Search results for: post

Authors: Shailendra Kumar, Lokesh Kashyap, Puneet Khanna, Nishant Patel, Rakesh Kumar, Arshad Ayub, Kelika Prakash, Yudhyavir Singh, Krithikabrindha V.

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Introduction: Spinal anesthesia is considered a standard anesthesia technique for caesarean delivery. The incidence of spinal hypotension during caesarean delivery is 70 -80%. Spinal hypotension may cause cerebral hypoperfusion in the mother, but physiologically cerebral autoregulatory mechanisms accordingly prevent cerebral hypoxia. Cerebral blood flow remains constant in the 50-150 mmHg of Cerebral Perfusion Pressure (CPP) range. Near-infrared spectroscopy (NIRS) is a non-invasive technology that is used to detect Cerebral Desaturation Events (CDEs) immediately compared to other conventional intraoperative monitoring techniques. Objective: The primary aim of the study is to correlate the change in cerebral oxygen saturation using NIRS with respect to a fall in mean blood pressure after spinal anaesthesia and to find out the effects of spinal hypotension on neonatal APGAR score, neonatal acid-base variations, and presence of Postoperative Delirium (POD). Methodology: NIRS sensors were attached to the forehead of all the patients, and their baseline readings of cerebral oxygenation on the right and left frontal regions and mean blood pressure were noted. Subarachnoid block was given with hyperbaric 0.5% bupivacaine plus fentanyl, the dose being determined by the individual anaesthesiologist. Co-loading of IV crystalloid solutions was given to the patient. Blood pressure reading and cerebral saturation were recorded every 1 minute till 30min. Hypotension was a fall in MAP less than 20% of the baseline values. Patients going for hypotension were treated with an IV Bolus of phenylephrine/ephedrine. Umbilical cord blood samples were taken for blood gas analysis, and neonatal APGAR was noted by a neonatologist. Study design: A prospective observational study conducted in a population of Thirty ASA 2 and 3 parturients scheduled for lower segment caesarean section (LSCS). Results: Mean fall in regional cerebral saturation is 28.48 ± 14.7% with respect to the mean fall in blood pressure 38.92 ± 8.44 mm Hg. The correlation coefficient between fall in saturation and fall in mean blood pressure is 0.057, and p-value {0.7} after subarachnoid block. A fall in regional cerebral saturation occurred 2±1 min before a fall in mean blood pressure. Twenty-nine out of thirty patients required vasopressors during hypotension. The first dose of vasopressor requirement is needed at 6.02±2 min after the block. The mean APGAR score was 7.86 and 9.74 at 1 and 5 min of birth, respectively, and the mean umbilical arterial pH of 7.3±0.1. According to DRS-98 (Delirium Rating Scale), the mean delirium rating score on postoperative day 1 and day 2 were 0.1 and 0.7, respectively. Discussion: There was a fall in regional cerebral oxygen saturation, which started before with respect to a significant fall in mean blood pressure readings but was statistically not significant. Maximal fall in blood pressure requiring vasopressors occurs within 10 min of SAB. Neonatal APGAR scores and acid-base variations were in the normal range with maternal hypotension, and there was no incidence of postoperative delirium in patients with post-spinal hypotension.

Keywords: cerebral oxygenation, LSCS, NIRS, spinal hypotension

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Authors: Ali Aghazadegan, Ali Shokri, Julia Mullarney

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River confluences are areas where there is a lot of mixing, which is often caused by the formation of shear layers and helical motions. The hydrodynamics of secondary circulation at river confluences with low flow discharge ratios and a 90° junction angle are investigated in this study. The analysis is based on Delft 3D modelling, which includes a three-dimensional time-averaged velocity field, turbulence, and water surface levels that have been validated using laboratory data. Confluence structure was characterized by shear layer, secondary circulation, and mixing at the junction and post confluence channel. This study analysis formation of the shear layer by generation of secondary circulations in variation discharge ratios. The values of streamwise, cross-wise, and vertical components are used to estimate the secondary circulation observed within and downstream of the tributary mouth. These variables are estimated for three horizontal planes at Z = [0.14; 0.07; 0.02] and for eight cross-sections at X = [-0.1; 0.00; 0.10; 0.2; 0.30; 0.4; 0.5; 0.6] within a range of 0.05 Y 0.30.

Keywords: river confluence, shear layer, secondary circulation, hydrodynamics

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Authors: Rohita Gupta, G. S. Brah, R. Verma, C. S. Mukhopadhayay

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Although chicken strains show differences in susceptibility to a number of diseases, the underlying immunological basis is yet to be elucidated. In the present study, heterophils were subjected to LPS stimulation and total RNA extraction, further differential gene expression was studied in broiler, layer and indigenous Aseel strain by Real Time RT-PCR at different time periods before and after induction. The expression of the 14 AvBDs and chTLR 1, 2, 3, 4, 5, 7, 15 and 21 was detectable in heterophils. The expression level of most of the AvBDs significantly increased (P<0.05) 3 hours post in vitro lipopolysaccharide challenge. Higher expression level and stronger activation of most AvBDs, NFkB-1 and IRF-3 in heterophils was observed with the stimulation of LPS in layer compared to broiler, and in Aseel compared to both layer and broiler. This investigation will allow more refined interpretation of immuno-genetic basis of the variable disease resistance/susceptibility in divergent stock of chicken including indigenous breed. Moreover, this study will be helpful in formulation of strategy for isolation of antimicrobial peptides from heterophils.

Keywords: differential expression, heterophils, cytokines, defensin, TLR

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Authors: Antonio Piga

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The issue of European cultural identity has become a prominent topic of discussion among political actors in the wake of the unsuccessful referenda held in France and the Netherlands in May and June 2006. The „period of reflection‟ announced by the European Council at the conclusion of June 2006 has provided an opportunity for the implementation of several initiatives and programmes designed to „bridge the gap‟ between the EU institutions and its citizens. Specific programmes were designed with the objective of enhancing the European Commission‟s external communication of its activities. Subsequently, further plans for democracy, debate, and dialogue were devised with the objective of fostering open and extensive discourse between EU institutions and citizens. Further documentation on communication policy emphasised the necessity of developing linguistic techniques to re-engage disenchanted or uninformed citizens with the European project. It was observed that the European Union is perceived as a „faceless‟ entity, which is attributed to the absence of a distinct public identity vis-à-vis its institutions. This contribution presents an analysis of a collection of informative publications regarding the European Union, entitled “Europe on the Move”. This collection of booklets provides comprehensive information about the European Union, including its historical origins, core values, and historical development, as well as its achievements, strategic objectives, policies, and operational procedures. The theoretical framework adopted for the longitudinal linguistic analysis of EU discourse is that of Systemic Functional Linguistics (SFL). In more detail, this study considers two basic systems of relations between clauses: firstly, the degree of interdependency (or taxis) and secondly, the logico-semantic relation of expansion. The former refers to the structural markers of grammatical relations between clauses within sentences, namely paratactic, hypotactic and embedded relations. The latter pertains to various logicosemantic relationships existing between the primary and secondary members of the clause nexus. These relationships include how the secondary clause expands the primary clause, which may be achieved by (a) elaborating it, (b) extending it or (c) enhancing it. This study examines the impact of the European Commission‟s post-referendum communication methods on the portrayal of Europe, its role in facilitating the EU institutional process, and its articulation of a specific EU identity linked to distinct values. The research reveals that the language employed by the EU is evidently grounded in an explanatory logic, elucidating the rationale behind their institutionalised acts. Nevertheless, the minimal use of hypotaxis in the post-referendum booklets, coupled with the inconsistent yet increasing ratio of parataxis to hypotaxis, may suggest a potential shift towards a logic of appearance, characterised by a predominant reliance on coordination and additive, and elaborative logico-semantic relations.

Keywords: systemic functional linguistics, logic of appearance, explanatory logic, interdependency, logico-semantic relation

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Authors: Hyojin Lim, Cuong Nguyen Khac, Ho-Youl Jung

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In this paper, we propose moving object detection method which is helpful for driver to safely take his/her car out of parking lot. When moving objects such as motorbikes, pedestrians, the other cars and some obstacles are detected at the rear-side of host vehicle, the proposed algorithm can provide to driver warning. We assume that the host vehicle is just before departure. Gaussian Mixture Model (GMM) based background subtraction is basically applied. Pre-processing such as smoothing and post-processing as morphological filtering are added.We examine “which color space has better performance for detection of moving objects?” Three color spaces including RGB, YCbCr, and Y are applied and compared, in terms of detection rate. Through simulation, we prove that RGB space is more suitable for moving object detection based on background subtraction.

Keywords: gaussian mixture model, background subtraction, moving object detection, color space, morphological filtering

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Authors: Eirini Arvanitaki

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The popular romance novel has the ability to withstand the test of time by carefully adjusting its contents to the twenty-first century and modern society. At the same time, it manages to preserve unaltered its traditional foundations (heteronormativity, heterosexual love, monogamy). This paper focuses on the projection of the hero’s masculinity in a selection of post-millennial popular romance narratives and attempts to discover if, and to what extent, this projection reinforces or challenges patriarchal ideas about gender. In the majority of these narratives, the hero is often presented as a hegemonic alpha male. However, hegemonic masculinity is not a fixed concept. Rather, it is subject to continuous change, which allows for the emergence of various dominant masculinities. With this in mind, and through a close textual analysis approach and a gender reading of romance narratives, the paper suggests that to a certain extent, the romance hero could be described as a platform onto which different forms of dominant masculinity are displayed and highlights that these masculinities do not necessarily clash, depend on, or function as a prerequisite for each other.

Keywords: gender, literary projections, masculinity, twenty-first century popular romance narratives

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Authors: Chalise Kiran

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The prime idea of inclusive education is to mainstream every child in education. However, it will be challenging for implementation when there are policy and practice gaps. It will be even more challenging when children have disabilities. Generally, the focus will be on the policy gap, but the problem may not always be with policy. The proper practice could be a challenge in the countries like Nepal. In determining practice, the teachers’ perceptions toward inclusive will play a vital role. Nepal has categorized disability in 7 types (physical, visual, hearing, vision/hearing, speech, mental, and multiple). Out of these, hearing impairment is the study realm. In the context of a limited number of researches on children with disabilities and rare researches on CWHI and their education in Nepal, this study is a pioneering effort in knowing basically the problems and challenges of CWHI focused on inclusive education in the schools including gaps and barriers in its proper implementation. Philosophically, the paradigm of the study is post-positivism. In the post-positivist worldview, the quantitative approach with the description of the situation and inferential relationship are revealed out in the study. This is related to the natural model of objective reality. The data were collected from an individual survey with the teachers and head teachers of 35 schools in Nepal. The survey questionnaire was prepared and filled by the respondents from the schools where the CWHI study in 7 provincial 20 districts of Nepal. Through these considerations, the perceptions of CWHI focused inclusive education were explored in the study. The data were analyzed using both descriptive and inferential tools on which the Likert scale-based analysis was done for descriptive analysis, and chi-square mathematical tool was used to know the significant relationship between dependent variables and independent variables. The descriptive analysis showed that the majority of teachers have positive perceptions toward implementing CWHI focused inclusive education, and the majority of them have positive perceptions toward CWHI focused inclusive education, though there are some problems and challenges. The study has found out the major challenges and problems categorically. Some of them are: a large number of students in a single class; availability of generic textbooks for CWHI and no availability of textbooks to all students; less opportunity for teachers to acquire knowledge on CWHI; not adequate teachers in the schools; no flexibility in the curriculum; less information system in schools; no availability of educational consular; disaster-prone students; no child abuse control strategy; no disabled-friendly schools; no free health check-up facility; no participation of the students in school activities and in child clubs and so on. By and large, it is found that teachers’ age, gender, years of experience, position, employment status, and disability with him or her show no statistically significant relation to successfully implement CWHI focused inclusive education and perceptions to CWHI focused inclusive education in schools. However, in some of the cases, the set null hypothesis was rejected, and some are completely retained. The study has suggested policy implications, implications for educational authority, and implications for teachers and parents categorically.

Keywords: children with hearing impairment, disability, inclusive education, perception

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Authors: Ziyu Liu, Martin Buijsen

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Although great achievements have been made since the beginning of the Chinese healthcare system reform in 1978, there still remain unresolved problems. Currently, the two leading social issues are accessibility and affordability of healthcare. Facing those challenges, Chinese government initiated the third round of healthcare system reform, accompanied by an array of measures. The newly launched strategies show a tendency to deliver healthcare as welfare goods, achieving equality through an ex-post perspective instead of an ex-ante view. However, if the reform efforts rely solely on the notion of “welfare”, the wrong idea of the government as the only duty-bearer in healthcare will arise. Several major threats, such as high costs as a result of inefficiencies and free riding then become imminent. Therefore, on the basis of Dworkin’s theory, this paper argues that individual responsibility should be introduced when constructing a sustainable healthcare system. And it should be equally highlighted as the duties of government. Furthermore, the notion of individual responsibility is believed to be necessary for promoting the justice of a healthcare system.

Keywords: Chinese healthcare system reform, individual responsibility, right to healthcare, social justice

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Authors: Gudelj Petra, Franic Ema, Kolega Maja

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Mental health is crucial for personal, social, and socio-economic development, becoming an increasingly relevant topic, especially in the post-global pandemic era. One vulnerable demographic comprises students who, during the pandemic, faced challenges such as adapting to new educational methods, societal or residential changes, heightened stress, responsibilities, and entering the job market. These life challenges proved insurmountable for some individuals during this phase. This research aimed to examine students' attitudes towards individuals seeking psychological help. By gaining a better understanding of young people's perceptions of seeking psychological assistance, a clearer insight into how to make psychological support more accessible and acceptable can be achieved. A questionnaire was completed by 210 students from various disciplines at the University of Zagreb. At the same time, the majority of students express a positive attitude towards seeking psychological help, a very small percentage reported having sought it. One of the most common obstacles to seeking appropriate help was a lack of financial means, with the most significant motivators being the positive experiences of those who sought help and an affordable cost.

Keywords: mental health, students, psychological support, attitudes

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Authors: Marzieh Nojomi, Azadeh Mottaghi, Arghavan Haj-Sheykholeslami, Narjes Khalili, Arash Tehrani Banihashemi

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Background and objectives: Domestic violence is a global problem with severe consequences throughout the life of the victims. Iran’s Ministry of Health has launched an intimate partner violence (IPV) prevention program, integrated in the primary health care services since 2016. The present study is a part of this national program’s evaluation. In this section, we aimed to examine spousal abuse victims’ knowledge and attitude towards domestic violence before and after receivingthese services. Methods: To assess the knowledge and attitudes of victims, a questionnaire designed by Ahmadzadand colleagues in 2013 was used. This questionnaire includes 15 questions regarding knowledge in the fields of definition, epidemiology, and effects on children, outcomes, and prevention of domestic violence. To assess the attitudes, this questionnaire has 10 questions regarding the attitudes toward the causes, effects, and legal or protective support services of domestic violence. To assess the satisfaction and the effect of the program on prevention or reduction of spousal violence episodes, two more questions were also added. Since domestic violence prevalence differs in different parts of the country, we chose nine areas with the highest, the lowest, and moderate prevalence of IPVfor the study. The link to final electronic version of the questionnaire was sent to the randomly selected public rural or urban health centers in the nine chosen areas. Since the study had to be completed in one month, we used newly identified victims as pre-intervention group and people who had at least received one related service from the program (like psychiatric consultation, education about safety measures, supporting organizations and etc.) during the previous year, as our post- intervention group. Results: A hundred and ninety-two newly identified IPV victims and 267 victims who had at least received one related program service during the previous year entered the study. All of the victims were female. Basic characteristics of the two groups, including age, education, occupation, addiction, spouses’ age, spouses’ addiction, duration of the current marriage, and number of children, were not statistically different. In knowledge questions, post- intervention group had statistically better scores in the fields of domestic violence outcomes and its effects on children; however, in the remaining areas, the scores of both groups were similar. The only significant difference in the attitude across the two groups was in the field of legal or protective support services. From the 267 women who had ever received a service from the program, 91.8% were satisfied with the services, and 74% reported a decrease in the number of violent episodes. Conclusion: National IPV prevention program integrated in the primary health care services in Iran is effective in improving the knowledge of victims about domestic violence outcomes and its effects on children. Improving the attitude and knowledge of domestic violence victims about its causes and preventive measures needs more effective interventions. This program can reduce the number of IPV episodes between the spouses, and satisfaction among the service users is high.

Keywords: intimate partner violence, assessment, health services, efficacy

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Authors: Kali Prasad Sarma, Nibedita Baul, Jinu Deka

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In the present study, pollution level of polycyclic aromatic hydrocarbon (PAH) in surface soil of historic Tezpur town located in the north bank of the River Brahmaputra were evaluated. In order to determine the seasonal distribution and concentration level of 16 USEPA priority PAHs surface soil samples were collected from 12 different sampling sites with various land use type. The total concentrations of 16 PAHs (∑16 PAHs) varied from 242.68µgkg-1to 7901.89µgkg-1. Concentration of total probable carcinogenic PAH ranged between 7.285µgkg-1 and 479.184 µgkg-1 in different seasons. However, the concentration of BaP, the most carcinogenic PAH, was found in the range of BDL to 50.01 µgkg-1. The composition profiles of PAHs in 3 different seasons were characterized by following two different types of ring: (1) 4-ring PAHs, contributed to highest percentage of total PAHs (43.75%) (2) while in pre- and post- monsoon season 3- ring compounds dominated the PAH profile, contributing 65.58% and 74.41% respectively. A high PAHs concentration with significant seasonality and high abundance of LMWPAHs was observed in Tezpur town. Soil PAHs toxicity was evaluated taking toxic equivalency factors (TEFs), which quantify the carcinogenic potential of other PAHs relative to BaP and estimate benzo[a]pyrene-equivalent concentration (BaPeq). The calculated BaPeq value signifies considerable risk to contact with soil PAHs. We applied cluster analysis and principal component analysis (PCA) with multivariate linear regression (MLR) to apportion sources of polycyclic aromatic hydrocarbons (PAHs) in surface soil of Tezpur town, based on the measured PAH concentrations. The results indicate that petrogenic and pyrogenic sources are the important sources of PAHs. A combination of chemometric and molecular indices were used to identify the sources of PAHs, which could be attributed to vehicle emissions, a mixed source input, natural gas combustion, wood or biomass burning and coal combustion. Source apportionment using absolute principle component scores–multiple linear regression showed that the main sources of PAHs are 22.3% mix sources comprising of diesel and biomass combustion and petroleum spill,13.55% from vehicle emission, 9.15% from diesel and natural gas burning, 38.05% from wood and biomass burning and 16.95% contribute coal combustion. Pyrogenic input was found to dominate source of PAHs origin with more contribution from vehicular exhaust. PAHs have often been found to co-emit with other environmental pollutants like heavy metals due to similar source of origin. A positive correlation was observed between PAH with Cr and Pb (r2 = 0.54 and 0.55 respectively) in monsoon season and PAH with Cd and Pb (r2 = 0.54 and 0.61 respectively) indicating their common source. Strong correlation was observed between PAH and OC during pre- and post- monsoon (r2=0.46 and r2=0.65 respectively) whereas during monsoon season no significant correlation was observed (r2=0.24).

Keywords: polycyclic aromatic hydrocarbon, Tezpur town, chemometric analysis, ecological risk assessment, pollution

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Authors: Peng-Hui Maffee Wan, Klarissa Ting Ting Chang, Rax Suen Chun Lung

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Icons, or pictorial and graphical objects, are commonly used in Human-Computer Interaction (HCI) fields as the mediator in order to communicate information to users. Yet there has been little studies focusing on a majority of the world’s population, semi-literate communities, in terms of the fundamental know-how for designing icons for such population. In this study, two sets of icons belonging in different icon taxonomy, abstract and concrete are designed for a mobile application for semi-literate agricultural communities. In this paper, we propose a triadic relationship of an icon, namely meaning, task and mental image, which inherits the triadic relationship of a sign. User testing with the application and a post-pilot questionnaire are conducted as the experimental approach in two rural villages in India. Icons belonging to concrete taxonomy perform better than abstract icons on the premise that the design of the icon fulfills the underlying rules of the proposed triadic relationship.

Keywords: icon, GUI, mobile app, semi-literate

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Authors: Fiona Mwaniki

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Climate change is considered a serious threat to sustainable development globally and as one of the greatest ecological, economic and social challenges of our time. The global demand for food is projected to increase by 60% by 2050. Small holder farmers who are vulnerable to the adverse effects of climate change are expected to contribute to this projected demand. Effective climate change education and communication is therefore required for smallholder and subsistence farmers’ in order to build communities that are more climate change aware, prepared and resilient. In Kenya radio is the most important and dominant mass communication tool for agricultural extension. This study investigated the potential role of radio in influencing farmers’ understanding and use of climate change information. The broad aims of this study were three-fold. Firstly, to identify Kenyan farmers’ perceptions and responses to the impacts of climate change. Secondly, to develop radio programs that communicate climate change information to Kenyan farmers and thirdly, to evaluate the impact of information disseminated through radio on farmers’ understanding and responses to climate change mitigation and adaptation. This study was conducted within the farming community of Kilifi County, located along the Kenyan coast. Education and communication about climate change was undertaken using radio to make available information understandable to different social and cultural groups. A mixed methods pre-and post-intervention design that provided the opportunity for triangulating results from both quantitative and qualitative data was used. Quantitative and qualitative data was collected simultaneously, where quantitative data was collected through semi structured surveys with 421 farmers’ and qualitative data was derived from 11 focus group interviews, six interviews with key informants and nine climate change experts. The climate change knowledge gaps identified in the initial quantitative and qualitative data were used in developing radio programs. Final quantitative and qualitative data collection and analysis enabled an assessment of the impact of climate change messages aired through radio on the farming community in Kilifi County. Results of this study indicate that 32% of the farmers’ listened to the radio programs and 26% implemented technologies aired on the programs that would help them adapt to climate change. The most adopted technologies were planting drought tolerant crops including indigenous crop varieties, planting trees, water harvesting and use of manure. The proportion of farmers who indicated they knew “a fair amount” about climate change increased significantly (Z= -5.1977, p < 0.001) from 33% (at the pre intervention phase of this study) to 64% (post intervention). However, 68% of the farmers felt they needed “a lot more” information on agriculture interventions (43%), access to financial resources (21%) and the effects of climate change (15%). The challenges farmers’ faced when adopting the interventions included lack of access to financial resources (18%), high cost of adaptation measures (17%), and poor access to water (10%). This study concludes that radio effectively complements other agricultural extension methods and has the potential to engage farmers’ on climate change issues and motivate them to take action.

Keywords: climate change, climate change intervention, farmers, radio

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: T. K. Hung

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Terrorism acts have occurred across both developed and developing states, with well-identified motivation and causes. For many years, terrorism eradication has become a major topic yet only passive actions were taken in response to acts. The linkage between the location of terrorism occurrence and breeding ground is not well-documented, resulting in the passive approach used in counter-terrorism nowadays. The evaluation investigates all post-9/11 terrorism affairs considering their state capacity, safety, ease of border access control, religion diversity, and technology access, to measure the level of breeding ground of the states. Those "weak" states with poor border access control, resources capacity and domestic safety are the best breeding ground for terrorists. Although many attacks were caused by religious motivation, religion diversity does not predict the breeding ground. States with censored technology access, particular computer-mediated communication, predict on the terrorism breeding ground, moderated by the level of breeding ground of neighboring states.

Keywords: counter-terrorism, lethality, security, terrorism

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Authors: Sharon Millen, Sarah Miller, Laura Dunne, Clare McGeady, Laura Neeson

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This paper presents the findings from a randomised controlled trial (RCT) and process evaluation of the Lifestart parenting programme. Lifestart is a structured child-centred programme of information and practical activity for parents of children aged from birth to five years of age. It is delivered to parents in their own homes by trained, paid family visitors and it is offered to parents regardless of their social, economic or other circumstances. The RCT evaluated the effectiveness of the programme and the process evaluation documented programme delivery and included a qualitative exploration of parent and child outcomes. 424 parents and children participated in the RCT: 216 in the intervention group and 208 in the control group across the island of Ireland. Parent outcomes included: parental knowledge of child development, parental efficacy, stress, social support, parenting skills and embeddedness in the community. Child outcomes included cognitive, language and motor development and social-emotional and behavioural development. Both groups were tested at baseline (when children were less than 1 year old), mid-point (aged 3) and at post-test (aged 5). Data were collected during a home visit, which took two hours. The process evaluation consisted of interviews with parents (n=16 at baseline and end-point), and focus groups with Lifestart Coordinators (n=9) and Family Visitors (n=24). Quantitative findings from the RCT indicated that, compared to the control group, parents who received the Lifestart programme reported reduced parenting-related stress, increased knowledge of their child’s development, and improved confidence in their parenting role. These changes were statistically significant and consistent with the hypothesised pathway of change depicted in the logic model. There was no evidence of any change in parents’ embeddedness in the community. Although four of the five child outcomes showed small positive change for children who took part in the programme, these were not statistically significant and there is no evidence that the programme improves child cognitive and non-cognitive skills by immediate post-test. The qualitative process evaluation highlighted important challenges related to conducting trials of this magnitude and design in the general population. Parents reported that a key incentive to take part in study was receiving feedback from the developmental assessment, which formed part of the data collection. This highlights the potential importance of appropriate incentives in relation to recruitment and retention of participants. The interviews with intervention parents indicated that one of the first changes they experienced as a result of the Lifestart programme was increased knowledge and confidence in their parenting ability. The outcomes and pathways perceived by parents and described in the interviews are also consistent with the findings of the RCT and the theory of change underpinning the programme. This hypothesises that improvement in parental outcomes, arising as a consequence of the programme, mediate the change in child outcomes. Parents receiving the Lifestart programme reported great satisfaction with and commitment to the programme, with the role of the Family Visitor being identified as one of the key components of the programme.

Keywords: parent-child relationship, parental self-efficacy, parental stress, school readiness

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Authors: Özgür Bahadir, Meltem Kurtuncu

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The study was designed as quasi-experimental and conducted to determine the effect of music therapy on anxiety, fear and pain management in 6-12-year-old children undergoing surgery. The present study was carried out between 01.01.2016 and 19.08.2016 in BEU. Application and Research Center. The children aged 6 -12 who applied for surgery between the mentioned dates constituted the universe of the study. In the quasi-experimental study that was conducted in the clinics where children received operational treatment, two groups were formed: experimental group (the children who received musical therapy before the surgery) and control group (the children who were administered surveys and the surgery service routines only). Each group consisted of 30 children, and the participants of the study were 60 children in total. Necessary permissions were obtained from the parents of the children hospitalized before the beginning of the implementation. The data was collected through Child Anxiety Sensitivity Index (CASI), “Fear In Medical Treatment Scale”, Face, Legs, Activity, Cry, Consolability Scale (FLACC), Visual Analog Scale (VAS) and Participant Information Form. In the analysis of the data, Kolmogorov-Smirnov distribution scale was used to examine the normality of the distribution along with descriptive statistics methods (Frequency, Percentage, Mean, Standard Deviation). Data was presented in the tables in numbers and percentages. Means were demonstrated along with the standard deviations. The research compared children received; case and control groups include socio-demographic perspective, non-significant difference statistically among similar groups are intertwined. The general level of fear regarding the medical processes before returning to service after the operation and 30 minutes before getting discharged was found to be significantly low in the experimental group compared to control group (p<0.05). No statistically significant difference was found between experimental and control groups in terms of general level of fear regarding the medical processes before the operation, during the operation day and in the recovery room after the operation (p>0.05). Total CASI AD (anxiety sensitivity) levels before the operation, day of the operation and 30 minutes before the discharge for patients in experimental group was found to be significantly higher than the control group (p>0.05). There was no statistically significant difference between the experimental and control groups in the total CASI AD levels for the post-operative recovery room and for returning to the service room after the operation (p>0.05). VAS levels for patients in the experimental group in the post-operative recovery room was significantly higher than the control group (p>0.05). There was no statistically significant difference between the groups in terms of VAS findings in returning to service room after the operation and in 30 minutes before the discharge (p>0.05). As a result of the research; applied children music therapy in the experimental group anxiety, fear, and pain of the scales, their scores average, is lower than the control group children in this situation an increase in the satisfaction of children and parents was observed. In line with this, music therapy preoperative anxiety, fear, and can be used as an effective method of decreasing postoperative pain clinics is suggested.

Keywords: anxiety, children, fear, music therapy, pain

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Authors: Morteza Azimi

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In Afghanistan, as a multi-ethnic country, there have been ethnic conflicts, especially after 2001. These conflicts are more visible among the four main ethnicities Pashtun, Tajik, Hazara, and Uzbek. In this paper, such ethnic conflicts and their roles in the political sphere will be discussed. The distribution of personal electronic ID cards, for example, has been one of the most controversial and unsuccessful projects in Afghanistan. As a result, the lack of clear population statistics has led to several corrupted and unsuccessful presidential elections since 2001. The nation-building process in post-Taliban Afghanistan, as well as the Afghan government’s failure to build a nation, are discussed. By referring to the hybridity theory of Homi Bhabha, it is argued that the process of assimilation for nation-building has not only failed but has deepened ethnic divisions. In the end, some suggestions and solutions for making the most out of ethnic diversity rather than suffering from it will be provided. It will be argued that diversity or difference improves the freedom of choices for groups and individuals; it boosts agency in comparison with life in an assimilated, coherent, and homogeneous society.

Keywords: Afghan identity, ethnicity, nation-building, political system, self and other

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Authors: Rahmatollah Amirjani

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By the emergence of the debate over the failure of Regionalism in the late 1970s, Critical Regional­ism was introduced as a different way to respond to the state of architecture in the post-war era. Critical Regionalism is most often understood as a discourse that not only mediates the language of modern architecture with the local cultures but also revives the relation between architecture and spectator as indexed by capitalism. Since the inception of Critical Regionalism, a large number of architectural practices have emerged around the globe; however, the work of the well-known Portuguese architect, Álvaro Siza, is considered as a unique case amongst works associated with the discourse of Critical Regionalism. This paper intends to respond to a number of questions, including; what are the origins of Critical Regionalism? How does Siza’s design strategy correspond to the thematic of Critical Regionalism? How does Siza recover the relation between object and subject in most of his projects? Using Siza’s housing project for the Malagueira district in Évora, Portugal, this article will attempt to answer these questions, and highlight Alvaro Siza’s design procedure which goes beyond the existing discourse of Critical Regionalism and contributes to our understanding of this practice.

Keywords: Alvaro Siza, critical regionalism, Malagueira housing, placelessness

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Authors: Alaa Mostafa, Samuel Dagogo-Jack, Vivian Thieu, Maria Yu, Nan Zhang, Dara Schuster, Luis-Emilio Garcia-Perez

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Dulaglutide (DU), a once-weekly glucagon-like peptide-1 receptor agonist, was studied in the AWARD clinical trial program in adult patients with type 2 diabetes (T2D) and demonstrated significant hemoglobin A1c (A1c) reduction and potential for weight loss. To evaluate the efficacy and safety of DU 1.5 mg and DU 0.75 mg in patients with T2D by baseline A1c <8.5% or ≥8.5%, a post-hoc analysis was conducted on AWARD-1 to -6 and -8 at 6 months. Across 7 studies, 55% to 82% of the DU-treated patients had a baseline A1c <8.5%, and 18% to 45% had a baseline A1c ≥8.5%. The ranges of A1c reductions with baseline A1c <8.5% and ≥8.5%, respectively, were: DU 1.5 mg: -0.67% to -1.25% and -1.22% to -2.37%; DU 0.75 mg: -0.53% to -1.07% and -1.37% to -2.19%. The A1c reduction from the pooled analysis was greater in patients with baseline A1c ≥8.5% than patients with baseline A1c <8.5%, respectively: DU 1.5 mg: -1.86% and -1.02%; DU 0.75 mg: -1.75% and -0.83%. DU treatments were well tolerated among baseline A1c subgroups. Across the AWARD program, DU 1.5 mg and DU 0.75 mg demonstrated significant A1c reduction in both subgroups with an acceptable safety profile. Compared to patients with baseline A1c <8.5%, patients with baseline A1c ≥8.5% had greater A1c reduction. Disclosures: This study was supported and conducted by Eli Lilly and Company, Indianapolis, IN, USA.

Keywords: A1c reduction, dulaglutide, type 2 diabetes, weight loss

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Authors: B. Prashantha, S. Anish

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The aim of the present study is to computationally evaluate the hemodynamic factors which affect the formation of atherosclerosis and plaque rupture in the human artery. An increase of atherosclerosis disease in the artery causes geometry changes, which results in hemodynamic changes such as flow separation, reattachment, and adhesion of new cells (chemotactic) in the artery. Hence, geometry plays an important role in the determining the nature of hemodynamic patterns. Influence of stenosis in the non-bifurcating artery, under pulsatile flow condition, has been studied on an idealized geometry. Analysis of flow through symmetric and asymmetric stenosis in the artery revealed the significance of oscillating shear index (OSI), flow separation, low WSS zones and secondary flow patterns on plaque formation. The observed characteristic of flow in the post-stenotic region highlight the importance of plaque eccentricity on the formation of secondary stenosis on the arterial wall.

Keywords: atherosclerotic plaque, oscillatory shear index, stenosis nature, wall shear stress

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Authors: Parsa Sheikhzadeh

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Polar bodies are cells that form by oogenesis in meiosis which differentiate and develop from oocytes. Although in many animals, these cells often die following meiotic maturation of the oocyte. Oocyte activation is during mammalian fertilization, sperm is fused with the oocyte's membrane, triggering the resumption of meiosis from the metaphase II arrest, the extrusion of the second polar body, and the exocytosis of cortical granules. The origin recognition complex proteins 4 (ORC4) forms a cage around the set of chromosomes that will be extruded during polar body formation before it binds to the chromatin shortly before zygotic DNA replication. One unique feature of the female gamete is that the polar bodies can provide beneficial information about the genetic background of the oocyte without potentially destroying it. Testing at the polar body (PB) stage was the least accurate, mainly due to the high incidence of post-zygotic events. On the other hand, the results from PB1-MII oocyte pair validated that PB1 contains nearly the same methylome (average Pearson correlation is 0.92) with sibling MII oocyte. In this article, we comprehensively examine the role of polar bodies in female human gametes.

Keywords: polar bodies, ORC4, oocyte, genetic, methylome, gamete, female

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Authors: Khairul Hasni

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A Memorandum of Understanding (MoU) for the cessation of hostilities was signed by Aceh's longstanding adversaries (the Government of Indonesia and the Free Aceh Movement (GAM) in August 2005. The Government of Indonesia has given the autonomy to Aceh Province of Indonesia, the Law Number 11 of 2006 the authority of the Aceh government to the implementation of the Islamic Sharia. The implementation of Islamic Sharia, Aceh can be a role model of Islam that glorifies women, the implementation of Islamic law in Aceh when enacted and got legality because it supported the socio-cultural and historical community. The value of the value of women's lives is shifted under the pressure of applying Islamic law, with this argument, the importance of justice and equality of policy enforcement in women's lives. Based on interviews conducted in 2016 and 2017 with women's activists, government officials, women non-governmental organizations in Aceh, this paper finds that there is lack of gender balance because of the many problems involving women in the enactment of regional regulations and control policies on women's bodies. The research points to ensure the implementation of Islamic Sharia practitioners have only directed to women and discrimination against women.

Keywords: women, policy, Islamic law, social

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Authors: May George

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Native speakers can play a significant role in improving second language learners speaking skills through weekly interaction. Speaking is one of the important skills that second language learners need to practice in order to be able to communicate the language. This study will examine Talkaboard as an important tool to achieve better outcomes in speaking a language. The subject of the study will be 16 advanced Arabic language learners at the college level. There will be a pre-test and post-test to examine the conversation outcomes using the Talkaborad tool. The students will be asked to write a summary and talk about their weekly conversation experience with the native speaker in class. The teacher will use a check list to determine the progress made in speaking the Arabic language. The results of this study will provide language teachers with information related to the native speakers’ role in language and the progress the second language learners made after interacting with native speakers.

Keywords: speaking, language, interaction, culture

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Authors: U. N. Bhatty, A. Bhatia, A. George, F. Fiaz

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Post-operatively, patients with the neck of femur fractures are the high-risk of venous thromboembolic events (VTE). NICE have issued guidelines in this regard. We investigated whether these guidelines were being followed. 124 patients undergoing neck of femur fracture surgery were retrospectively analysed at a major orthopaedic centre in England. 9% of patients received adequate anticoagulation (16.5% mortality). An education campaign subsequently took place, circular emails were sent to junior doctors and posters advertised. A reaudit 4 months later showed only 12% of the 68 patients received adequate anticoagulation (11.8% mortality). The education campaign failed to improve prescribing behaviours. Furthermore, as morbidity was not measured, the consequence of poor prescription is underestimated. Perhaps, poor prescribing is because of the silent nature of effective thromboprophylaxis; reducing its perceived effectiveness. Simple interventions are insufficient to change these habits and more intense work is needed; such as compulsory proformas for all high-risk patients.

Keywords: fracture, hip, orthopaedics, thromboembolism

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Authors: Thanasis K. Barlas, Helge A. Madsen

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A novel Active Flap System (AFS) has been developed at DTU Wind Energy, as a result of a 3-year R\&D project following almost 10 years of innovative research in this field. The full-scale AFS comprises an active deformable trailing edge has been tested at the unique rotating test facility at the Risoe Campus of DTU Wind Energy in Denmark. The design and instrumentation of the wing section and the active flap system (AFS) are described. The general description and objectives of the rotating test rig at the Risoe campus of DTU are presented, as used for the aeroelastic testing of the AFS in the recently finalized INDUFLAP project. The general description and objectives are presented, along with an overview of sensors on the setup and the test cases. The post-processing of data is discussed and results of steady flap step and azimuth control flap cases are presented.

Keywords: morphing, adaptive, flap, smart blade, wind turbine

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Authors: Philip Baillie, Stuart W. Campbell, Alexander M. Galloway, Stephen R. Cater, Norman A. McPherson

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This study compared the mechanical and microstructural properties produced during friction stir welding(FSW) of S275 structural steel in air and underwater. Post weld tests assessed the tensile strength, micro-hardness, distortion, Charpy impact toughness and fatigue performance in each case. The study showed that there was no significant difference in the strength, hardness or fatigue life of the air and underwater specimens. However, Charpy impact toughness was shown to decrease for the underwater specimens and was attributed to a lower degree of recrystallization caused by the higher rate of heat loss experienced when welding underwater. Reduced angular and longitudinal distortion was observed in the underwater welded plate compared to the plate welded in air.

Keywords: Charpy impact toughness, distortion, fatigue, friction stir welding(FSW), micro-hardness, underwater

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Authors: Saleh H. Abud, Z. Hassan, F. K. Yam

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Characteristics of MSM photodetector based on a porous In0.08Ga0.92N thin film were reported. Nanoporous structures of n-type In0.08Ga0.92N/AlN/Si thin films were synthesized by photoelectrochemical (PEC) etching at a ratio of 1:4 of HF:C2H5OH solution for 15 min. The structural and optical properties of pre- and post-etched thin films were investigated. Field emission scanning electron microscope and atomic force microscope images showed that the pre-etched thin film has a sufficiently smooth surface over a large region and the roughness increased for porous film. Blue shift has been observed in photoluminescence emission peak at 300 K for porous sample. The photoluminescence intensity of the porous film indicated that the optical properties have been enhanced. A high work function metals (Pt and Ni) were deposited as a metal contact on the porous films. The rise and recovery times of the devices were investigated at 390 nm chopped light. Finally, the sensitivity and quantum efficiency were also studied.

Keywords: porous InGaN, photoluminescence, SMS photodetector, atomic force microscopy

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Authors: Zohreh Afsharmand, Sokhanguei Yahya

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A growing body of literature suggests that that low-grade systemic inflammation associated to obesity plays a key role in the pathogenic mechanism of several disorders. In this study, the effect of 6 weeks aerobic training on IL-6 and IL-1B as inflammatory cytokine were investigated in adult obese women. For this purpose, 26 sedentary adult obese women were divided into exercise and control groups (n=12). Pre and post training of mentioned cytokines were measured in two groups. Student’s t-tests for paired samples were performed to determine whether there were significant within-group changes in the outcomes. A p value less than 0.05 was considered statistically significant. There were no statistically significant differences between the exercise and control groups with regard to anthropometrical markers or inflammatory cytokines. Despite the significant decrease in all anthropometrical markers, no significant differences were found in serum IL-6 and IL-1B by aerobic training with compared to baseline. Our findings indicate that aerobic training intervention for a short time is not associated with the anti-inflammatory property in obese women.

Keywords: aerobic training, cytokine, inflammation, obesity

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Authors: Dahna Alkahtani, Faryal Suraya, Fadah Alanazi

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Background: Buccal mucosal graft for urethral augmentation has surpassed other grafting options, and is now considered the standard of choice for substitution Urethroplasty. The graft has gained its popularity due to its excellent short and long-term results, easy harvesting as well as its ability in withstanding wet environments. However, although Buccal mucosal grafts are an excellent option, it is not free of complications, potential intraoral complications are bleeding, pain, swelling, injury to the nerve resulting in numbness, lip deviation or retraction. Objectives: The current study aims to evaluate the intraoral complications of buccal mucosa grafts harvested from one cheek, and used in Augmentation Urethroplasty. Methodology: The study was conducted retrospectively using the medical records of patients who underwent open augmentation urethroplasty with a buccal mucosa graft at King Khalid University Hospital, Saudi Arabia. Data collection of demographics included the type of graft used, presence or absence of strictures and its etiological factors. Pre-operative and post-operative evaluations were carried out on the subjects including the medical history, physical examination, uroflowmetry, retrograde urethrography, voiding cystourethrography and urine cultures were also noted. Further, the quality of life and complications of the procedure including the presence or occurrence of bleeding within 3-days post-procedure, the severity of pain, oral swelling after grafting, length of return to normal daily diet, painful surgical site, intake of painkillers, presence or absence of speech disturbance, numbness in the cheeks and lips were documented. Results: Thirty-two male subjects with ages ranging from 15 years to 72 years were included in the current study. Following the procedure, a hundred percent of the subjects returned to their normal daily diet by the sixth postoperative day. Further, the majority of the patients reported experiencing mild pain accounting for 61.3%, and 90.3% of the subjects reported using painkillers to control the pain. Surgical wound Pain was reportedly more common at the perineal site as 48.4% of the subjects experienced it; on the other hand, 41.9% of the patients experienced pain in the oral mucosa. The presence of speech disorders, as assessed through medical history, was found to be present in 3.2% of patients. The presence of numbness in the cheeks and lips was found in 3.2% of patients. Other complications such as parotid duct injury, delayed wound healing, non-healing wound and suture granuloma were rare as 90.3% of the subjects denied experiencing any of them, there were nonetheless reports of parotid duct injury by 6.5% of the patients, and non-healing wound by the 3.2% of patients. Conclusion: Buccal Mucosa Graft in Augmentation Urethroplasty is an ideal source of allograft, although not entirely painless; it is considerably safe with minimal intra-oral complication and undetectable strain on the patients’ quality of life.

Keywords: augmentation, buccal, graft, oral

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