Search results for: interventions

Authors: Ramin Mehdiabadi

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Background: Breast cancer remains the most prevalent cancer diagnosis and the leading cause of cancer death among women globally, representing 11.7% of new cases and 6.9% of deaths. While the incidence and mortality of major cancers are declining in developed regions like the United States and Western Europe, underdeveloped and developing countries exhibit an increasing trend, attributed to lifestyle factors such as smoking, physical inactivity, and high-calorie diets. Objective: This study explores the intricate relationship between the mammalian transcription factor forkhead box (FoxM1) and the microRNA miR-216b-5p in various subtypes of breast cancer, aiming to deepen the understanding of their roles in tumorigenesis, metastasis, and drug resistance. Methods: Breast cancer subtypes were categorized based on key biomarkers: estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2. These include luminal A, luminal B, HER2 enriched, triple-negative, and normal-like subtypes. We focused on analyzing the expression levels of FoxM1 and miR-216b-5p, given the known role of FoxM1 in cell proliferation and its implications in cancer pathologies such as lung, gastric, and breast cancers. Concurrently, miR-216b-5p's function as a tumor suppressor was evaluated to ascertain its regulatory effects on FoxM1. Results: Preliminary data indicate a nuanced interplay between FoxM1 and miR-216b-5p, suggesting a potential inverse relationship that varies across breast cancer subtypes. This relationship underscores the dual role of these biomarkers in modulating cancer progression and response to treatments. Conclusion: The findings advocate for the potential of miR-216b-5p to serve as a prognostic biomarker and a therapeutic target, particularly in subtypes where FoxM1 is prominently expressed. Understanding these molecular interactions provides crucial insights into the personalized treatment strategies and could lead to more effective therapeutic interventions in breast cancer management. Implications: The study highlights the importance of molecular profiling in breast cancer treatment and emphasizes the need for targeted therapeutic approaches in managing diverse cancer subtypes, particularly in varying global contexts where lifestyle factors significantly impact cancer dynamics.

Keywords: breast cancer, gene expression, FoxM1, microRNA

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Authors: Tamara Vagg, Cathy Shortt, Claire Hickey, Joseph A. Eustace, Barry J. Plant, Sabin Tabirca

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Introduction: Paper-based patient passports have been used advantageously for older patients, patients with diabetes, and patients with learning difficulties. However, these passports can experience issues with data security, patients forgetting to bring the passport, patients being over encumbered, and uncertainty with who is responsible for entering and managing data in this passport. These issues could be resolved by transferring the paper-based system to a convenient platform such as a smartphone application (app). Background: Life expectancy for some Cystic Fibrosis (CF) patients are rising and as such new complications and procedures are predicted. Subsequently, there is a need for education and management interventions that can benefit CF adults. This research proposes a CF patient passport to record basic medical information through a smartphone app which will allow CF adults access to their basic medical information. Aim: To provide CF patients with their basic medical information via mobile multimedia so that they can receive care when traveling abroad or between CF centres. Moreover, by recording their basic medical information, CF patients may become more aware of their own condition and more active in their health care. Methods: This app is designed by a CF multidisciplinary team to be a lightweight reflection of a hospital patient file. The passport app is created using PhoneGap so that it can be deployed for both Android and iOS devices. Data entered into the app is encrypted and stored locally only. The app is password protected and includes the ability to set reminders and a graph to visualise weight and lung function over time. The app is introduced to seven participants as part of a stress test. The participants are asked to test the performance and usability of the app and report any issues identified. Results: Feedback and suggestions received via this testing include the ability to reorder the list of clinical appointments via date, an open format of recording dates (in the event specifics are unknown), and a drop down menu for data which is difficult to enter (such as bugs found in mucus). The app is found to be usable and accessible and is now being prepared for a pilot study with adult CF patients. Conclusions: It is anticipated that such an app will be beneficial to CF adult patients when travelling abroad and between CF centres.

Keywords: Cystic Fibrosis, digital patient passport, mHealth, self management

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Authors: Andrea Zielke-Nadkarni

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Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: pain management, migrants, sociocultural context, palliative care

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Authors: Raphael Udeh, Luis García De Guadiana Romualdo, Xenia Dolje-Gore

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Background: Quite disturbing is the huge public health impact of COVID-19: As at today [25th March 2021, the COVID-19 global burden shows over 123 million cases and over 2.7 million deaths worldwide. Rationale: Recent evidence shows calprotectin’s potential as a therapeutic target, stating that tasquinimod, from the Quinoline-3-Carboxamide family is capable of blocking the interaction between calprotectin and TLR4. Hence preventing the cytokine release syndrome, that heralds the functional exhaustion in COVID-19. Early preclinical studies showed that tasquinimod inhibit tumor growth and prevent angiogenesis/cytokine storm. Phase I – III clinical studies in prostate cancer showed it has a good safety profile with good radiologic progression free survival but no effect on overall survival. Rationale/hypothesis: Strategic endeavors have been amplified globally to assess new therapeutic interventions for COVID-19 management – thus the clinical and antiviral efficacy of tasquinimod in COVID-19 remains to be explored. Hence the primary objective of this trial will be to evaluate the efficacy of tasquinimod in the treatment of adult patients with severe COVID-19 infections. Therefore, I hypothesise that among adults with COVID19 infection, tasquinimod will reduce the severe respiratory distress associated with COVID-19 compared to placebo, over a 28-day study period. Method: The setting is in Europe. Design – a randomized, placebo-controlled, phase II double-blinded trial. Trial lasts for 28 days from randomization, Tasquinimod capsule given as 0.5mg daily 1st fortnight, then 1mg daily 2nd fortnight. I0 outcome - assessed using six-point ordinal scale alongside eight 20 outcomes. 125 participants to be enrolled, data collection at baseline and subsequent data points, and safety reporting monitored via serological profile. Significance: This work could potentially establish tasquinimod as an effective and safe therapeutic agent for COVID-19 by reducing the severe respiratory distress, related time to recovery, time on oxygen/admission. It will also drive future research – as in larger multi-centre RCT.

Keywords: Calprotectin, COVID-19, Phase II Trial, Tasquinimod

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Authors: Parisa Gharibi Khoshkar

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The global outbreak of Covid-19 forced a swift shift in the education sector, transitioning from traditional in-person settings to remote online setups in a short period. This abrupt change, coupled with health risks and other stressors such as the lack of social interaction, has had a negative impact on academic staff, leading to increased job-related stress and psychological pressures that can result in burnout. To address this, the current research aims to investigate the relationship between job stress and burnout among academic staff in Hebron, Palestine. Furthermore, this study examines the moderating role of emotional intelligence to gain a deeper understanding of its effects in reducing burnout among academic staff and teachers. This research posits that emotional intelligence plays a vital role in helping individuals manage job-related stress and anxiety, thereby preventing burnout. Using a self-administered questionnaire, the study gathered data from 185 samples comprising teachers and administrative staff from two universities in Hebron. The data was analyzed using moderated regression analysis, ANOVA model, and interaction plots. The findings indicate that work-related stress has a direct and significant influence on burnout. Moreover, the current results highlight that emotional intelligence serves as a key determinant in managing the negative effects of the pandemic-induced stress that can lead to burnout among individuals. Given the high-demand nature of the education sector, this research strongly recommends that school authorities take proactive measures to provide much-needed support to academic staff, enabling them to better cope with job stress and fostering an environment that prioritizes individuals' wellbeing. The results of this study hold practical implications for both scholars and practitioners, as they highlight the importance of emotional intelligence in managing stress and anxiety effectively. Understanding the significance of emotional intelligence can aid in implementing targeted interventions and support systems to promote the well-being and resilience of academic staff amidst challenging circumstances.

Keywords: job stress, burnout, employee wellbeing, emotional intelligence, industrial organizational psychology, human resource management, organizational psychology

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Authors: Razieh Rezabeigi Sani, Alireza Farahani, Mahdi Haghi

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Displacement, local discontent, and forced exclusion have become prominent parts of urban regeneration activities in the Global North and South. This paper discusses the processes of massive displacement and neighborhood alteration as the consequences of a large-scale political/ideological placemaking project in central Tehran that transformed people's daily lives in surrounding neighborhoods. The conversion of Imam Hussein Square and connecting 17-Shahrivar Street to a pedestrian plaza in 2016 resulted in adjacent neighborhoods' physical, social, and economic degradation. The project has downgraded the economic and social characteristics of urban life in surrounding neighborhoods, commercialized residential land uses, displaced local people and businesses, and created unprecedented housing modes. This research has been conducted in two stages; first, after the project's implementation between 2017-2018, and second, when the street was reopened after local protests in 2021. In the first phase, 50+ on-site interviews were organized with planners, managers, and dwellers about the decision-making processes, design, and project implementation. We find that the project was based on the immediate political objectives and top-down power exertion of the local government in creating exclusive spaces (for religious ceremonies) without considering locals' knowledge, preferences, lifestyles, and everyday interactions. In the continued research in 2021, we utilized data gathered in facilitation activities and several meetings and interviews with local inhabitants and businesses to explore, design, and implement initiatives for bottom-up planning in these neighborhoods. The top-down and product-oriented (rather than process-oriented) planning, dependency on municipal financing rather than local partnerships, and lack of public participation proved to have continued effects on local participation. The paper concludes that urban regeneration projects must be based on the participation of different private/public actors, sustainable financial resources, and overall social and spatial analysis of the peripheral area before interventions.

Keywords: displacement, urban regeneration, distressed neighborhoods, ideological placemaking, Tehran

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Authors: Caroline Selai, Sushrut Jadhav

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Background: University College London (UCL), the first secular university in England to admit students regardless of their religion and gender, has nearly 29,000 students of which approximately 30% are international students. The UCL Cultural Consultation Service (CCS) for staff and students is a unique service that provides assistance to staff and students experiencing challenges in their teaching, enabling, support work or studies which they believe may have a cultural component. The service provides one-to-one and group consultations, lectures, seminars, ‘grand rounds’, interactive workshops and bespoke interventions. Data: This paper presents a content analysis of CCS referrals over the last 36 months. We focus on the experience of international students, many of whom experience not only a challenge to their academic identity but also a profound challenge to their personal cultural identity. We also present 3 vignettes to illustrate how students interpret, accept, contest and resist changes in their cultural and academic identity. Discussion: This paper highlights (i) how students from collectivist cultures attempt to assimilate within an individualistic, highly competitive western university that is bound by its own institutional norms; (ii) problems in negotiating challenges at the interface of culture and gender (iii) the impact of culturally different hierarchies of power, discrimination and authority and (iv) the significance of earlier traumatic and kinship conflicts. Many international students’ social identities are shaped by their cultural and family scripts. A large number have been taught that their teachers are to be revered and their teachings unchallenged. This is at odds with quintessential goal of the western university to encourage healthy scepticism and hone students’ critical thinking skills. Conclusions: Pupil-teacher ‘cultural transference’ and shifts in cultural academic identities of students underscore critical aspects of developmental and learning challenges for students. Staff-student cultural conflict requires a broader, systemic analysis of students, staff and the wider organisation. Our findings challenge Eurocentric psychodynamic concepts such as the nature of parent-child relationship in Western Europe. We argue for a broader, more inclusive approach to develop both effective pedagogic skills in euro-american academic institutions and culturally- appropriate psychodynamic theory to underpin counselling international students.

Keywords: academic identity, cultural transference, cultural consultation in higher education, cultural formulation, cultural identity.

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Authors: Govind Kumar

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The concept of ‘e-governance’ that was brought about by the new wave of reforms, namely ‘LPG’ in the early 1990s, has been enabling governments across the globe to digitally transform themselves. Digital transformation is leading the governments with qualitative decisions, optimization in rational use of resources, facilitation of cost-benefit analyses, and elimination of redundancy and corruption with the help of ICT-based applications interface. ICT-based applications/technologies have enormous potential for impacting positive change in the social lives of the global citizenry. Supercomputers test and analyze millions of drug molecules for developing candidate vaccines to combat the global pandemic. Further, e-commerce portals help distribute and supply household items and medicines, while videoconferencing tools provide a visual interface between the clients and hosts. Besides, crop yields are being maximized with the help of drones and machine learning, whereas satellite data, artificial intelligence, and cloud computing help governments with the detection of illegal mining, tackling deforestation, and managing freshwater resources. Such e-applications have the potential to take governance an extra mile by achieving 5 Es (effective, efficient, easy, empower, and equity) of e-governance and six Rs (reduce, reuse, recycle, recover, redesign and remanufacture) of sustainable development. If such digital transformation gains traction within the government framework, it will replace the traditional administration with the digitalization of public administration. On the other hand, it has brought in a new set of challenges, like the digital divide, e-illiteracy, technological divide, etc., and problems like handling e-waste, technological obsolescence, cyber terrorism, e-fraud, hacking, phishing, etc. before the governments. Therefore, it would be essential to bring in a rightful mixture of technological and humanistic interventions for addressing the above issues. This is on account of the reason that technology lacks an emotional quotient, and the administration does not work like technology. Both are self-effacing unless a blend of technology and a humane face are brought in into the administration. The paper will empirically analyze the significance of the technological framework of digital transformation within the government set up for the digitalization of public administration on the basis of the synthesis of two case studies undertaken from two diverse fields of administration and present a future framework of the study.

Keywords: digital transformation, electronic governance, public administration, knowledge framework

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Authors: Elham Azimzadeh, Fahimeh Khorshidi, Alireza Farsi

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Balance impairment and fear of falling in older adults may reduce their quality of life. Reactive balance training could improve rapid postural responses and fall prevention in the elderly during daily tasks. Performing postural training and simultaneously cognitive dual tasks could be similar to the daily circumstances. Purpose: This study aimed to determine the effect of balance training on stable and unstable surfaces under dual cognitive task conditions on postural control and fear of falling in the elderly. Methods: Thirty non-fallers of older adults (65-75 years) were randomly assigned to two training groups: stable-surface (n=10), unstable-surface (n=10), or a control group (n=10). The intervention groups underwent six weeks of balance training either on a stable (balance board) or an unstable (wobble board) surface while performing a cognitive dual task. The control group received no balance intervention. COP displacements in the anterioposterior (AP) and mediolateral (ML) directions using a computerized balance board, functional balance using TUG, and fear of falling using FES-I were measured in all participants before and after the interventions. Summary of Results: Mixed ANOVA (3 groups * 2 times) with repeated measures and post hoc test showed a significant improvement in both intervention groups in AP index (F= 11/652, P= 0/0002) and functional balance (F= 9/961, P= 0/0001). However, the unstable surface training group had more improvement. However, the fear of falling significantly improved after training on an unstable surface (p= 0/035). All groups had no significant improvement in the ML index (p= 0/817). In the present study, there was an improvement in the AP index after balance training. Conclusion: Unstable surface training may reduce reaction time in posterior ankle muscle activity. Furthermore, focusing attention on cognitive tasks can lead to maintaining balance unconsciously. Most of the daily activities need attention distribution among several activities. So, balance training concurrent to a dual cognitive task is challenging and more similar to the real world. According to the specificity of the training principle, it may improve functional independence and fall prevention in the elderly.

Keywords: cognitive dual task, elderly, fear of falling, postural control, unstable surface

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Authors: Alabi Olufemi, Adeyanju Taiwo, Oloruntoba Oluwasegun, Adeleye Bobola, Alabi Oyekemi

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The pastoral system is a predominant form of cattle production in Nigeria, characterized by extensive grazing on communal lands. However, this system is challenged by various factors, including tick infestation, which significantly affects cattle health and welfare hence this investigation which aims to provide an in-depth understanding of tick infestation in the context of Nigerian pastoral systems, emphasizing its impact on cattle health and welfare. The country harbors a diverse array of tick species that affect cattle. These ticks belong to different genera, including Rhipicephalus, Amblyomma, and Hyalomma, among others. Each species has unique characteristics, life cycles, and host preferences, contributing to the complexity of tick infestation dynamics in pastoral settings. Tick infestation has numerous detrimental effects on cattle health. The direct effects include blood loss, anemia, skin damage due to feeding, and the transmission of pathogens that cause diseases such as anaplasmosis, babesiosis, and theileriosis. Indirectly, tick infestation can lead to reduced productivity, weight loss, and increased susceptibility to other diseases.The welfare of cattle in Nigerian pastoral systems is significantly impacted by tick infestation. Infested cattle often exhibit signs of distress, including restlessness, reduced grazing activity, and altered behavior. Furthermore, the discomfort caused by tick bites can lead to chronic stress, compromising the overall welfare of the animals. Effective tick control is crucial for mitigating the impact of infestation on cattle health and welfare. Strategies such as acaricide application, pasture management, genetic selection for tick resistance cattle, and vaccination against tick-borne diseases are commonly used. Tick infestation presents a significant challenge to cattle production under the pastoral system in Nigeria. It not only impacts cattle health but also compromises their welfare. Addressing the issue of tick infestation requires a multifaceted approach that integrates effective control strategies with sustainable management practices. Further research is needed to develop tailored interventions that account for the unique characteristics of Nigerian pastoral systems, ultimately ensuring the well-being and productivity of cattle in these settings.

Keywords: tick infestation, pastoral system, welfare, cattle

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Authors: Joana Beyer

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Background: Alzheimer’s disease (AD) is the predominant cause of dementia, characterized by progressive cognitive decline. Posterior cortical atrophy (PCA) is a less common variant of AD, primarily affecting younger individuals and presenting with visual, visuospatial, and visuoperceptual deficits, often leading to delayed diagnosis due to its atypical presentation. Case Presentation: We report the case of a 58-year-old woman referred to psychiatric services with a two-year history of progressive visuospatial decline, mild memory difficulties, and language impairments, notably anomia. Despite undergoing cataract and squint surgeries, her visual symptoms persisted, impacting her professional life as a music educator. The neuropsychological evaluation revealed profound visuoperceptual and visuospatial disturbances, with neuroimaging supporting a diagnosis of PCA. Treatment with Donepezil showed symptom improvement, highlighting the challenges and importance of early intervention and managing this atypical form of AD. Methods: The diagnostic process involved comprehensive physical, neuropsychological assessments, and neuroimaging, including MRI and F18 FDG PET CT, which demonstrated severe bilateral posterior cortical involvement. The case underscores the utility of these modalities in diagnosing PCA. Results: The initiation of Donepezil, an acetylcholinesterase inhibitor, resulted in symptom improvement, emphasizing the potential for AD treatments to benefit PCA patients. However, challenges in management, including treatment side effects and the necessity of multidisciplinary care, are discussed. Conclusion: This case highlights PCA's diagnostic challenges due to its atypical presentation and the broader implications for managing younger patients with early-onset dementia. It underscores the necessity for early recognition, comprehensive assessment, and tailored management strategies, including both pharmacological and non-pharmacological interventions, to improve patients' quality of life. Additionally, the case illustrates the need for expanding community memory services to accommodate younger patients with atypical forms of dementia, advocating for a more inclusive approach to dementia care.

Keywords: Alzheimer’s disease, posterior cortical atrophy, dementia, diagnosis, management, donepezil, early-onset dementia

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Authors: Hancy Issac, Gerben Keijzers, Ian Yang, Clint Moloney, Jackie Lea, Melissa Taylor

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Introduction: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD. Aim: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED. Methods: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator. Results: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively. Conclusion: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.

Keywords: COPD, electronic proforma, modified delphi study, interdisciplinary, guideline adherence, COPD-X plan

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Authors: Panwad Wongthong, Thanan Apivantanaporn, Sutthiwan Amattayakul

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Nature-based tourism is one of the fastest growing industries that can bring in economic benefits, improve quality of life and promote conservation of biodiversity and habitats. As tourism develops, substantial socio-economic and environmental costs become more explicit. Particularly in island destinations, the dynamic system and geographical limitations makes the intensity of tourism development and severity of the negative environmental impacts greater. The current contribution of the tourism sector to global climate change is established at approximately 5% of global anthropogenic CO2 emissions. In all scenarios, tourism is anticipated to grow substantially and to account for an increasingly large share of global greenhouse gas emissions. This has prompted an urgent call for more sustainable alternatives. This study selected a small island of Koh Mak in Thailand as a case study because of its reputation of being laid back, family oriented and rich in biodiversity. Importantly, it is a test platform for low carbon tourism development project supported by the Designated Areas for Sustainable Tourism Administration (DASTA) in collaboration with the Institute for Small and Medium Enterprises Development (ISMED). The study explores strategies for low carbon tourism management and assesses challenges and opportunities for Koh Mak to become a low carbon tourism destination. The goal is to identify suitable management approaches applicable for Koh Mak which may then be adapted to other small islands in Thailand and the region. Interventions/initiatives to increase energy efficiency in hotels and resorts; cut carbon emissions; reduce impacts on the environment; and promote conservation will be analyzed. Ways toward long-term sustainability of climate-friendly tourism will be recommended. Recognizing the importance of multi-stakeholder involvement in the tourism sector, findings from this study can reward Koh Mak tourism industry with a triple-win: cost savings and compliance with higher standards/markets; less waste, air emissions and effluents; and better capabilities of change, motivation of business owners, staff, tourists as well as residents. The consideration of climate change issues in the planning and implementation of tourism development is of great significance to protect the tourism sector from negative impacts.

Keywords: climate change, CO2 emissions, low carbon tourism, sustainable tourism management

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Authors: Muuz Abraha Meshesha

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Illegal Migration, specifically Trafficking in person is one of the primary issues of the day affecting all states of the world with variation on the extent of the root causes and consequences that led people to migrate irregularly and the consequences it is costing on humanity. This paper intends to investigate the root causes and consequences of illegal migration in Ethiopia’s Tigray Regional state and come up with alternative intervening strategy. To come up with pertinent and robust research finding, this study employed mixed research approach involving qualitative and quantitative data in line with purposive and snow ball sampling selection technique. The study revealed that, though poverty is the most commonly sensed pushing factor for people to illegally migrate, the issue of psycho-social orientation and attitudinal immersion of the local community for illegal migration, both in thinking and action is the most pressing problem that urges serious intervention. Trafficking in persons and Illegal migration in general, is becoming the norm of the day in the study area that overtly reveal illegal migration is an issue beyond livelihood securing demand in practice. Basically, parties engaged in illegal migration and the accomplice with human traffickers these days in the study area are found to be more than urgency for food security and a need to escape from livelihood impoverishment. Therefore, this study come up with a new paradigm insight indicating that illegal migration is believed by the local community members as an optional path way of doing business in illegal way while the attitude of the community and officials authorized to regulate is being part of the channel or to the least tolerant of this grave global danger. The study also found that the effect of illegal migration is significantly manifested in long run than in short term periods. Therefore, a need for critical consideration on attitudinal based intervention and youth oriented and enforceable legal and policy framework accountability framework is required to face and control illegal migration by international, national, local stakeholders. Besides this, economy based development interventions that could engage and reorient the youth, as primary victims of trafficking, and expansion of large scale projects that can employ large number of youths at a time.

Keywords: human traficking, illegal migration, migration, tigray region

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Authors: Sarah Holdren, Laura Crook, Anne Drapkin Lyerly

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Objective: The COVID-19 Pandemic has drawn new attention to long-existing bioethical questions around pregnancy, childbirth, and parenthood. Due to the increased risk of severe COVID-19, pregnant individuals may experience anxiety regarding medical decision-making. Especially in the case of hospital births, questions around the ethics of bringing healthy pregnant individuals into a high-risk environment for viral transmission illuminate gaps in the American maternal and child healthcare system. Limited research has sought to understand the experiences of those who gave birth outside hospitals during this time. This study aims to understand pregnant individuals’ conceptualization of risk during the COVID-19 pandemic. Methods: Individuals who gave birth after March 2020 were recruited through advertisements on social media. Participants completed a 1-hour semi-structured interview and a demographic questionnaire. Interviews were transcribed and coded by members of the research team using thematic narrative analysis. Results: A total of 18 participants were interviewed and completed the demographic questionnaire. The language of risk was utilized in birth narratives in three different ways, which highlighted the multileveled and nuanced ways in which risk is understood and mitigated by pregnant and birthing individuals. These included: 1. The risk of contracting COVID-19 before, during, and after birth, 2. The risk of birth complications requiring medical interventions dependent on selected birthing space (home, birthing center, hospital), and 3. The overall risk of creating life in the middle of a pandemic. The risk of contracting COVID-19 and risk of birth complications were often weighed in paradoxical ways throughout each individual’s pregnancy, while phrases such as “pandemic baby” and “apocalypse” appeared throughout narratives and highlighted the broader implications of pregnancy and childbirth during this momentous time. Conclusions: Healthcare professionals should consider the variety of ways that pregnant and birthing individuals understand the risk when counseling patients on healthcare decisions, especially during times of healthcare crisis such as COVID-19. Future work should look to understand how the language of risk fits into a broader understanding of the human experience of growing life in times of crisis.

Keywords: maternal and child health, thematic narrative analysis, COVID-19, risk mitigation

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Authors: Lucia Varra, Marzia Timolo

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The interest of scholars towards corporate sustainability has strengthened in recent years in parallel with the growing need to undertake paths of cultural and organizational change, as a way for greater competitiveness and stakeholders’ satisfaction. In fact, studies on the business sustainability, while on the one hand have integrated the three dimensions of sustainability that existed for some time in the economic approaches (economic, environmental and social dimensions), on the other hand did not give rise to an organic construct that puts together the aspects of strategic management with corporate social responsibility and even less with the organizational issues. Therefore some important questions remain open: Which organizational structure and which operational mechanisms are coherent or propitious to a sustainability strategy? Existing studies appear to be fragmented, although some aspects have shared importance: knowledge management, human resource, management, leadership, innovation, etc. The construction of a model of sustainable organization that supports the sustainability strategy no longer seems to be postponed, as is its connection with the main practices of measuring corporate social responsibility performance. The paper aims to identify the organizational characteristics of a sustainable corporate. To this end, from a theoretical point of view the work examines the main existing literary contributions and, from a practical point of view, it presents a business case referring to a service organization that for years has undertaken the sustainability strategy. This paper is divided into two parts: the first part concerns a review of the main articles on the strategic management topic and the main organizational issues raised by the literature, such as knowledge management, leadership, innovation, etc.; later, a modeling of the main variables examined by scholars and an integration of these with the international measurement standards of CSR is proposed. In the second part, using the methodology of the case study company, the hypotheses and the structure of the proposed model that aims to integrate the strategic issues with the organizational aspects and measurement of sustainability performance, are applied to an Italian company, which has some organizational and human resource management interventions are in place to align strategic decisions with the structure and operating mechanisms of the structure. The case presented supports the hypotheses of the model.

Keywords: CSR, strategic management, sustainable leadership, sustainable human resource management, sustainable organization

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Authors: P. Pérez-Martín, G. Pedrós, P. Martínez-Jiménez, M. Varo-Martínez

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In recent decades, family habits related to children’s displacements to school have changed, increasing motorized travels against active modes. This entails a major negative impact on the urban environment, road safety in cities and the physical and psychological development of children. One of the more common actions used to reverse this trend is Walking School Bus (WSB), which consists of a predefined adult-scorted pedestrian route to school with several stops along the path where schoolchildren are collected. At Tirso de Molina School in Cordoba (Spain), a new ICT-based methodology to deploy WSB has been tested. A mobile app that allows the geoposition of the group, the notification of the arrival and real-time communication between the WSB participants have been presented to the families in order to organize and register the daily participation. After an initial survey to know the travel mode and the spatial distribution of the interested families, three WSB routes have been established and the families have been trained in the app usage. During nine weeks, 33 children have joined the WSB and their parents have accompanied the groups in turns. A high recurrence in the attendance has been registered. Through a final survey, participants have valued highly the tool and the methodology designed, emphasizing as most useful features of the mobile app: notifications system, chat and real-time monitoring. It has also been found that the tool has had a major impact on the degree of confidence of parents regarding the autonomous on foot displacement of their children to school. Moreover, 37,9% of the participant families have reported a total or partial modal shift from car to walking, and the benefits more reported are an increment of the parents available time and less problems in the travel to school daily organization. As a consequence, It has been proved the effectiveness of this user-centric innovative ICT-based methodology to reduce the levels of private car drop offs, minimize barriers of time constraints, volunteer recruitment, and parents’ safety concerns, while, at the same time, increase convenience and time savings for families. This pilot study can offer guidance for community coordinated actions and local authority interventions to support sustainable school travel outcomes.

Keywords: active travel, mobile app, sustainable mobility, urban transportation planning, walking school bus

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Authors: Tharwat Ibrahim Rushdy, Warda Youssef Mohammed Morsy, Hanaa Ali Ahmed Elfeky

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Background: Intra-aortic balloon pump (IABP) is the first and the most commonly used mechanical circulatory support for patients with acute coronary syndromes and cardiogenic shock. Therefore, critical care nurses not only have to know how to monitor and operate the IABP, but also to provide interventions for preventing possible complications. Aim of the study: To assess nurses' knowledge and practices regarding care of patients connected to IABP at the ICUs of Cairo University Hospitals. Research design: A descriptive exploratory design was utilized. Sample: Convenience samples of 40 nurses were included in the current study. Setting: This study was carried out at the Intensive Care Units of Cairo University Hospitals. Tools of data collection: Three tools were developed, tested for clarity, and feasibility: a- Nurses' personal background sheet, b- IABP nurses' knowledge self-administered questionnaire, and c- IABP Nurses' practice observational checklist. Results: The majority of the studied sample had unsatisfactory knowledge and practice level (88% & 95%) respectively with a mean of 9.45+2.94 and 30.5+8.7, respectively. Unsatisfactory knowledge was found regarding description and physiological effects, nursing care, indications, contraindications, complications, weaning, and removal of IABP in percentage of 95%, 90%, 72.5%, and 57.5%, respectively, with a mean total knowledge score of 9.45 +2.94. In addition, unsatisfactory practice was found regarding about preparation and initiation of IABP therapy, nursing practice during therapy, weaning, and removal of IABP in percentages of (97.5%, 97.5%, and 90%), respectively. Finally, knowledge level was found to differ significantly in relation to gender (t = 2.46 at P ≤ 0.018). However, gender didn't play a role in relation to practice (t = 0.086 at P≤ 0.932). Conclusion: In spite of having vital role in assessment and management of critically ill patients, critical care nurses in the current study had in general unsatisfactory knowledge and practice regarding care of patients connected to IABP. Recommendation: updating knowledge and practice of ICU nurses through carrying out continuing educational programs about IABP; strict observation of nurses' practice when caring for patients connected to IABP and provision of guidance to correct of poor practices and replication of this study on larger probability sample selected from different geographical locations.

Keywords: knowledge, practice, intra-aortic balloon pump (IABP), ICU nurses, intensive care unit (ICU), introduction

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Authors: Disha Bhanot, Vinish Kathuria

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This study focusses on the issue of distress sale in horticulture sector in India, which faces unique challenges, given the perishable nature of horticulture crops, seasonal production and paucity of post-harvest produce management links. Distress sale, from a farmer’s perspective may be defined as urgent sale of normal or distressed goods, at deeply discounted prices (way below the cost of production) and it is usually characterized by unfavorable conditions for the seller (farmer). The small and marginal farmers, often involved in subsistence farming, stand to lose substantially if they receive lower prices than expected prices (typically framed in relation to cost of production). Distress sale maximizes price uncertainty of produce leading to substantial income loss; and with increase in input costs of farming, the high variability in harvest price severely affects profit margin of farmers, thereby affecting their survival. The objective of this study is to model the occurrence of distress sale by tomato cultivators in the Indian state of Maharashtra, against the background of differential access to set of factors such as - capital, irrigation facilities, warehousing, storage and processing facilities, and institutional arrangements for procurement etc. Data is being collected using primary survey of over 200 farmers in key tomato growing areas of Maharashtra, asking information on the above factors in addition to seeking information on cost of cultivation, selling price, time gap between harvesting and selling, role of middleman in selling, besides other socio-economic variables. Farmers selling their produce far below the cost of production would indicate an occurrence of distress sale. Occurrence of distress sale would then be modelled as a function of farm, household and institutional characteristics. Heckman-two-stage model would be applied to find the probability/likelihood of a famer falling into distress sale as well as to ascertain how the extent of distress sale varies in presence/absence of various factors. Findings of the study would recommend suitable interventions and promotion of strategies that would help farmers better manage price uncertainties, avoid distress sale and increase profit margins, having direct implications on poverty.

Keywords: distress sale, horticulture, income loss, India, price uncertainity

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Authors: Therese Besnard

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Internationally in early childhood education (ECE), the great majority of teachers are women. Some groups believe that a greater male teacher presence in ECE would be beneficial for children, specifically for boys as it could offer a positive male model. It is a common belief that children would benefit from being exposed to both male and female models. Some believe that women are naturally better suited to offer quality care to young children comparatively to men. Some authors bring forth that after equivalent training, differences in the educational practices are purely individual and do not depend on the teacher’s gender. Others believe that a greater male presence in ECE would increase the risk of pedophilia or child abuse. The few scientific studies in this area suggest that differences could exist between male and female ECE teacher, in particular when it comes to play which is the mainstay of the ECE educational program. Male teachers describe themselves as being more playful and having a greater tendency to initiate physical and turbulent play comparatively to female teachers, who describe themselves as favoring games that are calmer and focused on social interaction. Observed directly, male teachers appear more actively engaged in play with children and propose more motor play than female teachers. Furthermore children who have both male and female teachers for one year show less behavior difficulties when compared to children with only female teachers. Despite a variety of viewpoints we don’t know if the educational practices of male ECE teachers, (emotional support, classroom organization or instructional support) are different than the educational practices of female teachers and if these practices are linked with children’s adaptation. This study compares the educational practices of 37 ECE teachers (57 % male) and analyses the link with children' social adaptation (n=221). Educational practices were assessed through observational measurements with the Classroom Assessment Scoring System (CLASS) in a natural class environment. Child social adaptation was assessed with the Social Competence and Behavior Evaluation (SCBE). Observational data reveals no differences between men's and women's scale of the CLASS. Results using Multilevel models analyses suggest that the ability to propose good classroom organization and give good instructional support are linked with better child' social adaptation, and that is always true for men and women teachers. The results are discussed on the basis of their potential impact on future educational interventions.

Keywords: child social adaptation, early childhood education, educational practices, men teacher

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Authors: Brenda Margaret Behan

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Kenya is a water-stressed country with highly varied socio-ecological environments in its devolved county system, and is currently implementing a polycentric water governance system; this paper examines the importance of social capital in community-based natural resource management and its role in supporting good water governance systems in the Kenya context. Through a robust literature review of theory and case studies, specific aspects of social capital are examined to determine their importance in the implementation of local community-based water management arrangements which support and complement the more formal institutions outlined in the 2002 and 2016 Water Acts of Kenya. Water is an increasingly important and scarce resource not only for Kenya, but for many communities across the globe, and lessons learned in the Kenya context can be useful for other countries and communities faced with similar challenges. Changing climates, increasing populations, and increased per capita consumption of water is contributing to a situation in which the management of water resources will be vital to community resilience. Community-based natural resource management is widely recognized as a building block and component of wider water resource management systems, and when properly conducted can provide a way to enable sustainable use of resources and empower communities. Greater attention to the social and cultural norms and traditional institutions associated with a community’s social capital can lead to better results for Kenya’s polycentric governance of water. The key findings and recommendations from this research show that in Kenya, traditional institutions need to be understood and integrated into governance systems; social values and cultural norms have a significant impact on the implementation of community-based water management efforts; and social capital is a dynamic concept which influences and is influenced by policies and practices. The community-based water management approach will continue to be a key cornerstone for Kenya’s polycentric water governance structure, especially in the more remote arid and semi-arid lands; thus, the successful integration of social capital aspects into planning and implementation will contribute to a strengthened, sustainable, and more equitable national water governance system. Specific observations and recommendations from this study will help practitioners and policymakers to better craft community-based interventions.

Keywords: community-based natural resource management, social capital, traditional institutions, water governance

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Authors: Rujeko Samanthia Chimukuche

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Introduction: Transboundary migration at both regional and continental levels has become the defining feature of the 21st century. The recent global migration crisis due to economic strife and war brings back to the fore an old age problem, but with fresh challenges. Migration and forced displacement are issues that require long-term solutions. In South Africa, for example, whilst much attention has been placed on xenophobic attacks and other issues at the nexus of immigrant and indigenous communities, the limited focus has been placed on the integration, specifically formal labour integration of immigrant communities and the gender inequalities that are prevalent. Despite noble efforts by South Africa, hosting several immigrants, several challenges arise in integrating the migrants into society as it is often difficult to harmonize the interests of indigenous communities and those of foreign nationals. This research study has aimed to fill in the gaps by analyzing how stringent immigration and visa regulations prevent skilled migrant women spouses from employment, which often results in several societal vices, including domestic abuse, minimum or no access to important services such as healthcare, education, social welfare among others. Methods: Using a qualitative approach, the study analyzed South Africa migration and labour policies in terms of mainstreaming the gender needs of skilled migrant women. Secondly, the study highlighted the migratory experiences and constraints of skilled Zimbabwean women migrant spouses in South Africa labour integration. The experiences of these women have shown the gender inequalities of the migratory policies. Thirdly, Zimbabwean women's opportunities and/or challenges in integration into the South African formal labour market were explored. Lastly, practical interventions to support the integration of skilled migrant women spouses into South Africa’s formal labour market were suggested. Findings: Key findings show that gender dynamics are pivotal in migration patterns and the mainstreaming of gender in migration policies. This study, therefore, contributed to the fields of gender and migration by examining ways in which gender rights of skilled migrant women spouses can be incorporated in labour integration policy making.

Keywords: accompanying spouse visa, gender-migration, labour-integration, Zimbabwean women

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Authors: Tiago Sigal Linhares, Ana Amélia Nascimento da Silva Bones, Juliana Miola, McArthur Alexander Barrow, Airton Tetelbom Stein

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Introduction: As a result of increased globalization and changing migration trends, it is expected that a significant portion of People Living with HIV/AIDS (PLWHA) will change their place of residence over time. In order to provide better health care, monitor the HIV epidemic and plan urban public health care and policies, there is a growing need to formulate a strategy for monitoring PLWHA care, location and migration patterns. The Porto Alegre District is characterized by a high prevalence of PLWHA and is considered one of the epicenters of HIV epidemic in Latin America. Objectives: The aim of this study is to create a digital and easily editable map in order to create a visual representation of the location of PLWHA and to monitor their migration within the city and the country in an effort to promote longitudinal care. Methods: This Experience Report used Google Maps Map Creator to generate an active digital map showing the location and changes in residence of 165 PLWHA who received care at two Primary Health Care (PHC) clinics, which attended an estimated population of five thousand patients, in downtown Porto Alegre over the last four years. Their current addresses were discovered in the unified Brazilian health care system digital records (e-SUS) and updated on the map. Results: A digital map with PLWHA current residence location was created. It was possible to demonstrate visually areas with a large concentration of PLWHA and the migration of the population within the city as wells as other cities, regions and states. Conclusions: An easily reproducible and free map could aid in PLWHA monitoring, urban public health planning, target interventions and situational diagnosis. Moreover, a visual representation of PLWHA location and migration could help bring more attention and investments to areas with geographic inequities or higher prevalence of PLWHA. It also enables notification of local PHC units of monitored patients inside their area, which are in clinical risk or with treatment abandonment through active case findings, improving the care of PLWHA.

Keywords: health care, medical public health, theoretical and conceptual innovations, urban public health

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Authors: Genevieve Lim, Arthur Shelley, Dongcheol Heo

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Abstract—Mobile technologies can enhance the learning process as it enables social engagement around concepts beyond the classroom and the curriculum. Early results in this ongoing research is showing that when learning interventions are designed specifically to generate new insights, mobile devices support regulated learning and encourage learners to collaborate, socialize and co-create new knowledge. As students navigate across the space and time boundaries, the fundamental social nature of learning transforms into mobile computer supported collaborative learning (mCSCL). The metacognitive interaction in mCSCL via mobile applications reflects the regulation of learning among the students. These metacognitive experiences whether self-, co- or shared-regulated are significant to the learning outcomes. Despite some insightful empirical studies, there has not yet been significant research that investigates the actual practice and processes of the new knowledge co-creation. This leads to question as to whether mobile learning provides a new channel to leverage learning? Alternatively, does mobile interaction create new types of learning experiences and how do these experiences co-create new knowledge. The purpose of this research is to explore these questions and seek evidence to support one or the other. This paper addresses these questions from the students’ perspective to understand how students interact when constructing knowledge in mCSCL and how students’ self-regulated learning (SRL) strategies support the co-creation of new knowledge in mCSCL. A pilot study has been conducted among international undergraduates to understand students’ perspective of mobile learning and concurrently develops a definition in an appropriate context. Using classroom action research (CAR) with multiple case studies, this study is being carried out in a private university in Thailand to narrow the research gaps in mCSCL and SRL. The findings will allow teachers to see the importance of social interaction for meaningful student engagement and envisage learning outcomes from a knowledge management perspective and what role mobile devices can play in these. The findings will signify important indicators for academics to rethink what is to be learned and how it should be learned. Ultimately, the study will bring new light into the co-creation of new knowledge in a social interactive learning environment and challenges teachers to embrace the 21st century of learning with mobile technologies to deepen and extend learning opportunities.

Keywords: mobile computer supported collaborative learning, mobile instant messaging, mobile learning, new knowledge co-creation, self-regulated learning

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Authors: Cláudia Patrocínio, Beatriz Fernandes, Ana Filipa Pires

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Background: Mirror therapy (MT) is used to improve motor function after stroke. During MT, a mirror is placed between the two upper limbs (UL), thus reflecting movements of the non- affected side as if it were the affected side. Objectives: The aim of this review is to analyze the evidence on the effec.tiveness of MT in the recovery of UL function in population with post chronic stroke. Methods: The literature search was carried out in PubMed, ISI Web of Science, and PEDro database. Inclusion criteria: a) studies that include individuals diagnosed with stroke for at least 6 months; b) intervention with MT in UL or comparing it with other interventions; c) articles published until 2023; d) articles published in English or Portuguese; e) randomized controlled studies. Exclusion criteria: a) animal studies; b) studies that do not provide a detailed description of the intervention; c) Studies using central electrical stimulation. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. Studies with < 4 on PEDro scale were excluded. Eighteen studies met all the inclusion criteria. Main results and conclusions: The quality of the studies varies between 5 and 8. One article compared muscular strength training (MST) with MT vs without MT and four articles compared the use of MT vs conventional therapy (CT), one study compared extracorporeal shock therapy (EST) with and without MT and another study compared functional electrical stimulation (FES), MT and biofeedback, three studies compared MT with Mesh Glove (MG) or Sham Therapy, five articles compared performing bimanual exercises with and without MT and three studies compared MT with virtual reality (VR) or robot training (RT). The assessment of changes in function and structure (International Classification of Functioning, Disability and Health parameter) was carried out, in each article, mainly using the Fugl Meyer Assessment-Upper Limb scale, activity and participation (International Classification of Functioning, Disability and Health parameter) were evaluated using different scales, in each study. The positive results were seen in these parameters, globally. Results suggest that MT is more effective than other therapies in motor recovery and function of the affected UL, than these techniques alone, although the results have been modest in most of the included studies. There is also a more significant improvement in the distal movements of the affected hand than in the rest of the UL.

Keywords: physical therapy, mirror therapy, chronic stroke, upper limb, hemiplegia

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Authors: Suehyun Cho, Darrell Harrington, Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Alex Kiselyov, Michael Shpigelmacher

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The Dandy-Walker malformation (DWM) represents a clinical syndrome manifesting as a combination of posterior fossa cyst, hypoplasia of the cerebellar vermis, and obstructive hydrocephalus. Anatomic hallmarks include hypoplasia of the cerebellar vermis, enlargement of the posterior fossa, and cystic dilatation of the fourth ventricle. Current treatments of DWM, including shunting of the cerebral spinal fluid ventricular system and endoscopic third ventriculostomy (ETV), are frequently clinically insufficient, require additional surgical interventions, and carry risks of infections and neurological deficits. Bionaut Labs develops an alternative way to treat Dandy-Walker Malformation (DWM) associated with non-communicating hydrocephalus. We utilize our discreet microsurgical Bionaut™ particles that are controlled externally and remotely to perform safe, accurate, effective fenestration of the Dandy-Walker cyst, specifically in the posterior fossa of the brain, to directly normalize intracranial pressure. Bionaut™ allows for complex non-linear trajectories not feasible by any conventional surgical techniques. The microsurgical particle safely reaches targets in the lower occipital section of the brain. Bionaut™ offers a minimally invasive surgical alternative to highly involved posterior craniotomy or shunts via direct fenestration of the fourth ventricular cyst at the locus defined by the individual anatomy. Our approach offers significant advantages over the current standards of care in patients exhibiting anatomical challenge(s) as a manifestation of DWM, and therefore, is intended to replace conventional therapeutic strategies. Current progress, including platform optimization, Bionaut™ control, and real-time imaging and in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of ovine models, will be discussed.

Keywords: Bionaut™, cerebral spinal fluid, CSF, cyst, Dandy-Walker, fenestration, hydrocephalus, micro-robot

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Authors: Carlos V. Gonzalez

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

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

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Authors: Olivera Lupescu, Taina Elena Avramescu, Mihail Nagea, Alexandru Dimitriu

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Acetabular fractures represent a real challenge due to their impact upon the long term function of the hip joint, and due to the risk of intra- and peri-operative complications especially that they affect young, active people. That is why treating these fractures require certain skills which must be exercised, regarding the pre-operative planning, as well as the execution of surgery.The authors retrospectively analyse 38 cases with acetabular fractures operated using the posterior approach in our hospital between 01.01.2013- 01.01.2015 for which complete medical records ensure a follow-up of 24 months, in order to establish the main causes of potential errors and to underline the methods for preventing them. This target is included in the Erasmus + project ‘Collaborative learning for enhancing practical skills for patient-focused interventions in gait rehabilitation after orthopedic surgery COR-skills’. This paper analyses the pitfalls revealed by these cases, as well as the measures necessary to enhance the practical skills of the surgeons who perform acetabular surgery. Pre-op planning matched the intra and post-operative outcome in 88% of the analyzed points, from 72% at the beginning to 94% in the last case, meaning that experience is very important in treating this injury. The main problems detected for the posterior approach were: nervous complications - 3 cases, 1 of them a complete paralysis of the sciatic nerve, which recovered 6 months after surgery, and in other 2 cases intra-articular position of the screws was demonstrated by post-operative CT scans, so secondary screw removal was necessary in these cases. We analysed this incident, too, due to lack of information about the relationship between the screws and the joint secondary to this approach. Septic complications appeared in 3 cases, 2 superficial and 1 profound (requiring implant removal). The most important problems were the reduction of the fractures and the positioning of the screws so as not to interfere with the the articular space. In posterior acetabular fractures, pre-op complex planning is important in order to achieve maximum treatment efficacy with minimum of risk; an optimal training of the surgeons insisting on the main points of potential mistakes ensure the success of the procedure, as well as a favorable outcome for the patient.

Keywords: acetabular fractures, articular congruency, surgical skills, vocational training

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Authors: Fuad Hamsyah

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

Keywords: disaster, Indonesia, psychosocial support, Philippines

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Authors: Angelika Dierolf, K. Rischer, A. Gonzalez-Roldan, P. Montoya, F. Anton, M. Van der Meulen

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Placebo analgesia is a powerful cognitive endogenous pain modulation mechanism with high relevance in pain treatment. Older people would benefit, especially from non-pharmacologic pain interventions, since this age group is disproportionately affected by acute and chronic pain, while pharmacological treatments are less suitable due to polypharmacy and age-related changes in drug metabolism. Although aging is known to affect neurobiological and physiological aspects of pain perception, as for example, changes in pain threshold and pain tolerance, its effects on cognitive pain modulation strategies, including placebo analgesia, have hardly been investigated so far. In the present study, we are assessing placebo analgesia in 35 older adults (60 years and older) and 35 younger adults (between 18 and 35 years). Acute pain was induced with short transdermal electrical pulses to the inner forearm, using a concentric stimulating electrode. Stimulation intensities were individually adjusted to the participant’s threshold. Next to the stimulation site, we applied sham transcutaneous electrical nerve stimulation (TENS). Participants were informed that sometimes the TENS device would be switched on (placebo condition), and sometimes it would be switched off (control condition). In reality, it was always switched off. Participants received alternating blocks of painful stimuli in the placebo and control condition and were asked to rate the intensity and unpleasantness of each stimulus on a visual analog scale (VAS). Pain-related evoked potentials were recorded with a 64-channel EEG. Preliminary results show a reduced placebo effect in older compared to younger adults in both behavioral and neurophysiological data. Older people experienced less subjective pain reduction under sham TENS treatment compared to younger adults, as evidenced by the VAS ratings. The N1 and P2 event-related potential components were generally reduced in the older group. While younger adults showed a reduced N1 and P2 under sham TENS treatment, this reduction was considerably smaller in older people. This reduced placebo effect in the older group suggests that cognitive pain modulation is altered in aging and may at least partly explain why older adults experience more pain. Our results highlight the need for a better understanding of the efficacy of non-pharmacological pain treatments in older adults and how these can be optimized to meet the specific requirements of this population.

Keywords: placebo analgesia, aging, acute pain, TENS, EEG

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