Search results for: disability inclusion
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2091

Search results for: disability inclusion

291 Urban Green Transitioning in The Face of Current Global Change: The Management Role of the Local Government and Residents

Authors: Titilope F. Onaolapo, Christiana A. Breed, Maya Pasgaard, Kristine E. Jensen, Peta Brom

Abstract:

In the face of fast-growing urbanization in most of the world's developing countries, there is a need to understand and address the risk and consequences involved in the indiscriminate use of urban green space. Tshwane city in South Africa has the potential to become one of the world's top biodiversity cities as South Africa is ranked one of the mega countries in biodiversity conservation, and Tshwane metropolitan municipality is the city with the wealthiest biodiversity with grassland biomes. In this study, we focus on the potentials and challenges of urban green transitioning from the Global South perspective with Tshwane city as the case study. We also address the issue of management conflicts that have resulted in informal and illegal activities in and around green spaces, with consequences such as land degradation, loss of livelihoods and biodiversity, and socio-ecological imbalances. A desk study review of eight policy frameworks related to green urban planning and development was done based on four GI principles: multifunctionality, connectivity, interdisciplinary and social inclusion. We interviewed 15 key informants in related departments in the city and administered 200 survey questionnaires among residents. We also had several workshops the other researchers and experts on biodiversity and ecosystem. We found out there is no specific document dedicated to green space management, and where green infrastructure was mentioned, it was focused on as an approach to climate mitigation and adaptation. Also, residents perceive green and open spaces as extra land that could be developed at will. We demonstrated the use of collaborative learning approaches in ecological and development research and the tying research to the existing frameworks, programs, and strategies. Based on this understanding. We outlined the need to incorporate principles of green infrastructure in policy frameworks on spatial planning and environmental development. Furthermore, we develop a model for co-management of green infrastructures by stakeholders, such as residents, developers, policymakers, and decision-makers, to maximize benefits. Our collaborative, interdisciplinary projects pursue SDG multifunctionality of goals 11 and 15 by simultaneously addressing issues around Sustainable Cities and Communities, Climate Action, Life on Land, and Strong Institutions, and halt and reverse land degradation and biodiversity.

Keywords: governance, green infrastructure, South Africa, sustainable development, urban planning, Tshwane

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290 In vivo Alterations in Ruminal Parameters by Megasphaera Elsdenii Inoculation on Subacute Ruminal Acidosis (SARA)

Authors: M. S. Alatas, H. D. Umucalilar

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SARA is a common and serious metabolic disorder in early lactation in dairy cattle and in finishing beef cattle, caused by diets with high inclusion of cereal grain. This experiment was performed to determine the efficacy of Megasphaera elsdenii, a major lactate-utilizing bacterium in prevention/treatment of SARA in vivo. In vivo experimentation, it was used eight ruminally cannulated rams and it was applied the rapid adaptation with the mixture of grain based on wheat (%80 wheat, %20 barley) and barley (%80 barley, %20 wheat). During the systematic adaptation, it was followed the probability of SARA formation by being measured the rumen pH with two hours intervals after and before feeding. After being evaluated the data, it was determined the ruminal pH ranged from 5,2-5,6 on the condition of feeding with 60 percentage of grain mixture based on barley and wheat, that assured the definite form of subacute acidosis. In four days SARA period, M. elsdenii (1010 cfu ml-1) was inoculated during the first two days. During the SARA period, it was observed the decrease of feed intake with M. elsdenii inoculation. Inoculation of M. elsdenii was caused to differentiation of rumen pH (P < 0,0001), while it was found the pH level approximately 5,55 in animals applied the inoculation, it was 5,63 pH in other animals. It was observed that total VFA with the bacterium inoculation tended to change in terms of grain feed (P < 0,07). It increased with the effect of total VFA inoculation in barley based diet, but it was more stabilized in wheat based diet. Bacterium inoculation increased the ratio of propionic acid (18,33%-21,38%) but it caused to decrease the butyric acid, and acetic/propionic acid. During the rapid adaptation, the concentration of lactic acid in the rumen liquid increased depending upon grain level (P<0,0001). On the other hand bacterium inoculation did not have an effect on concentration of lactic acid. M. elsdenii inoculation did not affect ruminal ammonia concentration. In the group that did not apply inoculation, the level of ruminal ammonia concentration was higher than the others applied inoculation. M. elsdenii inoculation did not changed protozoa count in barley-based diet whereas it decreased in wheat-based diet. In the period of SARA, it was observed that the level of blood glucose, lactate and hematocrit increased greatly after inoculation (P < 0,0001). When it is generally evaluated, it is seen that M. elsdenii inoculation has not a positive impact on rumen parameters. Therefore, to reveal the full impact of the inoculation with different strains, feedstuffs and animal groups, further research is required.

Keywords: In vivo, Subactute ruminal acidosis, Megasphaera elsdenii, Rumen fermentation

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289 Predictors of Motor and Cognitive Domains of Functional Performance after Rehabilitation of Individuals with Acute Stroke

Authors: A. F. Jaber, E. Dean, M. Liu, J. He, D. Sabata, J. Radel

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Background: Stroke is a serious health care concern and a major cause of disability in the United States. This condition impacts the individual’s functional ability to perform daily activities. Predicting functional performance of people with stroke assists health care professionals in optimizing the delivery of health services to the affected individuals. The purpose of this study was to identify significant predictors of Motor FIM and of Cognitive FIM subscores among individuals with stroke after discharge from inpatient rehabilitation (typically 4-6 weeks after stroke onset). A second purpose is to explore the relation among personal characteristics, health status, and functional performance of daily activities within 2 weeks of stroke onset. Methods: This study used a retrospective chart review to conduct a secondary analysis of data obtained from the Healthcare Enterprise Repository for Ontological Narration (HERON) database. The HERON database integrates de-identified clinical data from seven different regional sources including hospital electronic medical record systems of the University of Kansas Health System. The initial HERON data extract encompassed 1192 records and the final sample consisted of 207 participants who were mostly white (74%) males (55%) with a diagnosis of ischemic stroke (77%). The outcome measures collected from HERON included performance scores on the National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Functional Independence Measure (FIM). The data analysis plan included descriptive statistics, Pearson correlation analysis, and Stepwise regression analysis. Results: significant predictors of discharge Motor FIM subscores included age, baseline Motor FIM subscores, discharge NIHSS scores, and comorbid electrolyte disorder (R2 = 0.57, p <0.026). Significant predictors of discharge Cognitive FIM subscores were age, baseline cognitive FIM subscores, client cooperative behavior, comorbid obesity, and the total number of comorbidities (R2 = 0.67, p <0.020). Functional performance on admission was significantly associated with age (p < 0.01), stroke severity (p < 0.01), and length of hospital stay (p < 0.05). Conclusions: our findings show that younger age, good motor and cognitive abilities on admission, mild stroke severity, fewer comorbidities, and positive client attitude all predict favorable functional outcomes after inpatient stroke rehabilitation. This study provides health care professionals with evidence to evaluate predictors of favorable functional outcomes early at stroke rehabilitation, to tailor individualized interventions based on their client’s anticipated prognosis, and to educate clients about the benefits of making lifestyle changes to improve their anticipated rate of functional recovery.

Keywords: functional performance, predictors, stroke, recovery

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288 Combining Patients Pain Scores Reports with Functionality Scales in Chronic Low Back Pain Patients

Authors: Ivana Knezevic, Kenneth D. Candido, N. Nick Knezevic

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Background: While pain intensity scales remain generally accepted assessment tool, and the numeric pain rating score is highly subjective, we nevertheless rely on them to make a judgment about treatment effects. Misinterpretation of pain can lead practitioners to underestimate or overestimate the patient’s medical condition. The purpose of this study was to analyze how the numeric rating pain scores given by patients with low back pain correlate with their functional activity levels. Methods: We included 100 consecutive patients with radicular low back pain (LBP) after the Institutional Review Board (IRB) approval. Pain scores, numeric rating scale (NRS) responses at rest and in the movement,Oswestry Disability Index (ODI) questionnaire answers were collected 10 times through 12 months. The ODI questionnaire is targeting a patient’s activities and physical limitations as well as a patient’s ability to manage stationary everyday duties. Statistical analysis was performed by using SPSS Software version 20. Results: The average duration of LBP was 14±22 months at the beginning of the study. All patients included in the study were between 24 and 78 years old (average 48.85±14); 56% women and 44% men. Differences between ODI and pain scores in the range from -10% to +10% were considered “normal”. Discrepancies in pain scores were graded as mild between -30% and -11% or +11% and +30%; moderate between -50% and -31% and +31% and +50% and severe if differences were more than -50% or +50%. Our data showed that pain scores at rest correlate well with ODI in 65% of patients. In 30% of patients mild discrepancies were present (negative in 21% and positive in 9%), 4% of patients had moderate and 1% severe discrepancies. “Negative discrepancy” means that patients graded their pain scores much higher than their functional ability, and most likely exaggerated their pain. “Positive discrepancy” means that patients graded their pain scores much lower than their functional ability, and most likely underrated their pain. Comparisons between ODI and pain scores during movement showed normal correlation in only 39% of patients. Mild discrepancies were present in 42% (negative in 39% and positive in 3%); moderate in 14% (all negative), and severe in 5% (all negative) of patients. A 58% unknowingly exaggerated their pain during movement. Inconsistencies were equal in male and female patients (p=0.606 and p=0.928).Our results showed that there was a negative correlation between patients’ satisfaction and the degree of reporting pain inconsistency. Furthermore, patients talking opioids showed more discrepancies in reporting pain intensity scores than did patients taking non-opioid analgesics or not taking medications for LBP (p=0.038). There was a highly statistically significant correlation between morphine equivalents doses and the level of discrepancy (p<0.0001). Conclusion: We have put emphasis on the patient education in pain evaluation as a vital step in accurate pain level reporting. We have showed a direct correlation with patients’ satisfaction. Furthermore, we must identify other parameters in defining our patients’ chronic pain conditions, such as functionality scales, quality of life questionnaires, etc., and should move away from an overly simplistic subjective rating scale.

Keywords: pain score, functionality scales, low back pain, lumbar

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287 Polyvinyl Alcohol Incorporated with Hibiscus Extract Microcapsules as Combined Active and Intelligent Composite Film for Meat Preservation: Antimicrobial, Antioxidant, and Physicochemical Investigations

Authors: Ahmed F. Ghanem, Marwa I. Wahba, Asmaa N. El-Dein, Mohamed A. EL-Raey, Ghada E. A. Awad

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Numerous attempts are being performed in order to formulate suitable packaging materials for the meat products. However, to the best of our knowledge, the incorporation of the free hibiscus extract or its microcapsules in the pure polyvinyl alcohol (PVA) matrix as packaging materials for the meats is seldom reported. Therefore, this study aims at the protection of the aqueous crude extract of the hibiscus flowers utilizing the spry drying encapsulation technique. Results of the Fourier transform infrared (FTIR), the scanning electron microscope (SEM), and the particle size analyzer confirmed the successful formation of the assembled capsules via strong interactions, the spherical rough microparticles, and the particle size of ~ 235 nm, respectively. Also, the obtained microcapsules enjoy higher thermal stability than the free extract. Then, the obtained spray-dried particles were incorporated into the casting solution of the pure PVA film with a concentration of 10 wt. %. The segregated free-standing composite films were investigated, compared to the neat matrix, with several characterization techniques such as FTIR, SEM, thermal gravimetric analysis (TGA), mechanical tester, contact angle, water vapor permeability, and oxygen transmission. The results demonstrated variations in the physicochemical properties of the PVA film after the inclusion of the free and the extract microcapsules. Moreover, biological studies emphasized the biocidal potential of the hybrid films against the microorganisms contaminating the meat. Specifically, the microcapsules imparted not only antimicrobial but also antioxidant activities to the PVA matrix. Application of the prepared films on the real meat samples displayed a low bacterial growth with a slight increase in the pH over the storage time which continued up to 10 days at 4 oC, as further evidence to the meat safety. Moreover, the colors of the films did not significantly changed except after 21 days indicating the spoilage of the meat samples. No doubt, the dual-functional of the prepared composite films pave the way towards combined active and smart food packaging applications. This would play a vital role in the food hygiene, including also the quality control and the assurance.

Keywords: PVA, hibiscus, extraction, encapsulation, active packaging, smart and intelligent packaging, meat spoilage

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286 Velma-ARC’s Rehabilitation of Repentant Cybercriminals in Nigeria

Authors: Umukoro Omonigho Simon, Ashaolu David ‘Diya, Aroyewun-Olaleye Temitope Folashade

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The VELMA Action to Reduce Cybercrime (ARC) is an initiative, the first of its kind in Nigeria, designed to identify, rehabilitate and empower repentant cybercrime offenders popularly known as ‘yahoo boys’ in Nigerian parlance. Velma ARC provides social inclusion boot camps with the goal of rehabilitating cybercriminals via psychotherapeutic interventions, improving their IT skills, and empowering them to make constructive contributions to society. This report highlights the psychological interventions provided for participants of the maiden edition of the Velma ARC boot camp and presents the outcomes of these interventions. The boot camp was set up in a hotel premises which was booked solely for the 1 month event. The participants were selected and invited via the Velma online recruitment portal based on an objective double-blind selection process from a pool of potential participants who signified interest via the registration portal. The participants were first taken through psychological profiling (personality, symptomology and psychopathology) before the individual and group sessions began. They were profiled using the Minnesota Multiphasic Personality Inventory -2- Restructured Form (MMPI-2-RF), the latest version of its series. Individual psychotherapy sessions were conducted for all participants based on what was interpreted on their profiles. Focus group discussion was held later to discuss a movie titled ‘catch me if you can’ directed by Steven Spielberg, featuring Leonardo De Caprio and Tom Hanks. The movie was based on the true life story of Frank Abagnale, who was a notorious scammer and con artist in his youthful years. Emergent themes from the movie were discussed as psycho-educative parameters for the participants. The overall evaluation of outcomes from the VELMA ARC rehabilitation boot camp stemmed from a disaggregated assessment of observed changes which are summarized in the final report of the clinical psychologist and was detailed enough to infer genuine repentance and positive change in attitude towards cybercrime among the participants. Follow up services were incorporated to validate initial observations. This gives credence to the potency of the psycho-educative intervention provided during the Velma ARC boot camp. It was recommended that support and collaborations from the government and other agencies/individuals would assist the VELMA foundation in expanding the scope and quality of the Velma ARC initiative as an additional requirement for cybercrime offenders following incarceration.

Keywords: Velma-ARC, cybercrime offenders, rehabilitation, Nigeria

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285 Knowledge, Attitude, and Practice of Physical Activity among Adults in Alimosho Local Government Area

Authors: Elizabeth Adebomi Akinlotan, Olukemi Odukoya

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INTRODUCTION: Physical Activity is defined as activity that involves bodily movement which is done as a part of daily activity in the form of working, playing, active transportation such as walking and also as a form of recreational activity. Physical inactivity has been identified as the fourth leading risk factor for global mortality and morbidity causing an estimated 3.2 million deaths globally and 5.5% of total deaths and it remains a pressing public health issue. There is a shift in the major causes of death from communicable to non-communicable diseases in many developed countries and this is fast becoming the case in developing countries. Physical activity is an important determinant of health and has been associated with lower mortality rates as it reduces the risk of developing chronic diseases such as diabetes mellitus, hypertension, stroke, cancer and osteoporosis. It improves musculoskeletal health, controls weight and reduces symptoms of depression. AIM: The aim is to study the knowledge, attitude and practices of physical activity among adults in Alimosho local government area. METHODOLOGY: This was a descriptive cross sectional survey designed to study the knowledge, attitude and practice of physical activity among adults in Alimosho Local Government Area. The study population were 250 adults aged 18-65 who were residents of the area of more than 6 months duration and had no chronic disease condition or physical disability. A multistage sampling method was used to select the respondents and data was collected using interviewer administered questionnaires. The data was analyzed with the use of EPI-info 2007 statistical software. Chi Square was thereafter used to test the association between selected variables. The level of statistical significance was set at 5% (p<0.05). RESULTS: In general, majority (61.6%) of the respondents had a good knowledge of what physical activity entails, 34.0% had fair knowledge and 4.4% had poor knowledge. There was a favorable attitude towards physical activity among the respondents with 82.4% having an overall positive attitude. Below a third of the respondents (26.4%) reported having a high physical activity (METS > 3001) while 40.0% had moderate (601-3000 METS) levels of activity and 33.6% were inactive (<600METS). There is statistical significance between the gender of the respondent and the levels of physical activity (p=0.0007); 75.2% males reached the minimum recommendations while 24.8% were inactive and 55.0% females reached the minimum recommendations while 45.0% were inactive. Results also showed that of 95 respondents who were satisfied with their levels of physical activity, 33.7% were insufficiently active while 66.3% were either minimally active or highly active and of 110 who were unsatisfied with their levels of physical activity, 72.0% were above the minimum recommendations while 38.0% were insufficiently active. CONCLUSION: In contrast to the high level of knowledge and favorable attitude towards physical activity, there was a lower level of practice of high or moderate physical activities. It is recommended that more awareness should be created on the recommended levels of physical activity especially for the vigorous intensity and moderate intensity physical activity.

Keywords: METS, physical activity, physical inactivity, public health

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284 Analysis of Metamaterial Permeability on the Performance of Loosely Coupled Coils

Authors: Icaro V. Soares, Guilherme L. F. Brandao, Ursula D. C. Resende, Glaucio L. Siqueira

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Electrical energy can be wirelessly transmitted through resonant coupled coils that operate in the near-field region. Once in this region, the field has evanescent character, the efficiency of Resonant Wireless Power Transfer (RWPT) systems decreases proportionally with the inverse cube of distance between the transmitter and receiver coils. The commercially available RWPT systems are restricted to short and mid-range applications in which the distance between coils is lesser or equal to the coil size. An alternative to overcome this limitation is applying metamaterial structures to enhance the coupling between coils, thus reducing the field decay along the distance between them. Metamaterials can be conceived as composite materials with periodic or non-periodic structure whose unconventional electromagnetic behaviour is due to its unit cell disposition and chemical composition. This new kind of material has been used in frequency selective surfaces, invisibility cloaks, leaky-wave antennas, among other applications. However, for RWPT it is mainly applied as superlenses which are lenses that can overcome the optical limitation and are made of left-handed media, that is, a medium with negative magnetic permeability and electric permittivity. As RWPT systems usually operate at wavelengths of hundreds of meters, the metamaterial unit cell size is much smaller than the wavelength. In this case, electric and magnetic field are decoupled, therefore the double negative condition for superlenses are not required and the negative magnetic permeability is enough to produce an artificial magnetic medium. In this work, the influence of the magnetic permeability of a metamaterial slab inserted between two loosely coupled coils is studied in order to find the condition that leads to the maximum transmission efficiency. The metamaterial used is formed by a subwavelength unit cell that consist of a capacitor-loaded split ring with an inner spiral that is designed and optimized using the software Computer Simulation Technology. The unit cell permeability is experimentally characterized by the ratio of the transmission parameters between coils measured with and without the presence of the metamaterial slab. Early measurements results show that the transmission coefficient at the resonant frequency after the inclusion of the metamaterial is about three times higher than with just the two coils, which confirms the enhancement that this structure brings to RWPT systems.

Keywords: electromagnetic lens, loosely coupled coils, magnetic permeability, metamaterials, resonant wireless power transfer, subwavelength unit cells

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283 A Systematic Review of Sensory Processing Patterns of Children with Autism Spectrum Disorders

Authors: Ala’a F. Jaber, Bara’ah A. Bsharat, Noor T. Ismael

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Background: Sensory processing is a fundamental skill needed for the successful performance of daily living activities. These skills are impaired as parts of the neurodevelopmental process issues among children with autism spectrum disorder (ASD). This systematic review aimed to summarize the evidence on the differences in sensory processing and motor characteristic between children with ASD and children with TD. Method: This systematic review followed the guidelines of the preferred reporting items for systematic reviews and meta-analysis. The search terms included sensory, motor, condition, and child-related terms or phrases. The electronic search utilized Academic Search Ultimate, CINAHL Plus with Full Text, ERIC, MEDLINE, MEDLINE Complete, Psychology, and Behavioral Sciences Collection, and SocINDEX with full-text databases. The hand search included looking for potential studies in the references of related studies. The inclusion criteria included studies published in English between years 2009-2020 that included children aged 3-18 years with a confirmed ASD diagnosis, according to the DSM-V criteria, included a control group of typical children, included outcome measures related to the sensory processing and/or motor functions, and studies available in full-text. The review of included studies followed the Oxford Centre for Evidence-Based Medicine guidelines, and the Guidelines for Critical Review Form of Quantitative Studies, and the guidelines for conducting systematic reviews by the American Occupational Therapy Association. Results: Eighty-eight full-text studies related to the differences between children with ASD and children with TD in terms of sensory processing and motor characteristics were reviewed, of which eighteen articles were included in the quantitative synthesis. The results reveal that children with ASD had more extreme sensory processing patterns than children with TD, like hyper-responsiveness and hypo-responsiveness to sensory stimuli. Also, children with ASD had limited gross and fine motor abilities and lower strength, endurance, balance, eye-hand coordination, movement velocity, cadence, dexterity with a higher rate of gait abnormalities than children with TD. Conclusion: This systematic review provided preliminary evidence suggesting that motor functioning should be addressed in the evaluation and intervention for children with ASD, and sensory processing should be supported among children with TD. More future research should investigate whether how the performance and engagement in daily life activities are affected by sensory processing and motor skills.

Keywords: sensory processing, occupational therapy, children, motor skills

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282 The Role of Rapid Maxillary Expansion in Managing Obstructive Sleep Apnea in Children: A Literature Review

Authors: Suleman Maliha, Suleman Sidra

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Obstructive sleep apnea (OSA) is a sleep disorder that can result in behavioral and psychomotor impairments in children. The classical treatment modalities for OSA have been continuous positive airway pressure and adenotonsillectomy. However, orthodontic intervention through rapid maxillary expansion (RME) has also been commonly used to manage skeletal transverse maxillary discrepancies. Aim and objectives: The aim of this study is to determine the efficacy of rapid maxillary expansion in paediatric patients with obstructive sleep apnea by assessing pre and post-treatment mean apnea-hypopnea index (AHI) and oxygen saturations. Methodology: Literature was identified through a rigorous search of the Embase, Pubmed, and CINAHL databases. Articles published from 2012 onwards were selected. The inclusion criteria consisted of patients aged 18 years and under with no systemic disease, adenotonsillar surgery, or hypertrophy who are undergoing RME with AHI measurements before and after treatment. In total, six suitable papers were identified. Results: Three studies assessed patients pre and post-RME at 12 months. The first study consisted of 15 patients with an average age of 7.5 years. Following treatment, they found that RME resulted in both higher oxygen saturations (+ 5.3%) and improved AHI (- 4.2 events). The second study assessed 11 patients aged 5–8 years and also noted improvements, with mean AHI reduction from 6.1 to 2.4 and oxygen saturations increasing from 93.1% to 96.8%. The third study reviewed 14 patients aged 6–9 years and similarly found an AHI reduction from 5.7 to 4.4 and an oxygen saturation increase from 89.8% to 95.5%. All modifications noted in these studies were statistically significant. A long-term study reviewed 23 patients aged 6–12 years post-RME treatment on an annual basis for 12 years. They found that the mean AHI reduced from 12.2 to 0.4, with improved oxygen saturations from 78.9% to 95.1%. Another study assessed 19 patients aged 9-12 years at two months into RME and four months post-treatment. Improvements were also noted at both stages, with an overall reduction of the mean AHI from 16.3 to 0.8 and an overall increase in oxygen saturations from 77.9% to 95.4%. The final study assessed 26 children aged 7-11 years on completion of individual treatment and found an AHI reduction from 6.9 to 5.3. However, the oxygen saturation remained stagnant at 96.0%, but this was not clinically significant. Conclusion: Overall, the current evidence suggests that RME is a promising treatment option for paediatric patients with OSA. It can provide efficient and conservative treatment; however, early diagnosis is crucial. As there are various factors that could be contributing to OSA, it is important that each case is treated on its individual merits. Going forward, there is a need for more randomized control trials with larger cohorts being studied. Research into the long-term effects of RME and potential relapse amongst cases would also be useful.

Keywords: orthodontics, sleep apnea, maxillary expansion, review

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281 Modified Fuzzy Delphi Method to Incorporate Healthcare Stakeholders’ Perspectives in Selecting Quality Improvement Projects’ Criteria

Authors: Alia Aldarmaki, Ahmad Elshennawy

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There is a global shift in healthcare systems’ emphasizing engaging different stakeholders in selecting quality improvement initiatives and incorporating their preferences to improve the healthcare efficiency and outcomes. Although experts bring scientific knowledge based on the scientific model and their personal experience, other stakeholders can bring new insights and information into the decision-making process. This study attempts to explore the impact of incorporating different stakeholders’ preference in identifying the most significant criteria that should be considered in healthcare for electing the improvement projects. A Framework based on a modified Fuzzy Delphi Method (FDM) was built. In addition to, the subject matter experts, doctors/physicians, nurses, administrators, and managers groups contribute to the selection process. The research identifies potential criteria for evaluating projects in healthcare, then utilizes FDM to capture expertise knowledge. The first round in FDM is intended to validate the identified list of criteria from experts; which includes collecting additional criteria from experts that the literature might have overlooked. When an acceptable level of consensus has been reached, a second round is conducted to obtain experts’ and other related stakeholders’ opinions on the appropriate weight of each criterion’s importance using linguistic variables. FDM analyses eliminate or retain the criteria to produce a final list of the critical criteria to select improvement projects in healthcare. Finally, reliability and validity were investigated using Cronbach’s alpha and factor analysis, respectively. Two case studies were carried out in a public hospital in the United Arab Emirates to test the framework. Both cases demonstrate that even though there were common criteria between the experts and the stakeholders, still stakeholders’ perceptions bring additional critical criteria into the evaluation process, which can impact the outcomes. Experts selected criteria related to strategical and managerial aspects, while the other participants preferred criteria related to social aspects such as health and safety and patients’ satisfaction. The health and safety criterion had the highest important weight in both cases. The analysis showed that Cronbach’s alpha value is 0.977 and all criteria have factor loading greater than 0.3. In conclusion, the inclusion of stakeholders’ perspectives is intended to enhance stakeholders’ engagement, improve transparency throughout the decision process, and take robust decisions.

Keywords: Fuzzy Delphi Method, fuzzy number, healthcare, stakeholders

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280 Cardiothoracic Ratio in Postmortem Computed Tomography: A Tool for the Diagnosis of Cardiomegaly

Authors: Alex Eldo Simon, Abhishek Yadav

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This study aimed to evaluate the utility of postmortem computed tomography (CT) and heart weight measurements in the assessment of cardiomegaly in cases of sudden death due to cardiac origin by comparing the results of these two diagnostic methods. The study retrospectively analyzed postmortem computed tomography (PMCT) data from 54 cases of sudden natural death and compared the findings with those of the autopsy. The study involved measuring the cardiothoracic ratio (CTR) from coronal computed tomography (CT) images and determining the actual cardiac weight by weighing the heart during the autopsy. The inclusion criteria for the study were cases of sudden death suspected to be caused by cardiac pathology, while exclusion criteria included death due to unnatural causes such as trauma or poisoning, diagnosed natural causes of death related to organs other than the heart, and cases of decomposition. Sensitivity, specificity, and diagnostic accuracy were calculated, and to evaluate the accuracy of using the cardiothoracic ratio (CTR) to detect an enlarged heart, the study generated receiver operating characteristic (ROC) curves. The cardiothoracic ratio (CTR) is a radiological tool used to assess cardiomegaly by measuring the maximum cardiac diameter in relation to the maximum transverse diameter of the chest wall. The clinically used criteria for CTR have been modified from 0.50 to 0.57 for use in postmortem settings, where abnormalities can be detected by comparing CTR values to this threshold. A CTR value of 0.57 or higher is suggestive of hypertrophy but not conclusive. Similarly, heart weight is measured during the traditional autopsy, and a cardiac weight greater than 450 grams is defined as hypertrophy. Of the 54 cases evaluated, 22 (40.7%) had a cardiothoracic ratio (CTR) ranging from > 0.50 to equal 0.57, and 12 cases (22.2%) had a CTR greater than 0.57, which was defined as hypertrophy. The mean CTR was calculated as 0.52 ± 0.06. Among the 54 cases evaluated, the weight of the heart was measured, and the mean was calculated as 369.4 ± 99.9 grams. Out of the 54 cases evaluated, 12 were found to have hypertrophy as defined by PMCT, while only 9 cases were identified with hypertrophy in traditional autopsy. The sensitivity and specificity of the test were calculated as 55.56% and 84.44%, respectively. The sensitivity of the hypertrophy test was found to be 55.56% (95% CI: 26.66, 81.12¹), the specificity was 84.44% (95% CI: 71.22, 92.25¹), and the diagnostic accuracy was 79.63% (95% CI: 67.1, 88.23¹). The limitation of the study was a low sample size of only 54 cases, which may limit the generalizability of the findings. The comparison of the cardiothoracic ratio with heart weight in this study suggests that PMCT may serve as a screening tool for medico-legal autopsies when performed by forensic pathologists. However, it should be noted that the low sensitivity of the test (55.5%) may limit its diagnostic accuracy, and therefore, further studies with larger sample sizes and more diverse populations are needed to validate these findings.

Keywords: PMCT, virtopsy, CTR, cardiothoracic ratio

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279 Polyurethane Membrane Mechanical Property Study for a Novel Carotid Covered Stent

Authors: Keping Zuo, Jia Yin Chia, Gideon Praveen Kumar Vijayakumar, Foad Kabinejadian, Fangsen Cui, Pei Ho, Hwa Liang Leo

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Carotid artery is the major vessel supplying blood to the brain. Carotid artery stenosis is one of the three major causes of stroke and the stroke is the fourth leading cause of death and the first leading cause of disability in most developed countries. Although there is an increasing interest in carotid artery stenting for treatment of cervical carotid artery bifurcation therosclerotic disease, currently available bare metal stents cannot provide an adequate protection against the detachment of the plaque fragments over diseased carotid artery, which could result in the formation of micro-emboli and subsequent stroke. Our research group has recently developed a novel preferential covered-stent for carotid artery aims to prevent friable fragments of atherosclerotic plaques from flowing into the cerebral circulation, and yet retaining the ability to preserve the flow of the external carotid artery. The preliminary animal studies have demonstrated the potential of this novel covered-stent design for the treatment of carotid therosclerotic stenosis. The purpose of this study is to evaluate the biomechanical property of PU membrane of different concentration configurations in order to refine the stent coating technique and enhance the clinical performance of our novel carotid covered stent. Results from this study also provide necessary material property information crucial for accurate simulation analysis for our stents. Method: Medical grade Polyurethane (ChronoFlex AR) was used to prepare PU membrane specimens. Different PU membrane configurations were subjected to uniaxial test: 22%, 16%, and 11% PU solution were made by mixing the original solution with proper amount of the Dimethylacetamide (DMAC). The specimens were then immersed in physiological saline solution for 24 hours before test. All specimens were moistened with saline solution before mounting and subsequent uniaxial testing. The specimens were preconditioned by loading the PU membrane sample to a peak stress of 5.5 Mpa for 10 consecutive cycles at a rate of 50 mm/min. The specimens were then stretched to failure at the same loading rate. Result: The results showed that the stress-strain response curves of all PU membrane samples exhibited nonlinear characteristic. For the ultimate failure stress, 22% PU membrane was significantly higher than 16% (p<0.05). In general, our preliminary results showed that lower concentration PU membrane is stiffer than the higher concentration one. From the perspective of mechanical properties, 22% PU membrane is a better choice for the covered stent. Interestingly, the hyperelastic Ogden model is able to accurately capture the nonlinear, isotropic stress-strain behavior of PU membrane with R2 of 0.9977 ± 0.00172. This result will be useful for future biomechanical analysis of our stent designs and will play an important role for computational modeling of our covered stent fatigue study.

Keywords: carotid artery, covered stent, nonlinear, hyperelastic, stress, strain

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278 Thinking Differently about Diversity: A Literature Review

Authors: Natalie Rinfret, Francine Tougas, Ann Beaton

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Conventions No. 100 and 111 of the International Labor Organization, passed in 1951 and 1958 respectively, established the principles of equal pay for men and women for work of equal value and freedom from discrimination in employment. Governments of different countries followed suit. For example, in 1964, the Civil Rights Act was passed in the United States and in 1972, Canada ratified Convention 100. Thus, laws were enacted and programs were implemented to combat discrimination in the workplace and, over time, more than 90% of the member countries of the International Labour Organization have ratified these conventions by implementing programs such as employment equity in Canada aimed at groups recognized as being discriminated against in the labor market, including women. Although legislation has been in place for several decades, employment discrimination has not gone away. In this study, we pay particular attention to the hidden side of the effects of employment discrimination. This is the emergence of subtle forms of discrimination that often fly under the radar but nevertheless, have adverse effects on the attitudes and behaviors of members of targeted groups. Researchers have identified two forms of racial and gender bias. On the one hand, there are traditional prejudices referring to beliefs about the inferiority and innate differences of women and racial minorities compared to White men. They have the effect of confining these two groups to job categories suited to their perceived limited abilities and can result in degrading, if not violent and hateful, language and actions. On the other hand, more subtle prejudices are more suited to current social norms. However, this subtlety harbors a conflict between values of equality and remnants of negative beliefs and feelings toward women and racial minorities. Our literature review also takes into account an overlooked part of the groups targeted by the programs in place, senior workers, and highlights the quantifiable and observable effects of prejudice and discriminatory behaviors in employment. The study proposes a hybrid model of interventions, taking into account the organizational system (employment equity practices), discriminatory attitudes and behaviors, and the type of leadership to be advocated. This hybrid model includes, in the first instance, the implementation of initiatives aimed at both promoting employment equity and combating discrimination and, in the second instance, the establishment of practices that foster inclusion, the full and complete participation of all, including seniors, in the mission of their organization.

Keywords: employment discrimination, gender bias, the hybrid model of interventions, senior workers

Procedia PDF Downloads 192
277 Air Pollution on Stroke in Shenzhen, China: A Time-Stratified Case Crossover Study Modified by Meteorological Variables

Authors: Lei Li, Ping Yin, Haneen Khreis

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Stroke is the second leading cause of death and a third leading cause of death and disability worldwide in 2019. Given the significant role of environmental factors in stroke development and progression, it is essential to investigate the effect of air pollution on stroke occurrence while considering the modifying effects of meteorological variables. This study aimed to evaluate the association between short-term exposure to air pollution and the incidence of stroke subtypes in Shenzhen, China, and to explore the potential interactions of meteorological factors with air pollutants. The study analyzed data from January 1, 2006, to December 31, 2014, including 88,214 cases of ischemic stroke and 30,433 cases of hemorrhagic stroke among residents of Shenzhen. Using a time-stratified case–crossover design with conditional quasi-Poisson regression, the study estimated the percentage changes in stroke morbidity associated with short-term exposure to nitrogen dioxide (NO₂), sulfur dioxide (SO₂), particulate matter less than 10 mm in aerodynamic diameter (PM10), carbon monoxide (CO), and ozone (O₃). A five-day moving average of air pollution was applied to capture the cumulative effects of air pollution. The estimates were further stratified by sex, age, education level, and season. The additive and multiplicative interaction between air pollutants and meteorologic variables were assessed by the relative excess risk due to interaction (RERI) and adding the interactive term into the main model, respectively. The study found that NO₂ was positively associated with ischemic stroke occurrence throughout the year and in the cold season (November through April), with a stronger effect observed among men. Each 10 μg/m³ increment in the five-day moving average of NO₂ was associated with a 2.38% (95% confidence interval was 1.36% to 3.41%) increase in the risk of ischemic stroke over the whole year and a 3.36% (2.04% to 4.69%) increase in the cold season. The harmful effect of CO on ischemic stroke was observed only in the cold season, with each 1 mg/m³ increment in the five-day moving average of CO increasing the risk by 12.34% (3.85% to 21.51%). There was no statistically significant additive interaction between individual air pollutants and temperature or relative humidity, as demonstrated by the RERI. The interaction term in the model showed a multiplicative antagonistic effect between NO₂ and temperature (p-value=0.0268). For hemorrhagic stroke, no evidence of the effects of any individual air pollutants was found in the whole population. However, the RERI indicated a statistically additive and multiplicative interaction of temperature on the effects of PM10 and O₃ on hemorrhagic stroke onset. Therefore, the insignificant conclusion should be interpreted with caution. The study suggests that environmental NO₂ and CO might increase the morbidity of ischemic stroke, particularly during the cold season. These findings could help inform policy decisions aimed at reducing air pollution levels to prevent stroke and other health conditions. Additionally, the study provides valuable insights into the interaction between air pollution and meteorological variables, which underscores the need for further research into the complex relationship between environmental factors and health.

Keywords: air pollution, meteorological variables, interactive effect, seasonal pattern, stroke

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276 The Usefulness and Usability of a Linkedin Group for the Maintenance of a Community of Practice among Hand Surgeons Worldwide

Authors: Vaikunthan Rajaratnam

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Maintaining continuous professional development among clinicians has been a challenge. Hand surgery is a unique speciality with the coming together of orthopaedics, plastics and trauma surgeons. The requirements for a team-based approach to care with the inclusion of other experts such as occupational, physiotherapist and orthotic and prosthetist provide the impetus for the creation of communities of practice. This study analysed the community of practice in hand surgery that was created through a social networking website for professionals. The main objectives were to discover the usefulness of this community of practice created in the platform of the group function of LinkedIn. The second objective was to determine the usability of this platform for the purposes of continuing professional development among members of this community of practice. The methodology used was one of mixed methods which included a quantitative analysis on the usefulness of the social network website as a community of practice, using the analytics provided by the LinkedIn platform. Further qualitative analysis was performed on the various postings that were generated by the community of practice within the social network website. This was augmented by a respondent driven survey conducted online to assess the usefulness of the platform for continuous professional development. A total of 31 respondents were involved in this study. This study has shown that it is possible to create an engaging and interactive community of practice among hand surgeons using the group function of this professional social networking website LinkedIn. Over three years the group has grown significantly with members from multiple regions and has produced engaging and interactive conversations online. From the results of the respondents’ survey, it can be concluded that there was satisfaction of the functionality and that it was an excellent platform for discussions and collaboration in the community of practice with a 69 % of satisfaction. Case-based discussions were the most useful functions of the community of practice. This platform usability was graded as excellent using the validated usability tool. This study has shown that the social networking site LinkedIn’s group function can be easily used as a community of practice effectively and provides convenience to professionals and has made an impact on their practice and better care for patients. It has also shown that this platform was easy to use and has a high level of usability for the average healthcare professional. This platform provided the improved connectivity among professionals involved in hand surgery care which allowed for the community to grow and with proper support and contribution of relevant material by members allowed for a safe environment for the exchange of knowledge and sharing of experience that is the foundation of a community practice.

Keywords: community of practice, online community, hand surgery, lifelong learning, LinkedIn, social media, continuing professional development

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275 Outcome of Dacryocystorhinostomy with Peroperative Local Use of Mitomycin-C

Authors: Chandra Shekhar Majumder, Orin Sultana Jamie

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Background: Dacryocystorhinostomy (DCR) has been a widely accepted surgical intervention for nasolacrimal duct obstructions. Some previous studies demonstrated the potential benefits of the peroperative application of agents like Mitomycin-C (MMC) with DCR to improve surgical outcomes. Relevant studies are rare in Bangladesh, and there are controversies about the dose, duration of MMC, and outcome. Therefore, the present study aimed to investigate the comparative efficacy of DCR with and without MMC in a tertiary hospital in Bangladesh. Objective: The study aims to determine the outcome of a dacryocystorhinostomy with preoperative local use of mitomycin–C. Methods: An analytical study was conducted in the Department of Ophthalmology, Sir Salimullah Medical College & Mitford Hospital, Dhaka, from January 2023 to September 2023. Seventy patients who were admitted for DCR operation were included according to the inclusion and exclusion criteria. Patients were divided into two groups: those who underwent DCR with peroperative administration of 0.2 mg/ml Mitomycin-C for 5 minutes (Group I) and those who underwent DCR alone (Group II). All patients were subjected to detailed history taking, clinical examination, and relevant investigations. All patients underwent DCR according to standard guidelines and ensured the highest peroperative and postoperative care. Then, patients were followed up at 7th POD, 1-month POD, 3 months POD, and 6 months POD to observe the success rate between the two groups by assessing tearing condition, irrigation, height of tear meniscus, and FDDT- test. Data was recorded using a pre-structured questionnaire, and collected data were analyzed using SPSS 23. Results: The mean age of the study patients was 42.17±6.7 (SD) years and 42.29±7.1 (SD) years in Groups I and II, respectively, with no significant difference (p=0.945). At the 6th month’s follow-up, group I patients were observed with 94.3% frequency of symptom-free, 85.6% patency of lacrimal drainage system, 68.6% had tear meniscus <0.1mm and 88.6% had positive Fluorescence Dye Disappearance Test (FDDT test). In group II, 91.4% were symptom-free, 68.6% showed patency, 57.1% had a height of tear meniscus < 0.1 mm, and 85.6% had FDDT test positive. But no statistically significant difference was observed (p<.05). Conclusion: The use of Mitomycin-C preoperatively during DCR offers better postoperative outcomes, particularly in maintaining patency and achieving symptom resolution with more FDDT test positive and improvement of tear meniscus in the MMC group than the control group. However, this study didn’t demonstrate a statistically significant difference between the two groups. Further research with larger sample sizes and longer follow-up periods would be beneficial to corroborate these findings.

Keywords: dacryocystorhinostomy, mitomycin-c, dacryocystitis, nasolacrimal duct obstruction

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274 Support Services in Open and Distance Education: An Integrated Model of Open Universities

Authors: Evrim Genc Kumtepe, Elif Toprak, Aylin Ozturk, Gamze Tuna, Hakan Kilinc, Irem Aydin Menderis

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Support services are very significant elements for all educational institutions in general; however, for distance learners, these services are more essential than traditional (face-to-face) counterparts. One of the most important reasons for this is that learners and instructors do not share the same physical environment and that distance learning settings generally require intrapersonal interactions rather than interpersonal ones. Some learners in distance learning programs feel isolated. Furthermore, some fail to feel a sense of belonging to the institution because of lack of self-management skills, lack of motivation levels, and the need of being socialized, so that they are more likely to fail or drop out of an online class. In order to overcome all these problems, support services have emerged as a critical element for an effective and sustainable distance education system. Within the context of distance education support services, it is natural to include technology-based and web-based services and also the related materials. Moreover, institutions in education sector are expected to use information and communication technologies effectively in order to be successful in educational activities and programs. In terms of the sustainability of the system, an institution should provide distance education services through ICT enabled processes to support all stakeholders in the system, particularly distance learners. In this study, it is envisaged to develop a model based on the current support services literature in the field of open and distance learning and the applications of the distance higher education institutions. Specifically, content analysis technique is used to evaluate the existing literature in the distance education support services, the information published on websites, and applications of distance higher education institutions across the world. A total of 60 institutions met the inclusion criteria which are language option (English) and availability of materials in the websites. The six field experts contributed to brainstorming process to develop and extract codes for the coding scheme. During the coding process, these preset and emergent codes are used to conduct analyses. Two coders independently reviewed and coded each assigned website to ensure that all coders are interpreting the data the same way and to establish inter-coder reliability. Once each web page is included in descriptive and relational analysis, a model of support services is developed by examining the generated codes and themes. It is believed that such a model would serve as a quality guide for future institutions, as well as the current ones.

Keywords: support services, open education, distance learning, support model

Procedia PDF Downloads 174
273 Experiences of Students in a Cultural Competence Learning Project in Hong Kong- Themes from Qualitative Analysis

Authors: Diana Kwok

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Introduction: There is a rising concern on the educational needs of school guidance teachers, counselors, and sex educators to work effectively with students from multicultural groups, such as racial minorities, gender minorities, sexual minorities, and disability groups etc., and to respect cultural diversities. A specialized training model, the multicultural framework based on contact theory is recognized as necessary training model for professional training programs. Methodology: While the major focus of this project is on improving teaching and learning in teacher training courses within the department of Special Education and Counselling, it specifically aims to enhance the cultural competence of 102 participants enrolled in counseling and sexuality education courses by integrating the following teaching and learning strategies: 1) Panel presentation; 2) Case studies; 3) Experiential learning. Data sources from the participants consisted of the following: (a) questionnaires (MCKAS and ATLG) administered in classes; (b) weekly reflective journals, and c) focus group interviews with panel members. The focus group interviews with panel members were documented. Qualitatively, the weekly reflections were content analyzed. The presentation in this specific conference put focus on themes we found from qualitative content analysis of weekly reflective journals from 102 participants. Findings: Content analysis had found the following preliminary emergent themes: Theme I) Cultural knowledge and challenges to personal limitation. Students had gained a new perspective that specific cultural knowledge involved unique values and worldview. Awareness of limitation of counsellors is very important after actively acquiring the cultural knowledge. Theme 2 - Observation, engagement and active learning. Through the sharing and case studies, as well as visits to the communities, students recognized that observation and listening to the needs of cultural group members were the essential steps before taking any intervention steps. Theme 3 - Curiosity and desire for further inter-group dialogue. All students expressed their desire, curiosity, and motivation to have further inter-group dialogue in their future work settings. Theme 4: Experience with teaching and learning strategies. Students shared their perspectives on how teaching and learning strategies had facilitated their acquisition of cultural competence. Results of this analysis suggests that diverse teaching and learning strategies based on contact perspective had stimulated their curiosity to re-examine their values and motivated them to acquire cultural knowledge relevant to the cultural groups. Acknowledgment: The teaching and learning project was funded by the Teaching and Development Grant, Hong Kong Institute of Education (Project Number T0142).

Keywords: cultural competence, Chinese teacher students, teaching and learning, contacts

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272 Limiting Freedom of Expression to Fight Radicalization: The 'Silencing' of Terrorists Does Not Always Allow Rights to 'Speak Loudly'

Authors: Arianna Vedaschi

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This paper addresses the relationship between freedom of expression, national security and radicalization. Is it still possible to talk about a balance between the first two elements? Or, due to the intrusion of the third, is it more appropriate to consider freedom of expression as “permanently disfigured” by securitarian concerns? In this study, both the legislative and the judicial level are taken into account and the comparative method is employed in order to provide the reader with a complete framework of relevant issues and a workable set of solutions. The analysis moves from the finding according to which the tension between free speech and national security has become a major issue in democratic countries, whose very essence is continuously endangered by the ever-changing and multi-faceted threat of international terrorism. In particular, a change in terrorist groups’ recruiting pattern, attracting more and more people by way of a cutting-edge communicative strategy, often employing sophisticated technology as a radicalization tool, has called on law-makers to modify their approach to dangerous speech. While traditional constitutional and criminal law used to punish speech only if it explicitly and directly incited the commission of a criminal action (“cause-effect” model), so-called glorification offences – punishing mere ideological support for terrorism, often on the web – are becoming commonplace in the comparative scenario. Although this is direct, and even somehow understandable, consequence of the impending terrorist menace, this research shows many problematic issues connected to such a preventive approach. First, from a predominantly theoretical point of view, this trend negatively impacts on the already blurred line between permissible and prohibited speech. Second, from a pragmatic point of view, such legislative tools are not always suitable to keep up with ongoing developments of both terrorist groups and their use of technology. In other words, there is a risk that such measures become outdated even before their application. Indeed, it seems hard to still talk about a proper balance: what was previously clearly perceived as a balancing of values (freedom of speech v. public security) has turned, in many cases, into a hierarchy with security at its apex. In light of these findings, this paper concludes that such a complex issue would perhaps be better dealt with through a combination of policies: not only criminalizing ‘terrorist speech,’ which should be relegated to a last resort tool, but acting at an even earlier stage, i.e., trying to prevent dangerous speech itself. This might be done by promoting social cohesion and the inclusion of minorities, so as to reduce the probability of people considering terrorist groups as a “viable option” to deal with the lack of identification within their social contexts.

Keywords: radicalization, free speech, international terrorism, national security

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271 Structural-Lithological Conditions of Formation of Epithermal Gold Sulphide Satellite Deposits in the North Part of Chovdar Ore Area

Authors: Nabat Gojaeva, Mikayil Naghiyev, Sultan Jafarov, Gular Mikayilova

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Chovdar ore area is located in the contact of Dashkesan caldera and Shamkir horst-graben uplift, which comprises the central part of Lok-Karabakh Island arcs of South Caucasus metallogenic province in terms of regional tectonics. One of the main structural features of formation of the Mereh and Aghyokhush group of low sulfidation epithermal gold deposits, locating in the north peripheric part of the ore area, is involving the crossing areas of ore-hosting and ore-forming Pan-Caucasian-direction structurally-compound faults with the meridional, rhombically shaped faults. In addition, another significant feature is the temporally two- or three-stage ore formation. In the first stage -an early phase of Upper Bathonian age, sulfides are the dominant minerals, in the second stage- late ‘productive’ phase of Upper Bathonian age, mainly gold mineralization is formed. Also, in the Upper Jurassic – Lower Cretaceous ages, rarely-encountered Cu-polymetallic ore formations are documented. Finally, in the last stage, the re-dislocation of ore-formation is foreseen in the previously-formed mineralization areas. The faults in the strike and dip directions formed shearing, brecciation, sulfide mineralization aureoles, and hydrothermal alteration zones in the wall rocks along with the local depression blocks. The geological-structural analysis of the area shows that multiple and various morphogenetic volcano-tectonically fault systems have developed in the area. These fault systems have played a trap role for ore-formation in the intersected parts of faults mentioned above. Thus, in the referred parts, mostly predominance of felsic volcanism and metasomatic alteration (silicification, argillitic, etc.) of wall rocks, as well as the products of this volcanism, account for the inclusion of hydrothermal ore-forming fluids along these faults. It is possible to determine temporally and lithological-structural connection between the ore-formation along with local depression blocks and faults as borders for products of felsic volcanism of Upper Cretaceous-Lesser Jurassic ages, in the results of the replacement of hydrothermal alteration zones with relatively low-temperature metasomatic alterations while moving from the felsic parts to the margins, and due to being non-ore bearing intermediate and intermediate-felsic magmatic facies.

Keywords: Aghyokhush, fault, gold deposit, Mereh

Procedia PDF Downloads 195
270 The Effects of Collaborative Videogame Play on Flow Experience and Mood

Authors: Eva Nolan, Timothy Mcnichols

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Gamers spend over 3 billion hours collectively playing video games a week, which is arguably not nearly enough time to indulge in the many benefits gaming has to offer. Much of the previous research on video gaming is centered on the effects of playing violent video games and the negative impacts they have on the individual. However, there is a dearth of research in the area of non-violent video games, specifically the emotional and cognitive benefits playing non-violent games can offer individuals. Current research in the area of video game play suggests there are many benefits to playing for an individual, such as decreasing symptoms of depression, decreasing stress, increasing positive emotions, inducing relaxation, decreasing anxiety, and particularly improving mood. One suggestion as to why video games may offer such benefits is that they possess ideal characteristics to create and maintain flow experiences, which in turn, is the subjective experience where an individual obtains a heightened and improved state of mind while they are engaged in a task where a balance of challenge and skill is found. Many video games offer a platform for collaborative gameplay, which can enhance the emotional experience of gaming through the feeling of social support and social inclusion. The present study was designed to examine the effects of collaborative gameplay and flow experience on participants’ perceived mood. To investigate this phenomenon, an in-between subjects design involving forty participants were randomly divided into two groups where they engaged in solo or collaborative gameplay. Each group represented an even number of frequent gamers and non-frequent gamers. Each participant played ‘The Lego Movie Videogame’ on the Playstation 4 console. The participant’s levels of flow experience and perceived mood were measured by the Flow State Scale (FSS) and the Positive and Negative Affect Schedule (PANAS). The following research hypotheses were investigated: (i.) participants in the collaborative gameplay condition will experience higher levels of flow experience and higher levels of mood than those in the solo gameplay condition; (ii.) participants who are frequent gamers will experience higher levels of flow experience and higher levels of mood than non-frequent gamers; and (iii.) there will be a significant positive relationship between flow experience and mood. If the estimated findings are supported, this suggests that engaging in collaborative gameplay can be beneficial for an individual’s mood and that experiencing a state of flow can also enhance an individual’s mood. Hence, collaborative gaming can be beneficial to promote positive emotions (higher levels of mood) through engaging an individual’s flow state.

Keywords: collaborative gameplay, flow experience, mood, games, positive emotions

Procedia PDF Downloads 314
269 The Relationship between Violence against Women and Levels of Self-Esteem in Urban Informal Settlements of Mumbai, India: A Cross-Sectional Study

Authors: A. Bentley, A. Prost, N. Daruwalla, D. Osrin

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Background: This study aims to investigate the relationship between experiences of violence against women in the family, and levels of self-esteem in women residing in informal settlement (slum) areas of Mumbai, India. The authors hypothesise that violence against women in Indian households extends beyond that of intimate partner violence (IPV), to include other members of the family and that experiences of violence are associated with lower levels of self-esteem. Methods: Experiences of violence were assessed through a cross-sectional survey of 598 women, including questions about specific acts of emotional, economic, physical and sexual violence across different time points, and the main perpetrator of each. Self-esteem was assessed using the Rosenberg self-esteem questionnaire. A global score for self-esteem was calculated and the relationship between violence in the past year and Rosenberg self-esteem score was assessed using multivariable linear regression models, adjusted for years of education completed, and clustering using robust standard errors. Results: 482 (81%) women consented to interview. On average, they were 28.5 years old, had completed 6 years of education and had been married 9.5 years. 88% were Muslim and 46% lived in joint families. 44% of women had experienced at least one act of violence in their lifetime (33% emotional, 22% economic, 24% physical, 12% sexual). Of the women who experienced violence after marriage, 70% cited a perpetrator other than the husband for at least one of the acts. 5% had low self-esteem (Rosenberg score < 15). For women who experienced emotional violence in the past year, the Rosenberg score was 2.6 points lower (p < 0.001). It was 1.2 points lower (p = 0.03) for women who experienced economic violence. For physical or sexual violence in the past year, no statistically significant relationship with Rosenberg score was seen. However, for a one-unit increase in the number of different acts of each type of violence experienced in the past year, a decrease in Rosenberg score was seen (-0.62 for emotional, -0.76 for economic, -0.53 for physical and -0.47 for sexual; p < 0.05 for all). Discussion: The high prevalence of violence experiences across the lifetime was likely due to the detailed assessment of violence and the inclusion of perpetrators within the family other than the husband. Experiences of emotional or economic violence in the past year were associated with lower Rosenberg scores and therefore lower self-esteem, but no relationship was seen between experiences of physical or sexual violence and Rosenberg score overall. For all types of violence in the past year, a greater number of different acts were associated with a decrease in Rosenberg score. Emotional violence showed the strongest relationship with self-esteem, but for all types of violence the more complex the pattern of perpetration with different methods used, the lower the levels of self-esteem. Due to the cross-sectional nature of the study causal directionality cannot be attributed. Further work to investigate the relationship between severity of violence and self-esteem and whether self-esteem mediates relationships between violence and poorer mental health would be beneficial.

Keywords: family violence, India, informal settlements, Rosenberg self-esteem scale, self-esteem, violence against women

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268 Fear of Falling and Subjective Cognitive Decline Are Predictors of Fall Risk in Community-dwelling Older Adults Living in Low-income Settings

Authors: Ladda Thiamwong, Renata Komalasari

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Falls are the leading cause of disability and hospitalization in low-income older adults. Fear of falling is present in 20% to 85 % of older adults and has been identified as an independent risk factor of fall risk, activity restriction, and loss of independence. About 12% of American older adults have subjective cognitive decline. Cognitive impairment is also an established factor of fall risk. However, it is unclear whether measures of fear of falling and subjective cognitive decline have the greatest association with fall risk in low-income older adults. The aim of this study was to evaluate the association between fear of falling, subjective cognitive decline-functional performance (SCD-FP), and fall risk using simple screening tools. In this cross-section study, we collected data from community-dwelling older adults 60 years or older in low-income settings in Central Florida, and 86 participants were included in the data analysis. Fear of falling was assessed by the Short Fall Efficacy Scale- International (Short FES-I) with seven items. Subjective cognitive decline-functional performance (SCD-FP) was assessed by a self-reported experience of worsening or more frequent confusion or memory loss in the past 12 months and its functional implications. Fall risk was evaluated by the Centers for Disease Control and Prevention (CDC)'s Stay Independent checklist with 12 items. The majority of participants were female, and more than half of the participants were African American. More than half of the participants had a higher school degree or higher, and less than 20% had no financial problems. Less than 30% of the participants perceived their general health as very good- excellent. More than half of the participants lived alone, and less than 15% lived with a partner or spouse. About 60% of the participants had hypertension, 40% had diabetes, 16% had cancer, and 50% had arthritis. About 30% of the participants had difficulty walking up ten steps without resting, more than 40% felt unsteady when walking, and 30% had been advised to use a cane or walker to get around safely. Regression analysis showed that fall risk was associated with fear of falling ( = .524, p <.001) and subjective cognitive decline-functional performance ( = .465, p =.027). The structure coefficient showed that fear of falling (rs2 = .922) was a stronger predictor of fall risk than subjective cognitive decline-functional performance (rs2= .200). Fear of falling and subjective cognitive decline-functional performance are growing public health issues, and addressing those issues is a public priority. Proactive screening for fear of falling and subjective cognitive decline-functional performance is critical in fall prevention. A combination of all three self-reported tools (Short FES-I, SCD-FP, and CDC's Stay Independent checklist) takes less than 5 minutes to complete. Primary care providers or public health professionals should consider including these tools to screen fear of falling and subjective cognitive decline-functional performance as part of fall risk assessment, especially in low-income settings. Thus, encouraging older adults and healthcare professionals to discuss fear of falling, subjective cognitive decline, and fall risk during routine medical office visits.

Keywords: falls, fall risk, fear of falling, cognition, subjective cognitive decline, low-income, older adults, community, screening, nursing, primary care

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267 Effectiveness of N-Acetylcysteine in the Treatment of Adults with Trichotillomania: An Evidenced Based Review

Authors: Teresa Sarmento de Beires, Sofia Padilha, Pedro Arantes, Joana Ribeiro, Andreia Eiras

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Background: Trichotillomania is a psychiatric condition that is very challenging to treat, with no first-line medications approved by any medical agency. It is defined as a recurrent compulsive habit of pulling out one's own hair, usually from the scalp and eyebrows area, but it can also affect eyelashes or any other hair-bearing area. N-acetylcysteine, a glutamate modulator, has been studied as a possible treatment for several psychiatric and neurological disorders, considering its role in attenuating pathophysiological processes responsible for compulsive behaviors and, therefore, trichotillomania. Objective: This study aims to determine the efficacy of N-acetylcysteine in the treatment of adults with trichotillomania. Methodology: The authors researched guidelines, standards of clinical guidance, systematic reviews, meta-analyses, and randomized clinical trials, published in the last 20 years using the MeSH terms: "Trichotillomania” and “N-acetylcysteine” in the following databases: PubMed, Cochrane library, National Guideline Clearing House, National Institute of Health and Care Excellence (NICE), Canadian Medical Association Practice Guidelines and Database of Abstracts of Reviews of Effectiveness (DARE). The Strength of Recommendation Taxonomy (SORT) Scale, from the American Family Physician, was used to evaluate the level of evidence and assign the strength of recommendation. Results: The research found fifteen articles, among which only three were eligible according to the inclusion criteria: 1. systematic review and 2. meta-analyses. There was evidence of a probable beneficial effect of N-acetylcysteine on treatment response and reduction of trichotillomania symptom severity in adults, with moderate certainty in the effect estimate. There was no evidence of effectiveness with the use of inositol, antioxidants, naltrexone, or selective serotonin reuptake inhibitors (SSRIs) in the treatment of adults with trichotillomania. Clomipramine and Olanzapine showed potential treatment benefits, with low certainty. N-acetylcysteine had the least severe side effect profile in adults compared with the other potentially beneficial pharmacological treatments. Conclusion: Evidence points towards the effectiveness of N-acetylcysteine in the treatment of adults with trichotillomania, which exhibits a good tolerability profile with minimal adverse effects. Therefore, the authors attribute a level of evidence 2, the strength of recommendation B, to the prescription of N-acetylcysteine in the treatment of adults suffering from trichotillomania (SORT analysis). Further investigation is needed in order to extract high-quality conclusions from the meta-analysis.

Keywords: trichotillomania, hair pulling, treatment, n-acetylcysteine

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266 Peripheral Neuropathy after Locoregional Anesthesia

Authors: Dalila Chaid, Bennameur Fedilli, Mohammed Amine Bellelou

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The study focuses on the experience of lower-limb amputees, who face both physical and psychological challenges due to their disability. Chronic neuropathic pain and various types of limb pain are common in these patients. They often require orthopaedic interventions for issues such as dressings, infection, ulceration, and bone-related problems. Research Aim: The aim of this study is to determine the most suitable anaesthetic technique for lower-limb amputees, which can provide them with the greatest comfort and prolonged analgesia. The study also aims to demonstrate the effectiveness and cost-effectiveness of ultrasound-guided local regional anaesthesia (LRA) in this patient population. Methodology: The study is an observational analytical study conducted over a period of eight years, from 2010 to 2018. It includes a total of 955 cases of revisions performed on lower limb stumps. The parameters analyzed in this study include the effectiveness of the block and the use of sedation, the duration of the block, the post-operative visual analog scale (VAS) scores, and patient comfort. Findings: The study findings highlight the benefits of ultrasound-guided LRA in providing comfort by optimizing post-operative analgesia, which can contribute to psychological and bodily repair in lower-limb amputees. Additionally, the study emphasizes the use of alpha2 agonist adjuvants with sedative and analgesic properties, long-acting local anaesthetics, and larger volumes for better outcomes. Theoretical Importance: This study contributes to the existing knowledge by emphasizing the importance of choosing an appropriate anaesthetic technique for lower-limb amputees. It highlights the potential of ultrasound-guided LRA and the use of specific adjuvants and local anaesthetics in improving post-operative analgesia and overall patient outcomes. Data Collection and Analysis Procedures: Data for this study were collected through the analysis of medical records and relevant documentation related to the 955 cases included in the study. The effectiveness of the anaesthetic technique, duration of the block, post-operative pain scores, and patient comfort were analyzed using statistical methods. Question Addressed: The study addresses the question of which anaesthetic technique would be most suitable for lower-limb amputees to provide them with optimal comfort and prolonged analgesia. Conclusion: The study concludes that ultrasound-guided LRA, along with the use of alpha2 agonist adjuvants, long-acting local anaesthetics, and larger volumes, can be an effective approach in providing comfort and improving post-operative analgesia for lower-limb amputees. This technique can potentially contribute to the psychological and bodily repair of these patients. The findings of this study have implications for clinical practice in the management of lower-limb amputees, highlighting the importance of personalized anaesthetic approaches for better outcomes.

Keywords: neuropathic pain, ultrasound-guided peripheral nerve block, DN4 quiz, EMG

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265 Examining the Role of Farmer-Centered Participatory Action Learning in Building Sustainable Communities in Rural Haiti

Authors: Charles St. Geste, Michael Neumann, Catherine Twohig

Abstract:

Our primary aim is to examine farmer-centered participatory action learning as a tool to improve agricultural production, build resilience to climate shocks and, more broadly, advance community-driven solutions for sustainable development in rural communities across Haiti. For over six years, sixty plus farmers from Deslandes, Haiti, organized in three traditional work groups called konbits, have designed and tested low-input agroecology techniques as part of the Konbit Vanyan Kapab Pwoje Agroekoloji. The project utilizes a participatory action learning approach, emphasizing social inclusion, building on local knowledge, experiential learning, active farmer participation in trial design and evaluation, and cross-community sharing. Mixed methods were used to evaluate changes in knowledge and adoption of agroecology techniques, confidence in advancing agroecology locally, and innovation among Konbit Vanyan Kapab farmers. While skill and knowledge in application of agroecology techniques varied among individual farmers, a majority of farmers successfully adopted techniques outside of the trial farms. The use of agroecology techniques on trial and individual farms has doubled crop production in many cases. Farm income has also increased, and farmers report less damage to crops and property caused by extreme weather events. Furthermore, participatory action strategies have led to greater local self-determination and greater capacity for sustainable community development. With increased self-confidence and the knowledge and skills acquired from participating in the project, farmers prioritized sharing their successful techniques with other farmers and have developed a farmer-to-farmer training program that incorporates participatory action learning. Using adult education methods, farmers, trained as agroecology educators, are currently providing training in sustainable farming practices to farmers from five villages in three departments across Haiti. Konbit Vanyan Kapab farmers have also begun testing production of value-added food products, including a dried soup mix and tea. Key factors for success include: opportunities for farmers to actively participate in all phases of the project, group diversity, resources for application of agroecology techniques, focus on group processes and overcoming local barriers to inclusive decision-making.

Keywords: agroecology, participatory action learning, rural Haiti, sustainable community development

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264 Zoledronic Acid with Neoadjuvant Chemotherapy in Advanced Breast Cancer Prospective Study 2011–2014

Authors: S. Sakhri

Abstract:

Background: The use of Zoledronic acid (ZA) is an established place in the treatment of malignant tumors with a predilection for the skeleton of interest (in particular metastasis). Although the main target of Zoledronic acid was osteoclasts, there are preclinical data suggest that Zoledronic acid may have an antitumor effect on cells other than osteoclasts, including tumor cells. Antitumor activity, including the inhibition of tumor cell growth and the induction of apoptosis of tumor cells, inhibition of tumor cell adhesion and invasion, and anti-angiogenic effects have been demonstrated. Methods. From (2012 to 2014), 438 patients were included respondents the inclusion criteria, respectively. This is a prospective study over a 4 year period. Of all patients (N=438), 432 received neoadjuvant chemotherapy with Zoledronic acid. The primary end point was the pathologic complete response in advancer breast cancer stage. The secondary end point is to evaluate Clinical response according to RECIST criteria; estimate the bone density before and at the end of chemotherapy in women with locally advanced breast cancer, Toxicity Evaluation and Overall survival using Kaplan-Meier and log test. Result: The Objective response rate was 97% after (C4) with 3% stabilizations and 99, 3% of which 0.7% C8 after stabilization. The clinical complete response was 28% after C4 respectively, and 46.8% after C8, the pathologic complete response rate was 40.13% according to the classification Sataloff. We observed that the pathologic complete response rate was the most raised in the group including Her2 (luminal Her2 and Her2) the lowest in the triple negative group as classified by Sataloff. We found that the pCR is significantly higher in the age group (35-50 years) with 53.17%. Those who have more than 50 years in 2nd place with 27.7% and the lower in young woman 35 years pCR was 19%, not statistically significant, -The pCR was also in favor of the menopausal group in 51, 4%, and 48, 55% for non-menopausal women. The average duration of overall survival was also significantly in the subgroup (Luminal -Her2, Her2) compared with triple negative. It is 47.18 months in the luminal group vs. 38.95 in the triple negative group. -Was observed in our study a difference in quality of life between (C1) was the admission of the patient, and after (C8), we found an increase in general signs and a deterioration in the psychological state C1, in contrast to the C8 these general signs and mental status improves, up to 12, and 24 months. Conclusion The results of this study suggest that the addition of ZA to néoadjuvant CT has potential anti-cancer benefit in patients (Luminal -Her2, Her2) compared with triple negative with or without menopause status.

Keywords: HER2+, RH+, breast cancer, tyrosine kinase

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263 The Situation of Transgender Individuals Was Worsened During Covid-19

Authors: Kajal Attri

Abstract:

Introduction: Transgender people are considered third gender in India, although they still face identification issues and alienated from society. Furthermore, they face several challenges, including discrimination in employment, resources, education, and property as a result, most transgender people make a living through begging at traffic lights, trains, and buses; attending auspicious occasions such as childbirth and weddings; and engaging in sex work, which includes both home-based and street-based sex work. During COVID-19, maintaining social distance exacerbates transgender people's circumstances and prevents them from accessing health care services, sexual reassignment surgery, identity-based resources, government security, and financial stability. Nonetheless, the pandemic raised unfavorable attitudes about transgender persons, such as unsupportive family members and trouble forming emotional relationships. This study focuses on how we missed transgender people during COVID-19 to provide better facilities to cope with this situation when they are already the most vulnerable segment of the society. Methodology: The research was conducted using secondary data from published publications and grey literature obtained from four databases: Pubmed, Psychinfo, Science direct, and Google scholar. The literature included total 25 articles that met the inclusion criteria for a review. Result and Discussion: Transgender people, who are considered the most vulnerable sector of society, have already faced several obstacles as a result of the outbreak. The analysis underscores the difficulties that transgender persons faced during COVID-19, such as, They had trouble accessing the government's social security programmes during the lockdown, which provide rations and pensions since they lack the necessary identifying cards. The impact of COVID-19 leaves transgender people at heightened risk of poverty and ill health because they exist on the margins of society, those livelihood base on sex work, begging, and participation on auspicious occasions. They had a significant risk of contracting SARS-CoV2 because they lived in congested areas or did not have permanent shelter, and they were predominantly infected with HIV, cancer, and other non-communicable illnesses. The pandemic raised unfavorable attitudes about transgender persons, such as unsupportive family members and trouble forming emotional relationships. Conclusion: The study comes forward with useful suggestions based on content analysis and information to reduce the existing woes of transgenders during any pandemic like COVID-19.

Keywords: COVID-19, transgender, lockdown, transwomen, stigmatization

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262 Data Quality on Regular Childhood Immunization Programme at Degehabur District: Somali Region, Ethiopia

Authors: Eyob Seife

Abstract:

Immunization is a life-saving intervention which prevents needless suffering through sickness, disability, and death. Emphasis on data quality and use will become even stronger with the development of the immunization agenda 2030 (IA2030). Quality of data is a key factor in generating reliable health information that enables monitoring progress, financial planning, vaccine forecasting capacities, and making decisions for continuous improvement of the national immunization program. However, ensuring data of sufficient quality and promoting an information-use culture at the point of the collection remains critical and challenging, especially in hard-to-reach and pastoralist areas where Degehabur district is selected based on a hypothesis of ‘there is no difference in reported and recounted immunization data consistency. Data quality is dependent on different factors where organizational, behavioral, technical, and contextual factors are the mentioned ones. A cross-sectional quantitative study was conducted on September 2022 in the Degehabur district. The study used the world health organization (WHO) recommended data quality self-assessment (DQS) tools. Immunization tally sheets, registers, and reporting documents were reviewed at 5 health facilities (2 health centers and 3 health posts) of primary health care units for one fiscal year (12 months) to determine the accuracy ratio. The data was collected by trained DQS assessors to explore the quality of monitoring systems at health posts, health centers, and the district health office. A quality index (QI) was assessed, and the accuracy ratio formulated were: the first and third doses of pentavalent vaccines, fully immunized (FI), and the first dose of measles-containing vaccines (MCV). In this study, facility-level results showed both over-reporting and under-reporting were observed at health posts when computing the accuracy ratio of the tally sheet to health post reports found at health centers for almost all antigens verified where pentavalent 1 was 88.3%, 60.4%, and 125.6% for Health posts A, B, and C respectively. For first-dose measles-containing vaccines (MCV), similarly, the accuracy ratio was found to be 126.6%, 42.6%, and 140.9% for Health posts A, B, and C, respectively. The accuracy ratio for fully immunized children also showed 0% for health posts A and B and 100% for health post-C. A relatively better accuracy ratio was seen at health centers where the first pentavalent dose was 97.4% and 103.3% for health centers A and B, while a first dose of measles-containing vaccines (MCV) was 89.2% and 100.9% for health centers A and B, respectively. A quality index (QI) of all facilities also showed results between the maximum of 33.33% and a minimum of 0%. Most of the verified immunization data accuracy ratios were found to be relatively better at the health center level. However, the quality of the monitoring system is poor at all levels, besides poor data accuracy at all health posts. So attention should be given to improving the capacity of staff and quality of monitoring system components, namely recording, reporting, archiving, data analysis, and using information for decision at all levels, especially in pastoralist areas where such kinds of study findings need to be improved beside to improving the data quality at root and health posts level.

Keywords: accuracy ratio, Degehabur District, regular childhood immunization program, quality of monitoring system, Somali Region-Ethiopia

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