Search results for: cardiovascular risk factors

Authors: David Maman, David E. Rothem, Merav Ben Natan, Yaron Berkovich

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Introduction: Hip fractures are a major health concern due to their impact on disability, independence, and mortality. Timely rehabilitation is crucial for improving patient outcomes and reducing healthcare costs, yet delays in rehabilitation, often due to challenges in discharge processes, can lead to adverse events and increased healthcare burdens. Aim: The study aimed to investigate two primary aspects related to hip fracture older adults patients: firstly, identifying subgroups more prone to delayed discharge for further rehabilitation; and secondly, exploring the consequences of this delay on short-term outcomes and the incidence of adverse events. Methods: Conducting a retrospective analysis, we examined the medical records of 474 patients aged 65 and older, hospitalized for hip fractures between 2018 and 2022 in a major hospital in the north-central region of Israel. All patients were eligible for further rehabilitation, including options for in-patient or home-based care. Results: Of the studied patients, 61.4% experienced delayed discharge, with an average waiting period of 3.5 days. Factors such as older age, prolonged hospital stay, and the need for in-patient rehabilitation were associated with a higher likelihood of delayed discharge. Those promptly discharged demonstrated lower rates of infections, falls, and mortality. Furthermore, delayed discharge to further rehabilitation correlated with elevated hospitalization costs. Notably, no significant differences were observed in re-hospitalization or repeat surgery rates. Conclusion: This study underscores the pressing need for efficient strategies to ensure timely rehabilitation, particularly for older adults. Implementing such strategies can optimize outcomes, mitigate adverse events, and contribute to a reduction in healthcare costs.

Keywords: hip fracture rehabilitation, delayed discharge, older adults, healthcare coordination, adverse events

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Authors: Rebecca Johnson, Elizabeth Hoban

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Condom use among young men in Cambodia has declined between 2005 and 2014 which has public health implications such as increased risks of sexually transmitted infections, including HIV, and unplanned pregnancies. Conversations about sexual and reproductive health issues, including condom use, are not socially sanctioned in Cambodian society leaving young adults with limited knowledge of, and poor access to sexual and reproductive health services. Additionally, men play a dominant role in decision making regarding condom use within sexual partnerships. This study sought to fill a gap in knowledge by exploring young adult males’ attitudes, perceptions and behaviours regarding condom use. In February and March 2018, twenty young adult males, aged 18 to 24 years, were recruited from urban, peri urban and rural areas in Cambodia. The young adult males participated in a face-to-face semi structured interview that used an interview guide and photo elicitation method. The interview explored participants’ knowledge of sexual and reproductive health issues and efficacy, sexual behaviours, and use of condoms. Inductive thematic analysis was conducted and the following major themes emerged: understanding of reproduction, understanding of sexually transmitted infections, knowledge about condoms, condom use, access to condoms, and sexual behaviour. Participants’ knowledge of condoms and specific reasons for their use varied; most participants understood that condoms provide protection from sexually transmitted infections and prevent pregnancy. Stigma associated with condom access was consistently referred to as a problem and the main reason cited by young men for not using condoms during sexual intercourse. The perceived importance of condom use altered with partner type and relationship status, dependent upon the need for protection from sexually transmitted infections or pregnancy. Condoms were used for infection control in the context of multiple relationships, or as a contraceptive method for unmarried and some married couples. The majority of young men engaged in premarital sexual intercourse, of those men the many used condoms. The inconsistent use of condoms by young men in Cambodia is of public health concern because of the increased risk of sexually transmitted infections (including HIV), and unplanned pregnancy. Public health action is required in order to minimize long term health issues for individuals and the community. Health education is required to increase knowledge of condom use, sexually transmitted infections and HIV, and reduce the stigma associated with this topic. Sustainable health promotion programs are needed to increase ease of access to condoms for young people. Public health policy in Cambodia needs to be reviewed to improve sexual and reproductive health outcomes for young adults.

Keywords: Cambodia, condom use, sexual and reproductive health, young adult males

Procedia PDF Downloads 132

Authors: Jane E. Hill

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Quality of life is an important component for many. With that in mind, everyone will experience some type of loss within his or her lifetime. A person can experience loss due to break up, separation, divorce, estrangement, or death. An individual may experience loss of a job, loss of capacity, or loss caused by human or natural-caused disasters. An individual’s response to such a loss is unique to them, and not everyone will seek services to assist them with their grief due to loss. Counseling can promote positive outcomes for clients that are grieving by addressing the client’s personal loss and helping the client process their grief. However, a lack of understanding on the part of counselors of how people grieve may result in negative client outcomes such as poor health, psychological distress, or an increased risk of depression. Education and training in grief counseling can improve counselors’ problem recognition and skills in treatment planning. The purpose of this study was to examine whether the Council for Accreditation of Counseling and Related Educational Programs (CACREP) master’s degree counseling students view themselves as having been adequately trained in grief theories and skills. Many people deal with grief issues that prevent them from having joy or purpose in their lives and that leaves them unable to engage in positive opportunities or relationships. This study examined CACREP-accredited master’s counseling students’ self-reported competency, training, and education in providing grief counseling. The implications for positive social change arising from the research may be to incorporate and promote education and training in grief theories and skills in a majority of counseling programs and to provide motivation to incorporate professional standards for grief training and practice in the mental health counseling field. The theoretical foundation used was modern grief theory based on John Bowlby’s work on Attachment Theory. The overall research question was how competent do master’s-level counselors view themselves regarding the education or training they received in grief theories or counseling skills in their CACREP-accredited studies. The author used a non-experimental, one shot survey comparative quantitative research design. Cicchetti’s Grief Counseling Competency Scale (GCCS) was administered to CACREP master’s-level counseling students enrolled in their practicum or internship experience, which resulted in 153 participants. Using a MANCOVA, there was significance found for relationships between coursework taken and (a) perceived assessment skills (p = .029), (b) perceived treatment skills (p = .025), and (c) perceived conceptual skills and knowledge (p = .003). Results of this study provided insight for CACREP master’s-level counseling programs to explore and discuss curriculum coursework inclusion of education and training in grief theories and skills.

Keywords: counselor education and training, grief education and training, grief and loss, quality of life

Procedia PDF Downloads 194

Authors: Atefeh Shahbazi, Zahra Shahravi, Melika Mirghafari

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The application of fetal membranes in chronic wounds, particularly diabetic foot ulcers (DFUs), has shown remarkable efficacy in enhancing wound healing, with a notable impact on re-epithelialization. Fetal membranes exhibit potent anti-inflammatory and anti-scarring properties, primarily due to their ability to eliminate allogeneic amniotic cells while retaining a cytokine-rich matrix during preparation. When integrated with collagen, this combination creates a unique microenvironment within the wound, fostering the expansion of epithelial cells, fibroblasts, and keratinocytes ex vivo, while preserving their normal phenotype. These cells, in turn, stimulate the release of growth factors and healing signals essential for tissue regeneration. This study aims to assess the efficacy of fetal membranes combined with collagen in the management of DFUs by comparing standard care alone with standard care supplemented with fetal membrane allograft treatment. The study involved two groups of patients: Group A: Patients received the wound dressing with fetal membranes and collagen, followed up for 3 months (15 patients).Group B: Patients were treated with only sterile gauze, with no specialized dressing, and were followed up for 3 months (15 patients). The healing progress in both groups will be evaluated, and the outcomes will provide valuable insights into the potential for further improvements in wound care strategies. Preliminary findings emphasize the significant potential of fetal membranes to enhance healing in chronic diabetic wounds, demonstrating their ability to accelerate tissue regeneration, reduce inflammation, and promote faster, more effective wound closure.

Keywords: biological scaffold, stem cells, skin damage, diabetic foot ulcers

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Authors: Yibeltal T. Bayou, Yohana S. Mashalla, Gloria Thupayagale-Tshweneagae

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Background: Maternal mortality has been shown to be lower in urban areas than in rural areas. However, disparities for the fast-growing population of urban poor who struggle as much their rural counterparts to access quality healthcare are masked by the urban averages. The aim of this paper is to report on the findings of antenatal adequacy among slum residents in Addis Ababa, Ethiopia. Methods and Materials: A quantitative and cross-sectional community-based study design was employed. A stratified two-stage cluster sampling technique was used to determine the sample and data was collected using structured questionnaire administered to 837 women aged 15-49 years. Binary logistic regression models were employed to identify predictors of adequacy of antenatal care. Results: The majority of slum residents did not have adequate antenatal care services i.e., only 50.7%, 19.3% and 10.2% of the slum resident women initiated early antenatal care, received adequate antenatal care service contents and had overall adequate antenatal care services. Pregnancy intention, educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.9 times more likely to have overall adequate care compared to those with no formal education. Similarly, women whose last pregnancy was intended and clients of private healthcare facilities were 1.8 and 2.8 times more likely to have overall adequate antenatal care compared to those whose last pregnancy was unintended and clients of public healthcare facilities respectively. Conclusion: In order to improve ANC adequacy in the study area, the policymaking, planning, and implementation processes should focus on the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Keywords: Addis Ababa, adequacy of antenatal care, slum residents, maternal mortality

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Authors: Adesomoju O. A., E. A. Onemolease, G. O. Igene

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The study analyzed the determinants of food insecurity among smallholder farming households in the Southwestern part of Nigeria with Ondo and Osun States in focus. Multi-stage sampling procedures were employed to gather data from 389 farming households (194 from Ondo State and 195 from Osun State) spread across 4 agricultural zones, 8 local governments, and 24 communities. The data was analyzed using descriptive statistics, Ordinal regression, and Friedman test. Results revealed the average age of the respondents was 47 years with majority being male 63.75% and married 82.26% and having an household size of 6. Most household heads were educated (94.09%), engaged in farming for about 19 years, and do not belong to cooperatives (73.26%). Respondents derived income from both farming and non-farm activities with the average farm income being N216,066.8/annum and non-farm income being about N360,000/annum. Multiple technologies were adopted by respondents such as application of herbicides (77.63%), pesticides (73.26%) and fertilizers (66.58%). Using the FANTA Cornel model, food insecurity was prevalent in the study area with the majority (61.44%) of the households being severely food insecure, and 35.73% being moderately food insecure. In comparison, 1.80% and 1.03% were food-secured and mildly food insecure. The most significant constraints to food security among the farming households were the inability to access credit (mean rank = 8.78), poor storage infrastructure (8.57), inadequate capital (8.56), and high cost of farm chemicals (8.35). Significant factors related to food insecurity among the farming households were age (b = -0.059), education (b = -0.376), family size (b = 0.197), adoption of technology (b = -0.198), farm income (b = -0.335), association membership (b = -0.999), engagement in non-farm activities (b = -1.538), and access to credit (b = -0.853). Linking farmers' groups to credit institutions and input suppliers was proposed.

Keywords: food insecurity, FANTA Cornel, Ondo, Osun, Nigeria, Southwest, Livelihood

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Authors: Oluyomi Stephen Adeyemi, Kentaro Kato

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Toxoplasma gondii is the etiological agent of toxoplasmosis, a common parasitic disease capable of infecting a range of hosts, including nearly one-third of the human population. Current treatment options for toxoplasmosis patients are limited. In consequence, toxoplasmosis represents a large global burden that is further enhanced by the shortcomings of the current therapeutic options. These factors underscore the need for better anti-T. gondii agents and/or new treatment approach. In the present study, we sought to find out whether preparing and capping nanoparticles (NPs) in amino acids, would enhance specificity toward the parasite versus the host cell. The selection of amino acids was premised on the fact that T. gondii is auxotrophic for some amino acids. The amino acid-nanoparticles (amino-NPs) were synthesized, purified and characterized following established protocols. Next, we tested to determine the anti-T. gondii activity of the amino-NPs using in vitro experimental model of infection. Overall, our data show evidence that supports enhanced and excellent selective action against the parasite versus the host cells by amino-NPs. The findings are promising and provide additional support that warrants exploring the prospects of NPs as alternative anti-parasite agents. In addition, the anti-parasite action by amino-NPs indicates that nutritional requirement of parasite may represent a viable target in the development of better alternative anti-parasite agents. Furthermore, data suggest the anti-parasite mechanism of the amino-NPs involves multiple cellular processes including the production of reactive oxygen species (ROS), modulation of hypoxia-inducing factor-1 alpha (HIF-1α) as well as the activation of kynurenine pathway. Taken together, findings highlight further, the prospects of NPs as alternative source of anti-parasite agents.

Keywords: drug discovery, infectious diseases, mode of action, nanomedicine

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Authors: Lena Shulyakovskaya

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Every year, schools aim to develop and adopt new technology and pedagogy as a way to equip today's students with the needed 21st Century skills. However, the field of primary and secondary education may not be as open to embracing change in reality. Despite the drive to reform and innovation, the field of education in Canada is still very much steeped in tradition and uses many of the practices that came into effect over 50 years ago. Among those are employment and retention practices. Millennials are the youngest generation of professionals entering the workplace at this time and the ones leaving their jobs within just a few years. Almost half of new teachers leave Canadian schools within their first five years on the job. This paper discusses one of the contributing factors that lead Canadian millennial teachers to either leave or stay in the profession - standardized education system. Using an exploratory case study approach, in-depth interviews with former and current millennial teachers were conducted to learn about their experiences within the K-12 system. Among the findings were the young teachers' concerns about the constant changes to teaching practices and technological implementations that claimed to advance teaching and learning, and yet in reality only disguised and reiterated the same traditional, outdated, and standardized practices that already existed. Furthermore, while many millennial teachers aspired to be innovative with their curriculum and teaching practices, they felt trapped and helpless in the hands of school leaders who were very reluctant to change. While many new program ideas and technological advancements are being made openly available to teachers on a regular basis, it is important to consider the education field as a whole and how it plays into the teachers' ability to realistically implement changes. By the year 2025, millennials will make up approximately 75% of the North American workforce. It is important to examine generational differences among teachers and understand how millennial teachers may be shaping the future of primary and secondary schools, either by staying or leaving the profession.

Keywords: 21st century skills, millennials, teacher attrition, tradition

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Authors: Patricia M. Boechler, Heather M. Gautreau

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In this research study, postsecondary students completed an information learning task in an avatar-based 3D virtual learning environment. Three factors were of interest in relation to learning; 1) the influence of collaborative vs. independent conditions, 2) the influence of the spatial arrangement of the virtual environment (linear, random and clustered), and 3) the relationship of individual differences such as spatial skill, general computer experience and video game experience to learning. Students completed pretest measures of prior computer experience and prior spatial skill. Following the premeasure administration, students were given instruction to move through the virtual environment and study all the material within 10 information stations. In the collaborative condition, students proceeded in randomly assigned pairs, while in the independent condition they proceeded alone. After this learning phase, all students individually completed a multiple choice test to determine information retention. The overall results indicated that students in pairs did not perform any better or worse than independent students. As far as individual differences, only spatial ability predicted the performance of students. General computer experience and video game experience did not. Taking a closer look at the pairs and spatial ability, comparisons were made on pairs high/matched spatial ability, pairs low/matched spatial ability and pairs that were mismatched on spatial ability. The results showed that both high/matched pairs and mismatched pairs outperformed low/matched pairs. That is, if a pair had even one individual with strong spatial ability they would perform better than pairs with only low spatial ability individuals. This suggests that, in virtual environments, the specific individuals that are paired together are important for performance outcomes. The paper also includes a discussion of trends within the data that have implications for virtual environment education.

Keywords: avatar-based, virtual environment, paired learning, individual differences

Procedia PDF Downloads 119

Authors: Waqqas-ur-Rehman Butt, Martin Servin, Marion Pause

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In recent years, object detection has gained much attention and very encouraging research area in the field of computer vision. The robust object boundaries detection in an image is demanded in numerous applications of human computer interaction and automated surveillance systems. Many methods and approaches have been developed for automatic object detection in various fields, such as automotive, quality control management and environmental services. Inappropriately, to the best of our knowledge, object detection under illumination with shadow consideration has not been well solved yet. Furthermore, this problem is also one of the major hurdles to keeping an object detection method from the practical applications. This paper presents an approach to automatic object detection in images under non-standardized environmental conditions. A key challenge is how to detect the object, particularly under uneven illumination conditions. Image capturing conditions the algorithms need to consider a variety of possible environmental factors as the colour information, lightening and shadows varies from image to image. Existing methods mostly failed to produce the appropriate result due to variation in colour information, lightening effects, threshold specifications, histogram dependencies and colour ranges. To overcome these limitations we propose an object detection algorithm, with pre-processing methods, to reduce the interference caused by shadow and illumination effects without fixed parameters. We use the Y CrCb colour model without any specific colour ranges and predefined threshold values. The segmented object regions are further classified using morphological operations (Erosion and Dilation) and contours. Proposed approach applied on a large image data set acquired under various environmental conditions for wood stack detection. Experiments show the promising result of the proposed approach in comparison with existing methods.

Keywords: image processing, illumination equalization, shadow filtering, object detection

Procedia PDF Downloads 218

Authors: Prateek Bhattacharya

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The definition of 'control' in India is a rapidly evolving concept, owing to varying rights attached to varying securities. Shares with differential voting rights (DVRs) provide the holder with differential rights as to voting, as compared to ordinary equity shareholders of the company. Such DVRs can amount to both superior voting rights and inferior voting rights, where DVRs with superior voting rights amount to providing the holder with golden shares in the company. While DVRs are not a novel concept in India having been recognized since 2000, they were placed on a back burner by the Securities and Exchange Board of India (SEBI) in 2010 after issuance of DVRs with superior voting rights was restricted. In June 2019, the SEBI rekindled the ebbing fire of DVRs, keeping mind the fast-paced nature of the global economy, the government's faith that India’s ‘new age technology companies’ (i.e., Start-Ups) will lead the charge in achieving its goal of India becoming a $5 trillion dollar economy by 2024, and recognizing that the promoters of such Start-Ups seek to raise capital without losing control over their companies. DVRs with superior voting rights guarantee promoters with up to 74% shareholding in Start-Ups for a period of 5 years, meaning that the holder of such DVRs can exercise sole control and material influence over the company for that period. This manner of control has the potential of causing both pro-competitive and anti-competitive effects in the markets where these companies operate. On the one hand, DVRs will allow Start-Up promoters/founders to retain control of their companies and protect its business interests from foreign elements such as private/public investors – in a scenario where such investors have multiple investments in firms engaged in associated lines of business (whether on a horizontal or vertical level) and would seek to influence these firms to enter into potential anti-competitive arrangements with one another, DVRs will enable the promoters to thwart such scenarios. On the other hand, promoters/founders who themselves have multiple investments in Start-Ups, which are in associated lines of business run the risk of influencing these associated Start-Ups to engage in potentially anti-competitive arrangements in the name of profit maximisation. This paper shall be divided into three parts: Part I shall deal with the concept of ‘control’, as deliberated upon and decided by the SEBI and the Competition Commission of India (CCI) under both company/securities law and competition law; Part II shall review this definition of ‘control’ through the lens of DVRs, and Part III shall discuss the aforementioned potential pro-competitive and anti-competitive effects caused by the DVRs by examining the current Indian Start-Up scenario. The paper shall conclude by providing suggestions for the CCI to incorporate a clearer and more progressive concept of ‘control’.

Keywords: competition law, competitive effects, control, differential voting rights, DVRs, investor shareholding, merger control, start-ups

Procedia PDF Downloads 127

Authors: Hoyeon Park, Kyoung-jae Kim

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The product recommendation is a field of research that has received much attention in the recent information overload phenomenon. The proliferation of the mobile environment and social media cannot help but affect the results of the recommendation depending on how the factors of the user's situation are reflected in the recommendation process. Recently, research has been spreading attention to the context-aware recommender system which is to reflect user's contextual information in the recommendation process. However, until now, most of the context-aware recommender system researches have been limited in that they reflect the passive context of users. It is expected that the user will be able to express his/her contextual information through his/her active behavior and the importance of the context-aware recommender system reflecting this information can be increased. The purpose of this study is to propose a context-aware recommender system that can reflect the user's emotional state as an active context information to recommendation process. The context-aware recommender system is a recommender system that can make more sophisticated recommendations by utilizing the user's contextual information and has an advantage that the user's emotional factor can be considered as compared with the existing recommender systems. In this study, we propose a method to infer the user's emotional state, which is one of the user's context information, by using the user's facial expression data and to reflect it on the recommendation process. This study collects the facial expression data of a user who is looking at a specific product and the user's product preference score. Then, we classify the facial expression data into several categories according to the previous research and construct a model that can predict them. Next, the predicted results are applied to existing collaborative filtering with contextual information. As a result of the study, it was shown that the recommended results of the context-aware recommender system including facial expression information show improved results in terms of recommendation performance. Based on the results of this study, it is expected that future research will be conducted on recommender system reflecting various contextual information.

Keywords: context-aware, emotional state, recommender systems, business analytics

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Authors: Amira Abdelrasoul

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This study aimed to ascertain the controlled permeability of biomimetic cellulose triacetate (CTA) membranes by investigating the electrical oscillatory behavior across impregnated membranes (IM). The biomimetic CTA membranes were infused with a fatty acid to induce electrical oscillatory behavior and, hence, to ensure controlled permeability. In situ synchrotron radiation micro-computed tomography (SR-μCT) at the BioMedical Imaging and Therapy (BMIT) Beamline at the Canadian Light Source (CLS) was used to evaluate the main morphology of IMs compared to neat CTA membranes to ensure fatty acid impregnation inside the pores of the membrane matrices. A monochromatic beam at 20 keV was used for the visualization of the morphology of the membrane. The X-ray radiographs were recorded by means of a beam monitor AA-40 (500 μm LuAG scintillator, Hamamatsu, Japan) coupled with a high-resolution camera, providing a pixel size of 5.5 μm and a field of view (FOV) of 4.4 mm × 2.2 mm. Changes were evident in the phase transition temperatures of the impregnated CTA membrane at the melting temperature of the fatty acid. The pulsations of measured voltages were related to changes in the salt concentration of KCl in the vicinity of the electrode. Amplitudes and frequencies of voltage pulsations were dependent on the temperature and concentration of the KCl solution, which controlled the permeability of the biomimetic membranes. The presented smart biomimetic membrane successfully combined porous polymer support and impregnating liquid not only imitate the main barrier properties of the biological membranes but could be easily modified to achieve some new properties, such as facilitated and active transport, regulation by chemical, physical and pharmaceutical factors. These results open new frontiers for the facilitation and regulation of active transport and permeability through biomimetic smart membranes for a variety of biomedical and drug delivery applications.

Keywords: biomimetic, membrane, synchrotron, permeability, morphology

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Authors: B. Gechbaia, K. Goletiani, G. Gabedava, N. Mikeltadze

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At this stage, Georgia is a country which is actively involved in the European integration process, for which the primary priority is effective integration in the European education system. The modern Georgian higher education system is the process of establishing a new sociocultural reality, whose main priorities are determined by the Quality System as a continuous cycle of planning, implementation, checking and acting. Obviously, in this situation, the issue of management of education institutions comes out in the foreground, since the proper planning and implementation of personnel management processes is one of the main determinants of the company's performance. At the same time, one of the most important factors is the psychological comfort of the personnel, ensuring their protection and efficiency of stress management policy. The purpose of this research is to determine how intensely the relationship is between the psychological comfort of the personnel and the efficiency of the quality system in the institution as the quality assurance mechanisms of educational institutions affect the stability of personnel, prevention and management of the stressful situation. The research was carried out within the framework of the Internal Grant Project «The Role of Organizational Culture in the Process of Settlement of Management of Stress and Conflict, Georgian Reality and European Experience » of the Batumi Navigation Teaching University, based on the analysis of the survey results of target groups. The small-scale research conducted by us has revealed that the introduction of quality assurance system and its active implementation increased the quality of management of Georgian educational institutions, increased the level of universal engagement in internal and external processes and as a result, it has improved the quality of education as well as social and psychological comfort indicators of the society.

Keywords: quality assurance, effective management, stability of personnel, psychological comfort, stress management

Procedia PDF Downloads 158

Authors: Dielle Martins

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A 45-year-old female, Manju Devi, presented with a 6-month history of progressively changing voice, difficulty breathing for the past month, and worsening dysphagia for the past two weeks, particularly with solids. Direct laryngoscopy revealed an ulceroproliferative mass arising from the left aryepiglottic fold, obscuring the glottic opening. Imaging with contrast-enhanced CT of the neck showed a lobulated, heterogeneous mass in the hypo-pharyngeal region, encroaching into the airway and involving the aryepiglottic fold and pyriform sinus, raising concerns for a malignant lesion. Small reactive lymph nodes were identified in the left submandibular region and along the carotid sheath. Due to the location of the mass near the glottis and the risk of complete airway obstruction, securing the airway was a critical concern. An awake fiberoptic bronchoscopy for endotracheal intubation was chosen as the safest approach. The patient was prepped with local anesthesia to the airway using nebulized 10% lignocaine and 4% lignocaine spray to the oral mucosa. After obtaining informed consent, the patient was positioned supine on the operating table. To facilitate the fiberoptic intubation, the patient’s neck was extended, and the head was laterally rotated 30 degrees to the left. This positioning helped optimize the visualization of the glottic opening, which was obscured by the mass. The fiberoptic scope was carefully passed through the oral cavity, past the uvula, and into the laryngeal area. As the scope advanced, the ulceroproliferative mass was observed covering most of the glottis, with only the anterior commissure visible. After further gentle manipulation, including the use of a shoulder roll for additional neck extension and rotation, a clearer view of the anterior two-thirds of the glottis was achieved. A 6.5mm internal diameter endotracheal tube was advanced over the fiberoptic scope and successfully positioned just above the carina. General anesthesia was then induced, and an excision biopsy of the growth was performed. This case underscores the importance of careful preoperative airway evaluation and the role of awake fiberoptic intubation in managing complex airway obstructions. Proper patient positioning, including neck extension and lateral rotation, proved crucial for successful intubation in the presence of a mass obstructing the glottic opening. This case emphasizes the techniques used in the fiberoptic intubation and the careful positioning of the patient, which were critical for the success of the procedure.

Keywords: awake fiberoptic bronchoscopy in laryngeal growth, Difficult intubation in glottic cancer, glottic cancer, difficult airway

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Authors: Chernet Mulugeta, Girma Seyoum, Yeshineh Demrew, Kehabtimer Shiferaw

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Background: Obstetric fistula (OF) is a serious medical condition that includes an abnormal opening between the vagina and bladder (vesico-vaginal fistula) or the vagina and rectum (recto-vaginal fistula). It is usually caused by prolonged obstructed labour. Despite its serious health and psychosocial consequences, there is a paucity of evidence regarding the time it takes to heal from OF. Objective: The aim of this study was to assess the time to cure from obstetric fistula and its predictors among women admitted to Addis Ababa Hamlin Fistula Hospital, Addis Ababa, Ethiopia. Methodology: An institution-based retrospective cohort study was conducted from January 2015 to December 2020 among a randomly selected 434 women with OF in Addis Ababa Hamlin Fistula Hospital. Data was collected using a structured checklist adapted from a similar study. The open data kit (ODK) collected data was exported and analyzed by using STATA (14.2). Kaplan Meir was used to compare the recovery time from OF. To identify the predictors of OF, a Cox regression model was fitted, and an adjusted hazard ratio with a 95% confidence interval was used to estimate the strength of the associations. Results: The average time to recover from obstetric fistula was 3.95 (95% CI: 3.0-4.6) weeks. About ¾ of the women [72.8% (95% CI - 0.65-1.2)] were physically cured of obstetric fistula. Having secondary education and above [AHR=3.52; 95% CI (1.98, 6.25)] compared to no formal education, having a live birth [AHR=1.64; 95% CI (1.22, 2.21)], having an intact bladder [AHR=2.47; 95% CI (1.1, 5.54)] compared to totally destructed, and having a grade 1 fistula [AHR=1.98; 95% CI (1.19, 3.31)] compared to grade 3 were the significant predictors of shorter time to cure from an obstetric fistula. Conclusion and recommendation: Overall, the proportion of women with OF who were not being cured was unacceptably high. The time it takes for them to recover from the fistula was also extended. It connotes us to work on the identified predictors to improve the time to recovery from OF.

Keywords: time to recovery, obstetric fistula, predictors, Ethiopia

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Authors: John Adebayo Oloyhede

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This paper examines effect of financial liberalization on the stability of the demand for money function and its implication for exchange rate behaviour of three African countries. As the demand for money function is regarded as one of the two main building blocks of most exchange rate determination models, the other being purchasing power parity, its stability is required for the monetary models of exchange rate determination to hold. To what extent has the liberalisation policy of these countries, for instance liberalised interest rate, affected the demand for money function and what has been the consequence on the validity and relevance of floating exchange rate models? The study adopts the Autoregressive Instrumental Package (AIV) of multiple regression technique and followed the Almon Polynomial procedure with zero-end constraint. Data for the period 1986 to 2011 were drawn from three developing countries of Africa, namely: Gambia, Ghana and Nigeria, which did not only start the liberalization and floating system almost at the same period but share similar and diverse economic and financial structures. Its findings show that the demand for money was a stable function of income and interest rate at home and abroad. Other factors such as exchange rate and foreign interest rate exerted some significant effect on domestic money demand. The short-run and long-run elasticity with respect to income, interest rates, expected inflation rate and exchange rate expectation are not greater than zero. This evidence conforms to some extent to the expected behaviour of the domestic money function and underscores its ability to serve as good building block or assumption of the monetary model of exchange rate determination. This will, therefore, assist appropriate monetary authorities in the design and implementation of further financial liberalization policy packages in developing countries.

Keywords: financial liberalisation, exchange rates, demand for money, developing economies

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Authors: Klaus Froehlich-Gildhoff, Ullrich Boettinger, Katharina Rauh, Angela Schickler

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The Prevention Network Ortenaukreis, PNO, funded by the German Ministry of Education and Research, aims to promote physical and mental health as well as the social inclusion of 3 to 10 years old children and their families in the Ortenau district. Within a period of four years starting 11/2014 a community network will be established. One regional and five local prevention representatives are building networks with stakeholders of the prevention and health promotion field bridging the health care, educational and youth welfare system in a multidisciplinary approach. The regional prevention representative implements regularly convening prevention and health conferences. On a local level, the 5 local prevention representatives implement round tables in each area as a platform for networking. In the setting approach, educational institutions are playing a vital role when gaining access to children and their families. Thus the project will offer 18 month long organizational development processes with specially trained coaches to 25 kindergarten and 25 primary schools. The process is based on a curriculum of prevention and health promotion which is adapted to the specific needs of the institutions. Also to ensure that the entire region is reached demand oriented advanced education courses are implemented at participating day care centers, kindergartens and schools. Evaluation method: The project is accompanied by an extensive research design to evaluate the outcomes of different project components such as interview data from community prevention agents, interviews and network analysis with families at risk on their support structures, data on community network development and monitoring, as well as data from kindergarten and primary schools. The latter features a waiting-list control group evaluation in kindergarten and primary schools with a mixed methods design using questionnaires and interviews with pedagogues, teachers, parents, and children. Results: By the time of the conference pre and post test data from the kindergarten samples (treatment and control group) will be presented, as well as data from the first project phase, such as qualitative interviews with the prevention coordinators as well as mixed methods data from the community needs assessment. In supporting this project, the Federal Ministry aims to gain insight into efficient components of community prevention and health promotion networks as it is implemented and evaluated. The district will serve as a model region, so that successful components can be transferred to other regions throughout Germany. Accordingly, the transferability to other regions is of high interest in this project.

Keywords: childhood research, health promotion, physical health, prevention network, psychological well-being, social inclusion

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Authors: Li-Ting Huang, Yu-Hsiang Shen, Cing-Ciao Ke, Sheng-Pin Tseng, Fan-Pin Tseng, Yu-Ching Ni, Chia-Yu Lin

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Chest radiography is the most common technique for the diagnosis and follow-up of pulmonary diseases. However, the lesions superimposed with normal structures are difficult to be detected in chest radiography. Chest tomosynthesis is a relatively new technique to obtain 3D section images from a set of low-dose projections acquired over a limited angular range. However, there are some limitations with chest tomosynthesis. Patients undergoing tomosynthesis have to be able to hold their breath firmly for 10 seconds. A digital tomosynthesis system with advanced reconstruction algorithm and high-stability motion mechanism was developed by our research group. The potential for the system to perform a bidirectional chest scan within 10 seconds is expected. The purpose of this study is to realize the influences of the scan speed on the image quality for our digital tomosynthesis system. The major factors that lead image blurring are the motion of the X-ray source and the patient. For the fore one, an experiment of imaging a chest phantom with three different scan speeds, which are 6 cm/s, 8 cm/s, and 15 cm/s, was proceeded to understand the scan speed influences on the image quality. For the rear factor, a normal SD (Sprague-Dawley) rat was imaged with it alive and sacrificed to assess the impact on the image quality due to breath motion. In both experiments, the profile of the ROIs (region of interest) and the CNRs (contrast-to-noise ratio) of the ROIs to the normal tissue of the reconstructed images was examined to realize the degradations of the qualities of the images. The preliminary results show that no obvious degradation of the image quality was observed with increasing scan speed, possibly due to the advanced designs for the hardware and software of the system. It implies that higher speed (15 cm/s) than that of the commercialized tomosynthesis system (12 cm/s) for the proposed system is achieved, and therefore a complete chest scan within 10 seconds is expected.

Keywords: chest radiography, digital tomosynthesis, image quality, scan speed

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Authors: Stephanie Liu Lu

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With the proliferation of artificial intelligence tools in the field of education, it is crucial to explore their impact on language learning outcomes. This paper examines the use of AI tools, such as ChatGPT, in practical writing within business Chinese teaching to investigate how AI can enhance practical writing skills and teaching effectiveness. The study involved third and fourth-year university students majoring in accounting and finance from a university in Hong Kong within the context of a business correspondence writing class. Students were randomly assigned to a control group, who completed business letter writing independently, and an experimental group, who completed the writing with the assistance of AI. In the latter, the AI-assisted business letters were initially drafted by the students issuing commands and interacting with the AI tool, followed by the students' revisions of the draft. The paper assesses the performance of both groups in terms of grammatical expression, communicative effect, and situational awareness. Additionally, the study collected dialogue texts from interactions between students and the AI tool to explore factors that affect text generation and the potential impact of AI on enhancing students' communicative and identity awareness. By collecting and comparing textual performances, it was found that students assisted by AI showed better situational awareness, as well as more skilled organization and grammar. However, the research also revealed that AI-generated articles frequently lacked a proper balance of identity and writing purpose due to limitations in students' communicative awareness and expression during the instruction and interaction process. Furthermore, the revision of drafts also tested the students' linguistic foundation, logical thinking abilities, and practical workplace experience. Therefore, integrating AI tools and related teaching into the curriculum is key to the future of business Chinese teaching.

Keywords: AI-assistance, business Chinese, textual analysis, language education

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Authors: Atsebaha Gebrekidan Kahsay, Tsehaye Asmelash, Enquebaher Kassaye

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Background: Salmonella remains a global public health problem with a significant burden in sub-Saharan African countries. Human restricted cause of typhoid and paratyphoid fever are S. Typhi and S. Paratyphi, whereas S. Enteritidis and S. Typhimurium is the causative agent of invasive nontyphoidal diseases among humans and animals are their reservoir. The antibiotic resistance of Salmonella is another public health threat around the globe. To come up with full information about human and animal salmonellosis, we made a systematic review of the prevalence, serotypes, and antibiotic resistance of Salmonella in Ethiopia. Methods: This systematic review used Google Scholar and PubMed search engines to search articles from Ethiopia that were published in English in peer-reviewed international journals from 2010 to 2022. We used keywords to identify the intended research articles and used a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the inclusion and exclusion criteria. Frequencies and percentages were analyzed using Microsoft Excel. Results: Two hundred seven published articles were searched, and 43 were selected for a systematic review, human (28) and animals (15). The prevalence of Salmonella in humans and animals was 434 (5.2%) and 641(10.1%), respectively. Fourteen serotypes were identified from animals, and S. Typhimurium was among the top five. Among the ciprofloxacin-resistant isolates in human studies, 16.7% was the highest, whereas, for ceftriaxone, 100% resistance was reported. Conclusions: The prevalence of Salmonella among diarrheic patients and food handlers (5.2%) was lower than the prevalence in food animals (10.1%). We did not find serotypes of Salmonella in human studies, although fourteen serotypes were included in food-animal studies, and S. Typhimurium was among the top five. Salmonella species from some human studies revealed a non-susceptibility to ceftriaxone. We recommend further study about invasive nontyphoidal Salmonella and predisposing factors among humans and animals in Ethiopia.

Keywords: antibiotic resistance, prevalence, systematic review, serotypes, Salmonella, Ethiopia

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Authors: Alvin Manuel Vazhayil, Chaozhong Tan, Karl M. Wantzen

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As local community participation in river restoration projects is increasingly recognized to be crucial for sustainable outcomes, researchers are exploring factors that motivate community participation globally. In India, while there is consensus in literature on the importance of community engagement in river restoration projects, research on what drives local communities to participate is limited, especially given the societal and economic challenges common in the Global South. This study addresses this gap by exploring the drivers of community participation in the local river restoration initiatives of the "Now Let Me Flow" campaign in Kerala, India. The project aimed to restore 87,000 kilometers of streams through the middle-ground governance approach that integrated bottom-up community efforts with top-down governmental support. The fieldwork involved interviews with 26 key agents, including local leaders, policy practitioners, politicians, and environmental activists associated with the project, and the collection of secondary data from 12 documents including project reports and news articles. The data was analyzed in NVivo (NVivo 11 Plus for Windows, version 11.3.0.773) using thematic analysis which included two cycles of systematic coding. The findings reveal two main drivers influencing community participation: top-down actions from local governments, and bottom-up drivers within the community. The study highlights the importance of local stakeholder collaboration, support of local governments, and local community engagement in successful river restoration projects. These findings are consistent with other empirical studies on participatory environmental problem-solving globally. The results offer crucial insights for policymakers and governments to better design and implement effective and sustainable participatory river restoration projects.

Keywords: community initiatives, drivers of participation, environmental governance, river restoration

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Authors: B. Dejanova, S. Petrovska, L. Todorovska, J. Pluncevic, S. Mancevska, V. Antevska, E. Sivevska, I. Karagjozova

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Introduction: Aging process is mainly related to endothelial function which may be impaired by oxidative stress (OS). Exercise is known to be beneficial to aging process, which may improve health and prevent appearance of chronic diseases in elderly. The aim of the study was to investigate the OS markers related to exercise. Methods: A number of 80 subjects (healthy volunteers) were examined (38 male and 32 female), divided in 3 age groups: group I ≤ 30 years (n=24); group II – 31-50 years (n=24); group III - ≥ 51 year (n=32). Each group was divided to subgroups of sedentary subjects (SS) and subjects who exercise (SE). Group I: SS (n=11), SE (n=13); group II: SS (n=13), SE (n=10); group III: SS (n=23) SE (n=9). Lipid peroxidation (LP) as a fluorimetric method with thiobarbituric acid was used to estimate OS. Antioxidative status was determined by cell antioxidants such as enzymes - superoxide dismutase (SOD), glutathione peroxidase (GPx) and glucose 6 phosphate (G-6-PD); and by extra cell antioxidants such as glutathione reductase (GR), nitric oxide (NO) and total antioxidant capacity (TAC). Results: Increased values of LP were noticed along the aging process: group I – 3.30±0.3 µmol/L; group II – 3.91±0.2 µmol/L; group III – 3.94±0.8 µmol/L (p<0.05), while no statistical significance was found between male and female subjects. Statistical significance for OS was not found between SS and SE in group I as it was found in group II (p<0.05) and in group III (p<0.01). No statistical significance was found for all cell antioxidants and GR within the groups, while NO and TAC showed lower values in SS compared to SE in II (p<0.05) and in group III (p<0.05). Discussion and conclusion: Aging process showed increased OS which may be either due to impaired function of scavengers of free radicals or due to their enormous production. Well balanced exercise might be one of the factors that keep the integrity of blood vessel endothelium which slows down the aging process. Possible mechanism of exercise beneficial influence is shear stress by upregulation of genes coding for nitric oxide bioavailability. Thus, due to obtained results we may conclude that OS is found to be diminished in the subject groups who perform exercise.

Keywords: oxidative stress, aging process, exercise, endothelial function

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Authors: Velly Anatasia

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In the last few decades extensive research has been conducted into information technology (IT) adoption, testing a series of factors considered to be essential for improved diffusion. Some studies analyze IT characteristics such as usefulness, ease of use and/or security, others focus on the emotions and experiences of users and a third group attempts to determine the importance of socioeconomic user characteristics such as gender, educational level and income. The situation is similar regarding e-commerce, where the majority of studies have taken for granted the importance of including these variables when studying e-commerce adoption, as these were believed to explain or forecast who buys or who will buy on the internet. Nowadays, the internet has become a marketplace suitable for all ages and incomes and both genders and thus the prejudices linked to the advisability of selling certain products should be revised. The objective of this study is to test whether the socioeconomic characteristics of experienced e-shoppers such as gender rally moderate the effect of their perceptions of online shopping behavior. Current development of the online environment and the experience acquired by individuals from previous e-purchases can attenuate or even nullify the effect of these characteristics. The individuals analyzed are experienced e-shoppers i.e. individuals who often make purchases on the internet. The Technology Acceptance Model (TAM) was broadened to include previous use of the internet and perceived self-efficacy. The perceptions and behavior of e-shoppers are based on their own experiences. The information obtained will be tested using questionnaires which were distributed and self-administered to respondent accustomed using internet. The causal model is estimated using structural equation modeling techniques (SEM), followed by tests of the moderating effect of socioeconomic variables on perceptions and online shopping behavior. The expected findings of this study indicated that gender moderate neither the influence of previous use of the internet nor the perceptions of e-commerce. In short, they do not condition the behavior of the experienced e-shopper.

Keywords: Internet shopping, age groups, gender, income, electronic commerce

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Authors: Davie Hope Moyo

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The environment is a combination of two things: resources and hazards. One of the hazards that is a result of environmental changes is the occurrence of flooding. Floods are one of the disasters that are highly feared by people because they have a huge impact on the human population and their environment. In recent years, flooding disasters in the Nsanje district are increasing in both frequency and magnitude. This study aims to understand the root causes of this phenomenon. To understand the causes of flooding, this study focused on the case of TA Ndamera in the Nsanje district, southern Malawi. People in the Nsanje district face disruption in their day-to-day life because of floods that affect their communities. When floods happen, people lose their property, land, livestock, and even lives. The study was carried out in order to have a better understanding of the root causes of floods. The findings of this study may help the government and other development agencies to put in place mitigation measures that will make Nsanje District resilient to the occurrence of future flood hazards. Data was collected from the area of TA Ndamera in order to assess the causes of flooding in the district. Interviews, transect walks, and researcher observation was done to appreciate the topography of the district and evaluate other factors that are making the people become vulnerable to the impacts of flooding in the district. It was found that flooding in the district is mainly caused by heavy rainfall in the upper shire, settlements along river banks, deforestation, and the topography of the district in general. The research study ends by providing recommendation strategies that need to be put in place to increase the resilience of the communities to future flood hazards. The research recommends the development of indigenous knowledge systems to alert people of incoming floods, construction of evacuation centers to ease pressure on schools, savings, and insurance schemes, construction of dykes, desilting rivers, and afforestation.

Keywords: disaster causes, mitigation, safety measures, Nsanje Malawi

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Authors: Catherine Mangan, Beth Anderson

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There has been a significant drive to use online or hybrid learning in Higher Education (HE) over recent years. HEs with a virtual presence offer their communities a range of benefits, including the potential for greater inclusivity, diversity, and collaboration; more flexible learning packages; and more engaging, dynamic content. Institutions can also experience significant challenges when seeking to extend learning spaces in this way, as can learners themselves. For example, staff members’ and learners’ digital literacy varies (as do their perceptions of technologies in use), and there can be confusion about optimal approaches to implementation. Furthermore, the speed with which HE institutions have needed to shift to fully online or hybrid models, owing to the COVID19 pandemic, has highlighted the significant barriers to successful implementation. HE environments have been shown to predict a range of organisational, academic, and experiential outcomes, both positive and negative. Much research has focused on the social aspect of virtual platforms, as well as the nature and effectiveness of the technologies themselves. There remains, however, a relative paucity of synthesised knowledge on the psychology of learners’ relationships with their institutions; specifically, how individual difference and interpersonal factors predict students’ ability and willingness to engage with novel virtual learning spaces. Accordingly, extending learning spaces remains challenging for institutions, and wholly remote courses, in particular, can experience high attrition rates. Focusing on the last five years, this pragmatic review summarises evidence from the psychological and pedagogical literature. In particular, the review highlights the importance of addressing the psychological and relational complexities of students’ shift from offline to online engagement. In doing so, it identifies considerations for HE institutions looking to deliver in this way.

Keywords: higher education, individual differences, interpersonal relationships, online learning, virtual environment

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Authors: Oyetunji John Adenuga

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This study on the comparative analysis of the performance of teachers in private and public schools was carried out in Ibadan North West Local Government Area of Oyo State. This study examined the justification for the claim that there is difference in the performance of teachers in private and public primary schools and at the same time identified factors responsible for the difference in the performance of these teachers. A descriptive survey research design was used for the study. Data generated were analysed using t-test and regression analysis. The findings of the study revealed that there is significant difference in the performance of teachers in private and private primary schools in Ibadan North West Local Government Area of Oyo State (t=64.09; df=459; p,.05). The findings also revealed that the method of teaching in private primary schools is significantly different from the method of teaching in public primary schools in Ibadan North West Local Government Area of Oyo State (t=73.08; df=459; p,.05). Findings revealed that school leadership and management have significant contribution on the performance of private and public primary school teachers in Ibadan North West Local Area of Oyo State. Based on the finding, the following recommendations were made: Primary school teachers need to be motivated and rewarded for excellent performance. Primary schools should be properly equipped with teaching-aid facilities, laboratories and libraries. Government should use the findings of this study to improve on teaching materials provided to the primary school teachers in Nigeria. Public primary schools should be designed by education planners, administrators and government. Headmasters, proprietors and teachers of primary schools should look inward and give a performance appraisal and evaluation of themselves form time to time based on subject they taught. Finally, school administrators should be conscious of the way they manage the teachers in schools not only in informal situations but also in formal settings.

Keywords: private education, public education, school leadership, school management, teachers performance

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Authors: Isaac Kwabena Adubofour, Esther Serwaah Afreh

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Political speeches are structured in ways that ensure that the ideology of the leader is communicated in ways that the opinions of the audience are influenced towards certain lines of action, and in crisis situations like the outbreak of a global pandemic, public opinion and action are influenced through speeches. The foregoing explains the presence of metaphors in presidential speeches. Crises require, among other things, that the thoughts, emotions, and actions of the population are controlled in dealing with the problems at hand. The primary question this study assesses is how the use of metaphors in crisis situations, like the COVID-19 pandemic, influences thought, determines the policies a government adopts, and influences the reactions of the people. The study focused on twenty-four (24) addresses of the President of Ghana, Nana Addo Danquah Akuffo-Addo, on the COVID-19 pandemic and his government’s efforts to manage the crisis. The nature and relevance of presidential speeches and the presence of metaphors in such speeches have been investigated. However, there is a paucity of research on the connection between the presence of metaphors in presidential speeches and their influence on thought and action. Especially within the crisis of the COVID-19 pandemic, it is pertinent to investigate how the presence of metaphors in presidential addresses influences social thought and action. Thus, the current study sought to investigate the potential for metaphor use to influence thought and action on a national scale during the COVID crisis. The speeches were collected from the website of the presidency. The analysis was done using Metaphor Identification Process by the Praglejazz Group (2007) with conceptual metaphor theory (Lakoff & Johnson, 1980) as the theoretical foundation. The findings of the study show that the President’s adoption of war metaphors may not have been ideal since it triggered thoughts, policies, and social actions in line with war. For instance, the reference to health workers as heroes, heroines, and frontline workers praised the efforts of these workers over the efforts of the rest of the population, and that may have contributed to the apathy that arose among the citizens in dealing with the pandemic. This prioritization of the frontline workers explains why their taxes were forgiven for a considerable period. The government further absorbed utility bills of citizens during the pandemic. All these financial commitments may not have been advisable for a developing country like Ghana, but the authors argue that the actions may have been influenced by the metaphor that was adopted. Another finding that is explored is the problem of stigmatization in the country during the pandemic and its connection with the war metaphor. This investigation expands the research on metaphors, social thought and action, and crisis communication. Its contribution to metaphor use, thought, and action suggest its potential implication for education and other fields.

Keywords: conceptual metaphor theory, COVID-19, crisis communication, presidential addresses, risk communication

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Authors: Tan Lay Cheng (Cheryl), Low Huiqi

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Background: All children learn at different pace. Individualized learning is an approach that tailors to the individual learning needs of each child. When implementing this approach, educators have to base their lessons on the understanding that all students learn differently and that what works for one student may not work for another. In the current early childhood environment, individualized learning is for children with diverse needs. However, a typical developing child is also able to benefit from individualized learning. This research abstract explores the concept of utilizing DNA-MILE, a patented (in Singapore) DNA-based assessment tool that can be used to measure a variety of factors that can impact learning. The assessment report includes the dominant intelligence of the user or, in this case, the child. From the result, a personalized learning plan that is tailored to each individual student's needs. Methods: A study will be conducted to investigate the effectiveness of DNA-MILE in supporting individualized learning. The study will involve a group of 20 preschoolers who were randomly assigned to either a DNA-MILE-assessed group (experimental group) or a control group. 10 children in each group. The experimental group will receive DNA Mile assessments and personalized learning plans, while the control group will not. The children in the experimental group will be taught using the dominant intelligence (as shown in the DNA-MILE report) to enhance their learning in other domains. The children in the control group will be taught using the curriculum and lesson plan set by their teacher for the whole class. Parents’ and teachers’ interviews will be conducted to provide information about the children before the study and after the study. Results: The results of the study will show the difference in the outcome of the learning, which received DNA Mile assessments and personalized learning plans, significantly outperformed the control group on a variety of measures, including standardized tests, grades, and motivation. Conclusion: The results of this study suggest that DNA Mile can be an effective tool for supporting individualized learning. By providing personalized learning plans, DNA Mile can help to improve learning outcomes for all students.

Keywords: individualized, DNA-MILE, learning, preschool, DNA, multiple intelligence

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Authors: Kevin Soubly, Kaysara Khatun

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This study applies the existing Middle-Out Perspective (MOP) as a complementing analytical alternative to the customary dichotomous options of top-down vs. bottom-up strategies of international development and commons governance. It expands the framework by applying it to a new context of land management and environmental change, enabling fresh understandings of decision making around land use. Using a case study approach in Central Kalimantan, Indonesia among a village of indigenous Dayak, this study explores influences from both internal and external middle actors, utilizing qualitative empirical evidence and incorporating responses across 25 village households and 11 key stakeholders. Applying the factors of 'agency' and 'capacity' specific to the MOP, this study demonstrates middle actors’ unique capabilities and criticality to change due to their influence across various levels of decision-making. Study results indicate that middle actors play a large role, both passively and actively, both directly and indirectly, across various levels of decision-making, perception-shaping, and commons governance. In addition, the prominence of novel 'passive' middle actors, such as the internet, can provide communities themselves with a level of agency beyond that provided by other middle actors such as NGOs and palm oil industry entities – which often operate at the behest of the 'top' or out of self-interest. Further, the study posits that existing development and decision-making frameworks may misidentify the 'bottom' as the 'middle,' raising questions about traditional development and livelihood discourse, strategies, and support, from agricultural production to forest management. In conclusion, this study provides recommendations including that current policy preconceptions be reevaluated to engage middle actors in locally-adapted, integrative manners in order to improve governance and rural development efforts more broadly.

Keywords: environmental management, governance, Indonesia, land use, middle actors, middle-out perspective

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