architecture - left a leading legacy that has greatly influenced the domestic sphere and has further led the world in terms of good design and welfare. This study examines how four existing post-war domestic buildings establish a dialogue with nature and her variations over time. The case-studies unveil both memorable and unique biophilic resources through sophisticated and original design expressions, where transformative processes connect the users to the natural setting and reflect fundamental ways in which they attach meaning to the place. In addition, fascinating analogies in terms of this nature interaction with particular traditional Japanese architecture inform the research. They embody prevailing lessons for our time today. The research methodology is based on a thorough literature review combined with a phenomenological analysis into how these case-studies contribute to the connection between humans and nature, after conducting fieldwork throughout varying seasons to document understanding in nature transformations multi-sensory perception (via sight, touch, sound, smell, time and movement) as a core research strategy. The cases´ most outstanding features have been studied attending the following key parameters: 1. Space: 1.1. Relationships (itineraries); 1.2. Measures/scale; 2. Context: Context: Landscape reading in different weather/seasonal conditions; 3. Tectonic: 3.1. Constructive joints, elements assembly; 3.2. Structural order; 4. Materiality: 4.1. Finishes, 4.2. Colors; 4.3. Tactile qualities; 5. Daylight interplay. Departing from an artistic-scientific exploration this groundbreaking study provides sustainable practical design strategies, perspectives, and inspiration to boost humans´ contact with nature through the experience of the interior built environment. Some strategies are associated with access to outdoor space or require ample space, while others can thrive in a dense urban context without direct access to the natural environment. The objective is not only to produce knowledge, but to phase in biophilic design in the built environment, expanding its theory and practice into a new dimension. Its long-term vision is to efficiently enhance the health and well-being of urban communities through daily interaction with Nature.

Keywords: sustainability, biophilic design, architectural design, interior design, nature, Danish architecture, Japanese architecture

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Authors: Huiling Feng, Jihong Liang, Xiaodong Gong, Yongjun Xu

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Recording history is a tradition in ancient China. A record of a dynasty makes a dynastic history; a record of a locality makes a chorography, and a record of a clan makes a genealogy – the three combined together depicts a complete national history of China both macroscopically and microscopically, with genealogy serving as the foundation. Genealogy in ancient China traces back to a family tree or pedigrees in the early and medieval historical times. After Song Dynasty, the civilian society gradually emerged, and the Emperor had to allow people from the same clan to live together and hold the ancestor worship activities, thence compilation of genealogy became popular in the society. Since then, genealogies, regarded as important as ancestor and religious temples in a traditional villages even today, have played a primary role in identification of a clan and maintain local social order. Chinese genealogies are rich in their documentary materials. Take the Genealogy of Wu Clan in Gaoqian as an example. Gaoqian is a small village in Xianju County of Zhejiang Province. The Genealogy of Wu Clan in Gaoqian is composed of a whole set of materials from Foreword to Family Trees, Family Rules, Family Rituals, Family Graces and Glories, Ode to An ancestor’s Portrait, Manual for the Ancestor Temple, documents for great men in the clan, works written by learned men in the clan, the contracts concerning landed property, even notes on tombs and so on. Literally speaking, the genealogy, with detailed information from every aspect recorded in stylistic rules, is indeed the carrier of the entire culture of a clan. However, due to their scarcity in number and difficulties in reading, genealogies seldom fall into the horizons of common people. This paper, focusing on the case of the Genealogy of Wu Clan in the Village of Gaoqian, intends to reproduce a digital Genealogy by use of ICTs, through an in-depth interpretation of the literature and field investigation in Gaoqian Village. Based on this, the paper goes further to explore the general methods in transferring physical genealogies to digital ones and ways in visualizing the clanism culture embedded in the genealogies with a combination of digital technologies such as software in family trees, multimedia narratives, animation design, GIS application and e-book creators.

Keywords: clanism culture, multimedia narratives, genealogy of Wu Clan, GIS

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Authors: Davoud Dorranian, Hajar Sadeghi, Elmira Solati

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Carbon nanostructures in various forms were synthesized using pulsed laser ablation of a graphite target in different liquid environment. The beam of a Q-switched Nd:YAG laser of 1064-nm wavelength at 7-ns pulse width is employed to irradiate the solid target in water, acetone, alcohol, and cetyltrimethylammonium bromide (CTAB). Then the effect of the liquid environment on the characteristic of carbon nanostructures produced by laser ablation was investigated. The optical properties of the carbon nanostructures were examined at room temperature by UV–Vis-NIR spectrophotometer. The crystalline structure of the carbon nanostructures was analyzed by X-ray diffraction (XRD). The morphology of samples was investigated by field emission scanning electron microscope (FE-SEM). Transmission electron microscope (TEM) was employed to investigate the form of carbon nanostructures. Raman spectroscopy was used to determine the quality of carbon nanostructures. Results show that different carbon nanostructures such as nanoparticles and few-layer graphene were formed in various liquid environments. The UV-Vis-NIR absorption spectra of samples reveal that the intensity of absorption peak of nanoparticles in alcohol is higher than the other liquid environments due to the larger number of nanoparticles in this environment. The red shift of the absorption peak of the sample in acetone confirms that produced carbon nanoparticles in this liquid are averagely larger than the other medium. The difference in the intensity and shape of the absorption peak indicated the effect of the liquid environment in producing the nanoparticles. The XRD pattern of the sample in water indicates an amorphous structure due to existence the graphene sheets. X-ray diffraction pattern shows that the degree of crystallinity of sample produced in CTAB is higher than the other liquid environments. Transmission electron microscopy images reveal that the generated carbon materials in water are graphene sheet and in the other liquid environments are graphene sheet and spherical nanostructures. According to the TEM images, we have the larger amount of carbon nanoparticles in the alcohol environment. FE-SEM micrographs indicate that in this liquids sheet like structures are formed however in acetone, produced sheets are adhered and these layers overlap with each other. According to the FE-SEM micrographs, the surface morphology of the sample in CTAB was coarser than that without surfactant. From Raman spectra, it can be concluded the distinct shape, width, and position of the graphene peaks and corresponding graphite source.

Keywords: carbon nanostructures, graphene, pulsed laser ablation, graphite

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Authors: Jemima C. A. Sumboh

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Given the urgency and consensus for countries to move towards Universal Health Coverage (UHC), health financing systems need to be accurately and consistently monitored to provide valuable data to inform policy and practice. Most of the indicators for monitoring UHC, particularly catastrophe and impoverishment, are established based on the impact of out-of-pocket health payments (OOPHP) on households’ living standards, collected through varied household surveys. These surveys, however, vary substantially in survey methods such as the length of the recall period or the number of items included in the survey questionnaire or the farming of questions, potentially influencing the level of OOPHP. Using different survey instruments can provide inaccurate, inconsistent, erroneous and misleading estimates of UHC, subsequently influencing wrong policy decisions. Using data from a household budget survey conducted by the Navrongo Health Research Center in Ghana from May 2017 to December 2018, this study intends to explore the potential implications of using surveys with varied levels of disaggregation of OOPHP data on estimates of financial risk protection. The household budget survey, structured around food and non-food expenditure, compared three OOPHP measuring instruments: Version I (existing questions used to measure OOPHP in household budget surveys), Version II (new questions developed through benchmarking the existing Classification of the Individual Consumption by Purpose (COICOP) OOPHP questions in household surveys) and Version III (existing questions used to measure OOPHP in health surveys integrated into household budget surveys- for this, the demographic and health surveillance (DHS) health survey was used). Version I, II and III contained 11, 44, and 56 health items, respectively. However, the choice of recall periods was held constant across versions. The sample size for Version I, II and III were 930, 1032 and 1068 households, respectively. Financial risk protection will be measured based on the catastrophic and impoverishment methodologies using STATA 15 and Adept Software for each version. It is expected that findings from this study will present valuable contributions to the repository of knowledge on standardizing survey instruments to obtain estimates of financial risk protection that are valid and consistent.

Keywords: Ghana, household budget surveys, measuring financial risk protection, out-of-pocket health payments, survey instruments, universal health coverage

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Authors: Vanessa Kummer, Maik Meusel

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Real estate demand estimates are typically derived from transaction data. However, in regions with excess demand, transactions are driven by supply and therefore do not indicate what people are actually looking for. To estimate the demand for housing in Switzerland, search subscriptions from all important Swiss real estate platforms are used. These data do, however, suffer from missing information—for example, many users do not specify how many rooms they would like or what price they would be willing to pay. In economic analyses, it is often the case that only complete data is used. Usually, however, the proportion of complete data is rather small which leads to most information being neglected. Also, the data might have a strong distortion if it is complete. In addition, the reason that data is missing might itself also contain information, which is however ignored with that approach. An interesting issue is, therefore, if for economic analyses such as the one at hand, there is an added value by using the whole data set with the imputed missing values compared to using the usually small percentage of complete data (baseline). Also, it is interesting to see how different algorithms affect that result. The imputation of the missing data is done using unsupervised learning. Out of the numerous unsupervised learning approaches, the most common ones, such as clustering, principal component analysis, or neural networks techniques are applied. By training the model iteratively on the imputed data and, thereby, including the information of all data into the model, the distortion of the first training set—the complete data—vanishes. In a next step, the performances of the algorithms are measured. This is done by randomly creating missing values in subsets of the data, estimating those values with the relevant algorithms and several parameter combinations, and comparing the estimates to the actual data. After having found the optimal parameter set for each algorithm, the missing values are being imputed. Using the resulting data sets, the next step is to estimate the willingness to pay for real estate. This is done by fitting price distributions for real estate properties with certain characteristics, such as the region or the number of rooms. Based on these distributions, survival functions are computed to obtain the functional relationship between characteristics and selling probabilities. Comparing the survival functions shows that estimates which are based on imputed data sets do not differ significantly from each other; however, the demand estimate that is derived from the baseline data does. This indicates that the baseline data set does not include all available information and is therefore not representative for the entire sample. Also, demand estimates derived from the whole data set are much more accurate than the baseline estimation. Thus, in order to obtain optimal results, it is important to make use of all available data, even though it involves additional procedures such as data imputation.

Keywords: demand estimate, missing-data imputation, real estate, unsupervised learning

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Authors: Rapuane Eric Jan Pule

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Sport participation plays a significant role in learners’ well-being and lifestyle. Learners spend most of their time in the school environment, where they are monitored, guided and advised by teachers. Teachers have a good relationship with the learners, therefore they can play a major role in promoting and influencing learners to participate in physical activities, both competitive and recreational purposes. Their influence and involvement could assist in increasing the number learners' involvement in physical activities, sport and recreation at Township schools. The national sport and recreation plan in South Africa, recommends that promotion of sport and physical activities at primary and secondary schools should play an important role in helping learners commit to a live-long participation in sport, recreational and physical activities. Schoolteachers could play an influential role in ensuring that learners spent their leisure time productively through physical and recreational activities. However, the role and the influence of teachers in promoting physical and recreational activities have been previously overlooked in the literature. Part of this study focuses on the in-depth challenges encountered by primary and secondary school teachers at Township schools in promoting and influencing learners’ involvement in sport, recreation and physical activities. 109 primary and secondary teachers at Township schools agreed to participate in the study through the provision of informed consent. The participants consisted of 49 primary school teachers and 60 secondary school teachers. Quantitative approach was followed using validated structured questionnaire comprising 12 close-ended items were used. Findings indicated that teachers' can play a significant role in influencing and encouraging learners to participate in sport, recreation or physical activities. Teachers view physical activity as an important developmental component for learners. Primary school teachers believe that they have a significant role to play in encouraging and promoting physical activities, sport and recreation, as compared to the secondary school teachers. Both group of teachers at primary and secondary schools, believe that infrastructure development, financial support, and extra incentives could motivate them to promote physical, recreational and sporting activities at schools. Teachers also acknowledge that schools are facing challenges in implementing and coordinating physical activities and recreational programmes as required by the Department of sport and recreation South Africa. It is recommended that the Department of Basic Education and Sport and Recreation South Africa revise their policies regarding the role of teachers in promoting and administering physical and recreational activities at schools.

Keywords: township, physical activities, sport and recreation participation, learners, teachers, primary and secondary schools, physical education

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Authors: Vilma Zydziunaite, Simona Kersiene

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The concept of focused leadership means that the leader gathers the entire community in various ways to communicate and cooperate with each other, to share their knowledge and responsibility, to get involved in problem-solving, to create a safe and trusting environment and to satisfy the needs and interests of each community member. The study's aim is to analyze the teamwork of teachers working in kindergartens and schools and its CEOs by implementing confused leadership. A mixed research design was used for the research study. Quantitative research used the teamwork test "Team-Puls" (2003). Data is processed by the IBM SPSS version 29.0 software package. Semi-structured interviews were used for data collection, and qualitative content analysis was applied for data analysis. The results of quantitative research show that there is no statistically significant difference between the evaluation averages of kindergarten and school teachers. Likewise, the effectiveness and evaluation of teacher teamwork in educational institutions depend on different characteristics and processes, such as the number of participating teachers, the involvement of the institution's administration or the stages of team formation. In the qualitative research, the components of the focused leadership categories applied by the kindergarten and school CEOs emerged. The categories reflect the components of shared leadership. In the study, the sharing of responsibilities and cooperation among teachers and the sharing of knowledge among themselves is distinguished. This shows that the action takes place between the teachers when they participate in the processes voluntarily, according to their wishes or for certain reasons. Distributed leadership components occurs when leadership responsibility is extended beyond the school CEO. The components of servant leadership are expressed when the CEO achieves organizational goals in the service of others. Servant leadership is helping and striving for others, creating a safe environment. The level of the educational institution does not affect working teachers in the evaluation of working in a team. Giving freedom to teachers, the role of the CEO is dividing responsibilities and creating cooperation between teachers as well as ensuring teachers' interests, needs, emotional well-being and professional development.

Keywords: teamwork, school, teacher, school CEO, school environment, mixed research, Team-Puls test, semi-structured interview, questioning survey, qualitative content analysis, focused leadership, teacher leadership

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Authors: Albert Amagyei, Julia Carroll, Amanda R. Amorim Adegboye, Laura Strumidlo, Rosie Kneafsey

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Introduction: Classroom-based learning has persisted as the mainstream model of pre-registration nurse education. This model is often rigid, teacher-centered, and unable to support active learning and the practical learning needs of nursing students. Health Education England (HEE), a public body of the Department of Health and Social Care, hypothesises that blended learning (BL) programmes may address health system and nursing profession challenges, such as nursing shortages and lack of digital expertise, by exploring opportunities for providing predominantly online, remote-access study which may increase nursing student recruitment, offering alternate pathways to nursing other than the traditional classroom route. This study will provide evidence for blended learning strategies adopted in nursing education as well as examine nursing student learning experiences concerning the challenges and opportunities related to using blended learning within nursing education. Objective: This review will explore the challenges and opportunities of BL within pre-registration nurse education from the student's perspective. Methods: The search was completed within five databases. Eligible studies were appraised independently by four reviewers. The JBI-convergent segregated approach for mixed methods review was used to assess and synthesize the data. The study’s protocol has been registered with the International Register of Systematic Reviews with registration number// PROSPERO (CRD42023423532). Results: Twenty-seven (27) studies (21 quantitative and 6 qualitative) were included in the review. The study confirmed that BL positively impacts nursing students' learning outcomes, as demonstrated by the findings of the meta-analysis and meta-synthesis. Conclusion: The review compared BL to traditional learning, simulation, laboratory, and online learning on nursing students’ learning and programme outcomes as well as learning behaviour and experience. The results show that BL could effectively improve nursing students’ knowledge, academic achievement, critical skills, and clinical performance as well as enhance learner satisfaction and programme retention. The review findings outline that students’ background characteristics, BL design, and format significantly impact the success of the BL nursing programme.

Keywords: nursing student, blended learning, pre-registration nurse education, online learning

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Authors: Amrit Vasdev, Edwin Rho, Gurinder Vasdev

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Robotic surgery has enabled a new spectrum of minimally invasive breast reconstruction by improving visualization, surgeon posturing, and improved patient outcomes.1 The DaVinci robot system can be utilized in nipple sparing mastectomies and reconstructions. The process involves the insufflation of the subglandular space and a dissection of the mammary gland with a combination of cautery and blunt dissection. This case outlines a 35-year-old woman who has a long-standing family history of breast cancer and a diagnosis of a deleterious BRCA2 genetic mutation. She has decided to proceed with bilateral nipple sparing mastectomies with implants. Her perioperative mammogram and MRI were negative for masses, however, her left internal mammary lymph node was enlarged. She has taken oral contraceptive pills for 3-5 years and denies DES exposure, radiation therapy, human replacement therapy, or prior breast surgery. She does not smoke and rarely consumes alcohol. During the procedure, the patient received a standardized anesthetic for out-patient surgery of propofol infusion, succinylcholine, sevoflurane, and fentanyl. Aprepitant was given as an antiemetic and preoperative Tylenol and gabapentin for pain management. Concerns for the patient during the procedure included CO2 insufflation into the subcutaneous space. With CO2 insufflation, there is a potential for rapid uptake leading to severe acidosis, embolism, and subcutaneous emphysema.2To mitigate this, it is important to hyperventilate the patient and reduce both the insufflation pressure and the CO2 flow rate to the minimal acceptable by the surgeon. For intraoperative monitoring during this 6-9 hour long procedure, it has been suggested to utilize an Arterial-Line for end-tidal CO2 monitoring. However, in this case, it was not necessary as the patient had excellent cardiovascular reserve, and end-tidal CO2 was within normal limits for the duration of the procedure. A BIS monitor was also utilized to reduce anesthesia burden and to facilitate a prompt discharge from the PACU. Minimal Invasive Robotic Surgery will continue to evolve, and anesthesiologists need to be prepared for the new challenges ahead. Based on our limit number of patients, robotic mastectomy appears to be a safe alternative to open surgery with the promise of clearer tissue demarcation and better cosmetic results.

Keywords: anesthesia, mastectomies, robotic, hypercarbia

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Authors: Amberly Brigden, Ali Heawood, Emma C. Anderson, Richard Morris, Esther Crawley

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Background: Paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) is characterised by persistent, disabling fatigue. Health services see patients below the age of 12. This age group experience high levels of disability, with low levels of school attendance, high levels of fatigue, anxiety, functional disability and pain. CFS/ME interventions have been developed for adolescents, but the developmental needs of younger children suggest treatment should be tailored to this age group. Little is known about how intervention should be delivered to this age group, and further work is needed to explore this. Qualitative research aids patient-centered design of health intervention. Methods: Five to 11-year-olds and their parents were recruited from a specialist CFS/ME service. Semi-structured interviews explored the families’ experience of the condition and perspectives on treatment. Interactive and arts-based methods were used. Interviews were audio-recorded, transcribed and analysed thematically. Qualitative Results: 14 parents and 7 children were interviewed. Early analysis of the interviews revealed the importance of the social-ecological setting of the child, which led to themes being developed in the context of Systems Theory. Theme one relates to the level of the child, theme two the family system, theme three the organisational and societal systems, and theme four cuts-across all levels. Theme1: The child’s capacity to describe, understand and manage their condition. Younger children struggled to describe their internal experiences, such as physical symptoms. Parents felt younger children did not understand some concepts of CFS/ME and did not have the capabilities to monitor and self-regulate their behaviour, as required by treatment. A spectrum of abilities was described; older children (10-11-year-olds) were more involved in clinical sessions and had more responsibility for self-management. Theme2: Parents’ responsibility for managing their child’s condition. Parents took responsibility for regulating their child’s behaviour in accordance with the treatment programme. They structured their child’s environment, gave direct instructions to their child, and communicated the needs of their child to others involved in care. Parents wanted their child to experience a 'normal' childhood and took steps to shield their child from medicalization, including diagnostic labels and clinical discussions. Theme3: Parental isolation and the role of organisational and societal systems. Parents felt unsupported in their role of managing the condition and felt negative responses from primary care health services and schools were underpinned by a lack of awareness and knowledge about CFS/ME in younger children. This sometimes led to a protracted time to diagnosis. Parents felt that schools have the potential important role in managing the child’s condition. Theme4: Complexity and uncertainty. Many parents valued specialist treatment (which included activity management, physiotherapy, sleep management, dietary advice, medical management and psychological support), but felt it needed to account for the complexity of the condition in younger children. Some parents expressed uncertainty about the diagnosis and the treatment programme. Conclusions: Interventions for younger children need to consider the 'systems' (family, organisational and societal) involved in the child’s care. Future research will include interviews with clinicians and schools supporting younger children with CFS/ME.

Keywords: chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME), pediatric, qualitative, treatment

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Authors: A. Tarantino, F. Lops, G. Lopriore, G. Disciglio

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Biostimulants are known as the organic fertilizers that can be applied in agriculture in order to increase nutrient uptake, growth and development of plants and improve quality, productivity and the environmental positive impacts. The aim of this study was to test the effects of some commercial biostimulants products (Bion® 50 WG, Hendophyt ® PS, Ergostim® XL and Radicon®) on vegeto-productive behavior and qualitative characteristics of fruits of two emerging apricot cultivars (Orange Rubis® and Farbaly®). The study was conducted during the spring-summer season 2015, in a commercial orchard located in the agricultural area of Cerignola (Foggia district, Apulian region, Southern Italy). Eight years old apricot trees, cv ‘Orange Rubis’ and ‘Farbaly®’, were used. The experimental data recorded during the experimental trial were: shoot length, total number of flower buds, flower buds drop and time of flowering and fruit set. Total yield of fruits per tree and quality parameters were determined. Experimental data showed some specific differences among the biostimulant treatments. Concerning the yield of ‘Orange Rubis’, except for the Bion treatment, the other three biostimulant treatments showed a tendentially lower values than the control. The yield of ‘Farbaly’ was lower for the Bion and Hendophyt treatments, higher for the Ergostim treatment, when compared with the yield of the control untreated. Concerning the soluble solids content, the juice of ‘Farbaly’ fruits had always higher content than that of ‘Orange Rubis’. Particularly, the Bion and the Hendophyt treatments showed in both harvest values tendentially higher than the control. Differently, the four biostimulant treatments did not affect significantly this parameter in ‘Orange Rubis’. With regard to the fruit firmness, some differences were observed between the two harvest dates and among the four biostimulant treatments. At the first harvest date, ‘Orange Rubis’ treated with Bion and Hendophyt biostimulants showed texture values tendentially lower than the control. Instead, ‘Farbaly’ for all the biostimulant treatments showed fruit firmness values significantly lower than the control. At the second harvest, almost all the biostimulants treatments in both ‘Orange Rubis’ and ‘Farbaly’ cultivar showed values lower than the control. Only ‘Farbaly’ treated with Radicon showed higher value in comparison to the control.

Keywords: apricot, fruit quality, growth, organic natural fertilizer

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Authors: Joulié Aurélien, Jourdain Elsa, Bailly Xavier, Gasqui Patrick, Yang Elise, Leblond Agnès, Rousset Elodie, Sidi-Boumedine Karim

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Q fever is a worldwide zoonosis caused by the gram-negative obligate intracellular bacterium Coxiella burnetii. Following the recent outbreaks in the Netherlands, a hyper virulent clone was found to be the cause of severe human cases of Q fever. In livestock, Q fever clinical manifestations are mainly abortions. Although the abortion rates differ between ruminant species, C. burnetii’s virulence remains understudied, especially in enzootic areas. In this study, the infectious potential of three C. burnetii isolates collected from French farms of small ruminants were compared to the reference strain Nine Mile (in phase II and in an intermediate phase) using an in vivo (CD1 mice) model. Mice were challenged with 105 live bacteria discriminated by propidium monoazide-qPCR targeting the icd-gene. After footpad inoculation, spleen and popliteal lymph node were harvested at 10 days post-inoculation (p.i). The strain invasiveness in spleen and popliteal nodes was assessed by qPCR assays targeting the icd-gene. Preliminary results showed that the avirulent strains (in phase 2) failed to pass the popliteal barrier and then to colonize the spleen. This model allowed a significant differentiation between strain’s invasiveness on biological host and therefore identifying distinct virulence profiles. In view of these results, we plan to go further by testing fifteen additional C. burnetii isolates from French farms of sheep, goat and cattle by using the above-mentioned in vivo model. All 15 strains display distant MLVA (multiple-locus variable-number of tandem repeat analysis) genotypic profiles. Five of the fifteen isolates will bee also tested in vitro on ovine and bovine macrophage cells. Cells and supernatants will be harvested at day1, day2, day3 and day6 p.i to assess in vitro multiplication kinetics of strains. In conclusion, our findings might help the implementation of surveillance of virulent strains and ultimately allow adapting prophylaxis measures in livestock farms.

Keywords: Q fever, invasiveness, ruminant, virulence

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