Search results for: integrative-cyclical approach

Authors: Jennifer Kehinde, Claire O'donnell, Annmarie Grealish

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Introduction: Breastfeeding has been shown to provide numerous health benefits for both infants and mothers. The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. The decline in global breastfeeding rate can be linked to lack of adequate breastfeeding education during prenatal stage.This systematic review examined the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum. Method: This review was undertaken and reported in conformity with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement (PRISMA) and was registered on the international prospective register for systematic reviews (PROSPERO: CRD42020213853). A PICO analysis (population, intervention, comparison, outcome) was undertaken to inform the choice of keywords in the search strategy to formulate the review question which was aimed at determining the effectiveness of prenatal breastfeeding educational programs at improving breastfeeding uptake following birth. A systematic search of five databases (Cumulative Index to Nursing and Allied Health Literature, Medline, Psych INFO, and Applied Social Sciences Index and Abstracts) were searched between January 2014 until July 2021 to identify eligible studies. Quality assessment and narrative synthesis were subsequently undertaken. Results: Fourteen studies were included. All 14 studies used different types of breastfeeding programs; eight used a combination of curriculum based breastfeeding education program, group prenatal breastfeeding counselling and one-to-one breastfeeding educational programs which were all delivered in person; four studies used web-based learning platforms to deliver breastfeeding education prenatally which were both delivered online and face to face over a period of 3 weeks to 2 months with follow-up periods ranging from 3 weeks to 6 months; one study delivered breastfeeding educational intervention using mother-to-mother breastfeeding support groups in promoting exclusive breastfeeding and one study disseminated breastfeeding education to participants based on the theory of planned behaviour. The most effective interventions were those that included both theory and hands-on demonstrations. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, increase in positive attitude to breastfeeding and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care. Conclusion: Prenatal breastfeeding education increases women’s knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrates a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcome inherent in all the studies can be attributed to prenatal breastfeeding education. This review provides rigorous contemporary evidence that healthcare professionals and policymakers can apply when developing effective strategies to improve breastfeeding rates and ultimately improve the health outcomes of mothers and infants.

Keywords: breastfeeding, breastfeeding programs, breastfeeding self-efficacy, prenatal breastfeedng education

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Authors: Mohanad Elemary, Imose Itua, Rajeswari B. Matam

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Virologists and public health experts have been predicting potential pandemics from coronaviruses for decades. The viruses which caused the SARS and MERS pandemics and the Nipah virus led to many lost lives, but still, the COVID-19 pandemic caused by the SARS-CoV2 virus surprised many scientific communities, experts, and governments with its ease of transmission and its pathogenicity. Governments of various countries reacted by locking down entire populations to their homes to combat the devastation caused by the virus, which led to a loss of livelihood and economic hardship to many individuals and organizations. To revive national economies and support their citizens in resuming their lives, governments focused on the development and use of contact tracing apps as a digital way to track and trace exposure. Google and Apple introduced the Exposure Notification Systems (ENS) framework. Independent organizations and countries also developed different frameworks for contact tracing apps. The efficiency, popularity, and adoption rate of these various apps have been different across countries. In this paper, we present a critical analysis of the different contact tracing apps with respect to their efficiency, adoption rate and general perception, and the governmental strategies and policies, which led to the development of the applications. When it comes to the European countries, each of them followed an individualistic approach to the same problem resulting in different realizations of a similarly functioning application with differing results of use and acceptance. The study conducted an extensive review of existing literature, policies, and reports across multiple disciplines, from which a framework was developed and then validated through interviews with six key stakeholders in the field, including founders and executives in digital health startups and corporates as well as experts from international organizations like The World Health Organization. A framework of best practices and tactics is the result of this research. The framework looks at three main questions regarding the contact tracing apps; how to develop them, how to deploy them, and how to regulate them. The findings are based on the best practices applied by governments across multiple countries, the mistakes they made, and the best practices applied in similar situations in the business world. The findings include multiple strategies when it comes to the development milestone regarding establishing frameworks for cooperation with the private sector and how to design the features and user experience of the app for a transparent, effective, and rapidly adaptable app. For the deployment section, several tactics were discussed regarding communication messages, marketing campaigns, persuasive psychology, and the initial deployment scale strategies. The paper also discusses the data privacy dilemma and how to build for a more sustainable system of health-related data processing and utilization. This is done through principles-based regulations specific for health data to allow for its avail for the public good. This framework offers insights into strategies and tactics that could be implemented as protocols for future public health crises and emergencies whether global or regional.

Keywords: contact tracing apps, COVID-19, digital health applications, exposure notification system

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Authors: Tesfaye Dagne, Dagmawit Solomon, Firmaye Bogale, Yosef Gebreyohannes, Samson Mideksa, Mamuye Hadis, Desalegn Ararso, Ermias Woldie, Tsegaye Getachew, Sabit Ababor, Zelalem Kebede

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Globally, road traffic accident (RTA) is causing millions of deaths and injuries every year. It is one of the leading causes of death among people of all age groups and the problem is worse among young reproductive age group. Moreover the problem is increasing with an increasing number of vehicles. The majority of the problem happen in low and middle income countries (LMIC), even if the number of vehicles in these countries is low compared to their population. So, the objective of this paper is to summarize the best available evidence on interventions that can reduce road traffic accidents in low and middle income countries (LMIC). Method: A rapid evidence synthesis approach adapted from the SURE Rapid Response Service was applied to search, appraise and summarize the best available evidence on effective intervention in reducing road traffic injury. To answer the question under review, we searched for relevant studies from databases including PubMed, the Cochrane Library, TRANSPORT, Health system evidence, Epistemonikos, and SUPPORT summary. The following key terms were used for searching: Road traffic accident, RTA, Injury, Reduc*, Prevent*, Minimiz*, “Low and middle-income country”, LMIC. We found 18 articles through a search of different databases mentioned above. After screening for the titles and abstracts of the articles, four of them which satisfy the inclusion criteria were included in the final review. Then we appraised and graded the methodological quality of systematic reviews that are deemed to be highly relevant using AMSTAR. Finding: The identified interventions to reduce road traffic accidents were legislation and enforcement, public awareness/education, speed control/ rumble strips, road improvement, mandatory motorcycle helmet, graduated driver license, street lighting. Legislation and Enforcement: Legislation focusing on mandatory motorcycle helmet usage, banning cellular phone usage when driving, seat belt laws, decreasing the legal blood alcohol content (BAC) level from 0.06 g/L to 0.02 g/L bring the best result where enforcement is there. Public Awareness/Education: focusing on seat belt use, child restraint use, educational training in health centers and schools/universities, and public awareness with media through the distribution of videos, posters/souvenirs, and pamphlets are effective in the short run. Speed Control: through traffic calming bumps, or speed bumps, rumbled strips are effective in reducing accidents and fatality. Mandatory Motorcycle Helmet: is associated with reduction in mortality. Graduated driver’s license (GDL): reduce road traffic injury by 19%. Street lighting: is a low-cost intervention which may reduce road traffic accidents.

Keywords: evidence synthesis, injury, rapid review, reducing, road traffic accident

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Authors: Akiko Ohta, Masahiro Minami, Yusra Qadir, Jennifer York

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The Home Instruction for Parents of Preschool Youngsters (HIPPY) is a home instruction program for mothers of children 3 to 5 years old. Using role-play as a method of teaching, the participating mothers work with their home visitors and learn how to deliver the HIPPY curriculum to their children. Applying HIPPY, Reviving Hope and Home for High-risk Refugee Mothers Program (RHH) was created to provide more personalized peer support and to respond to ongoing settlement challenges for isolated and vulnerable Government Assisted Refugee (GAR) mothers. GARs often have greater needs and vulnerabilities than other refugee groups. While the support is available, they often face various challenges and barriers in starting their new lives in Canada, such as inadequate housing, low first-language literacy levels, low competency in English or French, and social isolation. The pilot project was operated by Mothers Matter Centre (MMC) from January 2019 to March 2021 in partnership with the Immigrant Services Society of BC (ISSofBC). The formative evaluation was conducted by a research team at Simon Fraser University. In order to provide more suitable support for GAR mothers, RHH intended to offer more flexibility in HIPPY delivery, supported by a home visitor, to meet the need of refugee mothers facing various conditions and challenges; to have a pool of financial resources to be used for the RHH families when necessitated during the program period; to have another designated staff member, called a community navigator, assigned to facilitate the support system for the RHH families in their settlement; to have a portable device available for each RHH mother to navigate settlement support resources; and to provide other variations of the HIPPY curriculum as an option for the RHH mothers, including a curriculum targeting pre-HIPPY age children. Reflections on each program component was collected from RHH mothers and staff members of MMC and ISSofBC, including frontline workers and management staff, through individual interviews and focus group discussions. Each of the RHH program components was analyzed and evaluated by applying Moore’s four domains framework to identify key information and generate new knowledge (data). To capture RHH mothers’ program experience more in depth based on their own reflections, the photovoice method was used. Some photos taken by the mothers will be shared to illustrate their RHH experience as part of their life stories. Over the period of the program, this evaluation observed how RHH mothers became more confident in various domains, such as communicating with others, taking public transportations alone, and teaching their own child(ren). One of the major factors behind the success was their home visitors’ flexibility and creativity to create a more meaningful and tailored approach for each mother, depending on her background and personal situation. The role of the community navigator was tested out and improved during the program period. The community navigators took the key role to assess the needs of the RHH families and connect them with community resources. Both the home visitors and community navigators were immigrant mothers themselves and owing to their dedicated care for the RHH mothers; they were able to gain trust and work closely and efficiently with RHH mothers.

Keywords: refugee mothers, settlement support, program evaluation, Canada

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Authors: Vera G. Dianova, Lori P. Montross, Charles M. Burke

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In the digital age, the widespread and frequently excessive use of mobile phones amongst university students is recognized as a significant distractor which interferes with their ability to enter a deep state of concentration during studies and diminishes their prospects of experiencing the enjoyable and instrumental state of flow, as defined and described by psychologist M. Csikszentmihalyi. This study has targeted 50 university students with the aim of teaching them to cultivate their ability to engage in deep work and to attain the state of flow, fostering more effective and enjoyable learning experiences. Prior to the start of the intervention, all participating students completed a comprehensive survey based on a variety of validated scales assessing their inclination toward lifelong learning, frequency of flow experiences during study, frustration tolerance, sense of agency, as well as their love of learning and daily time devoted to non-academic mobile phone activities. Several days after this initial assessment, students received a 90-minute lecture on the principles of flow and deep work, accompanied by a critical discourse on the detrimental effects of excessive mobile phone usage. They were encouraged to practice deep work and strive for frequent flow states throughout the semester. Subsequently, students submitted weekly surveys, including the 10-item CORE Dispositional Flow Scale, a 3-item agency scale and furthermore disclosed their average daily hours spent on non-academic mobile phone usage. As a final step, at the end of the semester students engaged in reflective report writing, sharing their experiences and evaluating the intervention's effectiveness. They considered alterations in their love of learning, reflected on the implications of their mobile phone usage, contemplated improvements in their tolerance for boredom and perseverance in complex tasks, and pondered the concept of lifelong learning. Additionally, students assessed whether they actively took steps towards managing their recreational phone usage and towards improving their commitment to becoming lifelong learners. Employing a mixed-methods approach our study offers insights into the dynamics of concentration, flow, mobile phone usage and attitudes towards learning among undergraduate and graduate university students. The findings of this study aim to promote profound contemplation, on the part of both students and instructors, on the rapidly evolving digital-age higher education environment. In an era defined by digital and AI advancements, the ability to concentrate, to experience the state of flow, and to love learning has never been more crucial. This study underscores the significance of addressing mobile phone distractions and providing strategies for cultivating deep concentration. The insights gained can guide educators in shaping effective learning strategies for the digital age. By nurturing a love for learning and encouraging lifelong learning, educational institutions can better prepare students for a rapidly changing labor market, where adaptability and continuous learning are paramount for success in a dynamic career landscape.

Keywords: deep work, flow, higher education, lifelong learning, love of learning

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Authors: Sonia Boscenco, Zihan Wang, Euclides José de Mendoça Filho, João Paulo Hoppe, Irina Pokhvisneva, Geoffrey B.C. Hall, Michael J. Meaney, Patricia Pelufo Silveira

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Entropy can be described as a measure of the number of states of a system, and when used in the context of physiological time-based signals, it serves as a measure of complexity. In functional connectivity data, entropy can account for the moment-to-moment variability that is neglected in traditional functional magnetic resonance imaging (fMRI) analyses. While brain fMRI resting state entropy has been associated with some pathological conditions like schizophrenia, no investigations have explored the association between brain entropy measures and individual differences in child behavior in healthy children. We describe a novel exploratory approach to evaluate brain fMRI resting state data in two child cohorts, and MAVAN (N=54, 4.5 years, 48% males) and GUSTO (N = 206, 4.5 years, 48% males) and its associations to child behavior, that can be used in future research in the context of child exposures and long-term health. Following rs-fMRI data pre-processing and Shannon entropy calculation across 32 network regions of interest to acquire 496 unique functional connections, partial correlation coefficient analysis adjusted for sex was performed to identify associations between entropy data and Strengths and Difficulties questionnaire in MAVAN and Child Behavior Checklist domains in GUSTO. Significance was set at p < 0.01, and we found eight significant associations in GUSTO. Negative associations were found between two frontoparietal regions and cerebellar posterior and oppositional defiant problems, (r = -0.212, p = 0.006) and (r = -0.200, p = 0.009). Positive associations were identified between somatic complaints and four default mode connections: salience insula (r = 0.202, p < 0.01), dorsal attention intraparietal sulcus (r = 0.231, p = 0.003), language inferior frontal gyrus (r = 0.207, p = 0.008) and language posterior superior temporal gyrus (r = 0.210, p = 0.008). Positive associations were also found between insula and frontoparietal connection and attention deficit / hyperactivity problems (r = 0.200, p < 0.01), and insula – default mode connection and pervasive developmental problems (r = 0.210, p = 0.007). In MAVAN, ten significant associations were identified. Two positive associations were found = with prosocial scores: the salience prefrontal cortex and dorsal attention connection (r = 0.474, p = 0.005) and the salience supramarginal gyrus and dorsal attention intraparietal sulcus (r = 0.447, p = 0.008). The insula and prefrontal connection were negatively associated with peer problems (r = -0.437, p < 0.01). Conduct problems were negatively associated with six separate connections, the left salience insula and right salience insula (r = -0.449, p = 0.008), left salience insula and right salience supramarginal gyrus (r = -0.512, p = 0.002), the default mode and visual network (r = -0.444, p = 0.009), dorsal attention and language network (r = -0.490, p = 0.003), and default mode and posterior parietal cortex (r = -0.546, p = 0.001). Entropy measures of resting state functional connectivity can be used to identify individual differences in brain function that are correlated with variation in behavioral problems in healthy children. Further studies applying this marker into the context of environmental exposures are warranted.

Keywords: child behaviour, functional connectivity, imaging, Shannon entropy

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Authors: Osman Ali, Jeanne Kriek

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Introduction: The current instructional approach entrenched in memorizing does not assist conceptual understanding in science. Instructional approaches that encourage research, investigation, and experimentation, which depict how scientists work, should be encouraged. One such teaching strategy is problem-based learning (PBL). PBL has many advantages; enhanced self-directed learning and improved problem-solving and critical thinking skills. However, despite many advantages, PBL has challenges. Research confirmed is time-consuming and difficult to formulate ill-structured questions. Professional development interventions are needed for in-service educators to adopt the PBL strategy. The purposively selected educators had to implement PBL in their classrooms after the intervention to develop their practice and then reflect on the implementation. They had to indicate their achievements and challenges. This study differs from previous studies as the rural educators were subjected to implementing PBL in their classrooms and reflected on their experiences, beliefs, and attitudes regarding PBL. Theoretical Framework: The study reinforced Vygotskian sociocultural theory. According to Vygotsky, the development of a child's cognitive is sustained by the interaction between the child and more able peers in his immediate environment. The theory suggests that social interactions in small groups create an opportunity for learners to form concepts and skills on their own better than working individually. PBL emphasized learning in small groups. Research Methodology: An exploratory case study was employed. The reason is that the study was not necessarily for specific conclusive evidence. Non-probability purposive sampling was adopted to choose eight schools from 89 rural public schools. In each school, two educators were approached, teaching physical sciences in grades 10 and 11 (N = 16). The research instruments were questionnaires, interviews, and lesson observation protocol. Two open-ended questionnaires were developed before and after intervention and analyzed thematically. Three themes were identified. The semi-structured interviews and responses were coded and transcribed into three themes. Subsequently, the Reform Teaching Observation Protocol (RTOP) was adopted for lesson observation and was analyzed using five constructs. Results: Evidence from analyzing the questionnaires before and after the intervention shows that participants knew better what was required to develop an ill-structured problem during the implementation. Furthermore, indications from the interviews are that participants had positive views about the PBL strategy. They stated that they only act as facilitators, and learners’ problem-solving and critical thinking skills are enhanced. They suggested a change in curriculum to adopt the PBL strategy. However, most participants may not continue to apply the PBL strategy stating that it is time-consuming and difficult to complete the Annual Teaching Plan (ATP). They complained about materials and equipment and learners' readiness to work. Evidence from RTOP shows that after the intervention, participants learn to encourage exploration and use learners' questions and comments to determine the direction and focus of classroom discussions.

Keywords: problem-solving, self-directed, critical thinking, intervention

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Authors: Elina Vroblevska, Toms Ratfelders

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This paper examines the impact of international status-seeking aspirations on great power behavior within the international system. In particular, we seek to test the assumption advanced by the proponents of the Social Identity Theory (SIT) that the inability to achieve social mobilization through joining perceived higher-status social groups (of states) leads great powers to adopt the approach of social competition in which they aim to equal or outdo the dominant group in the area on which its claim to superior status rests. Since the dissolution of the Soviet Union, Russia has struggled to be accepted as a great power by the group of Western states that had created the dominant international system order, while the Soviet states were isolated. While the 1990s and the beginning of the 21st century can be characterized by striving to integrate into the existing order, the second decade has seen a rather sharp turn towards creating a new power center for Russia through the realization of ideas of multipolarity rivalry and uniqueness of the state itself. Increasingly, we have seen the Kremlin striving to collaborate and mobilize groups of states that fall outside of the categories of democracy, multiculturalism, and international order, the way that is perceived by the dominant group, which can be described as the West. Instead, Russia builds its own narrative where it creates an alternative understanding of these values, differentiating from the higher-status social group. The Global South, from a Russian perspective, is the group of states that can still be swayed to create an alternative power center in the international system - one where Russia can assert its status as a great power. This is based on a number of reasons, the most important being that the global north is already highly institutionalized in terms of economy (the EU) and defense (NATO), leaving no room for Russia but to integrate within the existing framework. Second, the difference in values and their interpretation - Russia has been adamant, for the last twenty years, on basing its moral code on traditional values like religion, the heterosexual family model, and moral superiority, which contradict the overall secularism of the Global North. And last, the striking difference in understanding of state governance models - with Russia becoming more autocratic over the course of the last 20 years, it has deliberately created distance between itself and democratic states, entering a “gray area” of alternative understanding of democracy which is more relatable to the global South countries. Using computational text analysis of the excerpts of Vladimir Putin’s speeches delivered from 2000-2022 regarding the areas that fall outside the immediate area of interest of Russia (the Global South), we identify 80 topics that relate to the particular component of the great power status - interest to use force globally. These topics are compared across four temporal frames that capture the periods of more and less permissible Western social boundaries. We find that there exists a negative association between such permissiveness and Putin’s emphasis on the “use of force” topics. This lends further support to the Social Identity Theory and contributes to broadening its applicability to explaining the questions related to great power assertiveness in areas outside of their primary focus regions.

Keywords: Russia, Global South, great power, identity

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Authors: Zhenyu Zhang, Hsi-Hsien Wei

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Highway network systems play a vital role in disaster response for disaster-damaged areas. Damaged bridges in such network systems can impede disaster response by disrupting transportation of rescue teams or humanitarian supplies. Therefore, emergency inspection and repair of bridges to quickly collect damage information of bridges and recover the functionality of highway networks is of paramount importance to disaster response. A widely used measure of a network’s capability to recover from disasters is resilience. To enhance highway network resilience, plenty of studies have developed various repair scheduling methods for the prioritization of bridge-repair tasks. These methods assume that repair activities are performed after the damage to a highway network is fully understood via inspection, although inspecting all bridges in a regional highway network may take days, leading to the significant delay in repairing bridges. In reality, emergency repair activities can be commenced as soon as the damage data of some bridges that are crucial to emergency response are obtained. Given that emergency bridge inspection and repair (EBIR) activities are executed simultaneously in the response phase, the real-time interactions between these activities can occur – the blockage of highways due to repair activities can affect inspection routes which in turn have an impact on emergency repair scheduling by providing real-time information on bridge damages. However, the impact of such interactions on the optimal emergency inspection routes (EIR) and emergency repair schedules (ERS) has not been discussed in prior studies. To overcome the aforementioned deficiencies, this study develops a routing and scheduling model for EBIR while accounting for real-time inspection-repair interactions to maximize highway network resilience. A stochastic, time-dependent integer program is proposed for the complex and real-time interacting EBIR problem given multiple inspection and repair teams at locations as set post-disaster. A hybrid genetic algorithm that integrates a heuristic approach into a traditional genetic algorithm to accelerate the evolution process is developed. Computational tests are performed using data from the 2008 Wenchuan earthquake, based on a regional highway network in Sichuan, China, consisting of 168 highway bridges on 36 highways connecting 25 cities/towns. The results show that the simultaneous implementation of bridge inspection and repair activities can significantly improve the highway network resilience. Moreover, the deployment of inspection and repair teams should match each other, and the network resilience will not be improved once the unilateral increase in inspection teams or repair teams exceeds a certain level. This study contributes to both knowledge and practice. First, the developed mathematical model makes it possible for capturing the impact of real-time inspection-repair interactions on inspection routing and repair scheduling and efficiently deriving optimal EIR and ERS on a large and complex highway network. Moreover, this study contributes to the organizational dimension of highway network resilience by providing optimal strategies for highway bridge management. With the decision support tool, disaster managers are able to identify the most critical bridges for disaster management and make decisions on proper inspection and repair strategies to improve highway network resilience.

Keywords: disaster management, emergency bridge inspection and repair, highway network, resilience, uncertainty

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Authors: Cristina Maria Mendoza Sanchez, Maria Angeles Navarro Perán

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Introduction: Nursing as a profession, from its initial formation and after its development in practice, has been built and identified mainly from its technical competence and professionalization within the positivist approach of the XIX century that provides a conception of the disease built on the basis of to the biomedical paradigm, where the care provided is more focused on the physiological processes and the disease than on the suffering person understood as a whole. The main issue that is in need of study here is a review of the nursing profession's history to get to know how the nursing profession was before the XIX century. It is unclear if there were organizations or people with knowledge about looking after others or if many people survived by chance. The holistic care, in which the appearance of the disease directly affects all its dimensions: physical, emotional, cognitive, social and spiritual. It is not a concept from the 21st century. It is common practice, most probably since established life in this world, with the final purpose of covering all these perspectives through quality care. Objective: In this paper, we describe and analyze the history of education in nursing learning in terms of reviewing and analysing theoretical foundations of clinical teaching and learning in nursing, with the final purpose of determining and describing the development of the nursing profession along the history. Method: We have done a descriptive systematic review study, doing a systematically searched of manuscripts and articles in the following health science databases: Pubmed, Scopus, Web of Science, Temperamentvm and CINAHL. The selection of articles has been made according to PRISMA criteria, doing a critical reading of the full text using the CASPe method. A compliment to this, we have read a range of historical and contemporary sources to support the review, such as manuals of Florence Nightingale and John of God as primary manuscripts to establish the origin of modern nursing and her professionalization. We have considered and applied ethical considerations of data processing. Results: After applying inclusion and exclusion criteria in our search, in Pubmed, Scopus, Web of Science, Temperamentvm and CINAHL, we have obtained 51 research articles. We have analyzed them in such a way that we have distinguished them by year of publication and the type of study. With the articles obtained, we can see the importance of our background as a profession before modern times in public health and as a review of our past to face challenges in the near future. Discussion: The important influence of key figures other than Nightingale has been overlooked and it emerges that nursing management and development of the professional body has a longer and more complex history than is generally accepted. Conclusions: There is a paucity of studies on the subject of the review to be able to extract very precise evidence and recommendations about nursing before modern times. But even so, as more representative data, an increase in research about nursing history has been observed. In light of the aspects analyzed, the need for new research in the history of nursing emerges from this perspective; in order to germinate studies of the historical construction of care before the XIX century and theories created then. We can assure that pieces of knowledge and ways of care were taught before the XIX century, but they were not called theories, as these concepts were created in modern times.

Keywords: nursing history, nursing theory, Saint John of God, Florence Nightingale, learning, nursing education

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Authors: Samil Ozcan

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Airlines companies target different customer segments in consideration of pricing, service quality, flight network, etc. and their brand positioning accords with the marketization strategies developed in the same direction. The object of this study, Turkish Airlines, has many peculiarities regarding its brand positioning as compared to its rivals in the sector. In the first place, it appeals to a global customer group because of its Star Alliance membership and its broad flight network with 315 destination points. The second group in its customer segmentation includes domestic customers. For this group, the company follows a marketing strategy that plays to local culture and accentuates the image of Turkishness as an emotional allurement. The advertisements and publicity projects designed in this regard put little emphasis on the service quality the company offers to its clients; it addresses the emotions of the consumers rather than individual benefits and relies on the historical memory of the nation and shared cultural values. This study examines the publicity work which aims at the second segment customer group focusing on Turkish Airlines’ 85th Anniversary Commercial through a symbolic meaning analysis approach. The commercial presents six stories with undertones of nationalism in its theme. Nationalism is not just the product of collective interests based on reason but a result of patriotism in the sense of loyalty to state and nation and love of ethnic belonging. While nationalism refers to concrete notions such as blood tie, common ancestor, shared history, it is not the actuality of these notions that it draws its real strength but the emotions invested in them. The myths of origin, the idea of common homeland, boundary definitions, and symbolic acculturation have instrumental importance in the development of these commonalities. The commercial offers concrete examples for an analysis of Connor’s definition of nationalism based on emotions. Turning points in the history of the Turkish Republic and the historical mission Turkish Airlines undertook in these moments are narrated in six stories in the commercial with a highly emotional theme. These emotions, in general, depend on collective memory generated by national consciousness. Collective memory is not simply remembering the past. It is constructed through the reconstruction and reinterpretation of the past in the present moment. This study inquires the motivations behind the nationalist emotions generated within the collective memory by engaging with the commercial released for the 85th anniversary of Turkish Airlines as the object of analysis. Symbols and myths can be read as key concepts that reveal the relation between 'identity and memory'. Because myths and symbols do not merely reflect on collective memory, they reconstruct it as well. In this sense, the theme of the commercial defines the image of Turkishness with virtues such as self-sacrifice, helpfulness, humanity, and courage through a process of meaning creation based on symbolic mythologizations like flag and homeland. These virtues go beyond describing the image of Turkishness and become an instrument that defines and gives meaning to Turkish identity.

Keywords: collective memory, emotions, identity, nationalism

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Authors: O. O. Sufyani, M. E. Oraiby, S. A. Qumaiy, A. I. Alaamri, Z. M. Eisa, A. M. Hakami, M. A. Attafi, O. M. Alhassan, W. M. Elsideeg, E. M. Noureldin, Y. A. Hobani, Y. Q. Majrabi, I. A. Khardali, A. B. Maashi, A. A. Al Mane, A. H. Hakami, I. M. Alkhyat, A. A. Sahly, I. M. Attafi

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According to the Food and Agriculture Organization (FAO) Pesticides Use Database, pesticide use in agriculture in Saudi Arabia has more than doubled from 4539 tons in 2009 to 10496 tons in 2019. Among pesticides, pyrethroids is commonly used in Saudi Arabia. Pesticides may increase susceptibility to a variety of diseases, particularly among pesticide workers, due to their extensive use, indiscriminate use, and long-term exposure. Therefore, analyzing blood chemo-profiles and evaluating the detected substances as biomarkers for pyrethroid pesticide exposure may assist to identify and predicting adverse effects of exposure, which may be used for both preventative and risk assessment purposes. The purpose of this study was to (a) analyze chemo-profiling by Gas Chromatography-Mass Spectrometry (GC-MS) analysis, (b) identify the most commonly detected chemicals in a time-exposure-dependent manner using a Venn diagram, and (c) identify their associated disease among pesticide workers using analyzer tools on the Comparative Toxicogenomics Database (CTD) website, (250 healthy male volunteers (20-60 years old) who deal with pesticides in the Jazan region of Saudi Arabia (exposure intervals: 1-2, 4-6, 6-8, more than 8 years) were included in the study. A questionnaire was used to collect demographic information, the duration of pesticide exposure, and the existence of chronic conditions. Blood samples were collected for biochemistry analysis and extracted by solid-phase extraction for gas chromatography-mass spectrometry (GC-MS) analysis. Biochemistry analysis reveals no significant changes in response to the exposure period; however, an inverse association between the albumin level and the exposure interval was observed. The blood chemo-profiling was differentially expressed in an exposure time-dependent manner. This analysis identified the common chemical set associated with each group and their associated significant occupational diseases. While some of these chemicals are associated with a variety of diseases, the distinguishing feature of these chemically associated disorders is their applicability for prevention measures. The most interesting finding was the identification of several chemicals; erucic acid, pelargonic acid, alpha-linolenic acid, dibutyl phthalate, diisobutyl phthalate, dodecanol, myristic Acid, pyrene, and 8,11,14-eicosatrienoic acid, associated with pneumoconiosis, asbestosis, asthma, silicosis and berylliosis. Chemical-disease association study also found that cancer, digestive system disease, nervous system disease, and metabolic disease were the most often recognized disease categories in the common chemical set. The hierarchical clustering approach was used to compare the expression patterns and exposure intervals of the chemicals found commonly. More study is needed to validate these chemicals as early markers of pyrethroid insecticide-related occupational disease, which might assist evaluate and reducing risk. The current study contributes valuable data and recommendations to public health.

Keywords: occupational, toxicology, chemo-profiling, pesticide, pyrethroid, GC-MS

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Authors: Bhargavi G. Iyer, Ojaswi Bhagat

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It is often noted that the value of a novel idea lies in its successful implementation. However, successful implementation requires the nurturing and encouragement of innovation. Nascent competitors are a true representation of innovation in any given industry. A nascent competitor is an entity whose prospective innovation poses a future threat to an incumbent dominant competitor. While a nascent competitor benefits in several ways, it is also exposed significantly and is at greater risk of facing the brunt of exclusionary practises and abusive conduct by dominant incumbent competitors in the industry. This research paper aims to explore the risks and threats faced by nascent competitors and analyse the benefits they accrue as well as the advantages they proffer to the economy; through an analytical, critical study. In such competitive market environments, a rise of the acquisitions of nascent competitors by the incumbent dominants is observed. Therefore, this paper will examine the dynamics of nascent acquisition. Further, this paper hopes to specifically delve into the role of antitrust bodies in regulating nascent acquisition. This paper also aspires to deal with the question how to distinguish harmful from harmless acquisitions in order to facilitate ideal enforcement practice. This paper proposes mechanisms of scrutiny in order to ensure healthy market practises and efficient merger control in the context of nascent acquisitions. Taking into account the scope and nature of the topic, as well as the resources available and accessible, a combination of the methods of doctrinal research and analytical research were employed, utilising secondary sources in order to assess and analyse the subject of research. While legally evaluating the Killer Acquisition theory and the Nascent Potential Acquisition theory, this paper seeks to critically survey the precedents and instances of nascent acquisitions. In addition to affording a compendious account of the legislative framework and regulatory mechanisms in the United States, the United Kingdom, and the European Union; it hopes to suggest an internationally practicable legal foundation for domestic legislation and enforcement to adopt. This paper hopes to appreciate the complexities and uncertainties with respect to nascent acquisitions and attempts to suggest viable and plausible policy measures in antitrust law. It additionally attempts to examine the effects of such nascent acquisitions upon the consumer and the market economy. This paper weighs the argument of shifting the evidentiary burden on to the merging parties in order to improve merger control and regulation and expounds on its discovery of the strengths and weaknesses of the approach. It is posited that an effective combination of factual, legal, and economic analysis of both the acquired and acquiring companies possesses the potential to improve ex post and ex ante merger review outcomes involving nascent companies; thus, preventing anti-competitive practises. This paper concludes with an analysis of the possibility and feasibility of industry-specific identification of anti-competitive nascent acquisitions and implementation of measures accordingly.

Keywords: acquisition, antitrust law, exclusionary practises merger control, nascent competitor

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Authors: Simone Cinquemani, Lorenzo Mantovani, Aleksander Dabek

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New technologies in agriculture are opening new challenges and new opportunities. Among these, certainly, robotics, vision, and artificial intelligence are the ones that will make a significant leap, compared to traditional agricultural techniques, possible. In particular, the indoor farming sector will be the one that will benefit the most from these solutions. Vertical farming is a new field of research where mechanical engineering can bring knowledge and know-how to transform a highly labor-based business into a fully autonomous system. The aim of the research is to develop a multi-purpose, modular, and perfectly integrated platform for crop production in indoor vertical farming. Activities will be based both on hardware development such as automatic tools to perform different activities on soil and plants, as well as research to introduce an extensive use of monitoring techniques based on machine learning algorithms. This paper presents the preliminary results of a research project of a vertical farm living lab designed to (i) develop and test vertical farming cultivation practices, (ii) introduce a very high degree of mechanization and automation that makes all processes replicable, fully measurable, standardized and automated, (iii) develop a coordinated control and management environment for autonomous multiplatform or tele-operated robots in environments with the aim of carrying out complex tasks in the presence of environmental and cultivation constraints, (iv) integrate AI-based algorithms as decision support system to improve quality production. The coordinated management of multiplatform systems still presents innumerable challenges that require a strongly multidisciplinary approach right from the design, development, and implementation phases. The methodology is based on (i) the development of models capable of describing the dynamics of the various platforms and their interactions, (ii) the integrated design of mechatronic systems able to respond to the needs of the context and to exploit the strength characteristics highlighted by the models, (iii) implementation and experimental tests performed to test the real effectiveness of the systems created, evaluate any weaknesses so as to proceed with a targeted development. To these aims, a fully automated laboratory for growing plants in vertical farming has been developed and tested. The living lab makes extensive use of sensors to determine the overall state of the structure, crops, and systems used. The possibility of having specific measurements for each element involved in the cultivation process makes it possible to evaluate the effects of each variable of interest and allows for the creation of a robust model of the system as a whole. The automation of the laboratory is completed with the use of robots to carry out all the necessary operations, from sowing to handling to harvesting. These systems work synergistically thanks to the knowledge of detailed models developed based on the information collected, which allows for deepening the knowledge of these types of crops and guarantees the possibility of tracing every action performed on each single plant. To this end, artificial intelligence algorithms have been developed to allow synergistic operation of all systems.

Keywords: automation, vertical farming, robot, artificial intelligence, vision, control

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Authors: Andrés Lara Guillén, José M. Soriano Disla, Gemma Castejón Martínez, David Fernández-Gutiérrez

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The worldwide population is exponentially increasing, which causes a rising demand for food, energy and non-renewable resources. These demands must be attended to from a circular economy point of view. Under this approach, the obtention of strategic products from biowaste is crucial for the society to keep the current lifestyle reducing the environmental and social issues linked to the lineal economy. This is the main objective of the VALUEWASTE project. VALUEWASTE is about valorizing urban biowaste into proteins for food and feed and biofertilizers, closing the loop of this waste stream. In order to achieve this objective, the project validates three value chains, which begin with the anaerobic digestion of the biowaste. From the anaerobic digestion, three by-products are obtained: i) methane that is used by microorganisms, which will be transformed into microbial proteins; ii) digestate that is used by black soldier fly, producing insect proteins; and iii) a nutrient-rich effluent, which will be transformed into biofertilizers. VALUEWASTE is an innovative solution, which combines different technologies to valorize entirely the biowaste. However, it is also required to demonstrate that the solution is greener than other traditional technologies (baseline systems). On one hand, the proteins from microorganisms and insects will be compared with other reference protein production systems (gluten, whey and soybean). On the other hand, the biofertilizers will be compared to the production of mineral fertilizers (ammonium sulphate and synthetic struvite). Therefore, the aim of this study is to provide that biowaste valorization can reduce the environmental impacts linked to both traditional proteins manufacturing processes and mineral fertilizers, not only at a pilot-scale but also at an industrial one. In the present study, both baseline system and VALUEWASTE solution are evaluated through the Environmental Life Cycle Assessment (E-LCA). The E-LCA is based on the standards ISO 14040 and 14044. The Environmental Footprint methodology was the one used in this study to evaluate the environmental impacts. The results for the baseline cases show that the food proteins coming from whey have the highest environmental impact on ecosystems compared to the other proteins sources: 7.5 and 15.9 folds higher than soybean and gluten, respectively. Comparing feed soybean and gluten, soybean has an environmental impact on human health 195.1 folds higher. In the case of biofertilizers, synthetic struvite has higher impacts than ammonium sulfate: 15.3 (ecosystems) and 11.8 (human health) fold, respectively. The results shown in the present study will be used as a reference to demonstrate the better environmental performance of the bio-based products obtained through the VALUEWASTE solution. Other originalities that the E-LCA performed in the VALUEWASTE project provides are the diverse direct implications on investment and policies. On one hand, better environmental performance will serve to remove the barriers linked to these kinds of technologies, boosting the investment that is backed by the E-LCA. On the other hand, it will be a germ to design new policies fostering these types of solutions to achieve two of the key targets of the European Community: being self-sustainable and carbon neutral.

Keywords: anaerobic digestion, biofertilizers, circular economy, nutrients recovery

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Authors: Nishimwe Clemence, Mchunu Gugu, Mukamusoni Dariya

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Background: Community health workers and extension workers can play an important role in supporting families to adopt health practices, encourage delivery in a health care facility, and ensure time referral of mothers and newborns if needed. Saving the lives of neonates should, therefore, be a significant health outcome in any maternal and newborn health program that is being implemented. Furthermore, about half of a million mothers die from pregnancy-related causes. Maternal and newborn deaths related to the period of postnatal care are neglected. Some authors emphasized that in developing countries, newborn mortality rates have been reduced much more slowly because of the lack of many necessary facility-based and outreach service. The aim of this review was to critically analyze the implementation and integration process of the maternal and newborn health care program by maternal community health workers, into the health care system, in Africa. Furthermore, it aims to reduce maternal and newborn mortality. We addressed the following review question: (1) what process is involved in the implementation and integration of the maternal and newborn health care program by maternal community health workers during antenatal, delivery and postnatal care into health system care in Africa? Methods: The database searched was from Health Source: Nursing/Academic Edition through academic search complete via EBSCO Host. An iterative approach was used to go through Google scholarly papers. The reviewers considered adapted Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidance, and the Mixed Methods Appraisal Tool (MMAT) was used. Synthesis method in integrative review following elements of noting patterns and themes, seeing plausibility, clustering, counting, making contrasts and comparisons, discerning commons and unusual patterns, subsuming particulars into general, noting relations between variability, finding intervening factors and building a logical chain of evidence, using data–based convergent synthesis design. Results: From the seventeen of studies included, results focused on three dimensions inspired by the literature on antenatal, delivery, and postnatal interventions. From this, further conceptual framework was elaborated. The conceptual framework process of implementation and integration of maternal and newborn health care program by maternal community health workers was elaborated in order to ensure the sustainability of community based intervention. Conclusions: the review revealed that the implementation and integration of maternal and newborn health care program require planning. We call upon governments, non-government organizations, the global health community, all stakeholders including policy makers, program managers, evaluators, educators, and providers to be involved in implementation and integration of maternal and newborn health program in updated policy and community-based intervention. Furthermore, emphasis should be placed on competence, responsibility, and accountability of maternal community health workers, their training and payment, collaboration with health professionals in health facilities, and reinforcement of outreach service. However, the review was limited in focus to the African context, where the process of maternal and newborn health care program has been poorly implemented.

Keywords: Africa, implementation of integration, maternal, newborn

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Authors: Fstemeh Rais Esmaili, Ehsan Ranjbar

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Pedestrian streets as one type of urban public spaces have an important role in improving the quality of urban life. In Iran, planning and designing of pedestrian streets is in its primary steps. In spite of starting this approach in Iran, and designing several pedestrian streets, there are still not organized studies about quality assessment of pedestrian streets. As a result, the strength and weakness points of the initial experiences have not been utilized. This inattention to quality assessment have caused designing pedestrian streets to be limited to just vehicles traffic control and preliminary actions like paving; so that, special potentials of pedestrian streets for creating social, livable and dynamic public spaces have not been used. This article, as an organized study about quality assessment of pedestrian streets in Iran, tries to reach two main goals: first, introducing a framework for quality assessment of pedestrian streets in Iran, and second, creating a context for improving the quality of pedestrian streets especially for further experiences. The main research methods are description and context analyzing. With respect to comparative analysis of ideas about quality, considering international and local case studies and analyzing existing condition of Saf Pedestrian Street, a particular model for quality assessment has been introduced. In this model, main components and assessment criteria have been presented. On the basis of this model, questionnaire and checklist for assessment have been prepared. The questionnaire and interview have been used to assess qualities which are in direct contact with people and the checklist has been used for analyzing visual qualities by authors through observation. Some results of questionnaire and checklist show that 7 of 11 primary components, diversity, flexibility, cleanness, legibility and imaginably, identity, livability, form and physical setting are rated low and very low in quality degree. Three components, efficiency, comfort and distinctiveness, have medium and low quality degree and one component, access, linkage and permeability has high quality degree. Therefore, based on implemented analyzing process, Saf Pedestrian Street needs to be improved and these quality improvement priorities are determined based on presented criteria. Adaption of final results with existing condition illustrates the shortage of services for satisfying user’s needs, inflexibility and impossibility of using spaces in various times, lack of facilities for different climatic conditions, lack of facilities such as drinking fountain, inappropriate designing of existing urban furniture like garbage cans, and creating pollution and unsuitable view, lack of visual attractions, neglecting disabled persons in designing entrances, shortage of benches and their undesirable designing, lack of vegetation, absence of special characters making it different from other streets, preventing people taking part in the space causing lack of affiliation, lack of appropriate elements for leisure time and lack of exhilaration in the space. On the other hand, these results present high access and permeability, high safety, less sound pollution and more relief, comfortable movement along the way due to suitable pavement and economic efficiency, as the strength points of Saf pedestrian street.

Keywords: pedestrian streets, quality assessment, quality criteria, Saf Pedestrian Street

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Authors: Li Jiuen Ong, Magdalin Cheong, Sri Rahayu, Lek Alexander, Pei Ting Tan

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Background: Previous programme evaluations from the diabetes training programme conducted in Changi General Hospital revealed that healthcare professionals (HCPs) are keen to receive advance diabetes training and education, specifically in medical, nutritional therapy. HCPs also expressed a preference for interactive activities over didactic teaching methods to enhance their learning. Since the War on Diabetes was initiated by MOH in 2016, HCPs are challenged to be actively involved in continuous education to be better equipped to reduce the growing burden of diabetes. Hence, streamlining training to incorporate an element of fun is of utmost importance. Aim: The nutrition programme incorporates game play using an interactive board game that aims to provide a more conducive and less stressful environment for learning. The board game could be adapted for training of community HCPs, health ambassadors or caregivers to cope with the increasing demand of diabetes care in the hospital and community setting. Methodology: Stages for game’s conception (Jaffe, 2001) were adopted in the development of the interactive board game ‘Sweet Score™ ’ Nutrition concepts and topics in diabetes self-management are embedded into the game elements of varying levels of difficulty (‘Easy,’ ‘Medium,’ ‘Hard’) including activities such as a) Drawing/ sculpting (Pictionary-like) b)Facts/ Knowledge (MCQs/ True or False) Word definition) c) Performing/ Charades To study the effects of game play on knowledge acquisition and perceived experiences, participants were randomised into two groups, i.e., lecture group (control) and game group (intervention), to test the difference. Results: Participants in both groups (control group, n= 14; intervention group, n= 13) attempted a pre and post workshop quiz to assess the effectiveness of knowledge acquisition. The scores were analysed using paired T-test. There was an improvement of quiz scores after attending the game play (mean difference: 4.3, SD: 2.0, P<0.001) and the lecture (mean difference: 3.4, SD: 2.1, P<0.001). However, there was no significance difference in the improvement of quiz scores between gameplay and lecture (mean difference: 0.9, 95%CI: -0.8 to 2.5, P=0.280). This suggests that gameplay may be as effective as a lecture in terms of knowledge transfer. All the13 HCPs who participated in the game rated 4 out of 5 on the likert scale for the favourable learning experience and relevance of learning to their job, whereas only 8 out of 14 HCPs in the lecture reported a high rating in both aspects. 16. Conclusion: There is no known board game currently designed for diabetes training for HCPs.Evaluative data from future training can provide insights and direction to improve the game format and cover other aspects of diabetes management such as self-care, exercise, medications and insulin management. Further testing of the board game to ensure learning objectives are met is important and can assist in the development of awell-designed digital game as an alternative training approach during the COVID-19 pandemic. Learning through gameplay increases opportunities for HCPs to bond, interact and learn through games in a relaxed social setting and potentially brings more joy to the workplace.

Keywords: active learning, game, diabetes, nutrition

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Authors: Arup Dutta, Badrul Alam, Sayed M. Wazed, Taslima Newaz, Srobonti Dutta

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Background: In today's world, with modern science and contemporary technology, a lot of diseases may be quickly identified and ruled out, but children's fever of unknown origin (FUO) still presents diagnostic difficulties in clinical settings. Any fever that reaches 38 °C and lasts for more than seven days without a known cause is now classified as a fever of unknown origin (FUO). Despite tremendous progress in the medical sector, fever of unknown origin, or FOU, persists as a major health issue and a major contributor to morbidity and mortality, particularly in children, and its spectrum is sometimes unpredictable. The etiology is influenced by geographic location, age, socioeconomic level, frequency of antibiotic resistance, and genetic vulnerability. Since there are currently no known diagnostic algorithms, doctors are forced to evaluate each patient one at a time with extreme caution. A persistent fever poses difficulties for both the patient and the doctor. This prospective observational study was carried out in a Bangladeshi tertiary care hospital from June 2018 to May 2019 with the goal of identifying the epidemiological patterns of fever of unknown origin in pediatric patients. Methods: It was a hospital-based prospective observational study carried out on 106 children (between 2 months and 12 years) with prolonged fever of >38.0 °C lasting for more than 7 days without a clear source. Children with additional chronic diseases or known immunodeficiency problems were not allowed. Clinical practices that helped determine the definitive etiology were assessed. Initial testing included a complete blood count, a routine urine examination, PBF, a chest X-ray, CRP measurement, blood cultures, serology, and additional pertinent investigations. The analysis focused mostly on the etiological results. The standard program SPSS 21 was used to analyze all of the study data. Findings: A total of 106 patients identified as having FUO were assessed, with over half (57.5%) being female and the majority (40.6%) falling within the 1 to 3-year age range. The study categorized the etiological outcomes into five groups: infections, malignancies, connective tissue conditions, miscellaneous, and undiagnosed. In the group that was being studied, infections were found to be the main cause in 44.3% of cases. Undiagnosed cases came in at 31.1%, cancers at 10.4%, other causes at 8.5%, and connective tissue disorders at 4.7%. Hepato-splenomegaly was seen in people with enteric fever, malaria, acute lymphoid leukemia, lymphoma, and hepatic abscesses, either by itself or in combination with other conditions. About 53% of people who were not diagnosed also had hepato-splenomegaly at the same time. Conclusion: Infections are the primary cause of PUO (pyrexia of unknown origin) in children, with undiagnosed cases being the second most common cause. An incremental approach is beneficial in the process of diagnosing a condition. Non-invasive examinations are used to diagnose infections and connective tissue disorders, while invasive investigations are used to diagnose cancer and other ailments. According to this study, the prevalence of undiagnosed diseases is still remarkable, so extensive historical analysis and physical examinations are necessary in order to provide a precise diagnosis.

Keywords: children, diagnostic challenges, fever of unknown origin, pediatric fever, undiagnosed diseases

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Authors: Natàlia Garcia Soler, Timothy Moss

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Despite the multiple benefits of sustainable urban drainage, as demonstrated in numerous case studies across the world, urban rainwater harvesting techniques are generally restricted to isolated model projects. The leap from niche to mainstream has, in most cities, proved an elusive goal. Why policies promoting rainwater harvesting are limited in their widespread implementation has seldom been subjected to systematic analysis. Much of the literature on the policy, planning and institutional contexts of these techniques focus either on their potential benefits or on project design, but very rarely on a critical-constructive analysis of past experiences of implementation. Moreover, the vast majority of these contributions are restricted to single-case studies. There is a dearth of knowledge with respect to, firstly, policy implementation processes and, secondly, multi-case analysis. Insights from both, the authors argue, are essential to inform more effective rainwater harvesting in cities in the future. This paper presents preliminary findings from a research project on rainwater harvesting in cities from a social science perspective that is funded by the Swedish Research Foundation (Formas). This project – UrbanRain – is examining the challenges and opportunities of mainstreaming rainwater harvesting in three European cities. The paper addresses two research questions: firstly, what lessons can be learned on suitable policy incentives and planning instruments for rainwater harvesting from a meta-analysis of the relevant international literature and, secondly, how far these lessons are reflected in a study of past and ongoing rainwater harvesting projects in a European forerunner city. This two-tier approach frames the structure of the paper. We present, first, the results of the literature analysis on policy and planning issues of urban rainwater harvesting. Here, we analyze quantitatively and qualitatively the literature of the past 15 years on this topic in terms of thematic focus, issues addressed and key findings and draw conclusions on research gaps, highlighting the need for more studies on implementation factors, actor interests, institutional adaptation and multi-level governance. In a second step we focus in on the experiences of rainwater harvesting in Berlin and present the results of a mapping exercise on a wide variety of projects implemented there over the last 30 years. Here, we develop a typology to characterize the rainwater harvesting projects in terms of policy issues (what problems and goals are targeted), project design (which kind of solutions are envisaged), project implementation (how and when they were implemented), location (whether they are in new or existing urban developments) and actors (which stakeholders are involved and how), paying particular attention to the shifting institutional framework in Berlin. Mapping and categorizing these projects is based on a combination of document analysis and expert interviews. The paper concludes by synthesizing the findings, identifying how far the goals, governance structures and instruments applied in the Berlin projects studied reflect the findings emerging from the meta-analysis of the international literature on policy and planning issues of rainwater harvesting and what implications these findings have for mainstreaming such techniques in future practice.

Keywords: institutional framework, planning, policy, project implementation, urban rainwater management

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Authors: Jessica To

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Feedback is one of the powerful levers for enhancing students’ performance. However, some students are under-engaged with feedback because they lack responsibility for feedback uptake. To resolve this conundrum, recent literature proposes feedback partnerships in which students and teachers share the power and responsibilities to co-construct feedback. During feedback co-construction, students express feedback needs to teachers, and teachers respond to individuals’ needs in return. Though this approach can increase students’ feedback ownership, its application is lagging as the field lacks conceptual clarity and implementation guide. This presentation aims to discuss the conceptual framework of feedback partnerships and feedback co-construction strategies. It identifies the components of feedback partnerships and strategies which could facilitate feedback co-construction. A systematic literature review was conducted to answer the questions. The literature search was performed using ERIC, PsycINFO, and Google Scholar with the keywords “assessment partnership”, “student as partner,” and “feedback engagement”. No time limit was set for the search. The inclusion criteria encompassed (i) student-teacher partnerships in feedback, (ii) feedback engagement in higher education, (iii) peer-reviewed publications, and (iv) English as the language of publication. Those without addressing conceptual understanding and implementation strategies were excluded. Finally, 65 publications were identified and analysed using thematic analysis. For the procedure, the texts relating to the questions were first extracted. Then, codes were assigned to summarise the ideas of the texts. Upon subsuming similar codes into themes, four themes emerged: students’ responsibilities, teachers’ responsibilities, conditions for partnerships development, and strategies. Their interrelationships were examined iteratively for framework development. Establishing feedback partnerships required different responsibilities of students and teachers during feedback co-construction. Students needed to self-evaluate performance against task criteria, identify inadequacies and communicate their needs to teachers. During feedback exchanges, they interpreted teachers’ comments, generated self-feedback through reflection, and co-developed improvement plans with teachers. Teachers had to increase students’ understanding of criteria and evaluation skills and create opportunities for students’ expression of feedback needs. In feedback dialogue, teachers responded to students’ needs and advised on the improvement plans. Feedback partnerships would be best grounded in an environment with trust and psychological safety. Four strategies could facilitate feedback co-construction. First, students’ understanding of task criteria could be increased by rubrics explanation and exemplar analysis. Second, students could sharpen evaluation skills if they participated in peer review and received teacher feedback on the quality of peer feedback. Third, provision of self-evaluation checklists and prompts and teacher modeling of self-assessment process could aid students in articulating feedback needs. Fourth, the trust could be fostered when teachers explained the benefits of feedback co-construction, showed empathy, and provided personalised comments in dialogue. Some strategies were applied in interactive cover sheets in which students performed self-evaluation and made feedback requests on a cover sheet during assignment submission, followed by teachers’ response to individuals’ requests. The significance of this presentation lies in unpacking the conceptual framework of feedback partnerships and outlining feedback co-construction strategies. With a solid foundation in theory and practice, researchers and teachers could better enhance students’ engagement with feedback.

Keywords: conceptual framework, feedback co-construction, feedback partnerships, implementation strategies

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Authors: B. S. Premalatha, Mereen Rose Babu, Vaishali Prabhu

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Background: Dysphagia must be assessed, either subjectively or objectively, in order to properly address the swallowing difficulty. Providing therapeutic care to patients with dysphagia via tele mode was one approach for providing clinical services during the COVID-19 epidemic. As a result, the teleassessment of dysphagia has increased in India. Aim: This study aimed to identify challenges faced by Indian SLPs while providing teleassessment to individuals with dysphagia during the outbreak of COVID-19 from 2020 to 2021. Method: After receiving approval from the institute's institutional review board and ethics committee, the current study was carried out. The study was cross-sectional in nature and lasted from 2020 to 2021. The study enrolled participants who met the inclusion and exclusion criteria of the study. It was decided to recruit roughly 246 people based on the sample size calculations. The research was done in three stages: questionnaire development and content validation, questionnaire administration. Five speech and hearing professionals' content verified the questionnaire for faults and clarity. Participants received questionnaires via various social media platforms such as e-mail and WhatsApp, which were written in Microsoft Word and then converted to Google Forms. SPSS software was used to examine the data. Results: In light of the obstacles that Indian SLPs encounter, the study's findings were examined. Only 135 people responded. During the COVID-19 lockdowns, 38% of participants said they did not deal with dysphagia patients. After the lockout, 70.4% of SLPs kept working with dysphagia patients, while 29.6% did not. From the beginning of the oromotor examination, the main problems in completing tele evaluation of dysphagia have been highlighted. Around 37.5% of SLPs said they don't undertake the OPME online because of difficulties doing the evaluation, such as the need for repeated instructions from patients and family members and trouble visualizing structures in various positions. The majority of SLPs' online assessments were inefficient and time-consuming. A bigger percentage of SLPs stated that they will not advocate tele evaluation in dysphagia to their colleagues. SLPs' use of dysphagia assessment has decreased as a result of the epidemic. When it came to the amount of food, the majority of people proposed a small amount. Apart from placing the patient for assessment and gaining less cooperation from the family, most SLPs found that Internet speed was a source of concern and a barrier. Hearing impairment and the presence of a tracheostomy in patients with dysphagia proved to be the most difficult conditions to treat online. For patients with NPO, the majority of SLPs did not advise tele-evaluation. In the anterior region of the oral cavity, oral meal residue was more visible. The majority of SLPs reported more anterior than posterior leakage. Even while the majority of SLPs could detect aspiration by coughing, many found it difficult to discern the gurgling tone of speech after swallowing. Conclusion: The current study sheds light on the difficulties that Indian SLPs experience when assessing dysphagia via tele mode, indicating that tele-assessment of dysphagia is still to gain importance in India.

Keywords: dysphagia, teleassessment, challenges, Indian SLP

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Authors: Jo Mitchell, Daniel Johnson

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MindMax is a digital community and learning platform built to maximise the wellbeing and resilience of AFL Players and Australian men. The MindMax application engages men, via their existing connection with sport and video games, in a range of wellbeing ideas, stories and actions, because we believe fit minds, kick goals. MindMax is an AFL Players Association led project, supported by a Movember Foundation grant, to improve the mental health of Australian males aged between 16-35 years. The key engagement and delivery strategy for the project was digital technology, sport (AFL) and video games, underpinned by evidenced based wellbeing science. The project commenced April 2015, and the expected completion date is March 2017. This paper describes the conceptual model underpinning product development, including progress, key learnings and challenges, as well as the research agenda. Evaluation of the MindMax project is a multi-pronged approach of qualitative and quantitative methods, including participatory design workshops, online reference groups, longitudinal survey methods, a naturalistic efficacy trial and evaluation of the social and economic return on investment. MindMax is focused on the wellness pathway and maximising our mind's capacity for fitness by sharing and promoting evidence-based actions that support this. A range of these ideas (from ACT, mindfulness and positive psychology) are already being implemented in AFL programs and services, mostly in face-to-face formats, with strong engagement by players. Player's experience features strongly as part of the product content. Wellbeing science is a discipline of psychology that explores what helps individuals and communities to flourish in life. Rather than ask questions about illness and poor functioning, wellbeing scientists and practitioners ask questions about wellness and optimal functioning. While illness and wellness are related, they operate as separate constructs and as such can be influenced through different pathways. The essential idea was to take the evidence-based wellbeing science around building psychological fitness to the places and spaces that men already frequent, namely sport and video games. There are 800 current senior AFL players, 5000+ past players, and 11 million boys and men that are interested in the lives of AFL Players; what they think and do to be their best both on and off field. AFL Players are also keen video gamers – using games as one way to de-stress, connect and build wellbeing. There are 9.5 million active gamers in Australia with 93% of households having a device for playing games. Video games in MindMax will be used as an engagement and learning tool. Gamers (including AFL players) can also share their personal experience of how games help build their mental fitness. Currently available games (i.e., we are not in the game creation business) will also be used to motivate and connect MindMax participants. The MindMax model is built with replication by other sport codes (e.g., Cricket) in mind. It is intended to not only support our current crop of athletes but also the community that surrounds them, so they can maximise their capacity for health and wellbeing.

Keywords: Australian football league, digital application, positive psychology, wellbeing

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Authors: Tim Vollmer, Andrea Greven, Malte Brettel

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Family firms represent the predominant business structure worldwide, accounting for 90 percent of all operational businesses. These firms are essential to society and the economy. In the past decade, family firm exits increased by 72%; and in the next five years, 95,000 German family firms will be sold, acquired, or liquidated. For family firms, socioemotional wealth represents the frame of reference and value to preserve when making decisions. Family firm exits threaten the socioemotional wealth, as in extreme scenarios, economic logic may take over. So, a dilemma arises: Maintaining socioemotional wealth versus pursuing financial wealth. Family firm researchers agree that family involvement leads to specific goals, behaviors, and outcomes. For instance, the desire to protect socioemotional wealth when selling the firm and the focus on particular exit success dimensions, depending on the family's role inside the firm. However, despite the regularity of family firm exits, there is little research on the effect of family involvement on the family firm CEOs' perceived exit performance. We investigate the family firm CEOs' perceived exit performance, which we call exit success. Considering the deficiencies in the literature, we identify two research gaps. First, it remains unclear how family involvement affects the dimensions of exit success. Hence, we provide evidence of which success dimensions matter most depending on the family's involvement and how to differentiate successful from unsuccessful exits. Second, prior work has analyzed family involvement in the socioemotional wealth context but found contradictory findings. This work considers, for example, the family generation in control and identifies the tipping point of economic objectives becoming preferable over socioemotional wealth-related goals. This paper theorizes and empirically investigates, through the lens of socioemotional wealth and conflict theory, how socioemotional wealth mediates the relationship between family involvement and family firms' exit success. We analyze family firms' exit success dimensions of personal financial benefits, personal reputation, employee benefits, and firm mission persistence. Family involvement considers the family firms' heterogeneity in ownership, management, and generation. We use a quantitative approach in the form of an online survey by drawing on 116 responses from former family firm CEOs'. This study highlights that socioemotional wealth mediates the relationship between the dimensions of family involvement and exit success. The greater socioemotional wealth, the greater the family firm CEOs focus on the pro-organizational exit success dimensions of employee benefits and firm mission persistence. In contrast, the self-regarding dimension of personal financial benefits is significantly negatively affected. An important finding is that later generations and the number of family managers involved significantly negatively affect the two pro-organizational dimensions of exit success. Family ownership does not show any significant effect. Our work widens implications for research, theory, and practice by contributing in two meaningful ways. First, our results offer insights to differentiate successful from unsuccessful family firm exits and provide evidence of which success dimensions matter and which to focus on, most dependent on the family's role inside the firm. Second, our article advances research and empirical understanding of family firms and socioemotional wealth by clarifying contradictory findings.

Keywords: exit success, family firm exit, perceived exit performance, socioemotional wealth

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Authors: Antonio Boggia, Luisa Paolotti, Gianluca Massei, Lucia Rocchi, Elaine Pace, Maria Attard

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The aim of this paper is to present a methodology and a computer model for sustainability assessment based on the integration of Multi-criteria Decision Analysis (MCDA) with a Geographic Information System (GIS). It presents the result of a study for the implementation of a model for measuring sustainability to address the policy actions for the improvement of sustainability at territory level. The aim is to rank areas in order to understand the specific technical and/or financial support that is required to develop sustainable growth. Assessing sustainable development is a multidimensional problem: economic, social and environmental aspects have to be taken into account at the same time. The tool for a multidimensional representation is a proper set of indicators. The set of indicators must be integrated into a model, that is an assessment methodology, to be used for measuring sustainability. The model, developed by the Environmental Laboratory of the University of Perugia, is called GeoUmbriaSUIT. It is a calculation procedure developed as a plugin working in the open-source GIS software QuantumGIS. The multi-criteria method used within GeoUmbriaSUIT is the algorithm TOPSIS (Technique for Order Preference by Similarity to Ideal Design), which defines a ranking based on the distance from the worst point and the closeness to an ideal point, for each of the criteria used. For the sustainability assessment procedure, GeoUmbriaSUIT uses a geographic vector file where the graphic data represent the study area and the single evaluation units within it (the alternatives, e.g. the regions of a country, or the municipalities of a region), while the alphanumeric data (attribute table), describe the environmental, economic and social aspects related to the evaluation units by means of a set of indicators (criteria). The use of the algorithm available in the plugin allows to treat individually the indicators representing the three dimensions of sustainability, and to compute three different indices: environmental index, economic index and social index. The graphic output of the model allows for an integrated assessment of the three dimensions, avoiding aggregation. The presence of separate indices and graphic output make GeoUmbriaSUIT a readable and transparent tool, since it doesn’t produce an aggregate index of sustainability as final result of the calculations, which is often cryptic and difficult to interpret. In addition, it is possible to develop a “back analysis”, able to explain the positions obtained by the alternatives in the ranking, based on the criteria used. The case study presented is an assessment of the level of sustainability in the six regions of Malta, an island state in the middle of the Mediterranean Sea and the southernmost member of the European Union. The results show that the integration of MCDA-GIS is an adequate approach for sustainability assessment. In particular, the implemented model is able to provide easy to understand results. This is a very important condition for a sound decision support tool, since most of the time decision makers are not experts and need understandable output. In addition, the evaluation path is traceable and transparent.

Keywords: GIS, multi-criteria analysis, sustainability assessment, sustainable development

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Authors: Mayank Gupta, Siba Prasad Samal, Vasu Kakkirala

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The internet world and its priorities have changed considerably in the last decade. Browsing on smart phones has increased manifold and is set to explode much more. Users spent considerable time browsing different websites, that gives a great deal of insight into user’s preferences. Instead of plain information classifying different aspects of browsing like Bookmarks, History, and Download Manager into useful categories would improve and enhance the user’s experience. Most of the classification solutions are server side that involves maintaining server and other heavy resources. It has security constraints and maybe misses on contextual data during classification. On device, classification solves many such problems, but the challenge is to achieve accuracy on classification with resource constraints. This on device classification can be much more useful in personalization, reducing dependency on cloud connectivity and better privacy/security. This approach provides more relevant results as compared to current standalone solutions because it uses content rendered by browser which is customized by the content provider based on user’s profile. This paper proposes a Naive Bayes based lightweight classification engine targeted for a resource constraint devices. Our solution integrates with Web Browser that in turn triggers classification algorithm. Whenever a user browses a webpage, this solution extracts DOM Tree data from the browser’s rendering engine. This DOM data is a dynamic, contextual and secure data that can’t be replicated. This proposal extracts different features of the webpage that runs on an algorithm to classify into multiple categories. Naive Bayes based engine is chosen in this solution for its inherent advantages in using limited resources compared to other classification algorithms like Support Vector Machine, Neural Networks, etc. Naive Bayes classification requires small memory footprint and less computation suitable for smartphone environment. This solution has a feature to partition the model into multiple chunks that in turn will facilitate less usage of memory instead of loading a complete model. Classification of the webpages done through integrated engine is faster, more relevant and energy efficient than other standalone on device solution. This classification engine has been tested on Samsung Z3 Tizen hardware. The Engine is integrated into Tizen Browser that uses Chromium Rendering Engine. For this solution, extensive dataset is sourced from dmoztools.net and cleaned. This cleaned dataset has 227.5K webpages which are divided into 8 generic categories ('education', 'games', 'health', 'entertainment', 'news', 'shopping', 'sports', 'travel'). Our browser integrated solution has resulted in 15% less memory usage (due to partition method) and 24% less power consumption in comparison with standalone solution. This solution considered 70% of the dataset for training the data model and the rest 30% dataset for testing. An average accuracy of ~96.3% is achieved across the above mentioned 8 categories. This engine can be further extended for suggesting Dynamic tags and using the classification for differential uses cases to enhance browsing experience.

Keywords: chromium, lightweight engine, mobile computing, Naive Bayes, Tizen, web browser, webpage classification

Procedia PDF Downloads 163

Authors: Kyoungrean Kim

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Importance of deep-sea mineral resources is dramatically increasing due to the depletion of land mineral resources corresponding to increasing human’s economic activities. Korea has acquired exclusive exploration licenses at four areas which are the Clarion-Clipperton Fracture Zone in the Pacific Ocean (2002), Tonga (2008), Fiji (2011) and Indian Ocean (2014). The preparation for commercial mining of Nautilus minerals (Canada) and Lockheed martin minerals (USA) is expected by 2020. The London Protocol 1996 (LP) under International Maritime Organization (IMO) and International Seabed Authority (ISA) will set environmental guidelines for deep-sea mining until 2020, to protect marine environment. In this research, the applicability of washing/extraction treatment for the remediation of deep-sea mining tailings was mainly evaluated in order to present preliminary data to develop practical remediation technology in near future. Polymetallic nodule samples were collected at the Clarion-Clipperton Fracture Zone in the Pacific Ocean, then stored at room temperature. Samples were pulverized by using jaw crusher and ball mill then, classified into 3 particle sizes (> 63 µm, 63-20 µm, < 20 µm) by using vibratory sieve shakers (Analysette 3 Pro, Fritsch, Germany) with 63 µm and 20 µm sieve. Only the particle size 63-20 µm was used as the samples for investigation considering the lower limit of ore dressing process which is tens to 100 µm. Rhamnolipid and sodium alginate as biosurfactant and aluminum sulfate which are mainly used as flocculant were used as environmentally friendly additives. Samples were adjusted to 2% liquid with deionized water then mixed with various concentrations of additives. The mixture was stirred with a magnetic bar during specific reaction times and then the liquid phase was separated by a centrifugal separator (Thermo Fisher Scientific, USA) under 4,000 rpm for 1 h. The separated liquid was filtered with a syringe and acrylic-based filter (0.45 µm). The extracted heavy metals in the filtered liquid were then determined using a UV-Vis spectrometer (DR-5000, Hach, USA) and a heat block (DBR 200, Hach, USA) followed by US EPA methods (8506, 8009, 10217 and 10220). Polymetallic nodule was mainly composed of manganese (27%), iron (8%), nickel (1.4%), cupper (1.3 %), cobalt (1.3%) and molybdenum (0.04%). Based on remediation standards of various countries, Nickel (Ni), Copper (Cu), Cadmium (Cd) and Zinc (Zn) were selected as primary target materials. Throughout this research, the use of rhamnolipid was shown to be an effective approach for removing heavy metals in samples originated from manganese nodules. Sodium alginate might also be one of the effective additives for the remediation of deep-sea mining tailings such as polymetallic nodules. Compare to the use of rhamnolipid and sodium alginate, aluminum sulfate was more effective additive at short reaction time within 4 h. Based on these results, sequencing particle separation, selective extraction/washing, advanced filtration of liquid phase, water treatment without dewatering and solidification/stabilization may be considered as candidate technologies for the remediation of deep-sea mining tailings.

Keywords: deep-sea mining tailings, heavy metals, remediation, extraction, additives

Procedia PDF Downloads 155

Authors: Marie Boost

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Despite activation policies, forced personal initiative to step out of unemployment and a general prosper economic situation, poverty and financial hardship constitute a crucial role in the daily lives of many families in Germany. In 2015, ~16 million persons (20.2%) of the German population are at risk of poverty or social exclusion. This is illustrated by an unemployment rate of 13.3% in the research area, located in East Germany. Despite this high amount of persons living in vulnerable households, we know little about how they manage to stabilize their lives or even overcome poverty – apart from solely relying on welfare state benefits or entering in a stable, well-paid job. Most of them are struggling in precarious living circumstances, switching from one or several short-term, low-paid jobs into self-employment or unemployment, sometimes accompanied by welfare state benefits. Hence, insecurity and uncertain future expectation form a crucial part of their lives. Within the EU-funded project “RESCuE”, resilient practices of vulnerable households were investigated in nine European countries. Approximately, 15 expert interviews with policy makers, representatives from welfare state agencies, NGOs and charity organizations and 25 household interviews have been conducted within each country. It aims to find out more about the chances and conditions of social resilience. The research is based on the triangulation of biographical narrative interviews, followed by participatory photo interviews, asking the household members to portray their typical everyday life. The presentation is focusing on the explanatory strength of this mixed-methods approach in order to show the potential of household practices to overcome financial hardship. The methodological combination allows an in-depth analysis of the families and households everyday living circumstances, including their poverty and employment situation, whether formal and informal. Active household budgeting practices, such as saving and consumption practices are based on subsistence or Do-It-Yourself work. Especially due to the photo-interviews, the importance of inherent cultural and tacit knowledge becomes obvious as it pictures their typical practices, like cultivation and gathering fruits and vegetables or going fishing. One of the central findings is the multiple purposes of these practices. They contribute to ease financial burden through consumption reduction and strengthen social ties, as they are mostly conducted with close friends or family members. In general, non-commodified practices are found to be re-commodified and to contribute to ease financial hardship, e.g. by the use of commons, barter trade or simple mutual exchange (gift exchange). These practices can substitute external purchases and reduce expenses or even generate a small income. Mixing different income sources are found to be the most likely way out of poverty within the context of a precarious labor market. But these resilient household practices take its toll as they are highly preconditioned, and many persons put themselves into risk of overstressing themselves. Thus, the potentials and risks of resilient household practices are reflected in the presentation.

Keywords: consumption practices, labor market, qualitative research, resilience

Procedia PDF Downloads 221

Authors: Lazzat M. Zhamaliyeva, Nurgul A. Abenova, Gauhar S. Dilmagambetova, Ziyash Zh. Tanbetova, Moldir B. Ahmetzhanova, Tatyana P. Ostretcova, Aliya A. Yegemberdiyeva

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Introduction: There are many reasons for the weak training of family doctors in Kazakhstan: the unified national educational program is not focused on competencies, the role of a general practitioner (GP) is not clear, poor funding for the health care and education system, outdated teaching and assessment methods, inefficient management. We highlight two issues in particular. Firstly, academic teachers of family medicine (FM) in Kazakhstan do not practice as family doctors; most of them are narrow specialists (pediatricians, therapists, surgeons, etc.); they usually hold one-time consultations; clinical mentors from practical healthcare (non-academic teachers) do not have the teaching competences, and the vast majority of them are also narrow specialists. Secondly, clinical sites (polyclinics) are unprepared for general practice and do not follow the principles of family medicine; residents do not like to be in primary health care (PHC) settings due to the chaos that is happening there, as well as due to the lack of the necessary equipment for mastering and consolidating practical skills. Aim: We present the concept of the family physicians’ training office (FPTO), which is being created as a friendly learning environment for young general practitioners and for the involvement of academic teachers of family medicine in the practical work and innovative development of PHC. Methodology: In developing the conceptual framework and identifying practical activities, we drew on literature and expert input, and interviews. Results: The goal of the FPTO is to create a favorable educational and clinical environment for the development of the FM residents’ competencies, in which the residents with academic teachers and clinical mentors could understand and accept the principles of family medicine, improve clinical knowledge and skills, and gain experience in improving the quality of their practice in scientific basis. Three main areas of office activity are providing primary care to the patients, improving educational services for FM residents and other medical workers, and promoting research in PHC and innovations. The office arranges for residents to see outpatients at least 50% of the time, and teachers of FM departments at least 1/4 of their working time conduct general medical appointments next to residents. Taking into account the educational and scientific workload, the number of attached population for one GP does not exceed 500 persons. The equipment of the office allows FPTO workers to perform invasive and other manipulations without being sent to other clinics. In the office, training for residents is focused on their needs and aimed at achieving the required level of competence. International methodologies and assessment tools are adapted to local conditions and evaluated for their effectiveness and acceptability. Residents and their faculty actively conduct research in the field of family medicine. Conclusions: We propose to change the learning environment in order to create teams of like-minded people, to unite residents and teachers even more for the development of family medicine. The offices will also invest resources in developing and maintaining young doctors' interest in family medicine.

Keywords: educational environment, family medicine residents, family physicians’ training office, primary care research

Procedia PDF Downloads 134

Authors: Betelhem M. Negede, Maarten Voors, Hugo De Groote, Bart Minten

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Farmers in Ethiopia produce most of their own food during one agricultural season per year. Therefore, they need to use on-farm storage technologies to bridge the lean season and benefit from price arbitrage. Maize stored using traditional storage bags offer no protection from insects and molds, leading to high storage losses. In Ethiopia access to and use of modern storage technologies are still limited, restraining farmers to benefit from local maize price fluctuations. We used a randomized controlled trial among 871 maize farmers to evaluate the impacts of Purdue Improved Crop Storage (PICS) bags, also known as hermetic bags, on storage losses, and especially on behavioral changes with respect to consumption, marketing, and income among maize farmers in Ethiopia. This study builds upon the limited previous experimental research that has tried to understand farmers’ grain storage and post-harvest losses and identify mechanisms behind the persistence of these challenges. Our main hypothesis is that access to PICS bags allows farmers to increase production, storage and maize income. Also delay the length of maize storage, reduce maize post-harvest losses and improve their food security. Our results show that even though farmers received only three PICS bags that represent 10percent of their total maize stored, they delay their length of maize storage for sales by two weeks. However, we find no treatment effect on maize income, suggesting that the arbitrage of two weeks is too small. Also, we do not find any reduction in storage losses due to farmers’ reaction by selling early and by using cheap and readily available but potentially harmful storage chemicals. Looking at the heterogeneity treatment effects between the treatment variable and highland and lowland villages, we find a decrease in the percentage of maize stored by 4 percent in the highland villages. This confirms that location specific factors, such as agro-ecology and proximity to markets are important factors that influence whether and how much of the harvest a farmer stores. These findings highlight the benefits of hermetic storage bags, by allowing farmers to make inter-temporal arbitrage and by reducing potential health risks from storage chemicals. The main policy recommendation that emanates from our study is that postharvest losses reduction throughout the whole value chain is an important pathway to food and income security in Sub-Saharan Africa (SSA). However, future storage loss interventions with hermetic storage technologies should take into account the agro-ecology of the study area and quantify storage losses beyond farmers self-reported losses, such as the count and weigh method. Finally, studies on hermetic storage technologies indicate positive impacts on post-harvest losses and in improving food security, but the adoption and use of these technologies is currently still low in SSA. Therefore, future works on the scaling up of hermetic bags, should consider reasons why farmers only use PICS bags to store grains for consumption, which is usually related to a safety-first approach or due to lack of incentives (higher price from maize not treated with chemicals), and no grain quality check.

Keywords: arbitrage, PICS hermetic bags, post-harvest storage loss, RCT

Procedia PDF Downloads 136