Search results for: Anne Murphy
65 Assessing the Quality of Maternity Care in Sub-Saharan Africa Using the Donabedian Quality of Care Framework: A Systematic Scoping Review
Authors: Bernice Boafoaa Gyapong, Anne Jones, Sam Bassett, Janet Anderson
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Background: Maternal mortality and morbidity are global concerns, especially in sub-Saharan Africa (SSA). Most maternal mortalities occur at the time of birth. Quality intrapartum care is essential for improving maternal and newborn health outcomes. This scoping review aimed to assess and describe the quality of care during childbirth in SSA to provide an overview of the regional trend of the quality of intrapartum care, the challenges to quality care provision, and identify research gaps. Methods: A scoping review based on Arksey and O’Malley’s scoping review framework was conducted. Medline, CINAHL, PsycINFO, and maternal-infant databases were searched to identify the relevant studies for this review. A narrative summary was presented using themes based on the Donabedian structure, process, and outcome quality of care model. Results: A total of five hundred and forty-seven (547) publications were identified. Fifty-six (56) studies conducted in twenty (20) countries were included in the review. Thirty-four (34) were quantitative, sixteen (16) were qualitative, and six (6) were mixed methods. Most of the studies were related to the process component of quality of care. The provision of emergency obstetric care services, infrastructure, and availability of essential staff and equipment for perinatal care was inadequate in many facilities, particularly rural and peripheral health facilities. Many women experienced disrespectful care during childbirth. Routine care during labour and delivery was observed to be sub-optimal, yet some women reported high satisfaction with care. The use of health facilities for delivery was lower in health centres compared to hospitals. Conclusion: There are variations in the quality of maternity care provided in SSA. Intrapartum care quality is generally deficient in SSA, particularly in peripheral health facilities, health centres, and community clinics. Many of the quality-of-care issues identified are related to the structure component. Stakeholders must develop interventions that comprehensively address these interrelated issues to improve maternal healthcare quality, especially in primary healthcare facilities.Keywords: quality of care, maternity health, Sub-Saharan Africa, intrapartum
Procedia PDF Downloads 7064 Gender, Climate Change, and Resilience in Kenyan Pastoralist Communities
Authors: Anne Waithira Dormal
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Climate change is threatening pastoral livelihoods in Kajiado County, Kenya, through water shortages, livestock deaths, and increasing poverty. This study examines how these impacts differ for men and women within these communities. Limited access to resources, limited land and livestock rights, and limited decision-making power increase women's vulnerability, which is further burdened by traditional gender roles in water procurement. The research recognizes the complexity of climate change and emphasizes that factors such as wealth, family dynamics, and socioeconomic status also influence resilience. Effective adaptation strategies must address all genders. While livestock farming provides a safety net, socioeconomic empowerment through access to credit, healthcare, and education strengthens entire communities. An intersectional perspective that takes ethnicity, social status, and other factors into account is also crucial. This research, therefore, aims to examine how gender-specific adaptation strategies interact with gender and socioeconomic factors to determine the resilience of these Kenyan pastoralist communities. Such strategies, which address the specific needs and vulnerabilities of men and women, are expected to lead to increased resilience to climate change. The aim of the study is to identify effective, gender-specific adaptation strategies that can be integrated into climate change planning and implementation. Additionally, research awaits a deeper understanding of how socioeconomic factors interact with gender to influence vulnerability and resilience within these communities. The study uses a gender-sensitive qualitative approach with focus group discussions in four different pastoral and agropastoral communities. Both qualitative and demographic data are used to capture sources of income, education level, and household size of focus group respondents to increase the power of the analysis. While the research acknowledges the limitations of specific focus sites and potential biases in self-reporting, it offers valuable insights into gender and climate change in pastoral contexts. This study contributes to understanding gender-based vulnerabilities and building resilience in these communities.Keywords: climate adaptation strategies, climate change, climate resilience, gendered vulnerability, pastoralism
Procedia PDF Downloads 4663 Crisis Management and Corporate Political Activism: A Qualitative Analysis of Online Reactions toward Tesla
Authors: Roxana D. Maiorescu-Murphy
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In the US, corporations have recently embraced political stances in an attempt to respond to the external pressure exerted by activist groups. To date, research in this area remains in its infancy, and few studies have been conducted on the way stakeholder groups respond to corporate political advocacy in general and in the immediacy of such a corporate announcement in particular. The current study aims to fill in this research void. In addition, the study contributes to an emerging trajectory in the field of crisis management by focusing on the delineation between crises (unexpected events related to products and services) and scandals (crises that spur moral outrage). The present study looked at online reactions in the aftermath of Elon Musk’s endorsement of the Republican party on Twitter. Two data sets were collected from Twitter following two political endorsements made by Elon Musk on May 18, 2022, and June 15, 2022, respectively. The total sample of analysis stemming from the data two sets consisted of N=1,374 user comments written as a response to Musk’s initial tweets. Given the paucity of studies in the preceding research areas, the analysis employed a case study methodology, used in circumstances in which the phenomena to be studied had not been researched before. According to the case study methodology, which answers the questions of how and why a phenomenon occurs, this study responded to the research questions of how online users perceived Tesla and why they did so. The data were analyzed in NVivo by the use of the grounded theory methodology, which implied multiple exposures to the text and the undertaking of an inductive-deductive approach. Through multiple exposures to the data, the researcher ascertained the common themes and subthemes in the online discussion. Each theme and subtheme were later defined and labeled. Additional exposures to the text ensured that these were exhaustive. The results revealed that the CEO’s political endorsements triggered moral outrage, leading to Tesla’s facing a scandal as opposed to a crisis. The moral outrage revolved around the stakeholders’ predominant rejection of a perceived intrusion of an influential figure on a domain reserved for voters. As expected, Musk’s political endorsements led to polarizing opinions, and those who opposed his views engaged in online activism aimed to boycott the Tesla brand. These findings reveal that the moral outrage that characterizes a scandal requires communication practices that differ from those that practitioners currently borrow from the field of crisis management. Specifically, because scandals flourish in online settings, practitioners should regularly monitor stakeholder perceptions and address them in real-time. While promptness is essential when managing crises, it becomes crucial to respond immediately as a scandal is flourishing online. Finally, attempts should be made to distance a brand, its products, and its CEO from the latter’s political views.Keywords: crisis management, communication management, Tesla, corporate political activism, Elon Musk
Procedia PDF Downloads 9162 Interrelationship of Socio-Demographic Factors, Health Belief Dimensions and Compliance to Measles Vaccination among Filipino Mothers
Authors: Beryl Rene R. Lopez, Lesley Anne M. Lipat, Rhogene Barbette C. Lirio, Laurice Joy H. Llanes, Karl Philippe M. Llapitan, Einstein James R. Lopez, Socorro S. GuanHing
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Background: Measles remain as one of the most common childhood diseases despite the availability of the vaccine that is safe and cost-effective. Because of morbidity and mortality associated with the recent measles outbreak in the Philippines, there is an increasing concern from the health care professionals. Objective: The purpose of this study is to determine the relationship between the compliance of Filipino mothers to measles vaccination and their health beliefs when grouped according to the given socio-demographic factors using a researcher-made questionnaire. Research Methodology: This research utilized the descriptive-correlational research design. With the use of purposive sampling technique, the study involved 200 Filipino mothers aged 18 years old and above excluding those who are healthcare professionals with children aged 2-3 years old with either urban or rural as their settlements. Pre-testing was done prior to the actual data gathering. A questionnaire composed of 26 items involving socio-demographic, compliance, and health beliefs was distributed to the sample population. Statistical analysis was done with the use of Exploratory Factor Analysis (EFA) for the first research question and Structural Equation Model (SEM) for the second research question. Results: Four dimensions were generated with the use of EFA namely: Vulnerability-Oriented Beliefs (VOB), Knowledge-Oriented Beliefs (KOB), Accessibility-Oriented Beliefs (AOB), and Outcomes-Oriented Beliefs (OOB). These were then correlated with the mothers’ socio-demographic factors (age, educational attainment, the area of residence, the number of children, and family income) and their compliance to the measles vaccination schedule. Results showed significant and direct relationships between area of residence and compliance, family income and compliance, KOB and compliance, education and KOB, KOB and VOB, KOB and OOB, AOB and KOB, AOB and OOB, AOB and VOB, and lastly, OOB and VOB. Conclusion: The Knowledge – Oriented Belief dimension greatly influence compliance to measles vaccination. Other determinants of compliance like the area of residence, educational attainment, and family income significantly increase the Filipino mothers’ likelihood of compliance to measles vaccination, which have implications to health education.Keywords: socio-demographic, health beliefs, compliance, measles vaccination
Procedia PDF Downloads 37561 Peer Support Groups as a Tool to Increase Chances of Passing General Practice UK Qualification Exams
Authors: Thomas Abraham, Garcia de la Vega Felipe, Lubna Nishath, Nzekwe Nduka, Powell Anne-Marie
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Introduction: The purpose of this paper is to discuss the effectiveness of a peer support network created to provide medical education, pastoral support, and reliable resources to registrars to help them pass the MRCGP exams. This paper will include a description of the network and its purpose, discuss how it has been used by trainees since its creation, and explain how this methodology can be applied to other areas of medical education and primary care. Background: The peer support network was created in February 2021, using Facebook, Telegram, and WhatsApp platforms to facilitate discussion of cases and answer queries about the exams, share resources, and offer peer support from qualified GPs and specialists. The network was created and is maintained by the authors of this paper and is open to anyone who is registered with the General Medical Council (GMC) and is studying for the MRCGP exams. Purpose: The purpose of the network is to provide medical education, pastoral support, and reliable resources to registrars to help them pass the exams. The network is free to use and is designed to take the onus away from a single medical educator and collate a vast amount of information from multiple medical educators/trainers; thereby creating a digital library of information for all trainees - exam related or otherwise. Methodology The network is managed by a team of moderators who respond to queries and facilitate discussion. Smaller study groups are created from the main group and provide a platform for trainees to work together, share resources, and provide peer support. The network has had thousands of trainees using it since February 2021, with positive feedback from all trainees. Results: The feedback from trainees has been overwhelmingly positive. Word of mouth has spread rapidly, growing the groups exponentially. Trainees add colleagues to the groups and often stay after they pass their exams to 'give back' to their fellow trainees. To date, thousands of trainees have passed the MRCGP exams using the resources and support provided by the network. Conclusion The success of this peer support network demonstrates the effectiveness of creating a network of thousands of doctors to provide medical education and support.Keywords: peer support, medical education, pastoral support, MRCGP exams
Procedia PDF Downloads 13560 Improving Collective Health and Social Care through a Better Consideration of Sex and Gender: Analytical Report by the French National Authority for Health
Authors: Thomas Suarez, Anne-Sophie Grenouilleau, Erwan Autin, Alexandre Biosse-Duplan, Emmanuelle Blondet, Laurence Chazalette, Marie Coniel, Agnes Dessaigne, Sylvie Lascols, Andrea Lasserre, Candice Legris, Pierre Liot, Aline Metais, Karine Petitprez, Christophe Varlet, Christian Saout
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Background: The role of biological sex and gender identity -whether assigned or chosen- as health determinants are far from a recent discovery: several reports have stressed out how being a woman or a man could affect health on various scales. However, taking it into consideration beyond stereotypes and rigid binary assumptions still seems to be a work in progress. Method: The report is a synthesis on a variety of specific topics, each of which was studied by a specialist from the French National Authority for Health (HAS), through an analysis of existing literature on both healthcare policy construction process and instruments (norms, data analysis, clinical trials, guidelines, and professional practices). This work also implied a policy analysis of French recent public health laws and a retrospective study of guidelines with a gender mainstreaming approach. Results: The analysis showed that though sex and gender were well-known determinants of health, their consideration by both public policy and health operators was often incomplete, as it does not incorporate how sex and gender interact, as well as how they interact with other factors. As a result, the health and social care systems and their professionals tend to reproduce some stereotypical and inadequate habits. Though the data available often allows to take sex and gender into consideration, such data is often underused in practice guidelines and policy formulation. Another consequence is a lack of inclusiveness towards transgender or intersex persons. Conclusions: This report first urges for raising awareness of all the actors of health, in its broadest definition, that sex and gender matter beyond first-look conclusions. It makes a series of recommendations in order to reshape policy construction in the health sector on the one hand and to design public health instruments to make them more inclusive regarding sex and gender on the other hand. The HAS finally committed to integrate sex and gender preoccupations in its workings methods, to be a driving force in the spread of these concerns.Keywords: biological sex, determinants of health, gender, healthcare policy instruments, social accompaniment
Procedia PDF Downloads 12859 Proposing Smart Clothing for Addressing Criminal Acts Against Women in South Africa
Authors: Anne Mastamet-Mason
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Crimes against women is a global concern, and South Africa, in particular, is in a dilemma of dealing with constant criminal acts that face the country. Debates on violence against women in South Africa cannot be overemphasised any longer as crimes continue to rise year by year. The recent death of a university student at the University of Cape Town, as well as many other cases, continues to strengthen the need to find solutions from all the spheres of South African society. The advanced textiles market contains a high number and variety of technologies, many of which have protected status and constitute a relatively small portion of the textiles used for the consumer market. Examples of advanced textiles include nanomaterials, such as silver, titanium dioxide and zinc oxide, designed to create an anti-microbial and self-cleaning layer on top of the fibers, thereby reducing body smell and soiling. Smart textiles propose materials and fabrics versatile and adaptive to different situations and functions. Integrating textiles and computing technologies offer an opportunity to come up with differentiated characteristics and functionality. This paper presents a proposal to design a smart camisole/Yoga sports brazier and a smart Yoga sports pant garment to be worn by women while alone and while in purported danger zones. The smart garments are to be worn under normal clothing and cannot be detected or seen, or suspected by perpetrators. The garments are imbued with devices to sense any physical aggression and any abnormal or accelerated heartbeat that may be exhibited by the victim of violence. The signals created during the attack can be transmitted to the police and family members who own a mobile application system that accepts signals emitted. The signals direct the receiver to the exact location of the offence, and the victim can be rescued before major violations are committed. The design of the Yoga sports garments will be done by Professor Mason, who is a fashion designer by profession, while the mobile phone application system will be developed by Mr. Amos Yegon, who is an independent software developer.Keywords: smart clothing, wearable technology, south africa, 4th industrial revolution
Procedia PDF Downloads 20758 Clinical Presentation and Immune Response to Intramammary Infection of Holstein-Friesian Heifers with Isolates from Two Staphylococcus aureus Lineages
Authors: Dagmara A. Niedziela, Mark P. Murphy, Orla M. Keane, Finola C. Leonard
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Staphylococcus aureus is the most frequent cause of clinical and subclinical bovine mastitis in Ireland. Mastitis caused by S. aureus is often chronic and tends to recur after antibiotic treatment. This may be due to several virulence factors, including attributes that enable the bacterium to internalize into bovine mammary epithelial cells, where it may evade antibiotic treatment, or evade the host immune response. Four bovine-adapted lineages (CC71, CC97, CC151 and ST136) were identified among a collection of Irish S. aureus mastitis isolates. Genotypic variation of mastitis-causing strains may contribute to different presentations of the disease, including differences in milk somatic cell count (SCC), the main method of mastitis detection. The objective of this study was to investigate the influence of bacterial strain and lineage on host immune response, by employing cell culture methods in vitro as well as an in vivo infection model. Twelve bovine adapted S. aureus strains were examined for internalization into bovine mammary epithelial cells (bMEC) and their ability to induce an immune response from bMEC (using qPCR and ELISA). In vitro studies found differences in a variety of virulence traits between the lineages. Strains from lineages CC97 and CC71 internalized more efficiently into bovine mammary epithelial cells (bMEC) than CC151 and ST136. CC97 strains also induced immune genes in bMEC more strongly than strains from the other 3 lineages. One strain each of CC151 and CC97 that differed in their ability to cause an immune response in bMEC were selected on the basis of the above in vitro experiments. Fourteen first-lactation Holstein-Friesian cows were purchased from 2 farms on the basis of low SCC (less than 50 000 cells/ml) and infection free status. Seven cows were infected with 1.73 x 102 c.f.u. of the CC97 strain (Group 1) and another seven with 5.83 x 102 c.f.u. of the CC151 strain (Group 2). The contralateral quarter of each cow was inoculated with PBS (vehicle). Clinical signs of infection (temperature, milk and udder appearance, milk yield) were monitored for 30 days. Blood and milk samples were taken to determine bacterial counts in milk, SCC, white blood cell populations and cytokines. Differences in disease presentation in vivo between groups were observed, with two animals from Group 2 developing clinical mastitis and requiring antibiotic treatment, while one animal from Group 1 did not develop an infection for the duration of the study. Fever (temperature > 39.5⁰C) was observed in 3 animals from Group 2 and in none from Group 1. Significant differences in SCC and bacterial load between groups were observed in the initial stages of infection (week 1). Data is also being collected on cytokines and chemokines secreted during the course of infection. The results of this study suggest that a strain from lineage CC151 may cause more severe clinical mastitis, while a strain from lineage CC97 may cause mild, subclinical mastitis. Diversity between strains of S. aureus may therefore influence the clinical presentation of mastitis, which in turn may influence disease detection and treatment needs.Keywords: Bovine mastitis, host immune response, host-pathogen interactions, Staphylococcus aureus
Procedia PDF Downloads 15757 Groundwater Flow Dynamics in Shallow Coastal Plain Sands Aquifer, Abesan Area, Eastern Dahomey Basin, Southwestern Nigeria
Authors: Anne Joseph, Yinusa Asiwaju-Bello, Oluwaseun Olabode
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Sustainable administration of groundwater resources tapped in Coastal Plain Sands aquifer in Abesan area, Eastern Dahomey Basin, Southwestern Nigeria necessitates the knowledge of the pattern of groundwater flow in meeting a suitable environmental need for habitation. Thirty hand-dug wells were identified and evaluated to study the groundwater flow dynamics and anionic species distribution in the study area. Topography and water table levels method with the aid of Surfer were adopted in the identification of recharge and discharge zones where six recharge and discharge zones were delineated correspondingly. Dissolved anionic species of HCO3-, Cl-, SO42-and NO3- were determined using titrimetric and spectrophotometric method. The trend of significant anionic concentrations of groundwater samples are in the order Cl- > HCO3-> SO42- > NO3-. The prominent anions in the discharge and recharge area are Cl- and HCO3- ranging from 0.22ppm to 3.67ppm and 2.59ppm to 0.72ppm respectively. Analysis of groundwater head distribution and the groundwater flow vector in Abesan area confirmed that Cl- concentration is higher than HCO3- concentration in recharge zones. Conversely, there is a high concentration of HCO3- than Cl- inland towards the continent; therefore, HCO3-concentration in the discharge zones is higher than the Cl- concentration. The anions were to be closely related to the recharge and discharge areas which were confirmed by comparison of activities such as rainfall regime and anthropogenic activities in Abesan area. A large percentage of the samples showed that HCO3-, Cl-, SO42-and NO3- falls within the permissible limit of the W.H.O standard. Most of the samples revealed Cl- / (CO3- + HCO3-) ratio higher than 0.5 indicating that there is saltwater intrusion imprints in the groundwater of the study area. Gibbs plot shown that most of the samples is from rock dominance, some from evaporation dominance and few from precipitation dominance. Potential salinity and SO42/ Cl- ratios signifies that most of the groundwater in Abesan is saline and falls in a water class found to be insuitable for irrigation. Continuous dissolution of these anionic species may pose a significant threat to the inhabitants of Abesan area in the nearest future.Keywords: Abessan, Anionic species, Discharge, Groundwater flow, Recharge
Procedia PDF Downloads 12456 Religious Fundamentalism Prescribes Requirements for Marriage and Reproduction
Authors: Steven M. Graham, Anne V. Magee
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Most world religions have sacred texts and traditions that provide instruction about and definitions of marriage, family, and family duties and responsibilities. Given that religious fundamentalism (RF) is defined as the belief that these sacred texts and traditions are literally and completely true to the exclusion of other teachings, RF should be predictive of the attitudes one holds about these topics. The goals of the present research were to: (1) explore the extent to which people think that men and women can be happy without marriage, a significant sexual relationship, a long-term romantic relationship, and having children; (2) determine the extent to which RF is associated with these beliefs; and, (3) to determine how RF is associated with considering certain elements of a relationship to be necessary for thinking of that relationship as a marriage. In Study 1, participants completed a reliable and valid measure of RF and answered questions about the necessity of various elements for a happy life. Higher RF scores were associated with the belief that both men and women require marriage, a sexual relationship, a long-term romantic relationship, and children in order to have a happy life. In Study 2, participants completed these same measures and the pattern of results replicated when controlling for overall religiosity. That is, RF predicted these beliefs over and above religiosity. Additionally, participants indicated the extent to which a variety of characteristics were necessary to consider a particular relationship to be a marriage. Controlling for overall religiosity, higher RF scores were associated with the belief that the following were required to consider a relationship a marriage: religious sanctification, a sexual component, sexual monogamy, emotional monogamy, family approval, children (or the intent to have them), cohabitation, and shared finances. Interestingly, and unexpectedly, higher RF scores were correlated with less importance placed on mutual consent in order to consider a relationship a marriage. RF scores were uncorrelated with the importance placed on legal recognition or lifelong commitment and these null findings do not appear to be attributable to ceiling effects or lack of variability. These results suggest that RF constrains views about both the importance of marriage and family in one’s life and also the characteristics required to consider a relationship a proper marriage. This could have implications for the mental and physical health of believers high in RF, either positive or negative, depending upon the extent to which their lives correspond to these templates prescribed by RF. Additionally, some of these correlations with RF were substantial enough (> .70) that the relevant items could serve as a brief, unobtrusive measure of RF. Future research will investigate these possibilities.Keywords: attitudes about marriage, fertility intentions, measurement, religious fundamentalism
Procedia PDF Downloads 11855 Understanding the Interplay between Consumer Knowledge, Trust and Relationship Satisfaction in Financial Services
Authors: Torben Hansen, Lars Gronholdt, Alexander Josiassen, Anne Martensen
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Consumers often exhibit a bias in their knowledge; they often think that they know more or less than they do. The concept of 'knowledge over/underconfidence' (O/U) has in previous studies been used to investigate such knowledge bias. O/U appears as a combination of subjective and objective knowledge. Subjective knowledge relates to consumers’ perception of their knowledge, while objective knowledge relates to consumers’ absolute knowledge measured by objective standards. This separation leads to three scenarios: The consumer can either be knowledge calibrated (subjective and objective knowledge are similar), overconfident (subjective knowledge exceeds objective knowledge) or underconfident (objective knowledge exceeds subjective knowledge). Knowledge O/U is a highly useful concept in understanding consumer choice behavior. For example, knowledge overconfident individuals are likely to exaggerate their ability to make right choices, are more likely to opt out of necessary information search, spend less time to carry out a specific task than less knowledge confident consumers, and are more likely to show high financial trading volumes. Through the use of financial services as a case study, this study contributes to previous research by examining how consumer knowledge O/U affects two types of trust (broad-scope trust and narrow-scope trust) and consumer relationship satisfaction. Trust does not only concern consumer trust in individual companies (i.e., narrow.-scope confidence NST), but also concerns consumer confidence in the broader business context in which consumers plan and implement their behavior (i.e., broad scope trust, BST). NST is defined as "the expectation that the service provider can be relied on to deliver on its promises’, while BST is defined as ‘the expectation that companies within a particular business type can generally be relied on to deliver on their promises.’ This study expands our understanding of the interplay between consumer knowledge bias, consumer trust, and relationship marketing in two main ways: First, it is demonstrated that the more knowledge O/U a consumer becomes, the higher/lower NST and levels of relationship satisfaction will be. Second, it is demonstrated that BST has a negative moderating effect on the relationship between knowledge O/U and satisfaction, such that knowledge O/U has a higher positive/negative effect on relationship satisfaction when BST is low vs. high. The data for this study comprises 756 mutual fund investors. Trust is particularly important in consumers’ mutual fund behavior because mutual funds have important responsibilities in providing financial advice and in managing consumers’ funds.Keywords: knowledge, cognitive bias, trust, customer-seller relationships, financial services
Procedia PDF Downloads 30154 Embodied Communication - Examining Multimodal Actions in a Digital Primary School Project
Authors: Anne Öman
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Today in Sweden and in other countries, a variety of digital artefacts, such as laptops, tablets, interactive whiteboards, are being used at all school levels. From an educational perspective, digital artefacts challenge traditional teaching because they provide a range of modes for expression and communication and are not limited to the traditional medium of paper. Digital technologies offer new opportunities for representations and physical interactions with objects, which put forward the role of the body in interaction and learning. From a multimodal perspective the emphasis is on the use of multiple semiotic resources for meaning- making and the study presented here has examined the differential use of semiotic resources by pupils interacting in a digitally designed task in a primary school context. The instances analyzed in this paper come from a case study where the learning task was to create an advertising film in a film-software. The study in focus involves the analysis of a single case with the emphasis on the examination of the classroom setting. The research design used in this paper was based on a micro ethnographic perspective and the empirical material was collected through video recordings of small-group work in order to explore pupils’ communication within the group activity. The designed task described here allowed students to build, share, collaborate upon and publish the redesigned products. The analysis illustrates the variety of communicative modes such as body position, gestures, visualizations, speech and the interaction between these modes and the representations made by the pupils. The findings pointed out the importance of embodied communication during the small- group processes from a learning perspective as well as a pedagogical understanding of pupils’ representations, which were similar from a cultural literacy perspective. These findings open up for discussions with further implications for the school practice concerning the small- group processes as well as the redesigned products. Wider, the findings could point out how multimodal interactions shape the learning experience in the meaning-making processes taking into account that language in a globalized society is more than reading and writing skills.Keywords: communicative learning, interactive learning environments, pedagogical issues, primary school education
Procedia PDF Downloads 40853 Microalgae Hydrothermal Liquefaction Process Optimization and Comprehension to Produce High Quality Biofuel
Authors: Lucie Matricon, Anne Roubaud, Geert Haarlemmer, Christophe Geantet
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Introduction: This case discusses the management of two floor of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. Case Report: A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Discussion: Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk, and second primary cancer development.Keywords: microalgae, biofuels, hydrothermal liquefaction, biomass
Procedia PDF Downloads 13352 Femoral Neck Anteversion and Neck-Shaft Angles: Determination and Their Clinical Implications in Fetuses of Different Gestational Ages
Authors: Vrinda Hari Ankolekar, Anne D. Souza, Mamatha Hosapatna
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Introduction: Precise anatomical assessment of femoral neck anteversion (FNA) and the neck shaft angles (NSA) would be essential in diagnosing the pathological conditions involving hip joint and its ligaments. FNA of greater than 20 degrees is considered excessive femoral anteversion, whereas a torsion angle of fewer than 10 degrees is considered femoral retroversion. Excessive femoral torsion is not uncommon and has been associated with certain neurologic and orthopedic conditions. The enlargement and maturation of the hip joint increases at the 20th week of gestation and the NSA ranges from 135- 140◦ at birth. Material and methods: 48 femurs were tagged according to the GA and two photographs for each femur were taken using Nikon digital camera. Each femur was kept on a horizontal hard desk and end on an image of the upper end was taken for the estimation of FNA and a photograph in a perpendicular plane was taken to calculate the NSA. The images were transferred to the computer and were stored in TIFF format. Microsoft Paint software was used to mark the points and Image J software was used to calculate the angles digitally. 1. Calculation of FNA: The midpoint of the femoral head and the neck were marked and a line was drawn joining these two points. The angle made by this line with the horizontal plane was measured as FNA. 2. Calculation of NSA: The midpoint of the femoral head and the neck were marked and a line was drawn joining these two points. A vertical line was drawn passing through the tip of the greater trochanter to the inter-condylar notch. The angle formed by these lines was calculated as NSA. Results: The paired t-test for the inter-observer variability showed no significant difference between the values of two observers. (FNA: t=-1.06 and p=0.31; NSA: t=-0.09 and p=0.9). The FNA ranged from 17.08º to 33.97 º on right and 17.32 º to 45.08 º on left. The NSA ranged from 139.33 º to 124.91 º on right and 143.98 º to 123.8 º on left. Unpaired t-test was applied to compare the mean angles between the second and third trimesters which did not show any statistical significance. This shows that the FNA and NSA of femur did not vary significantly during the third trimester. The FNA and NSA were correlated with the GA using Pearson’s correlation. FNA appeared to increase with the GA (r=0.5) but the increase was not statistically significant. A decrease in the NSA was also noted with the GA (r=-0.3) which was also statistically not significant. Conclusion: The present study evaluates the FNA and NSA of the femur in fetuses and correlates their development with the GA during second and third trimesters. The FNA and NSA did not vary significantly during the third trimester.Keywords: anteversion, coxa antetorsa, femoral torsion, femur neck shaft angle
Procedia PDF Downloads 31951 The Language of Risk: Pregnancy and Childbirth in the COVID-19 Era
Authors: Sarah Holdren, Laura Crook, Anne Drapkin Lyerly
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Objective: The COVID-19 Pandemic has drawn new attention to long-existing bioethical questions around pregnancy, childbirth, and parenthood. Due to the increased risk of severe COVID-19, pregnant individuals may experience anxiety regarding medical decision-making. Especially in the case of hospital births, questions around the ethics of bringing healthy pregnant individuals into a high-risk environment for viral transmission illuminate gaps in the American maternal and child healthcare system. Limited research has sought to understand the experiences of those who gave birth outside hospitals during this time. This study aims to understand pregnant individuals’ conceptualization of risk during the COVID-19 pandemic. Methods: Individuals who gave birth after March 2020 were recruited through advertisements on social media. Participants completed a 1-hour semi-structured interview and a demographic questionnaire. Interviews were transcribed and coded by members of the research team using thematic narrative analysis. Results: A total of 18 participants were interviewed and completed the demographic questionnaire. The language of risk was utilized in birth narratives in three different ways, which highlighted the multileveled and nuanced ways in which risk is understood and mitigated by pregnant and birthing individuals. These included: 1. The risk of contracting COVID-19 before, during, and after birth, 2. The risk of birth complications requiring medical interventions dependent on selected birthing space (home, birthing center, hospital), and 3. The overall risk of creating life in the middle of a pandemic. The risk of contracting COVID-19 and risk of birth complications were often weighed in paradoxical ways throughout each individual’s pregnancy, while phrases such as “pandemic baby” and “apocalypse” appeared throughout narratives and highlighted the broader implications of pregnancy and childbirth during this momentous time. Conclusions: Healthcare professionals should consider the variety of ways that pregnant and birthing individuals understand the risk when counseling patients on healthcare decisions, especially during times of healthcare crisis such as COVID-19. Future work should look to understand how the language of risk fits into a broader understanding of the human experience of growing life in times of crisis.Keywords: maternal and child health, thematic narrative analysis, COVID-19, risk mitigation
Procedia PDF Downloads 16750 Barriers and Challenges to a Healthy Lifestyle for Postpartum Women and the Possibilities in an Information Technology-Based Intervention: A Qualitative Study
Authors: Pernille K. Christiansen, Mette Maria Skjøth, Line Lorenzen, Eva Draborg, Christina Anne Vinter, Trine Kjær, Mette Juel Rothmann
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Background and aims: Overweight and obesity are an increasing challenge on a global level. In Denmark, more than one-third of all pregnant women are overweight or obese, and many women exceed the gestational weight gain recommendations from the Institute of Medicine. Being overweight or obese, is associated with a higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Thus, it is important to focus on the women’s lifestyles between their pregnancies to lower the risk of gestational weight retention in the long run. The objective of this study was to explorer what barriers and challenges postpartum women experience with respect to healthy lifestyles during the postpartum period and to access whether an Information Technology based intervention might be a supportive tool to assist and motivate postpartum women to a healthy lifestyle. Materials and methods: The method is inspired by participatory design. A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. Results: From the women’s perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritise their own health-related risks, and to motivate them to plan and take care of their own health. As the women use Information Technology on a daily basis, the solution could be delivered through Information Technology. Finally, there is room for engaging the partner more in the communication related to the baby and family’s lifestyle. Conclusion: Postpartum women need tools that inform and motivate a healthy lifestyle postpartum. The tools should allow access to high-quality information from health care professionals, when the information is needed, and also allow engagement from the partner. Finally, Information Technology is a potential tool for delivering tools.Keywords: information technology, lifestyle, overweight, postpartum
Procedia PDF Downloads 14749 Educational Framework for Coaches on Injury Prevention in Adolescent Team Sports
Authors: Chantell Gouws, Lourens Millard, Anne Naude, Jan-Wessel Meyer, Brandon Stuwart Shaw, Ina Shaw
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Background: Millions of South African youths participate in team sports, with netball and rugby being two of the largest worldwide. This increased participation and professionalism have resulted in an increase in the number of musculoskeletal injuries. Objective: This study examined the extent to which sport coaching knowledge translates to the injuries and prevention of injuries in adolescents participating in netball and rugby. Methods: Thirty-four South African sports coaches participated in the study. Eighteen netball coaches and 16 rugby coaches with varying levels of coaching experience were selected to participate. An adapted version of Nash and Sproule’s questionnaire was used to investigate the coaches’ knowledge with regards to sport-specific common injuries, injury prevention, fitness/conditioning, individual technique development, training programs, mental training, and preparation of players. The analysis of data was carried out using a number of different techniques outlined by Nash and Sproule (2012). These techniques were determined by the type of data. Descriptive data was used to provide statistical analysis. Quantitative data was used to determine the educational framework and knowledge of sports coaches on injury prevention. Numerical data was obtained through questions on sports injuries, as well as coaches’ sports knowledge levels. Participants’ knowledge was measured using a standardized scoring system. Results: For the 0-4 years of netball coaching experience, 76.4% of the coaches had knowledge and experience and 33.3% appropriate first aid knowledge, while for the 9-12 years and 13-16 years, 100% of the coaches had knowledge and experience and first aid knowledge. For the 0-4 years in rugby coaching experience, 59.1% had knowledge and experience and 71% the appropriate first aid knowledge; for the 17-20 years, 100% had knowledge and experience and first aid, while for higher or equal to 25 years, 45.5% had knowledge and experience. In netball, 90% of injuries consisted of ankle injuries, followed by 70% for knee, 50% for shoulder, 20% for lower leg, and 15% for finger injuries. In rugby, 81% of the injuries occurred at the knee, followed by 50% for the shoulder, 40% for the ankle, 31% for the head and neck, and 25% for hamstring injuries. Six hours of training resulted in a 13% chance of injuries in netball and a 32% chance in rugby. For 10 hours of training, the injury prevalence was 10% in netball and 17% in rugby, while 15 hours resulted in an injury incidence of 58% in netball players and a 25% chance in rugby players. Conclusion: This study highlights the need for coaches to improve their knowledge in relation to injuries and injury prevention, along with factors that act as a preventative measure and promotes players’ well-being.Keywords: musculoskeletal injury, sport coaching, sport trauma
Procedia PDF Downloads 16148 Transdisciplinary Pedagogy: An Arts-Integrated Approach to Promote Authentic Science, Technology, Engineering, Arts, and Mathematics Education in Initial Teacher Education
Authors: Anne Marie Morrin
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This paper will focus on the design, delivery and assessment of a transdisciplinary STEAM (Science, Technology, Engineering, Arts, and Mathematics) education initiative in a college of education in Ireland. The project explores a transdisciplinary approach to supporting STEAM education where the concepts, methodologies and assessments employed derive from visual art sessions within initial teacher education. The research will demonstrate that the STEAM Education approach is effective when visual art concepts and methods are placed at the core of the teaching and learning experience. Within this study, emphasis is placed on authentic collaboration and transdisciplinary pedagogical approaches with the STEAM subjects. The partners included a combination of teaching expertise in STEM and Visual Arts education, artists, in-service and pre-service teachers and children. The inclusion of all stakeholders mentioned moves towards a more authentic approach where transdisciplinary practice is at the core of the teaching and learning. Qualitative data was collected using a combination of questionnaires (focused and open-ended questions) and focus groups. In addition, the data was collected through video diaries where students reflected on their visual journals and transdisciplinary practice, which gave rich insight into participants' experiences and opinions on their learning. It was found that an effective program of STEAM education integration was informed by co-teaching (continuous professional development), which involved a commitment to adaptable and flexible approaches to teaching, learning, and assessment, as well as the importance of continuous reflection-in-action by all participants. The delivery of a transdisciplinary model of STEAM education was devised to reconceptualizatise how individual subject areas can develop essential skills and tackle critical issues (such as self-care and climate change) through data visualisation and technology. The success of the project can be attributed to the collaboration, which was inclusive, flexible and a willingness between various stakeholders to be involved in the design and implementation of the project from conception to completion. The case study approach taken is particularistic (focusing on the STEAM-ED project), descriptive (providing in-depth descriptions from varied and multiple perspectives), and heuristic (interpreting the participants’ experiences and what meaning they attributed to their experiences).Keywords: collaboration, transdisciplinary, STEAM, visual arts education
Procedia PDF Downloads 4947 Geotechnical Education in the USA: A Comparative Analysis of Academic Schooling vs. Industry Needs in the Area of Earth Retaining Structures
Authors: Anne Lemnitzer, Eric Tavarez
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The academic rigor of the geotechnical engineering curriculum indicates strong institutional and geographical variations. Geotechnical engineering deals with the most challenging civil engineering material, as opposed to structural engineering, environmental studies, transportation engineering, and water resources. Yet, technical expectations posed by the practicing professional community do not necessarily consider the challenges inherent to the disparity in academic rigor and disciplinary differences. To recognize the skill shortages among current graduates as well as identify opportunities to better equip graduate students in specific fields of geotechnical engineering, a two-part survey was developed in collaboration with the Earth Retaining Structures (ERS) Committee of the American Society of Civil Engineers. Earth Retaining Structures are critical components of infrastructure systems and integral components to many major engineering projects. Within the geotechnical curriculum, Earth Retaining Structures is either taught as a separate course or major subject within a foundation design class. Part 1 of the survey investigated the breadth and depth of the curriculum with respect to ERS by requesting faculty across the United States to provide data on their curricular content, integration of practice-oriented course content, student preparation for professional licensing, and level of technical competency expected upon student graduation. Part 2 of the survey enables a comparison of training provided versus training needed. This second survey addressed practicing geotechnical engineers in all sectors of the profession (e.g., private engineering consulting, governmental agencies, contractors, suppliers/manufacturers) and collected data on the expectations with respect to technical and non-technical skills of engineering graduates entering the professional workforce. Results identified skill shortages in soft skills, critical thinking, analytical and language skills, familiarity with design codes and standards, and communication with various stakeholders. The data will be used to develop educational tools to advance the proficiency and expertise of geotechnical engineering students to meet and exceed the expectations of the profession and to stimulate a lifelong interest in advancing the field of geotechnical engineering.Keywords: geotechnical engineering, academic training, industry requirements, earth retaining structures
Procedia PDF Downloads 12646 Study of Durability of Porous Polymer Materials, Glass-Fiber-Reinforced Polyurethane Foam (R-PUF) in MarkIII Containment Membrane System
Authors: Florent Cerdan, Anne-Gaëlle Denay, Annette Roy, Jean-Claude Grandidier, Éric Laine
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The insulation of MarkIII membrane of the Liquid Natural Gas Carriers (LNGC) consists of a load- bearing system made of panels in reinforced polyurethane foam (R-PUF). During the shipping, the cargo containment shall be potentially subject to risk events which can be water leakage through the wall ballast tank. The aim of these present works is to further develop understanding of water transfer mechanisms and water effect on properties of R-PUF. This multi-scale approach contributes to improve the durability. Macroscale / Mesoscale Firstly, the use of the gravimetric technique has allowed to define, at room temperature, the water transfer mechanisms and kinetic diffusion, in the R-PUF. The solubility follows a first kinetic fast growing connected to the water absorption by the micro-porosity, and then evolves linearly slowly, this second stage is connected to molecular diffusion and dissolution of water in the dense membranes polyurethane. Secondly, in the purpose of improving the understanding of the transfer mechanism, the study of the evolution of the buoyant force has been established. It allowed to identify the effect of the balance of total and partial pressure of mixture gas contained in pores surface. Mesoscale / Microscale The differential scanning calorimetry (DSC) and Dynamical Mechanical Analysis (DMA), have been used to investigate the hydration of the hard and soft segments of the polyurethane matrix. The purpose was to identify the sensitivity of these two phases. It been shown that the glass transition temperatures shifts towards the low temperatures when the solubility of the water increases. These observations permit to conclude to a plasticization of the polymer matrix. Microscale The Fourier Transform Infrared (FTIR) study has been used to investigate the characterization of functional groups on the edge, the center and mid-way of the sample according the duration of submersion. More water there is in the material, more the water fix themselves on the urethanes groups and more specifically on amide groups. The pic of C=O urethane shifts at lower frequencies quickly before 24 hours of submersion then grows slowly. The intensity of the pic decreases more flatly after that.Keywords: porous materials, water sorption, glass transition temperature, DSC, DMA, FTIR, transfer mechanisms
Procedia PDF Downloads 52945 Microplastic Storages in Riverbed Sediments: Experimental on the Settling Process and Its Deposits
Authors: Alvarez Barrantes, Robert Dorrell, Christopher Hackney, Anne Baar, Roberto Fernandez, Daniel Parsons
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Microplastic particles entering fluvial environments are deposited with natural sediments. Their settling properties can change by the absorption or adsorption of contaminants, organic matter, and organisms. These deposits include positively, neutrally, and negatively buoyant particles. This study aims to understand how plastic particles of different densities interact with natural sediments as they settle and how they are stored within the sediment deposit. The results of this study contribute to a better understanding of the deposition of microplastic particles and associated pollution in rivers. A set of 48 experiments was designed to investigate the settling process of microplastic particles in freshwater. The experimental work describes the vertical variation of cohesive and/or non-cohesive sediment versus microplastic densities in deposited sediment. The experiment consisted of adding microplastic particles, sediment, and water in a waterproof carton tube of a height of 24 cm and a diameter of 5 cm. The plastic selected is positively, neutrally, and negatively buoyant. The sediments consist of sand and clay with four different concentrations. The mixture of materials was shaken until is thoroughly mixed and left to settle for 24 hours. After the settlement, the tubes were frozen at -20 °C to be able to cut them and measure the thickness of the deposits and analyze the sediment and plastic distribution. The most representative experiments were repeated in a glass tube of the same size; to analyse the influences of current flows and depositional process. Finally, the glass tube experiments were used to study organic materials adsorption in plastic, settling the sample for four months. Defined microplastic layers were identified as the density of the plastic change. Preliminary results show that most of the positive buoyancy particles floated, neutral buoyancy particles form a layer above the sediment and negative buoyancy particles mixed with the sediment. The vertical grain size distribution of the deposits was analysed to determine deposition variation with and without plastic. It is expected that the positively buoyant particles are trapped in the sediment by the currents flows and sink due to organic material adsorption. Finally, the experiments will explain how microplastic particles, including positively buoyant ones, are stored in natural sediment deposits.Keywords: microplastic adsorption process, microplastic deposition in natural sediment, microplastic pollution in rivers, storages of positive buoyancy microplastic particles
Procedia PDF Downloads 19444 Socioeconomic Burden of a Diagnosis of Cervical Cancer in Women in Rural Uganda: Findings from a Phenomenological Study
Authors: Germans Natuhwera, Peter Ellis, Acuda Wilson, Anne Merriman, Martha Rabwoni
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Objective: The aim of the study was to diagnose the socio-economic burden and impact of a diagnosis of cervical cancer (CC) in rural women in the context of low-resourced country Uganda, using a phenomenological enquiry. Methods: This was a multi-site phenomenological inquiry, conducted at three hospice settings; Mobile Hospice Mbarara in southwestern, Little Hospice Hoima in Western, and Hospice Africa Uganda Kampala in central Uganda. A purposive sample of women with a histologically confirmed diagnosis of CC was recruited. Data was collected using open-ended audio-recorded interviews conducted in the native languages of participants. Interviews were transcribed verbatim in English, and Braun and Clarke’s (2019) framework of thematic analysis was used. Results: 13 women with a mean age of 49.2 and age range 29-71 participated in the study. All participants were of low socioeconomic status. The majority (84.6%) had advanced disease at diagnosis. A fuller reading of transcripts produced four major themes clustered under; (1) socioeconomic characteristics of women, (2) impact of CC on women’s relationships, (3) disrupted and impaired activities of daily living (ADLs), and (4) economic disruptions. Conclusions: A diagnosis of CC introduces significant socio-economic disruptions in a woman’s and her family’s life. CC causes disability, impairs the woman and her family’s productivity hence exacerbating levels of poverty in the home. High and expensive out-of-pocket expenditure on treatment, investigations, and transport costs further compound the socio-economic burden. Decentralizing cancer care services to regional centers, scaling up screening services, subsidizing costs of cancer care services, or making cervical cancer care treatment free of charge, strengthening monitoring mechanisms in public facilities to curb the vice of healthcare workers soliciting bribes from patients, increased mass awareness campaigns about cancer, training more healthcare professionals in cancer investigation and management, and palliative care, and introducing an introductory course on gynecologic cancers into all health training institutions are recommended.Keywords: activities of daily living, cervical cancer, out-of-pocket, expenditure, phenomenology, socioeconomic
Procedia PDF Downloads 21643 Staying When Everybody Else Is Leaving: Coping with High Out-Migration in Rural Areas of Serbia
Authors: Anne Allmrodt
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Regions of South-East Europe are characterised by high out-migration for decades. The reasons for leaving range from the hope of a better work situation to a better health care system and beyond. In Serbia, this high out-migration hits the rural areas in particular so that the population number is in the red repeatedly. It might not be hard to guess that this negative population growth has the potential to create different challenges for those who stay in rural areas. So how are they coping with the – statistically proven – high out-migration? Having this in mind, the study is investigating the people‘s individual awareness of the social phenomenon high out-migration and their daily life strategies in rural areas. Furthermore, the study seeks to find out the people’s resilient skills in that context. Is the condition of high out-migration conducive for resilience? The methodology combines a quantitative and a qualitative approach (mixed methods). For the quantitative part, a standardised questionnaire has been developed, including a multiple choice section and a choice experiment. The questionnaire was handed out to people living in rural areas of Serbia only (n = 100). The sheet included questions about people’s awareness of high out-migration, their own daily life strategies or challenges and their social network situation (data about the social network was necessary here since it is supposed to be an influencing variable for resilience). Furthermore, test persons were asked to make different choices of coping with high out-migration in a self-designed choice experiment. Additionally, the study included qualitative interviews asking citizens from rural areas of Serbia. The topics asked during the interview focused on their awareness of high out-migration, their daily life strategies, and challenges as well as their social network situation. Results have shown the following major findings. The awareness of high out-migration is not the same with all test persons. Some declare it as something positive for their own life, others as negative or not effecting at all. The way of coping generally depended – maybe not surprising – on the people’s social network. However – and this might be the most important finding - not everybody with a certain number of contacts had better coping strategies and was, therefore, more resilient. Here the results show that especially people with high affiliation and proximity inside their network were able to cope better and shew higher resilience skills. The study took one step forward in terms of knowledge about societal resilience as well as coping strategies of societies in rural areas. It has shown part of the other side of nowadays migration‘s coin and gives a hint for a more sustainable rural development and community empowerment.Keywords: coping, out-migration, resilience, rural development, social networks, south-east Europe
Procedia PDF Downloads 12842 Time-Interval between Rectal Cancer Surgery and Reintervention for Anastomotic Leakage and the Effects of a Defunctioning Stoma: A Dutch Population-Based Study
Authors: Anne-Loes K. Warps, Rob A. E. M. Tollenaar, Pieter J. Tanis, Jan Willem T. Dekker
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Anastomotic leakage after colorectal cancer surgery remains a severe complication. Early diagnosis and treatment are essential to prevent further adverse outcomes. In the literature, it has been suggested that earlier reintervention is associated with better survival, but anastomotic leakage can occur with a highly variable time interval to index surgery. This study aims to evaluate the time-interval between rectal cancer resection with primary anastomosis creation and reoperation, in relation to short-term outcomes, stratified for the use of a defunctioning stoma. Methods: Data of all primary rectal cancer patients that underwent elective resection with primary anastomosis during 2013-2019 were extracted from the Dutch ColoRectal Audit. Analyses were stratified for defunctioning stoma. Anastomotic leakage was defined as a defect of the intestinal wall or abscess at the site of the colorectal anastomosis for which a reintervention was required within 30 days. Primary outcomes were new stoma construction, mortality, ICU admission, prolonged hospital stay and readmission. The association between time to reoperation and outcome was evaluated in three ways: Per 2 days, before versus on or after postoperative day 5 and during primary versus readmission. Results: In total 10,772 rectal cancer patients underwent resection with primary anastomosis. A defunctioning stoma was made in 46.6% of patients. These patients had a lower anastomotic leakage rate (8.2% vs. 11.6%, p < 0.001) and less often underwent a reoperation (45.3% vs. 88.7%, p < 0.001). Early reoperations (< 5 days) had the highest complication and mortality rate. Thereafter the distribution of adverse outcomes was more spread over the 30-day postoperative period for patients with a defunctioning stoma. Median time-interval from primary resection to reoperation for defunctioning stoma patients was 7 days (IQR 4-14) versus 5 days (IQR 3-13 days) for no-defunctioning stoma patients. The mortality rate after primary resection and reoperation were comparable (resp. for defunctioning vs. no-defunctioning stoma 1.0% vs. 0.7%, P=0.106 and 5.0% vs. 2.3%, P=0.107). Conclusion: This study demonstrated that early reinterventions after anastomotic leakage are associated with worse outcomes (i.e. mortality). Maybe the combination of a physiological dip in the cellular immune response and release of cytokines following surgery, as well as a release of endotoxins caused by the bacteremia originating from the leakage, leads to a more profound sepsis. Another explanation might be that early leaks are not contained to the pelvis, leading to a more profound sepsis requiring early reoperations. Leakage with or without defunctioning stoma resulted in a different type of reinterventions and time-interval between surgery and reoperation.Keywords: rectal cancer surgery, defunctioning stoma, anastomotic leakage, time-interval to reoperation
Procedia PDF Downloads 13841 Reading Informational or Fictional Texts to Students: Choices and Perceptions of Preschool and Primary Grade Teachers
Authors: Anne-Marie Dionne
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Teacher reading aloud to students is a practice that is well established in preschool and primary classrooms. Many benefits of this pedagogical activity have been highlighted in multiple studies. However, it has also been shown that teachers are not keen on choosing informational texts for their read aloud, as their selections for this venue are mainly fictional stories, mostly written in a unique narrative story-like structure. Considering that students soon have to read complex informational texts by themselves as they go from one grade to another, there is cause for concern because those who do not benefit from an early exposure to informational texts could be lacking knowledge of informational text structures that they will encounter regularly in their reading. Exposing students to informational texts could be done in different ways in classrooms. However, since read aloud appears to be such a common and efficient practice in preschool and primary grades, it is important to examine more deeply the factors taken into account by teachers when they are selecting their readings for this important teaching activity. Moreover, it seems critical to know why teachers are not inclined to choose more often informational texts when they are reading aloud to their pupils. A group of 22 preschool or primary grade teachers participated in this study. The data collection was done by a survey and an individual semi-structured interview. The survey was conducted in order to get quantitative data on the read-aloud practices of teachers. As for the interviews, they were organized around three categories of questions (exploratory, analytical, opinion) regarding the process of selecting the texts for the read-aloud sessions. A statistical analysis was conducted on the data obtained by the survey. As for the interviews, they were subjected to a content analysis aiming to classify the information collected in predetermined categories such as the reasons given to favor fictional texts over informative texts, the reasons given for avoiding informative texts for reading aloud, the perceptions of the challenges that the informative texts could bring when they are read aloud to students, and the perceived advantages that they would present if they were chosen more often for this activity. Results are showing variable factors that are guiding the teachers when they are making their selection of the texts to be read aloud. As for example, some of them are choosing solely fictional texts because of their convictions that these are more interesting for their students. They also perceive that the informational texts are not good choices because they are not suitable for pleasure reading. In that matter, results are pointing to some interesting elements. Many teachers perceive that read aloud of fictional or informational texts have different goals: fictional texts are read for pleasure and informational texts are read mostly for academic purposes. These results bring out the urgency for teachers to become aware of the numerous benefits that the reading aloud of each type of texts could bring to their students, especially the informational texts. The possible consequences of teachers’ perceptions will be discussed further in our presentation.Keywords: fictional texts, informational texts, preschool or primary grade teachers, reading aloud
Procedia PDF Downloads 15040 Walking across the Government of Egypt: A Single Country Comparative Study of the Past and Current Condition of the Government of Egypt
Authors: Homyr L. Garcia, Jr., Anne Margaret A. Rendon, Carla Michaela B. Taguinod
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Nothing is constant in this world but change. This is the reality wherein a lot of people fail to recognize and maybe, it is because of the fact that some see things that are happening with little value or no value at all until it’s gone. For the past years, Egypt was known for its stable government. It was able to withstand a lot of problems and crisis which challenged their country in ways which can never be imagined. In the present time, it seems like in just a snap of a finger, the said stability vanished and it was immediately replaced by a crisis which resulted to a failure in some parts of their government. In addition, this problem continued to worsen and the current situation of Egypt is just a reflection or a result of it. On the other hand, as the researchers continued to study the reasons why the government of Egypt is unstable, they concluded that there might be a possibility that they will be able to produce ways in which their country could be helped or improved. The instability of the government of Egypt is the product of combining all the problems which affects the lives of the people. Some of the reasons that the researchers found are the following: 1) unending doubts of the people regarding the ruling capacity of elected presidents, 2) removal of President Mohamed Morsi in position, 3) economic crisis, 4) a lot of protests and revolution happened, 5) resignation of the long term President Hosni Mubarak and 6) the office of the President is most likely available only to the chosen successor. Also, according to previous researches, there are two plausible scenarios for the instability of Egypt: 1) a military intervention specifically the Supreme Council of the Armed Forces or SCAF, resulting from a contested succession and 2) an Islamist push for political power which highlights the claim that religion is a hindrance towards the development of their country and government. From the eight possible reasons, the researchers decided that they will be focusing on economic crisis since the instability is more clearly seen in the country’s economy which directly affects the people and the government itself. In addition, they made a hypothesis which states that stable economy is a prerequisite towards a stable government. If they will be able to show how this claim is true by using the Social Autopsy Research Design for the qualitative method and Pearson’s correlation coefficient for the quantitative method, the researchers might be able to produce a proposal on how Egypt can stabilize their government and avoid such problems. Also, the hypothesis will be based from the Rational Action Theory which is a theory for understanding and modeling social and economy as well as individual behavior.Keywords: Pearson’s correlation coefficient, rational action theory, social autopsy research design, supreme council of the armed forces (SCAF)
Procedia PDF Downloads 40939 Semi-Empirical Modeling of Heat Inactivation of Enterococci and Clostridia During the Hygienisation in Anaerobic Digestion Process
Authors: Jihane Saad, Thomas Lendormi, Caroline Le Marechal, Anne-marie Pourcher, Céline Druilhe, Jean-louis Lanoiselle
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Agricultural anaerobic digestion consists in the conversion of animal slurry and manure into biogas and digestate. They need, however, to be treated at 70 ºC during 60 min before anaerobic digestion according to the European regulation (EC n°1069/2009 & EU n°142/2011). The impact of such heat treatment on the outcome of bacteria has been poorly studied up to now. Moreover, a recent study¹ has shown that enterococci and clostridia are still detected despite the application of such thermal treatment, questioning the relevance of this approach for the hygienisation of digestate. The aim of this study is to establish the heat inactivation kinetics of two species of enterococci (Enterococcus faecalis and Enterococcus faecium) and two species of clostridia (Clostridioides difficile and Clostridium novyi as a non-toxic model for Clostridium botulinum of group III). A pure culture of each strain was prepared in a specific sterile medium at concentration of 10⁴ – 10⁷ MPN / mL (Most Probable number), depending on the bacterial species. Bacterial suspensions were then filled in sterilized capillary tubes and placed in a water or oil bath at desired temperature for a specific period of time. Each bacterial suspension was enumerated using a MPN approach, and tests were repeated three times for each temperature/time couple. The inactivation kinetics of the four indicator bacteria is described using the Weibull model and the classical Bigelow model of first-order kinetics. The Weibull model takes biological variation, with respect to thermal inactivation, into account and is basically a statistical model of distribution of inactivation times as the classical first-order approach is a special case of the Weibull model. The heat treatment at 70 ºC / 60 min contributes to a reduction greater than 5 log10 for E. faecium and E. faecalis. However, it results only in a reduction of about 0.7 log10 for C. difficile and an increase of 0.5 log10 for C. novyi. Application of treatments at higher temperatures is required to reach a reduction greater or equal to 3 log10 for C. novyi (such as 30 min / 100 ºC, 13 min / 105 ºC, 3 min / 110 ºC, and 1 min / 115 ºC), raising the question of the relevance of the application of heat treatment at 70 ºC / 60 min for these spore-forming bacteria. To conclude, the heat treatment (70 ºC / 60 min) defined by the European regulation is sufficient to inactivate non-sporulating bacteria. Higher temperatures (> 100 ºC) are required as far as spore-forming bacteria concerns to reach a 3 log10 reduction (sporicidal activity).Keywords: heat treatment, enterococci, clostridia, inactivation kinetics
Procedia PDF Downloads 11238 Post COVID-19 Multi-System Inflammatory Syndrome Masquerading as an Acute Abdomen
Authors: Ali Baker, Russel Krawitz
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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.Keywords: acute-abdomen, MIS, COVID-19, ICU
Procedia PDF Downloads 12337 Overcoming Mistrusted Masculinity: Analyzing Muslim Men and Their Aspirations for Fatherhood in Denmark
Authors: Anne Hovgaard Jorgensen
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This study investigates how Muslim fathers in Denmark are struggling to overcome notions of mistrust from teachers and educators. Starting from school-home-cooperation (parent conferences, school-home communication, etc.), the study finds that many Muslim fathers do not feel acknowledged as a resource in the upbringing of their children. To explain these experiences further, the study suggest the notion of ‘mistrusted masculinity’ to grasp the controlling image these fathers meet in various schools and child-care-institutions in the Danish Welfare state. The paper is based on 9 months of fieldwork in a Danish school, a social housing area and in various ‘father groups’ in Denmark. Additional, 50 interviews were conducted with fathers, children, mothers, schoolteachers, and educators. By using Connell's concepts 'hegemonic' and 'marginalized' masculinity as steppingstones, the paper argues that these concepts might entail a too static and dualistic picture of gender. By applying the concepts of 'emergent masculinity' and 'emergent fatherhood' the paper brings along a long needed discussion of how Muslim men in Denmark are struggling to overcome and change the controlling images of them as patriarchal and/or ignorant fathers regarding the upbringing of their children. As such, the paper shows how Muslim fathers are taking action to change this controlling image, e.g. through various ‘father groups’. The paper is inspired by the phenomenological notions of ‘experience´ and in the light of this notion, the paper tells the fathers’ stories about their upbringing of their children and aspirations for fatherhood. These stories share light on how these fathers take care of their children in everyday life. The study also shows that the controlling image of these fathers have affected how some Muslim fathers are actually being fathers. The study shows that fear of family-interventions from teachers or social workers e.g. have left some Muslim fathers in a limbo, being afraid of scolding their children, and being confused of ‘what good parenting in Denmark is’. This seems to have led to a more lassie fair upbringing than these fathers actually wanted. This study is important since anthropologists generally have underexposed the notion of fatherhood, and how fathers engage in the upbringing of their children. Over more, the vast majority of qualitative studies of fatherhood have been on white middleclass fathers, living in nuclear families. In addition, this study is crucial at this very moment due to the major refugee crisis in Denmark and in the Western world in general. A crisis, which has resulted in a vast number of scare campaigns against Islam from different nationalistic political parties, which enforces the negative controlling image of Muslim fathers.Keywords: fatherhood, Muslim fathers, mistrust, education
Procedia PDF Downloads 19136 Influence of Controlled Retting on the Quality of the Hemp Fibres Harvested at the Seed Maturity by Using a Designed Lab-Scale Pilot Unit
Authors: Brahim Mazian, Anne Bergeret, Jean-Charles Benezet, Sandrine Bayle, Luc Malhautier
Abstract:
Hemp fibers are increasingly used as reinforcements in polymer matrix composites due to their competitive performance (low density, mechanical properties and biodegradability) compared to conventional fibres such as glass fibers. However, the huge variation of their biochemical, physical and mechanical properties limits the use of these natural fibres in structural applications when high consistency and homogeneity are required. In the hemp industry, traditional processes termed field retting are commonly used to facilitate the extraction and separation of stem fibers. This retting treatment consists to spread out the stems on the ground for a duration ranging from a few days to several weeks. Microorganisms (fungi and bacteria) grow on the stem surface and produce enzymes that degrade pectinolytic substances in the middle lamellae surrounding the fibers. This operation depends on the weather conditions and is currently carried out very empirically in the fields so that a large variability in the hemp fibers quality (mechanical properties, color, morphology, chemical composition…) is resulting. Nonetheless, if controlled, retting might be favorable for good properties of hemp fibers and then of hemp fibers reinforced composites. Therefore, the present study aims to investigate the influence of controlled retting within a designed environmental chamber (lab-scale pilot unit) on the quality of the hemp fibres harvested at the seed maturity growth stage. Various assessments were applied directly on fibers: color observations, morphological (optical microscope), surface (ESEM), biochemical (gravimetry) analysis, spectrocolorimetric measurements (pectins content), thermogravimetric analysis (TGA) and tensile testing. The results reveal that controlled retting leads to a rapid change of color from yellow to dark grey due to development of microbial communities (fungi and bacteria) at the stem surface. An increase of thermal stability of fibres due to the removal of non-cellulosic components along retting is also observed. A separation of bast fibers to elementary fibers occurred with an evolution of chemical composition (degradation of pectins) and a rapid decrease in tensile properties (380MPa to 170MPa after 3 weeks) due to accelerated retting process. The influence of controlled retting on the biocomposite material (PP / hemp fibers) properties is under investigation.Keywords: controlled retting, hemp fibre, mechanical properties, thermal stability
Procedia PDF Downloads 155