Search results for: child loss

Authors: Ronak Mishra, Sachin Kale

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Background: The clinical outcome of a new fixation device (femoral neck system, FNS) for femoral neck fractures is not described properly. The main purpose of this study was to evaluate the functional outcome of the patients of femoral neck fractures treated with FNS. Methods: A retrospective study was done among patients aged 60 years or less. On the basis of inclusion and exclusion criteria a final sample size of 30 was considered. Blood loss, type of fracture internal fixation, and length of clinical follow-up were all acquired from patient records. The volume of blood loss was calculated. The mean and standard deviation of continuous variables were reported (with range). Harris Hip score (HHS) And Post op xrays at intervals(6 weeks, 6 months ,12 months ) we used to clinically asses the patient. Results: Out of all 60% were females and 40% were males. The mean age of the patients was. 44.12(+-) years The comparison of functional outcomes of the patients treated with FNS using Harris Hip Score. It showed a highly significant comparison between the patients at post operatively , 6 weeks and 3 months and 12 months . There were no postoperative complications seen among the patients. Conclusion: FNS offers superior biomechanical qualities and greatly improved overall build stability. It allows for a significant reduction in operation time, potentially lowering risks and consequences associated with surgery.

Keywords: FNS, trauma, hip, neck femur fracture, minimally invasive surgery

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Authors: Roghieh A. Biroon, Zoleikha Abdollahi

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The recent growth of renewables, e.g., solar panels, batteries, and electric vehicles (EVs) in residential and small commercial sectors, has potential impacts on the stability and operation of power grids. Considering approximately 50 percent share of the residential and the commercial sectors in the electricity demand market, the significance of these impacts, and the necessity of addressing them are more highlighted. Utilities and power system operators should manage the renewable electricity sources integration with power systems in such a way to extract the most possible advantages for the power systems. The most common effect of high penetration level of the renewables is the reverse power flow in the distribution feeders when the customers generate more power than their needs. The reverse power flow causes voltage rise and thermal issues in the power grids. To overcome the voltage rise issues in the distribution system, several techniques have been proposed including reducing transformers short circuit resistance and feeder impedance, installing autotransformers/voltage regulators along the line, absorbing the reactive power by distributed generators (DGs), and limiting the PV and battery sizes. In this study, we consider a medium-scale battery energy storage to manage the power energy and address the aforementioned issues on voltage deviation and power loss increase. We propose an optimization algorithm to find the optimum size and location for the battery. The optimization for the battery location and size is so that the battery maintains the feeder voltage deviation and power loss at a certain desired level. Moreover, the proposed optimization algorithm controls the charging/discharging profile of the battery to absorb the negative power flow from residential and commercial customers in the feeder during the peak time and sell the power back to the system during the off-peak time. The proposed battery regulates the voltage problem in the distribution system while it also can play frequency regulation role in islanded microgrids. This battery can be regulated and controlled by the utilities or a third-party ancillary service provider for the utilities to reduce the power system loss and regulate the distribution feeder voltage and frequency in standard level.

Keywords: ancillary services, battery, distribution system and optimization

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Authors: Lalanthica Yogendran, Manassa Hany, Saira Pasha, Benjamin Chaucer, Simarpreet Kaur, Christopher Janusz

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Children and adolescent patients visit the Psychiatric Emergency Department (ED) for multiple reasons. Visiting the Psychiatric ED itself can be a traumatic experience that can affect an adolescents mental well-being, regardless of a history of mental illness. Despite this, limited research exists in this domain. Prospective studies have correlated adverse psychosocial determinants among adolescents to risk factors for poor well-being and unfavorable behavior outcomes. Studies have also shown that physiological stress is a contributor in the development of health problems and an increase in substance abuse in adolescents. This study aimed to retrospectively determine which psychosocial factors are associated with an increase in psychiatric ED visits. 600 charts of patients who had a psychiatric ED and inpatient admission visit from January 2014 through December 2014 were reviewed. Sociodemographics, diagnoses, ED visits and inpatient admissions were collected. Descriptive statistics, chi-square tests and independent t-test analyses were utilized to examine differences in the sample to determine which factors affected ED visits and admissions. The sample was 50% female, 35.2% self-identified black, and had a mean age of 13 years. The majority, 85%, went to public school and 17% were in special education. Attention Deficit Hyperactivity Disorder was the most common admitting diagnosis, found in 132(23%) responders. Most patients came from single parent household 305 (53%). The mean ages of patients that were sexually active, with legal issues, and reporting marijuana substance abuse were 15, 14.35, and 15 years respectively. Patients from two biological parent households had significantly fewer ED visits (1.2 vs. 1.7, p < 0.01) and admissions (0.09 vs. 0.26, p < 0.01). Among social factors, those who reported sexual, physical or emotional abuse had a significantly greater number of ED visits (2.1 vs. 1.5, p < 0.01) and admissions (0.61 vs. 0.14, p < 0.01) than those who did not. Patients that were sexually active or had legal issues or substance abuse with marijuana had a significantly greater number of admissions (0.43 vs. 0.17, p < 0.01), (0.54 vs. .18, p < 0.01) and (0.46 vs. 0.18, p < 0.01) respectively. This data supports the theory of the stability of a two parent home. Dual parenting plays a role in creating a safe space where a child can develop; this is shown by subsequent decreases in psychiatric ED visits and admissions. This may highlight the psychological protective role of a two parent household. Abuse can exacerbate existing psychiatric illness or initiate the onset of new disease. Substance abuse and legal issues result in early induction to the criminal system. Results show that this causes an increase in frequency of visits and severity of symptoms. Only marijuana, but not other illicit substances, correlated with higher incidence of psychiatric ED visits. This may speak to the psychotropic nature of tetrahydrocannabinols and their role in mental illness. This study demonstrates the array of psychosocial factors that lead to increased ED visits and admissions in children and adolescents.

Keywords: adolescent, child psychiatry, emergency department, substance abuse

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Authors: Esra Bora, Alper Omeroglu, Zeynep Pelin Polat, Oguzhan Kara, Fatih Akdogan, Sema Ucak Basat

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Hyponatremia is one of the most encountered electrolyte imbalance among all medical fields. It has a wide range of symptoms as well as complications from fatigue to loss of consciousness. Although a lot of factors can cause low sodium levels in serum, combining specific medications can lead to severe hyponatremia in a rapid onset which can cause high mortality and morbidity. The objective of this case report was to underline that prescribing specific medications disregarding their side effects can cause this common electrolyte imbalance but in a more severe manner. In this case report, we present a 46-year-old male patient with a serum sodium level of 104 mEq/L who consumed hydrochlorothiazide for hypertension and was under treatment with selective serotonin reuptake inhibitors (SSRIs) for major depression. The patient had tonic-clonic seizures at the second hour of the treatment and intubation was needed due to loss of consciousness and hypoxia. After proper replacement of sodium with hypertonic solutions in intensive care unit for nine days, extubation indicated. Even in healthy young males, hyponatremia due to two separately prescribed medications can lead life-threatening hyponatremia. Physicians should be aware of the side effects of diuretics, especially hydrochlorothiazides and SSRIs and their combinations.

Keywords: diuretics, hydrochlorothiazide, hyponatremia, SSRI

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Authors: Bishnu Prasad Devkota

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Peoples` perception is reflected in their attitudes and presumably their behavior towards wildlife conservation. The success of wildlife conservation initiatives in the mountains of Nepal is heavily dependent on local people. Therefore, Nepal has emphasized the involvement of local people in wildlife conservation, especially in the mountainous region. Local peoples` perception towards snow leopard conservation in six mountainous protected area of Nepal was carried out conducting 300 household surveys and 90 face to face key informant interviews. The average livestock holding was 27.74 animals per household with depredation rate of 10.6 % per household per annum. Livestock was the source of 32.74% of the total mean annual income of each household. In average, the economic loss per household per annum due to livestock depredation was US $ 490. There was significant difference in people´s perception towards snow leopard conservation in protected areas of mountainous region of Nepal. These differences were due to economic, educational and cultural factors. 54.4% local people showed preference for snow leopard conservation. The perception of local people toward snow leopard was significantly difference by the economic status of local people. Involvement of local people in conservation activities had positive impact towards wildlife conservation in the mountain region of Nepal. Timely introducing incentive programs can be a supportive way for sustaining the conservation of snow leopards in the Nepalese Himalayas.

Keywords: economic loss, livestock depredation, local people, perception, snow leopard

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Authors: Gianluca Castelnuovo, Giada Pietrabissa, Gian Mauro Manzoni, Margherita Novelli, Emanuele Maria Giusti, Roberto Cattivelli, Enrico Molinari

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Diabesity could be defined as a new global epidemic of obesity and being overweight with many complications and chronic conditions. Such conditions include not only type 2 diabetes, but also cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer, and various psychosocial and psychopathological disorders. The financial direct and indirect burden (considering also the clinical resources involved and the loss of productivity) is a real challenge in many Western health-care systems. Recently the Lancet journal defined diabetes as a 21st-century challenge. In order to promote patient compliance in diabesity treatment reducing costs, evidence-based interventions to improve weight-loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. Moreover, new technologies can provide useful solutions in this multidisciplinary approach, above all in maintaining long-term compliance and adherence in order to ensure clinical efficacy. Psychological therapies with diet and exercise plans could better help patients in achieving weight loss outcomes, both inside hospitals and clinical centers and during out-patient follow-up sessions. In the management of chronic diseases clinical psychology play a key role due to the need of working on psychological conditions of patients, their families and their caregivers. mHealth approach could overcome limitations linked with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies: one of the best up-to-date application is the management of obesity with type 2 diabetes, where mHealth solutions can provide remote opportunities for enhancing weight reduction and reducing complications from clinical, organizational and economic perspectives. A stepped care mHealth-based approach is an interesting perspective in chronic care management of obesity with type 2 diabetes. One promising future direction could be treating obesity, considered as a chronic multifactorial disease, using a stepped-care approach: -mhealth or traditional based lifestyle psychoeducational and nutritional approach. -health professionals-driven multidisciplinary protocols tailored for each patient. -inpatient approach with the inclusion of drug therapies and other multidisciplinary treatments. -bariatric surgery with psychological and medical follow-up In the chronic care management of globesity mhealth solutions cannot substitute traditional approaches, but they can supplement some steps in clinical psychology and medicine both for obesity prevention and for weight loss management.

Keywords: clinical health psychology, mhealth, obesity, type 2 diabetes, stepped care, chronic care management

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Authors: Cansu Bozer, Saadet İrem Turgut

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Artificial intelligence (AI) has become one of the most important technologies of the digital age and is transforming many sectors, including education. The advantages offered by AI, such as automation, personalised learning, and data analytics, create new opportunities for both teachers and students in education systems. Preschool education plays a fundamental role in the cognitive, social, and emotional development of children. In this period, the foundations of children's creative thinking, problem-solving, and critical thinking skills are laid. Educational technologies, especially artificial intelligence-based applications, are thought to contribute to the development of these skills. For example, artificial intelligence-supported digital learning tools can support learning processes by offering activities that can be customised according to the individual needs of each child. However, the successful use of artificial intelligence-based applications in preschool education can be realised under the guidance of teachers who have the right knowledge about this technology. Therefore, it is of great importance to measure preschool teachers' awareness levels of artificial intelligence and to understand which variables affect this awareness. The aim of this study is to measure preschool teachers' awareness levels of artificial intelligence and to determine which factors are related to this awareness. In line with this purpose, teachers' level of knowledge about artificial intelligence, their thoughts about the role of artificial intelligence in education, and their attitudes towards artificial intelligence will be evaluated. The study will be conducted with 100 teachers working in Turkey using a descriptive survey model. In this context, ‘Artificial Intelligence Awareness Level Scale for Teachers’ developed by Ferikoğlu and Akgün (2022) will be used. The collected data will be analysed using SPSS (Statistical Package for the Social Sciences) software. Descriptive statistics (frequency, percentage, mean, standard deviation) and relationship analyses (correlation and regression analyses) will be used in data analysis. As a result of the study, the level of artificial intelligence awareness of preschool teachers will be determined, and the factors affecting this awareness will be identified. The findings obtained will contribute to the determination of studies that can be done to increase artificial intelligence awareness in preschool education.

Keywords: education, child development, artificial intelligence, preschool teachers

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Authors: S. Neelima, P. S. Subramanyam

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A distribution system is an interface between the bulk power system and the consumers. Among these systems, radial distributions system is popular because of low cost and simple design. In distribution systems, the voltages at buses reduces when moved away from the substation, also the losses are high. The reason for a decrease in voltage and high losses is the insufficient amount of reactive power, which can be provided by the shunt capacitors. But the placement of the capacitor with an appropriate size is always a challenge. Thus, the optimal capacitor placement problem is to determine the location and size of capacitors to be placed in distribution networks in an efficient way to reduce the power losses and improve the voltage profile of the system. For this purpose, in this paper, two stage methodologies are used. In the first stage, the load flow of pre-compensated distribution system is carried out using ‘dimension reducing distribution load flow algorithm (DRDLFA)’. On the basis of this load flow the potential locations of compensation are computed. In the second stage, Genetic Algorithm (GA) technique is used to determine the optimal location and size of the capacitors such that the cost of the energy loss and capacitor cost to be a minimum. The above method is tested on IEEE 9 and 34 bus system and compared with other methods in the literature.

Keywords: dimension reducing distribution load flow algorithm, DRDLFA, genetic algorithm, electrical distribution network, optimal capacitors placement, voltage profile improvement, loss reduction

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Authors: Maíra O. Palm, Cintia Marangoni, Ozair Souza, Noeli Sellin

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Wastes from a vegetal extracts industry (cocoa, oak, Guarana and mate) were characterized by particle size, proximate and ultimate analysis, lignocellulosic fractions, high heating value, thermal analysis (Thermogravimetric analysis – TGA, and Differential thermal analysis - DTA) and energy density to evaluate their potential as biomass in the form of briquettes for power generation. All wastes presented adequate particle sizes to briquettes production. The wastes showed high moisture content, requiring previous drying for use as briquettes. Cocoa and oak wastes had the highest volatile matter contents with maximum mass loss at 310 ºC and 450 ºC, respectively. The solvents used in the aroma extraction process influenced in the moisture content of the wastes, which was higher for mate due to water has been used as solvent. All wastes showed an insignificant loss mass after 565 °C, hence resulting in low ash content. High carbon and hydrogen contents and low sulfur and nitrogen contents were observed ensuring a low generation of sulfur and nitrous oxides. Mate and cocoa exhibited the highest carbon and lignin content, and high heating value. The dried wastes had high heating value, from 17.1 MJ/kg to 20.8 MJ/kg. The results indicate the energy potential of wastes for use as fuel in power generation.

Keywords: agro-industrial waste, biomass, briquettes, combustion

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Authors: Mojtaba Eshraghi Arani

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According to the international conventions for the carriage of goods by sea, the consignee is the person who is entitled to take delivery of the cargo from the carrier. Such a person is usually named in the relevant box of the bill of lading unless the latter is issued “To Order” or “To Bearer”. However, there are some cases in which the apparent consignee, as above, was not intended to take delivery of cargo, like the L/C issuing bank or the freight forwarder who are named as consignee only for the purpose of security or acceleration of transit process. In such cases as well as the BL which is issued “To Order”, the so-called “real consignee” can be found out in the “Notify Party” box. The dispute revolves around the choice between apparent consignee and real consignee for being entitled not only to take delivery of the cargo but also to sue the carrier for any damages or loss. While it is a generally accepted rule that only the apparent consignee shall be vested with such rights, some courts like France’s Cour de Cassation have declared that the “Notify Party”, as the real consignee, was entitled to sue the carrier and in some cases, the same court went far beyond and permitted the real consignee to take suit even where he was not mentioned on the BL as a “Notify Party”. The main argument behind such reasoning is that the real consignee is the person who suffered the loss and thus had a legitimate interest in bringing action; of course, the real consignee must prove that he incurred a loss. It is undeniable that the above-mentioned approach is contrary to the position of the international conventions on the express definition of consignee. However, international practice has permitted the use of BL in a different way to meet the business requirements of banks, freight forwarders, etc. Thus, the issue is one of striking a balance between the international conventions on the one hand and existing practices on the other hand. While the latest convention applicable for sea transportation, i.e., the Rotterdam Rules, dealt with the comparable issue of “shipper” and “documentary shipper”, it failed to cope with the matter being discussed. So a new study is required to propose the best solution for amending the current conventions for carriage of goods by sea. A qualitative method with the concept of interpretation of data collection has been used in this article. The source of the data is the analysis of domestic and international regulations and cases. It is argued in this manuscript that the judge is not allowed to recognize any one as real consignee, other than the person who is mentioned in the “Consingee” box unless the BL is issued “To Order” or “To Bearer”. Moreover, the contract of carriage is independent of the sale contract and thus, the consignee must be determined solely based on the facts of the BL itself, like “Notify Party” and not any other contract or document.

Keywords: real consignee, cargo, delivery, to order, notify the party

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Authors: Luai Z. Hasoun, Steven W. Bailey, Kitti K. Outlaw, June E. Ayling

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Human skin color is thought to have evolved to balance sufficient photochemical synthesis of vitamin D versus the need to protect not only DNA but also folate from degradation by ultraviolet light (UV). Although the risk of DNA damage and subsequent skin cancer is related to light skin color, the effect of UV on skin folate of any species is unknown. Here we show that UVA irradiation at 13 mW/cm2 for a total exposure of 187 J/cm2 (similar to a maximal daily equatorial dose) induced a significant loss of total folate in epidermis of ex vivo white skin. No loss was observed in black skin samples, or in the dermis of either color. Interestingly, while the concentration of 5 methyltetrahydrofolate (5-MTHF) fell in white epidermis, a concomitant increase of tetrahydrofolic acid was found, though not enough to maintain the total pool. These results demonstrate that UVA indeed not only decreases folate in skin, but also rearranges the pool components. This could be due in part to the reported increase of NADPH oxidase activity upon UV irradiation, which in turn depletes the NADPH needed for 5-MTHF biosynthesis by 5,10-methylenetetrahydrofolate reductase. The increased tetrahydrofolic acid might further support production of the nucleotide bases needed for DNA repair. However, total folate was lost at a rate that could, with strong or continuous enough exposure to ultraviolet radiation, substantially deplete light colored skin locally, and also put pressure on total body stores for individuals with low intake of folate.

Keywords: depletion, folate, human skin, ultraviolet

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Authors: Chahrazed Salhi, Ayoub Zeroual, Yasmina Hamitouche

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Soil water erosion poses a significant threat to the watersheds in Algeria today. The degradation of storage capacity in large dams over the past two decades, primarily due to erosion, necessitates a comprehensive understanding of the factors that contribute to soil erosion. The Isser watershed, located in the Northwestern region of Algeria, faces additional challenges such as recurrent droughts and the presence of delicate marl and clay outcrops, which amplify its susceptibility to water erosion. This study aims to employ advanced techniques such as Geographic Information Systems (GIS) and Remote Sensing (RS), in conjunction with the Canonical Correlation Analysis (CCA) method and Soil Water Assessment Tool (SWAT) model, to predict specific erosion patterns and analyze the key factors influencing erosion in the Isser basin. To accomplish this, an array of data sources including rainfall, climatic, hydrometric, land use, soil, digital elevation, and satellite data were utilized. The application of the SWAT model to the Isser basin yielded an average annual soil loss of approximately 16 t/ha/year. Particularly high erosion rates, exceeding 12 T/ha/year, were observed in the central and southern parts of the basin, encompassing 41% of the total basin area. Through Canonical Correlation Analysis, it was determined that vegetation cover and topography exerted the most substantial influence on erosion. Consequently, the study identified significant and spatially heterogeneous erosion throughout the study area. The impact of land topography on soil loss was found to be directly proportional, while vegetation cover exhibited an inverse proportional relationship. Modeling specific erosion for the Ladrat dam sub-basin estimated a rate of around 39 T/ha/year, thus accounting for the recorded capacity loss of 17.80% compared to the bathymetric survey conducted in 2019. The findings of this research provide valuable decision-support tools for soil conservation managers, empowering them to make informed decisions regarding soil conservation measures.

Keywords: Isser watershed, RS, CCA, SWAT, vegetation cover, topography

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Authors: C. A. Bradley, D. Patsios, D. Berridge

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This paper presents evidence to better understand the risk and protective factors related to sibling conflict and the patterns of association between sibling conflict and negative adjustment outcomes by incorporating additional familial and societal factors within statistical models of risk and adjustment. It was conducted through the secondary analysis of a large representative cross-sectional dataset of children in the UK. The original study includes proxy interviews for young children and self-report interviews for adolescents. The study applies an ecological systems framework for the analyses. Hierarchical regression models assess risk and protective factors and adjustment outcomes associated with sibling conflict. Interactions reveal differential effect between contextual risk factors and the social context of influence. The general pattern of findings suggested that, although factors affecting likelihood of experiencing sibling conflict were often determined by child age, some remained consistent across childhood. These factors were often conditional on each other, reinforcing the importance of an ecological framework. Across both age-groups, sibling conflict was associated with siblings closer in age; male sibling groups; most advantaged socio-economic group; and exposure to community violence, such as witnessing violent assault or robbery. The study develops the evidence base on the influence of ethnicity and socio-economic group on sibling conflict by exploring interactions between social context. It also identifies key new areas of influence – such as family structure, disability, and community violence in exacerbating or reducing risk of conflict. The study found negative associations between sibling conflict and young children’s mental well-being and adolescents' mental well-being and anti-social behaviour, but also more context specific associations – such as sibling conflict moderating the negative impact of adversity and high risk experiences for young children such as parental violence toward the child.

Keywords: adjustment, conflict, ecological systems, family systems, risk and protective factors, sibling

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Authors: Rendong Cai, Bei Peng, Yanping Dong

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In risk decision making, individuals are found to be susceptible to 'frames': people tend to be risk averse when the choice is described in terms of potential 'gains' (gain frame), whereas they tend to be risk seeking when the same choice is described in terms of potential 'losses' (loss frame); this effect is termed the framing effect. The framing effect has been well documented and some studies even find a developmental reversal in the framing effect: The more experience an individual has in a certain field, the easier for him to be influenced by the frame relevant to the field, resulting in greater decision inconsistency. Recent studies reported that using a foreign language can reduce the framing effect. However, it is not clear whether foreign language use can overcome the developmental reversal in the framing effect. The present study investigated three potential factors that may influence the developmental reversal in the framing effect: specialized knowledge of the participants, the language in which the problem is presented, and the types of problems. The present study examined the decision making behavior of 188 Chinese-English bilinguals who majored in Finance, with a group of 277 English majors as the control group. They were asked to solve a financial problem (experimental condition) and a life problem (control condition). Each problem was presented in one of the following four versions: native language-gain frame, foreign language-gain frame, native language-loss frame, and foreign language-loss frame. Results revealed that for the life problem, under the native condition, both groups were affected by the frame; but under the foreign condition, this framing effect disappeared for the financial majors. This confirmed that foreign language use modulates framing effects in general decision making, which served as an effective baseline. For the financial problem, under the native condition, only the financial major was observed to be influenced by the frame, which was a developmental reversal; under the foreign condition, however, this framing effect disappeared. The results provide further empirical evidence for the universal of the developmental reversal in risky decision making. More importantly, the results suggest that using a foreign language can overcome such reversal, which has implications for the reduction of decision biases in professionals. The findings also shed new light on the complex interaction between general decision-making and bilingualism.

Keywords: the foreign language effect, developmental reversals, the framing effect, bilingualism

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Authors: Yvonne Nanaama Brew, Bismark Jampim Abrokwah

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Children with disabilities in Ghana are not routinely registered, and this can imply that they may be neglected in national policy planning since global estimates may not be near the exact numbers. Although there are some studies with reports on the prevalence of disability among children in Ghana, reliable information on the prevalence, types of disability in children, and children who die with disabilities in the Greater Accra region are lacking. The current study seeks to investigate the incidence of disability among children two to fourteen years at selected districts in the Greater Accra region of Ghana. A cross-sectional design is adapted with a quantitative method for this study. Parents with disabled children who access child welfare clinics at the Greater Accra regional hospital, Maamobi hospital, Ga west, and Ga south district hospitals will be selected through purposive sampling for the study. An adapted UNICEF structured Ten Questions will be used to collect relevant data about participants. The responses to the questions will be either 'Yes' or 'No'. Parents with children who answer 'Yes' to a disability and purposively sampled parents with children who answer 'No' to disability will be invited to Child Health Clinic at the Greater Accra regional hospital for a free clinical assessment. Data will be entered into Microsoft Office Excel 2013 and imported into STATA version 15 for analysis. The study is expected to provide reliable disaggregated data on less than fourteen years of children with disabilities in the Greater Accra region. The findings and recommendations of the study will demonstrate the importance of early detection of disability and facilitate more quality and holistic planning of appropriate programmes that best safeguard the rights of children with disabilities in Ghana. It will help in policy and decision-making on children less than fourteen years with disabilities in Ghana. Also, findings will be useful for health facilities in Ghana to plan services for disabled children. Finally, the study is expected to add to the guides for the National Council of Persons with Disabilities to fulfill its legal mandate for disabled persons in Ghana.

Keywords: prevalence, disability, children, Ghana

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Authors: Md. Samsuzzaman, M. T. Islam, J. S. Mandeep, N. Misran

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In this article, a compact simple structure modified Swastika shape patch multiband antenna on a substrate of available low cost polymer resin composite material is designed for Wi-Fi and WiMAX applications. The substrate material consists of an epoxy matrix reinforced by woven glass. The designed micro-strip line fed compact antenna comprises of a planar wide square slot ground with four slits and Swastika shape radiation patch with a rectangular slot. The effect of the different substrate materials on the reflection coefficients of the proposed antennas was also analyzed. It can be clearly seen that the proposed antenna provides a wider bandwidth and acceptable return loss value compared to other reported materials. The simulation results exhibits that the antenna has an impedance bandwidth with -10 dB return loss at 3.01-3.89 GHz and 4.88-6.10 GHz which can cover both the WLAN, WiMAX and public safety WLAN bands. The proposed swastika shape antenna was designed and analyzed by using a finite element method based simulator HFSS and designed on a low cost FR4 (polymer resin composite material) printed circuit board. The electrical performances and superior frequency characteristics make the proposed material antenna desirable for wireless communications.

Keywords: epoxy resin polymer, multiband, swastika shaped, wide slot, WLAN/WiMAX

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Authors: Sadeq Al Yaari, Fayza Alhammadi, Ayman Al Yaari, Montaha Al Yaari, Aayah Al Yaari, Adham Al Yaari, Sajedah Al Yaari, Saleh Al Yami

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Background: A rapidly increasing number of studies that focus on the relationship between language and cortical (CD) and subcortical dementias (SCD) have recently shown that such correlation is existent. Mounting evidence suggests that cognitive impairments should be investigated against language disorders. Aims: This study aims at investigating how language is associated with dementia diseases namely CD &SCD in light of psychoneurolinguistic approach. Method: Data from multiple sources (e.g., theses, dissertations, articles, research, medical records, direct testing, staff reports, and client observations) have been integrated to provide a detailed analysis of the relationship between language and CD&SCD. The researchers identified over 20 most of dementia types, and described them. Having collected and described data, the researchers then analyzed these data independently to see to what extent CD&SCD are involved in matters concerning language. Results: Results of the present study demonstrate that language and CD&SCD are undoubtedly correlated with each other. The loss of the ability of some organs to perform certain functions (due to any of the dementia diseases) results in no way to the loss of some language aspects and /or speech skills. In clearer terms, it is rare to find a patient with dementia who is not suffering from partial or complete linguistic difficulties. Many deficits run through the current interpretation of linguistic disorders: language disorders, speech disorders, articulation disorders, or voice disorders.

Keywords: cortical dementia, subcortical dementia, diseases, psychoneurolinguistics, language, impairments, relationship

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Authors: Taha Kadir Yesin, Hanyu Liu, Zhangfan Ding, Amit Singh, Qi Tian, Yuheng Zhang, Biswajyoti Borah, Junyu Chen, Anjali P. Kusumbe

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The skeletal structure and bone marrow endothelium collectively form a critical functional unit essential for bone development, health, and aging. At the core of osteogenesis and bone formation lies the dynamic process of angiogenesis. In this study, we reveal a potent endogenous anabolic NCAM1-14.3.3. ζδ-derived- Peptide interaction, which stimulates bone angiogenesis and osteogenesis during homeostasis, aging, and age-related bone diseases. Employing high-resolution imaging and inducible cell-specific mouse genetics, our results elucidate the pivotal role of the NCAM1-14.3.3.ζδ-derived-Peptide interaction in driving the expansion of Clec14a+ angiogenic endothelial cells. Notably, Clec14a+ endothelial cells express key osteogenic factors. The NCAM1-14.3.3.ζδ-derived-Peptide interaction in osteoblasts drives osteoblast differentiation, ultimately contributing to the genesis of bone. Moreover, the NCAM1-14.3.3.ζδ-derived-Peptide interaction leads to a reduction in bone resorption. In age-associated vascular and bone loss diseases, stimulating the NCAM1-14.3.3.ζδ-derived-Peptide interaction not only promotes angiogenesis but also reverses bone loss. Consequently, harnessing the endogenous anabolic potential of the NCAM1-14.3.3.ζδ-derived-Peptide interaction emerges as a promising therapeutic modality for managing age-related bone diseases.

Keywords: endothelial cell, NCAM1, Clec14a, 14.3.3.ζδ

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Authors: Esther Mafunda, Simbarashe Muparangi

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The present paper tests the applicability of the Regression Hypothesis on the pathological language dissolution of a Shona male adult with Broca’s aphasia. It particularly assesses the prediction of the Regression Hypothesis, which states that the process according to which language is forgotten will be the reversal of the process according to which it will be acquired. The main aim of the paper is to find out whether mirror symmetries between L1 acquisition and L1 dissolution of tense in Shona and, if so, what might cause these regression patterns. The paper also sought to highlight the practical contributions that Linguistic theory can make to solving language-related problems. Data was collected from a 46-year-old male adult with Broca’s aphasia who was receiving speech therapy at St Giles Rehabilitation Centre in Harare, Zimbabwe. The primary data elicitation method was experimental, using the probe technique. The TART (Test for Assessing Reference Time) Shona version in the form of sequencing pictures was used to access tense by Broca’s aphasic and 3.5-year-old child. Using the SPSS (Statistical Package for Social Studies) and Excel analysis, it was established that the use of the future tense was impaired in Shona Broca’s aphasic whilst the present and past tense was intact. However, though the past tense was intact in the male adult with Broca’s aphasic, a reference to the remote past was made. The use of the future tense was also found to be difficult for the 3,5-year-old speaking child. No difficulties were encountered in using the present and past tenses. This means that mirror symmetries were found between L1 acquisition and L1 dissolution of tense in Shona. On the basis of the results of this research, it can be concluded that the use of tense in a Shona adult with Broca’s aphasia supports the Regression Hypothesis. The findings of this study are important in terms of speech therapy in the context of Zimbabwe. The study also contributes to Bantu linguistics in general and to Shona linguistics in particular. Further studies could also be done focusing on the rest of the Bantu language varieties in terms of aphasia.

Keywords: Broca’s Aphasia, regression hypothesis, Shona, language dissolution

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Authors: Pymaneh Bairami Rad

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The present work was planned with the aim to study the histological changes that might occur in the sciatic nerve of adult male albino rat following antimony trioxide exposure and to throw more light on the protective role of vitamin "E" on the peripheral neurotoxicity induced by this environmental toxin Sixty adult male albino rats, weighing 183 - 235 grams, were utilized in this work. The animals were divided into 3 groups; each of 20 rats: animals of group I served as control, animals of group II received antimony trioxide daily for 12 successive weeks , animals of group III received antimony trioxide and vitamin "E" daily for the same duration. Antimony trioxide was given in a daily dose of 500 mg/ kg body weight which represents 1/40 of the known LD50 and vitamin "E" was administered in a daily dose of 300 mg/kg body weight. Both antimony trioxide and vitamin "E" were given to the animals by gastric intubation. This research revealed many histological changes in the sciatic nerve, following exposure to antimony trioxide, including Wallerian degeneration in most myelinated nerve fibers with pleomorphic destruction, fragmentation, loss of normal lamination and rupture of myelin sheaths. The axoplasms of these nerve fibers were irregular, degenerated and contained myelin fragments with loss of neurofibrils. Obvious increase in endoneurium was also observed. Concomitant administration of vitamin "E" with antimony trioxide resulted in marked improvement in the histological changes observed in the sciatic nerve.

Keywords: neurotoxicity, antimony, vitamin e, anatomy, histology

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Authors: Pavlína Částková, Jiří Kropáč, Jan Kubrický

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The paper deals with the current issue of Information and Communication Technologies and their implementation into the educational activities of preschool children. The issue is addressed in the context of technical education and the specifics of its implementation in a kindergarten. One of the main topics of this paper is a technical game activity of a preschool child, and its possibilities, benefits and risks. The paper presents games/toys as one of the means of exploring and understanding technology as an essential part of human culture.

Keywords: ICT, technical education, pre-school age, technical games

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Authors: Laila Jeebodh Desai

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Storytelling as a therapeutic intervention entails the narrating of events by externalising emotions, thoughts and responses to life-changing events such as loss and grief. This creates the opportunity for clients to engage with psychologists by projecting various beliefs and challenges, such as grief, through a range of therapeutic modalities. This study conducts an inquiry into the ways in which storytelling can be utilised by educational psychologists with adolescent clients to address behavioural challenges relating to grief. This qualitative study therefore aims to facilitate an understanding of the use and benefits of storytelling as a therapeutic intervention. This has been achieved by examining interviews with four educational psychologists who have utilised storytelling as a therapeutic intervention with adolescent clients to overcome challenges with grief. The participants (educational psychologists) discussed case studies during interviews, which provided evidence of their practical administration of storytelling as a therapeutic intervention incorporating integrated theoretical approaches through the use of blended therapeutic techniques. Behavioural challenges relating to grief were also predominant in the case study information provided by the participants. The participants further confirmed that the term ‘grief’ included different types of loss that were experienced among adolescent clients. The implications and recommendations of the findings encouraged the utilisation of storytelling as a therapeutic intervention with adolescent clients in addressing behavioural challenges related to grief, based on the outcome of the case studies discussed by the participants.

Keywords: storytelling, therapeutic intervention, adolescents, grief

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Authors: Saeed Abbas, Rahilla Tabassum, Haider Abbas, Babar Khan, Shahid Hussain, Muhammad Zafar Khan, Fazal Karim, Yawar Abbas, Rizwan Karim

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Human–carnivore conflict is considered to be a major conservation and rural livelihood concern because many carnivore species have been heavily victimized due to elevated conflict levels with communities. Like other snow leopard range countries, this situation prevails in Pakistan, where WWF is currently working under Asia High Mountain Project (AHMP) in Gilgit-Baltistan of Pakistan. To mitigate such conflicts requires a firm understanding of grazing and predation pattern including human-carnivore interaction. For this purpose we conducted a survey in Hoper valley (one of the AHMP project sites in Pakistan), during August, 2013 through a questionnaire based survey and unstructured interviews covering 647 households, permanently residing in the project area out of the total 900 households. The valley, spread over 409 km2 between 36°7'46" N and 74°49'2"E, at 2900m asl in Karakoram ranges is considered to be one of an important habitat of snow leopard and associated prey species such as Himalayan ibex. The valley is home of 8100 Brusho people (ancient tribe of Northern Pakistan) dependent on agro-pastoral livelihoods including farming and livestock rearing. The total number of livestock reported were (N=15,481) out of which 8346 (53.91%) were sheep, 3546 (22.91%) goats, 2193 (14.16%) cows, 903 (5.83%) yaks, 508 (3.28%) bulls, 28 (0.18%) donkeys, 27 (0.17%) zo/zomo (cross breed of yak and cow), and 4 (0.03%) horses. 83 percent respondent (n=542 households) confirmed loss of their livestock during the last one year July, 2012 to June, 2013 which account for 2246 (14.51%) animals. The major reason of livestock loss include predation by large carnivores such as snow leopards and wolf (1710, 76.14%) followed by diseases (536, 23.86%). Of the total predation cases snow leopard is suspected to kill 1478 animals (86.43%). Among livestock sheep were found to be the major prey of snow leopard (810, 55%) followed by goats (484, 32.7%) cows (151, 10.21%), yaks (15, 1.015%), zo/zomo (7, 0.5%) and donkey (1, 0.07%). The reason for the mass depredation of sheep and goats is that they tend to browse on twigs of bushes and graze on soft grass near cliffs. They are also considered to be very active as compared to other species in moving quickly and covering more grazing area. This makes them more vulnerable to snow leopard attack. The majority (1283, 75%) of livestock killed by predators occurred during the warm season (May-September) in alpine and sub-alpine pastures and remaining (427, 25%) occurred in the winter season near settlements in valley. It was evident from the recent study that Snow leopard kills outside the pen were (1351, 79.76%) as compared to inside pen (359, 20.24%). Assessing the economic loss of livestock predation we found that the total loss of livestock predation in the study area is equal to PKR 11,230,000 (USD 105,797), which is about PRK 17, 357 (USD 163.51) per household per year. Economic loss incurred by the locals due to predation is quite significant where the average cash income per household per year is PKR 85,000 (USD 800.75).

Keywords: carnivores, conflict, predation, livelihood, conservation, rural, snow leopard, livestock

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Authors: Hamed Delrobai Ghoochan Atigh

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Androgenic alopecia (AGA) is a common form of hair loss, impacting approximately 50% of females, which leads to reduced self-esteem and quality of life. It causes progressive follicular miniaturization in genetically predisposed individuals. Mesotherapy -- a minimally invasive procedure, topical 2% minoxidil, and oral finasteride have emerged as popular treatment options in the realm of cosmetics. However, the efficacy of mesotherapy compared to other options remains unclear. This study aims to assess the effectiveness of mesotherapy when it is added to topical 2% minoxidil treatment on female androgenic alopecia. Mesotherapy, also known as intradermotherapy, is a technique that entails administering multiple intradermal injections of a carefully composed mixture of compounds in low doses, applied at various points in close proximity to or directly over the affected areas. This study involves a randomized controlled trial with 100 female participants diagnosed with androgenic alopecia. The subjects were randomly assigned to two groups: Group A used topical 2% minoxidil twice daily and took Finastride oral tablet. For Group B, 10 mesotherapy sessions were added to the prior treatment. The injections were administered every week in the first month of treatment, every two weeks in the second month, and after that the injections were applied monthly for four consecutive months. The response assessment was made at baseline, the 4th session, and finally after 6 months when the treatment was complete. Clinical photographs, 7-point Likert scale patient self-evaluation, and 7-point Likert scale assessment tool were used to measure the effectiveness of the treatment. During this evaluation, a significant and visible improvement in hair density and thickness was observed. The study demonstrated a significant increase in treatment efficacy in Group B compared to Group A post-treatment, with no adverse effects. Based on the findings, it appears that mesotherapy offers a significant improvement in female AGA over minoxidil. Hair loss was stopped in Group B after one month and improvement in density and thickness of hair was observed after the third month. The findings from this study provide valuable insights into the efficacy of mesotherapy in treating female androgenic alopecia. Our evaluation offers a detailed assessment of hair growth parameters, enabling a better understanding of the treatments' effectiveness. The potential of this promising technique is significantly enhanced when carried out in a medical facility, guided by appropriate indications and skillful execution. An interesting observation in our study is that in areas where the hair had turned grey, the newly regrown hair does not retain its original grey color; instead, it becomes darker. The results contribute to evidence-based decision-making in dermatological practice and offer different insights into the treatment of female pattern hair loss.

Keywords: androgenic alopecia, female hair loss, mesotherapy, topical 2% minoxidil

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Authors: M. Javanmard

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This study was aimed at analyzing the effects of packaging (MAP) and preservation conditions on the packaged fresh walnut kernel quality. The central composite plan was used for evaluating the effect of oxygen (0–10%), carbon dioxide (0-10%), and temperature (4-26 °C) on qualitative characteristics of walnut kernels. Also, the response level technique was used to find the optimal conditions for interactive effects of factors, as well as estimating the best conditions of process using least amount of testing. Measured qualitative parameters were: peroxide index, color, decreased weight, mould and yeast counting test, and sensory evaluation. The results showed that the defined model for peroxide index, color, weight loss, and sensory evaluation is significant (p < 0.001), so that increase of temperature causes the peroxide value, color variation, and weight loss to increase and it reduces the overall acceptability of walnut kernels. An increase in oxygen percentage caused the color variation level and peroxide value to increase and resulted in lower overall acceptability of the walnuts. An increase in CO₂ percentage caused the peroxide value to decrease, but did not significantly affect other indices (p ≥ 0.05). Mould and yeast were not found in any samples. Optimal packaging conditions to achieve maximum quality of walnuts include: 1.46% oxygen, 10% carbon dioxide, and temperature of 4 °C.

Keywords: shelled walnut, MAP, quality, storage temperature

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Authors: Dalia Bhattacharjee

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Motherhood as an institution is considered as sacred. Reproduction and motherhood have always been a concern of the private space of home. However, with the emergence of technologies like the Assisted Reproductive Technologies (ARTs), this intimate area has moved into the public. A woman can now become a mother with artificial insemination done by expert medical professionals in a hospital. With this development, the meanings of motherhood and childrearing have altered. Mothers have been divided into ‘ovarian mothers’ (those who provide the eggs), ‘uterine mothers’ (those who carry out the pregnancy and give birth), and ‘social mothers’ (those who raise the child). Thus, the ART business deconstructs motherhood by defining who the biological mother is and who the social mother is and who – despite contributing parts or processes of her body to the life of the child is not a mother, but merely the donor of a product, be it the egg or the womb, which is owned by those who are favoured by the contract. The industry of commercial surrogacy in India has been estimated to be of $2.3 billion as of 2012. There are many women who work as surrogate mothers in this industry for the exchange of money. It runs like a full-fledged business guided by a highly profit oriented capitalist market. The reproductive labourers are identified as mere womb renters or victims and not as active agents in such arrangements. Such a discourse undercuts the agency exercised by the women. The present study is an ethnography into the commercial surrogacy industry in India. This journey furthers the understanding of the dilemmas faced by the reproductive labourers. The paper emphasizes on the experiences of reproduction and motherhood outside the private space of the home in the commercial surrogacy industry in India, and, argues that this multiplicity of experiences need much focus and attention, where, the consumer becomes ‘the’ citizen and the women workers continue to be victims. The study draws on the narratives of the reproductive labourers, who remain at the center, and yet, at the periphery of such arrangements. This feminist ethnography is informed by the feminist standpoint theory to account for and analyse these varied experiences which further the understanding of the dilemmas faced by the reproductive labourers.

Keywords: commercial surrogacy, ethnography, motherhood, standpoint theory

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Authors: Rashmi Gupta

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Rewarding stimuli capture attention involuntarily as a result of an association process that develops quickly during value learning, referred to as the reward or value-driven attentional capture. It is essential to compare reward with punishment processing to get a full picture of value-based modulation in visual attention processing. Hence, the present study manipulated both valence/value (reward as well as punishment) and motivational salience (probability of an outcome: high vs. low) together. Series of experiments were conducted, and there were two phases in each experiment. In phase 1, participants were required to learn to associate specific face stimuli with a high or low probability of winning or losing points. In the second phase, these conditioned stimuli then served as a distractor or prime in a speeded letter search task. Faces with high versus low outcome probability, regardless of valence, slowed the search for targets (specifically the left visual field target) and suggesting that the costs to performance on non-emotional cognitive tasks were only driven by motivational salience (high vs. loss) associated with the stimuli rather than the valence (gain vs. loss). It also suggests that the processing of motivationally salient stimuli is right-hemisphere biased. Together, results of these studies strengthen the notion that our visual attention system is more sensitive to affected by motivational saliency rather than valence, which termed here as motivational-driven attentional capture.

Keywords: attention, distractors, motivational salience, valence

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Authors: Patsy Tan, Dana Baltutis

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This presentation demonstrates the effectiveness of music therapy in co-treatment with speech pathology and occupational therapy as an innovative way when working with children and adolescents with complex individual differences to facilitate communication, emotional, motor and social skills development. Each child with special needs and their carer has an individual profile which encompasses their visual-spatial, auditory, language, learning, mental health, family dynamic, sensory-motor, motor planning and sequencing profiles. The most common issues among children with special needs, especially those diagnosed with Autism Spectrum Disorder, are in the areas of regulation, communication, and social-emotional development. The ability of children living with challenges to communicate and use language and understand verbal and non-verbal information, as well as move their bodies to explore and interact with their environments in social situations, depends on the children being regulated both internally and externally and trusting their communication partners and understanding what is happening in the moment. For carers, it is about understanding the tempo, rhythm, pacing, and timing of their own individual profile, as well as the profile of the child they are interacting with, and how these can sync together. In this study, music therapy is used in co-treatment sessions with a speech pathologist and/or an occupational therapist using the DIRFloortime approach to facilitate the regulation, attention, engagement, reciprocity and social-emotional capacities of children presenting with complex individual differences. Documented changes in 10 domains of children’s development over a 12-month period using the Individual Music Therapy Assessment Profile (IMTAP) were observed. Children were assessed biannually, and results show significant improvements in the social-emotional, musicality and receptive language domains indicating that co-treatment with a music therapist using the DIRFloortime framework is highly effective. This presentation will highlight strategies that facilitate regulation, social-emotional and communication development for children and adolescents with complex individual profiles.

Keywords: communication, shared attention, regulation, social emotional

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Authors: Abdel Khalek Selim, Safaa Mahmoud

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Experiments were designed to study nitrogen loss through leaching in soil columns treated with different nitrogen sources and elemental sulfur. The soil material (3 kg alluvial or calcareous soil) were packed in Plexiglas columns (10 cm diameter). The soil columns were treated with 2 g N in the form of Ca(NO3)2, urea, urea + inhibitor (Nitrapyrin), another set of these treatments was prepared to add elemental sulfur. During incubation period, leaching was performed by applying a volume of water that allows the percolation of 250-ml water throughout the soil column. The leachates were analyzed for NH4-N and N03-N. After 10 weeks, soil columns were cut into four equal segments and analyzed for ammonium, nitrate, and total nitrogen. Results indicated the following: Ca(NO3)2 treatment showed a rapid NO3 leaching, especially in the first 3 weeks, in both clay and calcareous soils. This means that soil texture did not play any role in this respect. Sulfur addition also did not affect the rate of NO3 leaching. In urea treatment, there was a steady increase of NH4- and NO3–N from one leachate to another. Addition of sulfur with urea slowed down the nitrification process and decreased N losses. Clay soil contained residual N much more than calcareous soil. Almost one-third of added nitrogen might have been immobilized by soil microorganisms or lost through other loss paths. Nitrification inhibitor can play a role in preserving added nitrogen from being lost through leaching. Combining the inhibitor with elemental sulfur may help to stabilize certain preferred ratio of NH4 to NO3 in the soil for the benefit of the growing plants.

Keywords: alluvial soil, calcareous soil, elemental sulfur, nitrate leaching

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Authors: Hannah M. Russell

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‘The Attach Project’ (TAP), is an educational intervention aimed at improving educational and socio-emotional outcomes for children who are looked after. TAP is underpinned by Attachment Theory and is adapted from Dyadic Developmental Psychotherapy (DDP), which is a treatment for children and young people impacted by complex trauma and disorders of attachment. TAP has been implemented in primary schools in Northern Ireland throughout the 2018/19 academic year. During this time, a design and implementation study has been conducted to assess the promise of effectiveness for the future dissemination and ‘scaling-up’ of the programme for a larger, randomised control trial. TAP has been designed specifically for implementation in a school setting and is comprised of a whole school element and a more individualised Key Adult-Key Child pairing. This design and implementation study utilises a mixed-methods research design consisting of quantitative, qualitative, and observational measures with stakeholder input and involvement being considered an integral component. The use of quantitative measures, such as self-report questionnaires prior to and eight months following the implementation of TAP, enabled the analysis of the strengths and direction of relations between the various components of the programme, as well as the influence of implementation factors. The use of qualitative measures, incorporating semi-structured interviews and focus groups, enabled the assessment of implementation factors, identification of implementation barriers, and potential methods of addressing these issues. Observational measures facilitated the continual development and improvement of ‘TAP training’ for school staff. Preliminary findings have provided evidence of promise for the effectiveness of TAP and indicate the potential benefits of introducing this type of attachment-based intervention across other educational settings. This type of intervention could benefit not only children who are looked after but all children who may be impacted by complex trauma or disorders of attachment. Furthermore, findings from this study demonstrate that it is possible for children to form a secondary attachment relationship with a significant adult in school. However, various implementation factors which should be addressed were identified throughout the study, such as the necessity of protected time being introduced to facilitate the development of a positive Key Adult- Key Child relationship. Furthermore, additional ‘re-cap’ training is required in future dissemination of the programme, to maximise ‘attachment friendly practice’ in the whole staff team. Qualitative findings have also indicated that there is a general opinion across school staff that this type of Key Adult- Key Child pairing could be more effective if it was introduced as soon as children begin primary school. This research has provided ample evidence for the need to introduce relationally based interventions in schools, to help to ensure that children who are looked after, or who are impacted by complex trauma or disorders of attachment, can thrive in the school environment. In addition, this research has facilitated the identification of important implementation factors and barriers to implementation, which can be addressed prior to the ‘scaling-up’ of TAP for a robust, randomised controlled trial.

Keywords: attachment, complex trauma, educational interventions, implementation

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