Search results for: Taiwanese people
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 7189

Search results for: Taiwanese people

5689 A Study of Effectiveness of Topical Grapeseed Oil for Reducing Wrinkles on Periorbital Areas in Asian People in Thailand

Authors: Cherish Romina Prajitno, Sunisa Thaichinda

Abstract:

One indicator of facial aging is wrinkles. Not only that, but wrinkles are a key indicator in our world of facial aesthetics. Wrinkles occur where fault lines develop in aging skin. Nowadays, people are more motivated to keep up their appealing and young appearance. Many individuals are seeking a fast recovery time for their aesthetic procedures and are interested in non-invasive techniques that have a proven track record for successful outcomes. The purpose of this study is to see the efficacy of 100% (pure) grapeseed oil for reducing periorbital wrinkles. This study used the split-face, double-blind method, and this treatment was administered for three months at random to fifteen patients, with the grapeseed oil at one side of the face and the other side with the placebo. The main outcome measure was determined by conducting a comparative analysis of the participants' wrinkle results during each visit using the VIsioscan® VC98. Additionally, we evaluated the skin's elasticity and barrier function using the Cutometer® MP 530 and Tewameter® TM300. Furthermore, we administered a satisfaction score questionnaire to the patients in the 12th week. The findings of the study indicate that grapeseed oil exhibited a noteworthy effect in diminishing the appearance of wrinkles in the periorbital region, enhancing the viscoelastic properties of the periorbital skin, and improving the functionality of the skin barrier in the periorbital area.

Keywords: periorbital wrinkles, pure grapeseed oil, split-face method

Procedia PDF Downloads 69
5688 Cultural Identity and Self-Censorship in Social Media: A Qualitative Case Study

Authors: Nastaran Khoshsabk

Abstract:

The evolution of communication through the Internet has influenced shaping and reshaping the self-presentation of social media users. Online communities both connect people and give voice to the voiceless allowing them to present themselves nationally and globally. People all around the world are experiencing censorship in different aspects of their life. Censorship can be externally imposed because of the political situations, or it can be self-imposed. Social media users choose the content they want to share and decide about the online audiences with whom they want to share this content. Most social media networks, such as Facebook, enable their users to be selective about the shared content and its availability to other people. However, sometimes instead of targeting a specific audience, users self-censor themselves or decide not to share various forms of information. These decisions are of particular importance in countries such as Iran where Internet is not the arena of free self-presentation and people are encouraged to stay away from political participation in the country and acting against the Islamic values. Facebook and some other social media tools are blocked in countries such as Iran. This project investigates the importance of social media in the life of Iranians to explore how they present themselves and construct their digital selves. The notion of cultural identity is applied in this research to explore the educational and informative role of social media in the identity formation and cultural representation of Facebook users. This study explores the self-censorship of Iranian adult Facebook users through their online self-representation and communication on the Internet. The data in this qualitative multiple case study have been collected through individual synchronous online interviews with the researcher’s Facebook friends and through the analysis of the participants’ Facebook profiles and activities over a period of six months. The data is analysed with an emphasis on the identity formation of participants through the recognition of the underlying themes. The exploration of online interviews is on the basis of participants’ personal accounts of self-censorship and cultural understanding through using social media. The driven codes and themes have been categorised considering censorship and place of culture on representation of self. Participants were asked to explain their views about censorship and conservatism through using social media. They reported their thoughts about deciding which content to share on Facebook and which to self-censor and their reasons behind these decisions. The codes and themes have been categorised considering censorship and its role in representation of idealised self. The ‘actual self’ showed to be hidden by an individual for different reasons such as its influence on their social status, academic achievements and job opportunities. It is hoped that this research will have implications for education contexts in countries that are experiencing social media filtering by offering an increased understanding of the importance of online communities; which can provide an educational environment to talk and learn about social taboos and constructing adults’ identity in virtual environment and through cultural self-presentation.

Keywords: cultural identity, identity formation, online communities, self-censorship

Procedia PDF Downloads 237
5687 Airflow Characteristics and Thermal Comfort of Air Diffusers: A Case Study

Authors: Tolga Arda Eraslan

Abstract:

The quality of the indoor environment is significant to occupants’ health, comfort, and productivity, as Covid-19 spread throughout the world, people started spending most of their time indoors. Since buildings are getting bigger, mechanical ventilation systems are widely used where natural ventilation is insufficient. Four primary tasks of a ventilation system have been identified indoor air quality, comfort, contamination control, and energy performance. To fulfill such requirements, air diffusers, which are a part of the ventilation system, have begun to enter our lives in different airflow distribution systems. Detailed observations are needed to assure that such devices provide high levels of comfort effectiveness and energy efficiency. This study addresses these needs. The objective of this article is to observe air characterizations of different air diffusers at different angles and their effect on people by the thermal comfort model in CFD simulation and to validate the outputs with the help of data results based on a simulated office room. Office room created to provide validation; Equipped with many thermal sensors, including head height, tabletop, and foot level. In addition, CFD simulations were carried out by measuring the temperature and velocity of the air coming out of the supply diffuser. The results considering the flow interaction between diffusers and surroundings showed good visual illustration.

Keywords: computational fluid dynamics, fanger’s model, predicted mean vote, thermal comfort

Procedia PDF Downloads 118
5686 A Review on Factors Influencing Implementation of Secure Software Development Practices

Authors: Sri Lakshmi Kanniah, Mohd Naz’ri Mahrin

Abstract:

More and more businesses and services are depending on software to run their daily operations and business services. At the same time, cyber-attacks are becoming more covert and sophisticated, posing threats to software. Vulnerabilities exist in the software due to the lack of security practices during the phases of software development. Implementation of secure software development practices can improve the resistance to attacks. Many methods, models and standards for secure software development have been developed. However, despite the efforts, they still come up against difficulties in their deployment and the processes are not institutionalized. There is a set of factors that influence the successful deployment of secure software development processes. In this study, the methodology and results from a systematic literature review of factors influencing the implementation of secure software development practices is described. A total of 44 primary studies were analysed as a result of the systematic review. As a result of the study, a list of twenty factors has been identified. Some of factors that affect implementation of secure software development practices are: Involvement of the security expert, integration between security and development team, developer’s skill and expertise, development time and communication between stakeholders. The factors were further classified into four categories which are institutional context, people and action, project content and system development process. The results obtained show that it is important to take into account organizational, technical and people issues in order to implement secure software development initiatives.

Keywords: secure software development, software development, software security, systematic literature review

Procedia PDF Downloads 377
5685 Consumption of Fat Burners Leads to Acute Liver Failure: A Systematic Review protocol

Authors: Anjana Aggarwal, Sheilja Walia

Abstract:

Prevalence of obesity and overweight is increasing due to sedentary lifestyles and busy schedules of people that spend less time on physical exercise. To reduce weight, people are finding easier and more convenient ways. The easiest solution is the use of dietary supplements and fat burners. These are products that decrease body weight by increasing the basal metabolic rate. Various reports have been published on the consumption of fat burners leading to heart palpitations, seizures, anxiety, depression, psychosis, bradycardia, insomnia, muscle contractions, hepatotoxicity, and even liver failure. Case reports and series are reporting that the ingredients present in the fat burners caused acute liver failure (ALF) and hepatic toxicity in many cases. Another contributing factor is the absence of regulations from the Food and Drug Administration on these products, leading to increased consumption and a higher risk of liver diseases among the population. This systematic review aims to attain a better understanding of the dietary supplements used globally to reduce weight and document the case reports/series of acute liver failure caused by the consumption of fat burners. Electronic databases like PubMed, Cochrane, Google Scholar, etc., will be systematically searched for relevant articles. Various websites of dietary products and brands that sell such supplements, Journals of Hepatology, National and international projects launched for ALF, and their reports, along with the review of grey literature, will also be done to get a better understanding of the topic. After discussing with the co-author, the selection and screening of the articles will be performed by the author. The studies will be selected based on the predefined inclusion and exclusion criteria. The case reports and case series that will be included in the final list of the studies will be assessed for methodological quality using the CARE guidelines. The results from this study will provide insights and a better understanding of fat burners. Since the supplements are easily available in the market without any restrictions on their sale, people are unaware of their adverse effects. The consumption of these supplements causes acute liver failure. Thus, this review will provide a platform for future larger studies to be conducted.

Keywords: acute liver failure, dietary supplements, fat burners, weight loss supplements

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5684 Locating the Best Place for Earthquake Refugee Camps by OpenSource Software: A Case Study for Tehran, Iran

Authors: Reyhaneh Saeedi

Abstract:

Iran is one of the regions which are most prone for earthquakes annually having a large number of financial and mortality and financial losses. Every year around the world, a large number of people lose their home and life due to natural disasters such as earthquakes. It is necessary to provide and specify some suitable places for settling the homeless people before the occurrence of the earthquake, one of the most important factors in crisis planning and management. Some of the natural disasters can be Modeling and shown by Geospatial Information System (GIS). By using GIS, it would be possible to manage the spatial data and reach several goals by making use of the analyses existing in it. GIS has a determining role in disaster management because it can determine the best places for temporary resettling after such a disaster. In this research QuantumGIS software is used that It is an OpenSource software so that easy to access codes and It is also free. In this system, AHP method is used as decision model and to locate the best places for temporary resettling, is done based on the related organizations criteria with their weights and buffers. Also in this research are made the buffer layers of criteria and change them to the raster layers. Later on, the raster layers are multiplied on desired weights then, the results are added together. Eventually, there are suitable places for resettling of victims by desired criteria by different colors with their optimum rate in QuantumGIS platform.

Keywords: disaster management, temporary resettlement, earthquake, QuantumGIS

Procedia PDF Downloads 396
5683 Representation and Reality: Media Influences on Japanese Attitudes towards China

Authors: Shuk Ting Kinnia Yau

Abstract:

As China has become more and more influential in the global and geo-political arena, mutual understanding between Japan and China has also become a topic of paramount importance. There have always been tensions between the two countries, but unfortunately, each country tends to blame the other for fanning emotions. This research will investigate portrayals of China and the Chinese people in Japanese media such as newspapers, TV news, TV drama, and cinema over this period, focusing on media sources that have particularly wide viewership or readership. By doing so, it attempts to detect any general trends in the positive or negative character of such portrayals and to see if they correlate with the results of surveys of attitudes among the general population. To the degree that correlations may be found, the question arises as to whether the media portrayals are a reflection of societal attitudes towards the Chinese, on one hand, or may be playing a role in promoting such attitudes, on the other. The relationship here is, without doubt, more complex than a simple one-way relationship of cause and effect, but indications of some direction of causality may be suggested by trends in one occurring before or after the other. Evidence will also be sought of possible longer-term trends in media portrayals of China and the Chinese people in Japan during the post-2012 period, i.e., Abe Shinzo’s second term as prime minister, in comparison to earlier periods. Perceptions of Japan’s view of China and the Chinese, both inside and outside the scholarly world, tend to be oversimplified and are often incomprehensive. This research calls attention to the role played by the media in promoting or de-promoting Sino-Japanese relations. By analyzing the nature and background of images of China and the Chinese people presented in the Japanese media, especially under the new Abe Regime, this research seeks to promote a more balanced and comprehensive understanding of attitudes in Japanese society towards its gigantic neighbor. Scholars have seen the increasingly fragile Sino-Japanese relationship as inseparable from the real-world political conflicts that have become more frequent in recent years and have sought to draw a correlation between the two. The influence of the media, however, remains a mostly under-explored domain in the academic world. Against this background, this research aims to provide an enriched scholarly understanding of Japan’s perception of China by investigating to what extent such perception can be seen to be affected by subjective or selective forms of presentation of China found in the Japanese media, or vice versa.

Keywords: Abe Shinzo, China, Japan, media

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5682 Disability and Sexuality: A Human Right Approach to Sexual and Reproductive Health of the Hearing-Impaired Adolescents in Developing Countries

Authors: Akanle Florence Foluso

Abstract:

Access to health care and people’s ability to have a responsible, satisfying and safe sexual life is clearly a defined human right of people with hearing impairment and others with disabilities. This paper investigates the extent to which the hearing impaired have a satisfying, safe sexual life and whether their human right in regard to information and education is violated. The study population consists of all hearing-impaired adolescents and young adults aged 10-24 years who are currently enrolled in primary and secondary schools in Nigeria. A sample of 389 hearing-impaired adolescents was selected, and an adapted version of the illustrative questionnaire for interview - survey by John Cleland was used to collect the data. A correlation of 0.80 was obtained at a P<0.05 level of significance. Teachers in the school of the deaf who used sign language were used in the administration of the questionnaire. The data generated were analyzed using Frequency counts. Summary of responses on access to information, education, voluntary testing, counseling and reproductive services. This is to be violated or protected. Findings show that a gap exists in the level of knowledge of SRH services and voluntary counseling because more than half the respondents are not aware of these services in their community. Access to information, education and health services are rights denied to the hearing impaired. So, their rights are violated.

Keywords: sexuality, gender, reproductive health, human right

Procedia PDF Downloads 58
5681 Community Communications and Micro-Level Shifts: The Case of Video Volunteers’ IndiaUnheard Program

Authors: Pooja Ichplani, Archna Kumar, Jessica Mayberry

Abstract:

Community Video (CV) is a participatory medium that has immense potential to strengthen community communications and amplify the voice of people for their empowerment. By building capacities especially of marginalized community groups and providing a platform to freely voice their ideas, CV endeavours to bring about shifts towards more participatory, bottom up development processes and greater power in the hands of the people, especially the disadvantaged. In various parts of the world, among marginalized community groups, community video initiatives have become instrumental in facilitating micro-level, yet significant changes in communities. Video Volunteers (VV) is an organization that promotes community media and works towards providing disadvantaged communities with journalistic, critical thinking and creative skills they need for catalysing change in their communities. Working since 2002, VV has evolved a unique community media model fostering locally-owned and managed media production, as well as building people’s capacities to articulate and share their perspectives on the issues that matter to them – on a local and a global scale. Further, by integrating a livelihood aspect within its model, VV has actively involved people from poor marginalized communities and provided them a new tool for serving their communities whilst keeping their identities intact. This paper, based on a qualitative research, seeks to map the range of VV impacts in communities and provide an in-depth analysis of factors contributing to VV impacting change in communities. Study tools included content analysis of a longitudinal sample of impact videos produced, narratives of community correspondents using the Most Significant Change Technique (MSCT) and interviews with key informants. Using a multi-fold analysis, the paper seeks to gain holistic insights. At the first level, the paper profiles the Community Correspondents (CCs), spearheading change, and maps their personal and social context and their perceptions about VV in their personal lives. Secondly, at an organizational level, the paper maps the significance of impacts brought about in the CCs communities and their association, challenges and achievements while working with VV. Lastly, at the community level, it consists of analysis of the nature of impacts achieved and aspects influencing the same. Finally, the study critiques the functioning of Video Volunteers as a community media initiative using the tipping point theory emphasizing on the power of context that is constituted by their socio-cultural environment. It concludes how empowerment of its Community Correspondents, multifarious activities during pre and post video production, and other innovative mechanisms have enabled in center staging issues of marginalized communities and snowballing processes of change in communities.

Keywords: community media, empowerment, participatory communication, social change

Procedia PDF Downloads 137
5680 Technology Transfer of Indigenous Technologies: Emerging Aid to Indian Health Sector

Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

Abstract:

India is battling with the issues of accessibility, affordability and availability of quality health to the masses. Indian medical heritage which dated back to 3000 BC unveils the rich knowledge pool which has undergone a perceptible change over years, such as eradication of many communicable diseases, increasing individual awareness of quality health and import driven medical device market etc. Despite a slew of initiatives the holistic slogan of ‘health for all’ remains elusive and a concern for the nation. The 21st-century projects a myriad of challenges like cultural diversity, large population, demographic dividend and geographical segmentation leading to varied needs of people as per their regional conditions of climate, disease prevalence, nutrition and sanitation. But these challenges are also opportunities for the development of indigenous, low cost and accessible technologies to tackle them. This requires reinforcing the potential of indigenous technologies in coordination with prevailing health issues in various regions of country. This paper emphasis on the strategy for exploring the indigenous technologies with entrusted up-scaling to meet the diverse needs of the people. This review proposes to adopt technology transfer as a strategy to establish a vibrant ecosystem for identifying and up-scaling the indigenous medical technologies with diligent hand-holding for public health.

Keywords: health, indigenous, medical technology, technology transfer

Procedia PDF Downloads 251
5679 Lip Localization Technique for Myanmar Consonants Recognition Based on Lip Movements

Authors: Thein Thein, Kalyar Myo San

Abstract:

Lip reading system is one of the different supportive technologies for hearing impaired, or elderly people or non-native speakers. For normal hearing persons in noisy environments or in conditions where the audio signal is not available, lip reading techniques can be used to increase their understanding of spoken language. Hearing impaired persons have used lip reading techniques as important tools to find out what was said by other people without hearing voice. Thus, visual speech information is important and become active research area. Using visual information from lip movements can improve the accuracy and robustness of a speech recognition system and the need for lip reading system is ever increasing for every language. However, the recognition of lip movement is a difficult task because of the region of interest (ROI) is nonlinear and noisy. Therefore, this paper proposes method to detect the accurate lips shape and to localize lip movement towards automatic lip tracking by using the combination of Otsu global thresholding technique and Moore Neighborhood Tracing Algorithm. Proposed method shows how accurate lip localization and tracking which is useful for speech recognition. In this work of study and experiments will be carried out the automatic lip localizing the lip shape for Myanmar consonants using the only visual information from lip movements which is useful for visual speech of Myanmar languages.

Keywords: lip reading, lip localization, lip tracking, Moore neighborhood tracing algorithm

Procedia PDF Downloads 352
5678 Sensory Interventions for Dementia: A Review

Authors: Leigh G. Hayden, Susan E. Shepley, Cristina Passarelli, William Tingo

Abstract:

Introduction: Sensory interventions are popular therapeutic and recreational approaches for people living with all stages of dementia. However, it is unknown which sensory interventions are used to achieve which outcomes across all subtypes of dementia. Methods: To address this gap, we conducted a scoping review of sensory interventions for people living with dementia. We conducted a search of the literature for any article published in English from 1 January 1990 to 1 June 2019, on any sensory or multisensory intervention targeted to people living with any kind of dementia, which reported on patient health outcomes. We did not include complex interventions where only a small aspect was related to sensory stimulation. We searched the databases Medline, CINHAL, and Psych Articles using our institutional discovery layer. We conducted all screening in duplicate to reduce Type 1 and Type 2 errors. The data from all included papers were extracted by one team member, and audited by another, to ensure consistency of extraction and completeness of data. Results: Our initial search captured 7654 articles, and the removal of duplicates (n=5329), those that didn’t pass title and abstract screening (n=1840) and those that didn’t pass full-text screening (n=281) resulted in 174 articles included. The countries with the highest publication in this area were the United States (n=59), the United Kingdom (n=26) and Australia (n=15). The most common type of interventions were music therapy (n=36), multisensory rooms (n=27) and multisensory therapies (n=25). Seven articles were published in the 1990’s, 55 in the 2000’s, and the remainder since 2010 (n=112). Discussion: Multisensory rooms have been present in the literature since the early 1990’s. However, more recently, nature/garden therapy, art therapy, and light therapy have emerged since 2008 in the literature, an indication of the increasingly diverse scholarship in the area. The least popular type of intervention is a traditional food intervention. Taste as a sensory intervention is generally avoided for safety reasons, however it shows potential for increasing quality of life. Agitation, behavior, and mood are common outcomes for all sensory interventions. However, light therapy commonly targets sleep. The majority (n=110) of studies have very small sample sizes (n=20 or less), an indicator of the lack of robust data in the field. Additional small-scale studies of the known sensory interventions will likely do little to advance the field. However, there is a need for multi-armed studies which directly compare sensory interventions, and more studies which investigate the use of layering sensory interventions (for example, adding an aromatherapy component to a lighting intervention). In addition, large scale studies which enroll people at early stages of dementia will help us better understand the potential of sensory and multisensory interventions to slow the progression of the disease.

Keywords: sensory interventions, dementia, scoping review

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5677 The Value and Role of Higher Education in the Police Profession

Authors: Habib Ahmadi, Mohamad Ali Ameri

Abstract:

In this research, the perception and understanding of police officers about the value of higher education have been investigated. A qualitative research approach and phenomenological method were used, and in data analysis, the Claizi method was used. In this research, 17 people with different degrees and occupations were selected by purposive sampling method until saturation and were investigated using a semi-structured interview tool. After the data was collected, recorded, and coded in the Atlas T software, it was formulated in the form of main categories and concepts. The general views of police officers participating in this research show the importance of university education in police jobs(76%). The analysis of participants' experiences led to the identification of seven main categories of the value and role of higher education, including; 1- Improvement of behavior and social skills, 2- Opportunities to improve and improve job performance, 3- Professionalization of police work, 4- Financial motivation, 5- People's satisfaction with police services, 6- Improvement of writing and technical skills Statement, 7- Raising the level of expectation and expectations was misplaced (negative perception). The findings of this study support the positive attitude and professionalism of the educated police. Therefore, considering the change of paradigm in society as well as the change of technologies, more complex organizational designs, and the perception of police officers, it is concluded that the police field needs officers with higher education to enable them to understand the new global environment.

Keywords: lived experience, higher education, police professionalization, perceptions of police officers

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5676 Efficiency of Using E-Wallets as Payment Method in Marikina City During COVID-19 Pandemic

Authors: Noel Paolo Domingo, James Paul Menina, Laurente Ferrer

Abstract:

Most people were forced to stay at home and limit their physical contact during the COVID-19 pandemic. Due to the situation, strict implementation of government policies and safety protocols encouraged consumers to utilize cashless or digital transactions through e-wallets. In this study, the researchers aim to investigate the efficiency of using e-wallets as a payment method during the COVID-19 pandemic in Marikina City. The study examined the efficiency of e-wallets in terms of Usefulness, Convenience, and Safety and Security based on respondents’ assessment. Questionnaires developed by the researchers were distributed to a total of 400 e-wallet users in Marikina City aged 15 years old and above to gather data by using a purposive sampling technique. The data collected was processed using SPSS version 26. Frequency, percentage, and mean were utilized to describe the profile of respondents and their assessment of e-wallets in terms of the three constructs. ANOVA and t-tests were also employed to test the significant differences in the respondent’s assessment when the demographic profile was considered. The study revealed that when it comes to usefulness, e-wallet is efficient while in terms of convenience, and safety and security, e-wallet has been proven to be very efficient. During the COVID-19 pandemic, utilizing e-wallets has been embraced by most consumers. By enhancing its features, more people will be satisfied with using e-wallets.

Keywords: efficiency of e-wallets, usefulness, convenience, safety and security

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5675 Analyzing the Performance of Machine Learning Models to Predict Alzheimer's Disease and its Stages Addressing Missing Value Problem

Authors: Carlos Theran, Yohn Parra Bautista, Victor Adankai, Richard Alo, Jimwi Liu, Clement G. Yedjou

Abstract:

Alzheimer's disease (AD) is a neurodegenerative disorder primarily characterized by deteriorating cognitive functions. AD has gained relevant attention in the last decade. An estimated 24 million people worldwide suffered from this disease by 2011. In 2016 an estimated 40 million were diagnosed with AD, and for 2050 is expected to reach 131 million people affected by AD. Therefore, detecting and confirming AD at its different stages is a priority for medical practices to provide adequate and accurate treatments. Recently, Machine Learning (ML) models have been used to study AD's stages handling missing values in multiclass, focusing on the delineation of Early Mild Cognitive Impairment (EMCI), Late Mild Cognitive Impairment (LMCI), and normal cognitive (CN). But, to our best knowledge, robust performance information of these models and the missing data analysis has not been presented in the literature. In this paper, we propose studying the performance of five different machine learning models for AD's stages multiclass prediction in terms of accuracy, precision, and F1-score. Also, the analysis of three imputation methods to handle the missing value problem is presented. A framework that integrates ML model for AD's stages multiclass prediction is proposed, performing an average accuracy of 84%.

Keywords: alzheimer's disease, missing value, machine learning, performance evaluation

Procedia PDF Downloads 250
5674 Sustainable Drinking Water Treatment Method Using Solar Light

Authors: Ayushi Arora

Abstract:

Solar photocatalysis has the potential to treat drinking water in a sustainable and cost effective manner. According to WHO, there should not be any colony forming units (CFU) per 100 mL present in drinking water, and as per the Central Pollution Control Board (CPCB) of India, the bathing water should have less than 500 CFU/100 mL and the maximum permissible limit is 2500 CFU/100 mL. In this study, 8 water sources near our collaborators, Indian Institute of Technology, Kharagpur, India, were analysed, and it was found that 6 out of 8 sources of water had significant coliform count in them. Two of them were chosen to be treated by solar photocatalysis a) well water which had a count of 4800 CFU/100 mL for total coliforms and was used by people for drinking purposes, and b) pond water which had a count of 92000 CFU/100 mL for total coliforms and 3000 CFU/mL for E.Coli and was used by people for washing and bathing purposes. In this study, a semiconductor-semiconductor, composite BTO-TiO2-RMSG & TiO2-SiO2 were tested for their ability to be activated under solar light and to reduce Total Coliforms and E.Coli bacteria in real world contaminated water, and it was found that both catalysts were both able to reduce the total coliform count in water by 99.7% and 98.2 % in 2 hrs respectively. They have also shown promising results in reusability tests. This study demonstrates the ability of solar photocatalysis to be used in real world drinking water treatment and will promote future advancements in this field.

Keywords: sustainable water treatment, waterpurification technologies, water policies, water pollution and environmental engineering

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5673 The Design of English Materials to Communicate the Identity of Mueang Distict, Samut Songkram for Ecotourism

Authors: Kitda Praraththajariya

Abstract:

The main purpose of this research was to study how to communicate the identity of the Mueang district, Samut Songkram province for ecotourism. The qualitative data was collected through studying related materials, exploring the area, in-depth interviews with three groups of people: three directly responsible officers who were key informants of the district, twenty foreign tourists and five Thai tourist guides. A content analysis was used to analyze the qualitative data. The two main findings of the study were as follows: 1. The identity of Amphur (District) Mueang, Samut Songkram province. This establishment was near the Mouth of Maekong River for normal people and tourists, consisting of rest accommodations. There are restaurants where food and drinks are served, rich mangrove forests, Hoy Lod (Razor Clam) and mangrove trees. Don Hoy Lod, is characterized by muddy beaches, is a coastal wetland for Ramsar Site. It is at 1099th ranging where the greatest number of Hoy Lod (Razor Clam) can be seen from March to May each year. 2. The communication of the identity of Amphur Mueang, Samut Songkram province which the researcher could find and design to present in English materials can be summed up in 4 items: 1) The history of Amphur Mueang, Samut Songkram province 2) Wat Phet Samut Worrawihan 3) The Learning source of Ecotourism: Don Hoy Lod and Mangrove forest 4) How to keep Amphur Mueang, Samut Songkram province for ecotourism.

Keywords: foreigner tourists, signified, semiotics, ecotourism

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5672 An Empirical Research on Customer Knowledge Management in the Iranian Banks

Authors: Ebrahim Gharleghi

Abstract:

This paper aims to examine how customer knowledge management (CKM) can be implemented in Iranian Banks in practice, with the focus on the human resource (people, technology and processes) as important factors of CKM. A conceptual model of an analytical CKM strategy for CKM in this Iranian Banks is developed from the findings and literature review. This article has been based on interviews and distributing the questionnaire. Data were collected from 260 managers from bank managers. The paper finds that hypotheses were tested using student’s t-test (one-sample t-test), Pearson correlation analysis and regression analysis. Test of hypotheses revealed that human, technology and processes factors positively and significantly influenced the implementation of CKM practices. These findings tend to corroborate our conceptual model. Human factor of CKM was found to be more significantly affecting appropriate CKM implementation than others CKM factors, indicating that this factor is more important than the others aspects of CKM. On the other hand, this factor is appropriate in Iranian Banks. Process is in second part and technology is in final part. This indicates that technology infrastructures are so weak in Iranian Banks for CKM implementation. In this paper there is little or no empirical evidence investigating the amount of the execution of the CKM in Iranian Banks. This paper rectifies this imbalance by clarifying the significance human, technology and processes factors in CKM implementation.

Keywords: knowledge management, customer relationship management, customer knowledge management, integration, people, technology, process

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5671 Mental Health and the Criminal Justice System: A Review on the Mental Health Diversion Programs and Their Effectiveness in Reducing Recidivism

Authors: Lianyan Zhou

Abstract:

According to the National Conference of State Legislatures, a person experiencing a mental health crisis is more likely to encounter law enforcement than crisis intervention or treatment. People with mental illness are overrepresented in incarceration, often resulting in exacerbation of the symptoms and increasing the likelihood of recidivism and rearrest. To address the issue of the large number of people with mental illness cycling through the criminal justice system, mental health courts and diversion programs were established. Mental health diversion programs are considered as more appropriate options for offenders whose mental illness is significantly contributing to their criminal offenses. However, these programs are controversial, with criticism that offenders may view the programs as the only to get treatment or to avoid jail time. This paper provides a comprehensive review of the effectiveness of mental health diversion programs. More specifically, it examines how these programs may reduce recidivism compared to incarceration. Materials presented in this review were selected from forensic and general psychology journals. Additional policy documents, government reports, and court records are also included for discussion. The results suggest that mental health diversion programs are overall more successful in intervening compared to incarcerations. The recidivism rates for program participants are lower. However, individual factors do contribute to the outcome of the programs.

Keywords: diversion programs, forensic psychology, justice system, mental health courts, mental illness, rearrest, recidivism

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5670 Human Identification and Detection of Suspicious Incidents Based on Outfit Colors: Image Processing Approach in CCTV Videos

Authors: Thilini M. Yatanwala

Abstract:

CCTV (Closed-Circuit-Television) Surveillance System is being used in public places over decades and a large variety of data is being produced every moment. However, most of the CCTV data is stored in isolation without having integrity. As a result, identification of the behavior of suspicious people along with their location has become strenuous. This research was conducted to acquire more accurate and reliable timely information from the CCTV video records. The implemented system can identify human objects in public places based on outfit colors. Inter-process communication technologies were used to implement the CCTV camera network to track people in the premises. The research was conducted in three stages and in the first stage human objects were filtered from other movable objects available in public places. In the second stage people were uniquely identified based on their outfit colors and in the third stage an individual was continuously tracked in the CCTV network. A face detection algorithm was implemented using cascade classifier based on the training model to detect human objects. HAAR feature based two-dimensional convolution operator was introduced to identify features of the human face such as region of eyes, region of nose and bridge of the nose based on darkness and lightness of facial area. In the second stage outfit colors of human objects were analyzed by dividing the area into upper left, upper right, lower left, lower right of the body. Mean color, mod color and standard deviation of each area were extracted as crucial factors to uniquely identify human object using histogram based approach. Color based measurements were written in to XML files and separate directories were maintained to store XML files related to each camera according to time stamp. As the third stage of the approach, inter-process communication techniques were used to implement an acknowledgement based CCTV camera network to continuously track individuals in a network of cameras. Real time analysis of XML files generated in each camera can determine the path of individual to monitor full activity sequence. Higher efficiency was achieved by sending and receiving acknowledgments only among adjacent cameras. Suspicious incidents such as a person staying in a sensitive area for a longer period or a person disappeared from the camera coverage can be detected in this approach. The system was tested for 150 people with the accuracy level of 82%. However, this approach was unable to produce expected results in the presence of group of people wearing similar type of outfits. This approach can be applied to any existing camera network without changing the physical arrangement of CCTV cameras. The study of human identification and suspicious incident detection using outfit color analysis can achieve higher level of accuracy and the project will be continued by integrating motion and gait feature analysis techniques to derive more information from CCTV videos.

Keywords: CCTV surveillance, human detection and identification, image processing, inter-process communication, security, suspicious detection

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5669 The Development of User Behavior in Urban Regeneration Areas by Utilizing the Floating Population Data

Authors: Jung-Hun Cho, Tae-Heon Moon, Sun-Young Heo

Abstract:

A lot of urban problems, caused by urbanization and industrialization, have occurred around the world. In particular, the creation of satellite towns, which was attributed to the explicit expansion of the city, has led to the traffic problems and the hollowization of old towns, raising the necessity of urban regeneration in old towns along with the aging of existing urban infrastructure. To select urban regeneration priority regions for the strategic execution of urban regeneration in Korea, the number of population, the number of businesses, and deterioration degree were chosen as standards. Existing standards had a limit in coping with solving urban problems fundamentally and rapidly changing reality. Therefore, it was necessary to add new indicators that can reflect the decline in relevant cities and conditions. In this regard, this study selected Busan Metropolitan City, Korea as the target area as a leading city, where urban regeneration such as an international port city has been activated like Yokohama, Japan. Prior to setting the urban regeneration priority region, the conditions of reality should be reflected because uniform and uncharacterized projects have been implemented without a quantitative analysis about population behavior within the region. For this reason, this study conducted a characterization analysis and type classification, based on the user behaviors by using representative floating population of the big data, which is a hot issue all over the society in recent days. The target areas were analyzed in this study. While 23 regions were classified as three types in existing Busan Metropolitan City urban regeneration priority region, 23 regions were classified as four types in existing Busan Metropolitan City urban regeneration priority region in terms of the type classification on the basis of user behaviors. Four types were classified as follows; type (Ⅰ) of young people - morning type, Type (Ⅱ) of the old and middle-aged- general type with sharp floating population, type (Ⅲ) of the old and middle aged-24hour-type, and type (Ⅳ) of the old and middle aged with less floating population. Characteristics were shown in each region of four types, and the study results of user behaviors were different from those of existing urban regeneration priority region. According to the results, in type (Ⅰ) young people were the majority around the existing old built-up area, where floating population at dawn is four times more than in other areas. In Type (Ⅱ), there were many old and middle-aged people around the existing built-up area and general neighborhoods, where the average floating population was more than in other areas due to commuting, while in type (Ⅲ), there was no change in the floating population throughout 24 hours, although there were many old and middle aged people in population around the existing general neighborhoods. Type (Ⅳ) includes existing economy-based type, central built-up area type, and general neighborhood type, where old and middle aged people were the majority as a general type of commuting with less floating population. Unlike existing urban regeneration priority region, these types were sub-divided according to types, and in this study, approach methods and basic orientations of urban regeneration were set to reflect the reality to a certain degree including the indicators of effective floating population to identify the dynamic activity of urban areas and existing regeneration priority areas in connection with urban regeneration projects by regions. Therefore, it is possible to make effective urban plans through offering the substantial ground by utilizing scientific and quantitative data. To induce more realistic and effective regeneration projects, the regeneration projects tailored to the present local conditions should be developed by reflecting the present conditions on the formulation of urban regeneration strategic plans.

Keywords: floating population, big data, urban regeneration, urban regeneration priority region, type classification

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5668 Multimodal Rhetoric in the Wildlife Documentary, “My Octopus Teacher”

Authors: Visvaganthie Moodley

Abstract:

While rhetoric goes back as far as Aristotle who focalised its meaning as the “art of persuasion”, most scholars have focused on elocutio and dispositio canons, neglecting the rhetorical impact of multimodal texts, such as documentaries. Film documentaries are being increasingly rhetoric, often used by wildlife conservationists for influencing people to become more mindful about humanity’s connection with nature. This paper examines the award-winning film documentary, “My Octopus Teacher”, which depicts naturalist, Craig Foster’s unique discovery and relationship with a female octopus in the southern tip of Africa, the Cape of Storms in South Africa. It is anchored in Leech and Short’s (2007) framework of linguistic and stylistic categories – comprising lexical items, grammatical features, figures of speech and other rhetoric features, and cohesiveness – with particular foci on diction, anthropomorphic language, metaphors and symbolism. It also draws on Kress and van Leeuwen’s (2006) multimodal analysis to show how verbal cues (the narrator’s commentary), visual images in motion, visual images as metaphors and symbolism, and aural sensory images such as music and sound synergise for rhetoric effect. In addition, the analysis of “My Octopus Teacher” is guided by Nichol’s (2010) narrative theory; features of a documentary which foregrounds the credibility of the narrative as a text that represents real events with real people; and its modes of construction, viz., the poetic mode, the expository mode, observational mode and participatory mode, and their integration – forging documentaries as multimodal texts. This paper presents a multimodal rhetoric discussion on the sequence of salient episodes captured in the slow moving one-and-a-half-hour documentary. These are: (i) The prologue: on the brink of something extraordinary; (ii) The day it all started; (iii) The narrator’s turmoil: getting back into the ocean; (iv) The incredible encounter with the octopus; (v) Establishing a relationship; (vi) Outwitting the predatory pyjama shark; (vii) The cycle of life; and (viii) The conclusion: lessons from an octopus. The paper argues that wildlife documentaries, characterized by plausibility and which provide researchers the lens to examine the ideologies about animals and humans, offer an assimilation of the various senses – vocal, visual and audial – for engaging viewers in stylized compelling way; they have the ability to persuade people to think and act in particular ways. As multimodal texts, with its use of lexical items; diction; anthropomorphic language; linguistic, visual and aural metaphors and symbolism; and depictions of anthropocentrism, wildlife documentaries are powerful resources for promoting wildlife conservation and conscientizing people of the need for establishing a harmonious relationship with nature and humans alike.

Keywords: documentaries, multimodality, rhetoric, style, wildlife, conservation

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5667 Public Health Emergency Management (PHEM) to COVID-19 Pandemic in North-Eastern Part of Thailand

Authors: Orathai Srithongtham, Ploypailin Mekathepakorn, Tossaphong Buraman, Pontida Moonpradap, Rungrueng Kitpati, Chulapon Kratet, Worayuth Nak-ai, Suwaree Charoenmukkayanan, Peeranuch Keawkanya

Abstract:

The COVID-19 pandemic was effect to the health security of the Thai people. The PHEM principle was essential to the surveillance, prevention, and control of COVID-19. This study aimed to present the process of prevention and control of COVID-19 from February 29, 2021- April 30, 2022, and the factors and conditions influent the successful outcome. The study areas were three provinces. The target group was 37 people, composed of public health personnel. The data was collected in-depth, and group interviews followed the non-structure interview guide and were analyzed by content analysis. The components of COVID-19 prevention and control were found in the process of PHEM as follows; 1) Emergency Operation Center (EOC) with an incidence command system (ICS) from the district to provincial level and to propose the provincial measure, 2) Provincial Communicable Disease Committee (PCDC) to decide the provincial measure 3) The measure for surveillance, prevention, control, and treatment of COVID-19, and 4) outcomes and best practices for surveillance and control of COVID-19. The success factors of 4S and EC were as follows; Space: prepare the quarantine (HQ, LQ), Cohort Ward (CW), field hospital, and community isolation and home isolation to face with the patient and risky group, Staff network from various organization and group cover the community leader and Health Volunteer (HV), Stuff the management and sharing of the medical and non-medical equipment, System of Covid-19 respond were EOC, ICS, Joint Investigation Team (JIT) and Communicable Disease Control Unit (CDCU) for monitoring the real-time of surveillance and control of COVID-19 output, Environment management in hospital and the community with Infections Control (IC) principle, and Culture in term of social capital on “the relationship of Isan people” supported the patient provide the good care and support. The structure of PHEM, Isan’s Culture, and good preparation was a significant factor in the three provinces.

Keywords: public health, emergency management, covid-19, pandemic

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5666 Importance of Collegiality to Improve the Effectiveness of a Poorly Resourced School

Authors: Prakash Singh

Abstract:

This study focused on the importance of collegiality to improve the effectiveness of a poorly resourced school (PRS). In an effective school that embraces collegiality as its culture, one can expect to find a teaching staff and a management team that shares responsibilities and accountabilities through the development of a common purpose and vision, regardless of whether the school is considered to be poorly resourced or not. Working together in collegial teams is a more effective way to accomplish tasks and to create a climate for effective learning, even for learners in PRSs from poor communities. The main aim of this study was therefore to determine whether collegiality as a leadership strategy could extract the best from people in a PRS, and consequently create the most effective and efficient educational climate possible. The responses received from the teachers and the principal at the PRS supports the notion that collegiality does have a positive influence on learning, as demonstrated by the improved academic achievement of the learners. The teachers were now more involved in the school. They agreed that this was a positive development. Their descriptions of increased involvement, shared accountability and shared decision-making identified important aspects of collegiality that transformed the school from being dysfunctional. Hence, it is abundantly clear that a collegial leadership style can help extract the best from people because the most effective and efficient educational climate can be created at a school when collegiality is employed. Collegial leadership demonstrates that even in PRSs, there are boundless opportunities to improve teaching and learning.

Keywords: collegiality, collegial leadership, effective educational climate, poorly resourced school

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5665 Loud Silence: A Situation Analysis of Youth Living with Hearing Impairment in Uganda

Authors: Wandera Stephen Ojumbo

Abstract:

People living with hearing impairment in Uganda are one of the most excluded minority groups in the country. The Uganda National Association of the Deaf estimates that deaf people make up 3.4% of Uganda’s 43 million people. Deaf Children and youth often appear withdrawn because they face social stigma. In 2009, photojournalist Stephen Wandera Ojumbo conducted an exhibition in Kampala titled “Silent Voices with colourful Hearts” showcasing the life of deaf children at Uganda School for the Deaf, Ntinda, in order to create awareness of their plight, raising funds for the construction of a vocational centre for the deaf that didn’t continue their education due to: lack of funds, non-inclusive educational institutions, and for those who cannot read and write. These children, whose lives were exhibited in 2009, are currently youths. In Uganda, there are just five primary schools for the deaf (three of these are located in Kampala, the capital city), and barely five secondary schools for the deaf. At the moment, some deaf children only receive special needs training equivalent to primary seven levels and the majority don’t make it to secondary school education level due to the fact that English is a second language to them. There is a communication gap between speaking parents and deaf children, which leads to the breakage of family bonds. The deaf youth run away from their homes to form a community where they can communicate freely. Likewise, employment opportunities for the deaf are equally very limited. It’s for this reason that a follow-up photo exhibition was conducted to expose more about what the youthful deaf people and their guardians go through in Uganda to get jobs, live and fit in the community, how they communicate and get understood, bonding with families instead of running away to bond with fellow deaf persons. The photo exhibition under the theme “Loud Silence” was significant in showcasing the ability of deaf youths in Uganda and eliciting solutions to make a more inclusive society for the deaf. It is hoped that partners in development will join in for intervention. The methodology used included individual interviews with the deaf youth and their parents and caretakers; photography at household and community levels; document review at organizations working with the deaf; observations; and key informant interviews with relevant personnel working with the deaf. Some of the major findings include: i) Effective sign language communication is key in deaf education, family bonding, and developing a sense of belonging; ii) Love and intimacy can keep the deaf bound together; iii) Education is important; everybody should struggle even if alone; iv) Games and sports are a unifying factor and most loved among the deaf; and v) better communication skills build confidence in deaf youth. In conclusion, concerted efforts are still needed to make Uganda schools more inclusive for deaf persons. This will enable a secure future for deaf youths.

Keywords: deaf, education, excluded, photo exhibition

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5664 Stress, Anxiety and Its Associated Factors Within the Transgender Population of Delhi: A Cross-Sectional Study

Authors: Annie Singh, Ishaan Singh

Abstract:

Background: Transgenders are people who have a gender identity different from their sex assigned at birth. Their gender behaviour doesn’t match their body anatomy. The community faces discrimination due to their gender identity all across the world. The term transgender is an umbrella term for many people non-conformal to their biological identity; note that the term transgender is different from gender dysphoria, which is a DSM-5 disorder defined as problems faced by an individual due to their non-conforming gender identity. Transgender people have been a part of Indian culture for ages yet have continued to face exclusion and discrimination in society. This has led to the low socio-economic status of the community. Various studies done across the world have established the role of discrimination, harassment and exclusion in the development of psychological disorders. The study is aimed to assess the frequency of stress and anxiety in the transgender population and understand the various factors affecting the same. Methodology: A cross-sectional survey of self consenting transgender individuals above the age of 18 residing in Delhi was done to assess their socioeconomic status and experiential ecology. Recruitment of participants was done with the help of NGOs. The survey was constructed GAD-7 and PSS-10, two well-known scales were used to assess the stress and anxiety levels. Medians, means and ranges are used for reporting continuous data wherever required, while frequencies and percentages are used for categorical data. For associations and comparison between groups in categorical data, the Chi-square test was used, while the Kruskal-Wallis H test was employed for associations involving multiple ordinal groups. SPSS v28.0 was used to perform the statistical analysis for this study. Results: The survey showed that the frequency of stress and anxiety is high in the transgender population. A demographic survey indicates a low socio-economic background. 44% of participants reported facing discrimination on a daily basis; the frequency of discrimination is higher in transwomen than in transmen. Stress and anxiety levels are similar among both transmen and transwomen. Only 34.5% of participants said they had receptive family or friends. The majority of participants (72.7%) reported a positive or neutral experience with healthcare workers. The prevalence of discrimination is significantly lower in the higher educated groups. Analysis of data shows a positive impact of acceptance and reception on mental health, while discrimination is correlated with higher levels of stress and anxiety. Conclusion: The prevalence of widespread transphobia and discrimination faced by the transgender community has culminated in high levels of stress and anxiety in the transgender population and shows variance according to multiple socio-demographic factors. Educating people about the LGBT community formation of support groups, policies and laws are required to establish trust and promote integration.

Keywords: transgender, gender, stress, anxiety, mental health, discrimination, exclusion

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5663 Embodied Spiritualities and Emerging Search for Social Transformation: An Embodied Ethnographic Study of Yoga Practices in Medellin, Colombia

Authors: Lina M. Vidal

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This paper discusses yoga practices involvement in both self-transformation and social transformations by means of an embodied ethnographic approach to different initiatives for social change in Medellín. In the context of gradual popularization of embodied spiritualities, yoga practices have opened their way in calls for social change in a performative perspective which involves collective experiences, reflections and production of embodied knowledge. Through the reflection on bodily dimension and corporal experience, this ethnographic approach acknowledges inter-corporality and somatic modes of attention during observations and personal experiences. In social change initiatives that include yoga practices were identified transformations of common understanding on social issues such as it is produced by institutionalized education, health system and other fields of knowledge. This is clearly visible in yoga projects for children in vulnerable conditions, homeless people, prisoners, and young people recovering from drug addiction. These projects are often promoted by organizations and networks, which incorporate individual life stories into collective experiences. Dissemination of yoga is heading to a broad institutional and cultural legitimation of yoga and of spirituality that impact different fields of social work and everyday life in general. This way, yoga is becoming an embodied activist way of life and a legitimate field for social work.

Keywords: embodied ethnography, Medellin, social transformation, embodied spiritualities, yoga practices

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5662 Steps to Create a Wine Tourism Product Based on Storytelling

Authors: Yorgos Darlas

Abstract:

This original research aims at creating a wine tourism experience specially designed for Thessaloniki, based on retsina, a traditional Greek wine produced continuously since 5400 BC. Wine is a staple of the Greek dinner table, and this is particularly true for Thessaloniki, a city with a rich culinary tradition member of the UNESCO Creative Cities Network for gastronomy. Our methodology is based on historical and folklore research in order to shed light on the history and culture around the production and enjoyment of wine. In addition, we use quantitative and qualitative market research with the aim of recording modern habits and trends related to wine enjoyment. The above research has revealed the habits, rules, and rituals of the people of Thessaloniki, demonstrating the close link between the city’s culinary heritage and retsina. Thanks to this close link, the people of the city have a strong emotional bond with retsina, always ready to share a relevant story loaded with memories. Based on the findings of the research, our aim is to create a new wine tourism product for Thessaloniki based on storytelling. This wine tourism experience will provide visitors with the opportunity to discover the city through the personal stories of locals. At the same time, they will be acquainted with the history and the culture of retsina by visiting landmarks associated with its production and consumption and discovering the city’s multifaceted gastronomic heritage through pairings with retsina.

Keywords: retsina, Thessaloniki, wine tourism, marketing, storytelling

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5661 Law Relating to Health and Health Care: A Systematic Mechanism and Critical Study with Reference to Bangladesh

Authors: MD. Kamruzzaman

Abstract:

As a developing country, Bangladesh has seen an increase in total GDP in recent years. But it can be further improved by developing “Health-Care” (HC) services because it has enormous infrastructure problems all over the country. Bangladesh's HC system is now clearly poised to undergo reform at any process level, including prevention, diagnosis, and treatment. Although the Bangladeshi government is trying to develop the HC sector, due to health corruption in this sector, the improvement has not accelerated yet. For this reason, lots of Bangladeshi people are facing acute diseases. Regarding the prevention, diagnosis, and treatment of disease, this research will illustrate the law relating to health and HC to ensure excellent health and well-being. Firstly, this paper investigates health under Bangladeshi law from different perspectives related to the HC system. A massive gap has been investigated in this research after comparing Bangladeshi and international health law (HL). Secondly, a practical scenario is investigated and compared with international HC law. It is evident that the Bangladeshi HC system did not achieve a satisfactory standard level concerning international law. A staggering 70% of Bangladesh's population lives in rural areas, with no restrictions on access to hospitals and clinics. However, it is clear that proper HC infrastructure and some new medical practices are urgently needed to ensure HC quality. Finally, this research provides suggestions for developing a HC system to ensure the health of all Bangladeshi people that needs to be immediately implemented by the Bangladeshi government. This research has practical implications in the HC system for any developing country to maintain their citizen's safety.

Keywords: HC system, law relating, bangladeshi HL, international HL, human HC suggestions

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5660 Stroke Prevention in Patients with Atrial Fibrillation and Co-Morbid Physical and Mental Health Problems

Authors: Dina Farran, Mark Ashworth, Fiona Gaughran

Abstract:

Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is associated with an increased risk of stroke, contributing to heart failure and death. In this project, we aim to improve patient safety by screening for stroke risk among people with AF and co-morbid mental illness. To do so, we started by conducting a systematic review and meta-analysis on prevalence, management, and outcomes of AF in people with Serious Mental Illness (SMI) versus the general population. We then evaluated oral anticoagulation (OAC) prescription trends in people with AF and co-morbid SMI in King’s College Hospital. We also evaluated the association between mental illness severity and OAC prescription in eligible patients in South London and Maudsley (SLaM) NHS Foundation Trust. Next, we implemented an electronic clinical decision support system (eCDSS) consisting of a visual prompt on patient electronic Personal Health Records to screen for AF-related stroke risk in three Mental Health of Older Adults wards at SLaM. Finally, we assessed the feasibility and acceptability of the eCDSS by qualitatively investigating clinicians’ perspectives of the potential usefulness of the eCDSS (pre-intervention) and their experiences and their views regarding its impact on clinicians and patients (post-intervention). The systematic review showed that people with SMI had low reported rates of AF. AF patients with SMI were less likely to receive OAC than the general population. When receiving warfarin, people with SMI, particularly bipolar disorder, experienced poor anticoagulation control compared to the general population. Meta-analysis showed that SMI was not significantly associated with an increased risk of stroke or major bleeding when adjusting for underlying risk factors. The main findings of the first observational study were that among AF patients having a high stroke risk, those with co-morbid SMI were less likely than non-SMI to be prescribed any OAC, particularly warfarin. After 2019, there was no significant difference between the two groups. In the second observational study, patients with AF and co-morbid SMI were less likely to be prescribed any OAC compared to those with dementia, substance use disorders, or common mental disorders, adjusting for age, sex, stroke, and bleeding risk scores. Among AF patients with co-morbid SMI, warfarin was less likely to be prescribed to those having alcohol or substance dependency, serious self-injury, hallucinations or delusions, and activities of daily living impairment. In the intervention, clinicians were asked to confirm the presence of AF, clinically assess stroke and bleeding risks, record risk scores in clinical notes, and refer patients at high risk of stroke to OAC clinics. Clinicians reported many potential benefits for the eCDSS, including improving clinical effectiveness, better identification of patients at risk, safer and more comprehensive care, consistency in decision making and saving time. Identified potential risks included rigidity in decision-making, overreliance, reduced critical thinking, false positive recommendations, annoyance, and increased workload. This study presents a unique opportunity to quantify AF patients with mental illness who are at high risk of severe outcomes using electronic health records. This has the potential to improve health outcomes and, therefore patients' quality of life.

Keywords: atrial fibrillation, stroke, mental health conditions, electronic clinical decision support systems

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