Search results for: resuscitation team member

Authors: Mariam Khaled, Noha Farag, Ghada Mohamed Abdel Salam, Khaled Abu-Aisha, Mohamed El-Azizi

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Gastric and colorectal cancers are among the most frequent causes of cancer-associated mortalities in Africa. They have been considered as a global public health concern, as nearly one million new cases are reported per year. IL-1β is a pro-inflammatory cytokine-produced by activated macrophages and monocytes- and a member of the IL-1 family. The inactive IL-1β precursor is cleaved and activated by caspase-1 enzyme, which itself is activated by the assembly of intracellular structures defined as NLRP3 (Nod Like receptor P3) inflammasomes. Activated IL-1β stimulates the Interleukin-1 receptor type-1 (IL-1R1), which is responsible for the initiation of a signal transduction pathway leading to cell proliferation. It has been proven that the IL-1β gene is a highly polymorphic gene in which single nucleotide polymorphisms (SNPs) may affect its expression. It has been previously reported that SNPs including base transitions between C and T at positions, -511 (C-T; dbSNP: rs16944) and -31 (C-T; dbSNP: rs1143627), from the transcriptional start site, contribute to the pathogenesis of gastric and colorectal cancers by affecting IL-1β levels. Altered production of IL-1β due to such polymorphisms is suspected to stimulate an amplified inflammatory response and promote Epithelial Mesenchymal Transition leading to malignancy. Allele frequency distribution of the IL-1β-31 and -511 SNPs, in different populations, and their correlation to the incidence of gastric and colorectal cancers, has been intriguing to researchers worldwide. The current study aims to investigate allele distributions of the IL-1β SNPs among gastric and colorectal cancers Egyptian patients. In order to achieve to that, 89 Biopsy and surgical specimens from the antrum and corpus mucosa of chronic gastritis subjects and gastric and colorectal carcinoma patients was collected for DNA extraction followed by restriction fragment length polymorphism polymerase chain reaction (RFLP-PCR). The amplified PCR products of IL-1β-31C > T and IL-1β-511T > C were digested by incubation with the restriction endonuclease enzymes ALu1 and Ava1. Statistical analysis was carried out to determine the allele frequency distribution in the three studied groups. Also, the effect of the IL-1β -31 and -511 SNPs on nuclear factor binding was analyzed using Fluorescence Electrophoretic Mobility Shift Assay (EMSA), preceded by nuclear factor extraction from gastric and colorectal tissue samples and LPS stimulated monocytes. The results of this study showed that a significantly higher percentage of Egyptian gastric cancer patients have a homozygous CC genotype at the IL-1β-31 position and a heterozygous TC genotype at the IL-1β-511 position. Moreover, a significantly higher percentage of the colorectal cancer patients have a homozygous CC genotype at the IL-1β-31 and -511 positions as compared to the control group. In addition, the EMSA results showed that IL-1β-31C/T and IL-1β-511T/C SNPs do not affect nuclear factor binding. Results of this study suggest that the IL-1β-31 C/T and IL-1β-511 T/C may be correlated to the incidence of gastric cancer in Egyptian patients; however, similar findings couldn’t be proven in the colorectal cancer patients group for the IL-1β-511 T/C SNP. This is the first study to investigate IL-1β -31 and -511 SNPs in the Egyptian population.

Keywords: colorectal cancer, Egyptian patients, gastric cancer, interleukin-1β, single nucleotide polymorphisms

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Authors: Mohamed El Fares Djellatou, Fracoise Filion

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The Ashukin program that means bridge in Naskapi or Atikamekw language, has been designed to offer a partnership between nursing students and an indigenous community. The students design a health promotion project tailored to the needs of the community. The issues of intimidation in primary school and cyber-dependence in high school were some concerns in a rural Atikamekw community. The goal of the project was to have a conversation with indigenous youths, aged 10-16 years old, on the challenges presented by intimidation and cyber dependence as well as promoting healthy relationships online and within the community. Methods: Multiple progressive inquiry questions (PIQs) were used to assess the feasibility and importance of this project for the Atikamekw nation, and to determine a plan to follow. The theoretical foundations to guide the conception of the project were the Population Health Promotion Model (PHPM), the First Nations Holistic Lifelong Learning Model, and the Medicine Wheel. A broad array of social determinants of health were addressed, including healthy childhood development, personal health practices, and coping skills, and education. The youths were encouraged to participate in interactive educational sessions, using PowerPoint presentations and pamphlets as the main effective strategies. Additional tools such as cultural artworks and physical activities were introduced to strengthen the inter-relational and team spirit within the Indigenous population. A quality assurance tool (QAT) was developed specifically to determine the appropriateness of these health promotion tools. Improvements were guided by the feedback issued by the indigenous schools’ teachers and social workers who filled the QATs. Post educational sessions, quantitative results have shown that 93.48% of primary school students were able to identify the different types of intimidation, 72.65% recognized more than two strategies, and 52.1% were able to list at least four resources to diffuse intimidation. On the other hand, around 75% of the adolescents were able to name at least three negative effects, and 50% listed three strategies to reduce cyber-dependence. This project was meant to create a bridge with the First Nation through health promotion, a population that is known to be disadvantaged due to systemic health inequity and disparities. Culturally safe care was proposed to deal with the two identified priority issues, and an educational toolkit was given to both schools to ensure the sustainability of the project. The project was self-financed through fundraising activities, and it yielded better results than expected.

Keywords: indigenous, first nation, bullying, cyber-dependence, internet addiction, intimidation, youth, adolescents, school, community nursing, health promotion

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Authors: Ashok Kumar, Parveen Parveen

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India is bestowed with an extremely high population of plant species with medicinal value and even has two biodiversity hotspots. Indian systems of medicine including Ayurveda, Siddha and Unani have historically been serving humankind across the world since time immemorial. About 1500 plant species have well been documented in Ayurvedic Nighantus as official medicinal plants. Additionally, several hundred species of plants are being routinely used as medicines by local people especially tribes living in and around forests. The natural resources for medicinal plants have unscientifically been over-exploited forcing rapid depletion in their genetic diversity. Moreover, renewed global interest in herbal medicines may even lead to additional depletion of medicinal plant wealth of the country, as about 95% collection of medicinal plants for pharmaceutical preparation is being carried out from natural forests. On the other hand, huge export market of medicinal and aromatic plants needs to be seriously tapped for enhancing inflow of foreign currency. Asparagus racemosus Willd., a member of family Liliaceae, is one of thirty-two plant species that have been identified as priority species for cultivation and conservation by the National Medicinal Plant Board (NMPB), Government of India. Though attention is being focused on standardization of agro-techniques and extraction methods, little has been designed on genetic improvement and selection of desired types with higher root production and saponin content, a basic ingredient of medicinal value. The saponin not only improves defense mechanisms and controls diabetes but the roots of this species promote secretion of breast milk, improved lost body weight and considered as an aphrodisiac. There is ample scope for genetic improvement of this species for enhancing productivity substantially, qualitatively and quantitatively. It is emphasized to select desired genotypes with sufficient genetic diversity for important economic traits. Hybridization between two genetically divergent genotypes could result in the synthesis of new F1 hybrids consisting of useful traits of both the parents. The evaluation of twenty seed sources of Asparagus racemosus assembled different geographical locations of India revelled high degree of variability for traits of economic importance. The maximum genotypic and phenotypic variance was observed for shoot height among shoot related traits and for root length among root related traits. The shoot height, genotypic variance, phenotypic variance, genotypic coefficient of variance, the phenotypic coefficient of variance was recorded to be 231.80, 3924.80, 61.26 and 1037.32, respectively, where those of the root length were 9.55, 16.80, 23.46 and 41.27, respectively. The maximum genetic advance and genetic gain were obtained for shoot height among shoot-related traits and root length among root-related traits. Index values were developed for all seed sources based on the four most important traits, and Panthnagar (Uttrakhand), Jodhpur (Rajasthan), Dehradun (Uttarakhand), Chandigarh (Punjab), Jammu (Jammu & Kashmir) and Solan (Himachal Pradesh) were found to be promising seed sources.

Keywords: asparagus, genetic, genotypes, variance

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Authors: Mario Chiasson, Monique Boudreau

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Problem statement: Innovation in education has become a central topic of discussion at various levels, including schools and scholarly literature, driven by the global technological advancements of Industry 4.0. This study aims to contribute to the ongoing dialogue by examining the role of innovation in transforming school culture through the reimagination of traditional structures. The study argues that such a transformation necessitates an understanding and experience of systems leadership. This paper presents the case of the Francophone South School District, where a transformative initiative created an innovative learning environment by engaging students, teachers, and community members collaboratively through eco-communities. Traditional barriers and structures in education were dismantled to facilitate this process. The research component of this paper focuses on the Intr’Appreneur project, a unique initiative launched by the district team in the New Brunswick, Canada to support a system-wide transformation towards progressive and innovative organizational models. Methods This study is part of a larger research project that focuses on the transformation of educational systems in six pilot schools involved in the Intr’Appreneur project. Due to COVID-19 restrictions, the project was downscaled to three schools, and virtual qualitative interviews were conducted with volunteer teachers and administrators. Data was collected from students, teachers, and principals regarding their perceptions of the new learning environment and experiences. The analysis process involved developing categories, establishing codes for emerging themes, and validating the findings. The study emphasizes the importance of system leadership in achieving successful transformation. Results: The findings demonstrate that school principals played a vital role in enabling system-wide change by fostering a dynamic, collaborative, and inclusive culture, coordinating and mobilizing community members, and serving as educational role models who facilitated active and personalized pedagogy among the teaching staff. These qualities align with the characteristics of Leadership 4.0 and are crucial for successful school system transformations. Conclusion: This paper emphasizes the importance of systems leadership in driving educational transformations that extend beyond pedagogical and technological advancements. The research underscores the potential impact of such a leadership approach on teaching, learning, and leading processes in Education 4.0.

Keywords: leadership, system transformation, innovation, innovative learning environment, Education 4.0, system leadership

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Authors: Dan Geneau, Mary Claire Geneau, Seth Lenetsky, Ming -Chang Tsai, Marc Klimstra

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Introduction— Horizontal force-velocity profiling (HFVP) involves modeling an athletes linear sprint kinematics to estimate valuable maximum force and velocity metrics. This approach to performance modeling has been used in field-based team sports and has recently been introduced to ice-hockey as a forward skating performance assessment. While preliminary data has been collected on ice, distance constraints of the on-ice test restrict the ability of the athletes to reach their maximal velocity which result in limits of the model to effectively estimate athlete performance. This is especially true of more elite athletes. This report explores whether athletes on-ice are able to reach a velocity plateau similar to what has been seen in overground trials. Fourteen male Major Junior ice-hockey players (BW= 83.87 +/- 7.30 kg, height = 188 ± 3.4cm cm, age = 18 ± 1.2 years n = 14) were recruited. For on-ice sprints, participants completed a standardized warm-up consisting of skating and dynamic stretching and a progression of three skating efforts from 50% to 95%. Following the warm-up, participants completed three on ice 45m sprints, with three minutes of rest in between each trial. For overground sprints, participants completed a similar dynamic warm-up to that of on-ice trials. Following the warm-up participants completed three 40m overground sprint trials. For each trial (on-ice and overground), radar was used to collect instantaneous velocity (Stalker ATS II, Texas, USA) aimed at the participant’s waist. Sprint velocities were modelled using custom Python (version 3.2) script using a mono-exponential function, similar to previous work. To determine if on-ice tirals were achieving a maximum velocity (plateau), minimum acceleration values of the modeled data at the end of the sprint were compared (using paired t-test) between on-ice and overground trials. Significant differences (P<0.001) between overground and on-ice minimum accelerations were observed. It was found that on-ice trials consistently reported higher final acceleration values, indicating a maximum maintained velocity (plateau) had not been reached. Based on these preliminary findings, it is suggested that reliable HFVP metrics cannot yet be collected from all ice-hockey populations using current methods. Elite male populations were not able to achieve a velocity plateau similar to what has been seen in overground trials, indicating the absence of a maximum velocity measure. With current velocity and acceleration modeling techniques, including a dependency of a velocity plateau, these results indicate the potential for error in on-ice HFVP measures. Therefore, these findings suggest that a greater on-ice sprint distance may be required or the need for other velocity modeling techniques, where maximal velocity is not required for a complete profile.   

Keywords: ice-hockey, sprint, skating, power

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Authors: Shyamani Hettiarachchi, Gopi Kitnasamy

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Background: The potentially high level of physical need and dependency experienced by children with cerebral palsy could affect the quality of life (QOL) of the child, the caregiver and his/her family. Poor QOL in children with cerebral palsy is associated with the parent-child relationship, limited opportunities for social participation, limited access to healthcare services, psychological well-being and the child's physical functioning. Given that children experiencing disabilities have little access to remedial support with an inequitable service across districts in Sri Lanka, and given the impact of culture and societal stigma, there may be differing viewpoints across respondents. Objectives: The aim of this study was to evaluate the psychometric properties of the Tamil version of the Cerebral Palsy Quality of Life for Children (CPQOL-Child) Questionnaire. Design: An instrument development and validation study. Methods: Forward and backward translations of the CPQOL-Child were undertaken by a team comprised of a physiotherapist, speech and language therapist and two linguists for the primary caregiver form and the child self-report form. As part of a pilot phase, the Tamil version of the CPQOL was completed by 45 primary caregivers with children with cerebral palsy and 15 children with cerebral palsy (GMFCS level 3-4). In addition, the primary caregivers commented on the process of filling in the questionnaire. The psychometric properties of test-retest reliability, internal consistency and construct validity were undertaken. Results: The test-retest reliability and internal consistency were high. A significant association (p < 0.001) was found between limited motor skills and poor QOL. The Cronbach's alpha for the whole questionnaire was at 0.95.Similarities and divergences were found between the two groups of respondents. The child respondents identified limited motor skills as associated with physical well-being and autonomy. Akin to this, the primary caregivers associated the severity of motor function with limitations of physical well-being and autonomy. The trend observed was that QOL was not related to the level of impairment but connected to environmental factors by the child respondents. In addition to this, the main concern among primary caregivers about the child's future and on the child's lack of independence was not fully captured by the QOL questionnaire employed. Conclusions: Although the initial results of the CPQOL questionnaire show high test-retest reliability and internal consistency of the instrument, it does not fully reflect the socio-cultural realities and primary concerns of the caregivers. The current findings highlight the need to take child and caregiver perceptions of QOL into account in clinical practice and research. It strongly indicates the need for culture-specific measures of QOL.

Keywords: cerebral palsy, CPQOL, culture, quality of life

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Authors: Patcharaporn Sakulpong, Wiriya Phokhwang

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Background: Banpunrug (Love Sharing House) established in 2013 provides a community-based palliative care for patients with cancer from 7 provinces in southern Thailand. These patients come to receive outpatient chemotherapy and radiotherapy at Suratthani Cancer Hospital. They are poor and uneducated; they need an accommodation during their 30-45 day course of therapy. Methods: A community-participatory action research (PAR) was employed to establish a model of palliative care for patients with cancer. The participants included health care providers, community, and patients and families. The PAR process includes problem identification and need assessment, community and team establishment, field survey, organization founding, model of care planning, action and inquiry (PDCA), outcome evaluation, and model distribution. Results: The model of care at Banpunrug involves the concepts of HHHS model, in that Banpunrug is a Home for patients; patients live in a house comfortable like in a Hotel resource; the patients are given care and living facilities similarly to those in a Hospital; the house is a School for patients to learn how to take care themselves, how to live well with cancer, and most importantly how to prepare themselves for a good death. The house is also a humanized care school for health care providers. Banpunrug’s philosophy of care is based on friendship therapy, social and spiritual support, community partnership, patient-family centeredness, Live & Love sharing house, and holistic and humanized care. With this philosophy, the house is managed as a home of the patients and everyone involved; everything is costless for all eligible patients and their family members; all facilities and living expense are donated from benevolent people, friends, and community. Everyone, including patients and family, has a sense of belonging to the house and there is no authority between health care providers and the patients in the house. The house is situated in a temple and a community and supported by many local nonprofit organizations and healthcare facilities such as a health promotion hospital at sub-disctrict level and Suratthani Cancer Hospital. Village health volunteers and multi-professional health care volunteers have contributed not only appropriate care, but also knowledge and experience to develop a distinguishing HHHS community-based palliative care model for patients with cancer. Since its opening the house has been a home for more than 400 patients and 300 family members. It is also a model for many national and international healthcare organizations and providers, who come to visit and learn about palliative care in and by community. Conclusions: The success of this palliative care model comes from community involvement, multi-professional volunteers and distributions, and concepts of HHHS model. Banpunrug promotes a consistent care across the cancer trajectory independent of prognosis in order to strengthen a full integration of palliative

Keywords: community-based palliative care, model, participatory action research, patients with cancer

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Authors: Neal Rupani

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Background: A surgical trainee has limited learning opportunities in the operating room in order to gain an ever-increasing standard of surgical skill, competency, and proficiency. These opportunities continue to decline due to numerous factors such as the European Working Time Directive and increasing requirement for service provision. It is therefore imperative to obtain the highest educational value from each educational opportunity. A measure that has yet to be validated in England on surgical trainees called the Operating Room Educational Environment Measure (OREEM) has been developed to identify and evaluate each component of the educational environment with a view to steer future change in optimising educational events in theatre. Aims: The aims of the study are to assess the reliability of the OREEM within England and to evaluate the surgical trainee’s objective perspective of the current operating room educational environment within one region within England. Methods: Using a quantitative study approach, data was collected over one month from surgical trainees within Health Education Thames Valley (Oxford) using an online questionnaire consisting of demographic data, the OREEM, a global satisfaction score. Results: 140 surgical trainees were invited to the study, with an online response of 54 participants (response rate = 38.6%). The OREEM was shown to have good internal consistency (α = 0.906, variables = 40) and unidimensionality, along with all four of its subgroups. The mean OREEM score was 79.16%. The areas highlighted for improvement predominantly focused on improving learning opportunities (average subscale score = 72.9%) and conducting pre- and post-operative teaching (average score = 70.4%). The trainee perception is most satisfactory for the level of supervision and workload (average subscale score = 82.87%). There was no differences found between gender (U = 191.5, p = 0.535) or type of hospital (U = 258.0, p = 0.099), but the learning environment was favoured towards senior trainees (U = 223.5, p = 0.017). There was strong correlation between OREEM and the global satisfaction score (r = 0.755, p<0.001). Conclusions: The OREEM was shown to be reliable in measuring the educational environment in the operating room. This can be used to identify potentially modifiable components for improvement and as an audit tool to ensure high standards are being met. The current perception of the education environment in Health Education Thames Valley is satisfactory, and modifiable internal and external factors such as reducing service provision requirements, empowering trainees to plan lists, creating a team-working ethic between all personnel, and using tools that maximise learning from each operation have been identified to improve learning in the future. There is a favourable attitude to use of such improvement tools, especially for those currently dissatisfied.

Keywords: education environment, surgery, post-graduate education, OREEM

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Authors: Ivonete Teresinha Schulter Buss Heidemann, Michelle Kuntz Durand, Aline Megumi Arakawa-Belaunde, Sandra Mara Corrêa, Leandro Martins Costa Do Araujo, Kamila Soares Maciel

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Primary Health Care is defined as the level of a system of services that enables the achievement of answers to health needs. This level of care produces services and actions of attention to the person in the life cycle and in their health conditions or diseases. Primary Health Care refers to a conception of care model and organization of the health system that in Brazil seeks to reorganize the principles of the Unified Health System. This system is based on the principle of health as a citizen's right and duty of the State. Primary health care has family health as a priority strategy for its organization according to the precepts of the Unified Health System, structured in the logic of new sectoral practices, associating clinical work and health promotion. Thus, this study seeks to know the possibilities and limits of the care developed by professionals working in Primary Health Care. It was conducted by a qualitative approach of the participant action type, based on Paulo Freire's Research Itinerary, which corresponds to three moments: Thematic Investigation; Encoding and Decoding; and, Critical Unveiling. The themes were investigated in a health unit with the development of a culture circle with 20 professionals, from a municipality in southern Brazil, in the first half of 2021. The participants revealed as possibilities the involvement, bonding and strengthening of the interpersonal relationships of the professionals who work in the context of primary care. Promoting welcoming in primary care has favoured care and teamwork, as well as improved access. They also highlighted that care planning, the use of technologies in the process of communication and the orientation of the population enhances the levels of problem-solving capacity and the organization of services. As limits, the lack of professional recognition and the scarce material and human resources were revealed, conditions that generate tensions for health care. The reduction in the number of professionals and the low salary are pointed out as elements that boost the motivation of the health team for the development of the work. The participants revealed that due to COVID-19, the flow of care had as a priority the pandemic situation, which affected health care in primary care, and prevention and health promotion actions were canceled. The study demonstrated that empowerment and professional involvement are fundamental to promoting comprehensive and problem-solving care. However, limits of the teams are observed when exercising their activities, these are related to the lack of human and material resources, and the expansion of public health policies is urgent.

Keywords: health promotion, primary health care, health professionals, welcoming.

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Authors: Umara Nissar Rafiqi, Irum Gul, Nazima Nasrullah, Monica Saifi, Malik Z. Abdin

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Background: Stevia rebaudiana, a member of Asteraceae family is an important medicinal plant and produces a commercially used non-caloric natural sweetener, which is also an alternate herbal cure for diabetes. Steviol glycosides are the main sweetening compounds present in these plants. Secondary metabolites are crucial to the adaption of plants to the environment and its overcoming stress conditions. In agricultural procedures, the abiotic stresses like salinity, high metal toxicity and drought, in particular, are responsible for the majority of the reduction that differentiates yield potential from harvestable yield. Salt stress and heavy metal toxicity lead to increased production of reactive oxygen species (ROS). To avoid oxidative damage due to ROS and osmotic stress, plants have a system of anti-oxidant enzymes along with several stress induced enzymes. This helps in scavenging the ROS and relieve the osmotic stress in different cell compartments. However, whether stress induced toxicity modulates the activity of these enzymes in Stevia rebaudiana is poorly understood. Aim: The present study focussed on the effect of salinity, heavy metal toxicity (lead and mercury) on physiological traits and transcriptional profiling of Stevia rebaudiana. Method: Stevia rebaudiana plants were collected from the Central Institute of Medicinal and Aromatic plants (CIMAP), Patnagar, India and maintained under controlled conditions in a greenhouse at Hamdard University, Delhi, India. The plants were subjected to different concentrations of salt (0, 25, 50 and 75 mM respectively) and heavy metals, lead and mercury (0, 100, 200 and 300 µM respectively). The physiological traits such as shoot length, root numbers, leaf growth were evaluated. The samples were collected at different developmental stages and analysed for transcription profiling by RT-PCR. Transcriptional studies in stevia rebaudiana involves important antioxidant enzymes: catalase (CAT), superoxide dismutase (SOD), cytochrome P450 monooxygenase (CYP) and stress induced aquaporin (AQU), auxin repressed protein (ARP-1), Ndhc gene. The data was analysed using GraphPad Prism and expressed as mean ± SD. Result: Low salinity and lower metal toxicity did not affect the fresh weight of the plant. However, this was substantially decreased by 55% at high salinity and heavy metal treatment. With increasing salinity and heavy metal toxicity, the values of all studied physiological traits were significantly decreased. Chlorosis in treated plants was also observed which could be due to changes in Fe:Zn ratio. At low concentrations (upto 25 mM) of NaCl and heavy metals, we did not observe any significant difference in the gene expressions of treated plants compared to control plants. Interestingly, at high salt concentration and high metal toxicity, a significant increase in the expression profile of stress induced genes was observed in treated plants compared to control (p < 0.005). Conclusion: Stevia rebaudiana is tolerant to lower salt and heavy metal concentration. This study also suggests that with the increase in concentrations of salt and heavy metals, harvest yield of S. rebaudiana was hampered.

Keywords: Stevia rebaudiana, natural sweetener, salinity, heavy metal toxicity

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Authors: Emily Moore, Andrew Gaukroger, Matthew Solan, Lucy Bailey, Alexandra Boxall, Andrew Carne, Chintu Gadamsetty, Charlotte Morley, Katy Western, Iwona Kolodziejczyk

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Introduction: Rupture of the Achilles tendon is common and has a long recovery period. Most cases are managed non-operatively. Foot and Ankle Surgeons advise an ultrasound scan to check the gap between the torn ends. A large gap (with the ankle in equinus) is a relative indication for surgery. The definitive decision regarding surgical versus non-operative management can only be made once an ultrasound scan is undertaken and the patient is subsequently reviewed by a Foot and Ankle surgeon. To get to this point, the patient journey involves several hospital departments. In nearby trusts, patients reattend for a scan and go to the plaster room both before and after the ultrasound for removal and re-application of the cast. At a third visit to the hospital, the surgeon and patient discuss options for definitive treatment. It may take 2-3 weeks from the initial Emergency Department visit before the final treatment decision is made. This “wasted time” is ultimately added to the recovery period for the patient. In this hospital, Achilles rupture patients are seen in a weekly multidisciplinary OneStop Heel Pain clinic. This pathway was already efficient but subject to occasional frustrating delays if a key staff member was absent. A new pathway was introduced with the goal to reduce delays to a definitive treatment plan. Method: A retrospective series of Achilles tendon ruptures managed according to the 2019 protocol was identified. Time taken from the Emergency Department to have both an ultrasound scan and specialist Foot and Ankle surgical review were calculated. 30 consecutive patients were treated with our new pathway and prospectively followed. The time taken for a scan and for specialist review were compared to the 30 consecutive cases from the 2019 (pre-COVID) cohort. The new pathway includes 1. A new contoured splint applied to the front of the injured limb held with a bandage. This can be removed and replaced (unlike a plaster cast) in the ultrasound department, removing the need for plaster room visits. 2. Urgent triage to a Foot and Ankle specialist. 3. Ultrasound scan for assessment of rupture gap and deep vein thrombosis check. 4. Early decision regarding surgery. Transfer to weight bearing in a prosthetic boot in equinuswithout waiting for the once-a-week clinic. 5. Extended oral VTE prophylaxis. Results: The time taken for a patient to have both an ultrasound scan and specialist review fell > 50%. All patients in the new pathway reached a definitive treatment decision within one week. There were no significant differences in patient demographics or rates of surgical vs non-operative treatment. The mean time from Emergency Department visit to specialist review and ultrasound scan fell from 8.7 days (old protocol) to 2.9 days (new pathway). The maximum time for this fell from 23 days (old protocol) to 6 days (new pathway). Conclusion: Teamwork and innovation have improved the experience for patients with an Achilles tendon rupture. The new pathway brings many advantages - reduced time in the Emergency Department, fewer hospital visits, less time using crutches and reduced overall recovery time.

Keywords: orthopaedics, achilles rupture, ultrasound, innovation

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Authors: Julia A. Ermakova

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As a member of a multicultural society, it is imperative that individuals demonstrate the highest level of decorum in order to exemplify the beauty of their culture. Adab, the practice of praiseworthy words and deeds, as well as possessing good manners and pursuing that which is considered good, is a fundamental concept that guards against all types of mistakes. In Islam, etiquette for every situation in life is taught, and it constitutes the way of life for a Muslim. In light of this, the personality of an elegant Muslim woman can be described as one who embodies the following qualities: Firstly, cultural speech and erudition are essential components. Improving one's intellect, learning new things, reading diverse literature, expanding one's vocabulary, working on articulation, and avoiding obscene speech and verbosity are crucial. Additionally, listening more than speaking and being willing to discuss one's culture when asked are commendable qualities. Conversely, it is important to avoid discussing foolish matters with foolish people and to be able to respond appropriately and change the subject if someone attempts to hurt or manipulate. Secondly, the style of speech is also of paramount importance. It is recommended to speak in a measured tone with a quiet voice and deep breathing. Avoiding rushing and shortness of breath is also recommended. Thirdly, awareness of how to greet others is essential. Combining Shariah and small talk etiquette, such as making a gesture of respect by putting one's hand to the chest and smiling slightly when a man offers a handshake, is recommended. Understanding the rules of small talk, taboo topics, and self-presentation is also important. Fourthly, knowing how to give and receive compliments without devaluing them is imperative. Knowledge of the rules of good manners and etiquette, both secular and Shariah, is also essential. Fifthly, avoiding arguments and responding elegantly to rudeness and tactlessness is a sign of an elegant Muslim woman. Treating everyone with respect and avoiding prejudices, taboo topics, inappropriate questions, and bad habits are all aspects of politeness. Sixthly, a neat appearance appropriate to Shariah and the local community, as well as a well-put-together outfit with a touch of elegance and style, are crucial. Posture, graceful movement, and a pleasant gaze are also important. Finally, good spirits and inner calm are key to projecting a harmonious image, which encourages people to listen attentively. Giving thanks to Allah in every situation in life is the key to maintaining good spirits. In conclusion, an elegant Muslim woman in a multicultural society is characterized by her high moral qualities and adherence to Islamic etiquette. These qualities, such as cultural speech and erudition, style of speech, awareness of how to greet, knowledge of good manners and etiquette, avoiding arguments, politeness, a neat appearance, and good spirits, all contribute to projecting an image of elegance and respectability. By exemplifying these qualities, Muslim women can serve as positive ambassadors for their culture and religion in diverse societies.

Keywords: adab, elegance, muslim woman, multicultural societies, good manners, etiquette

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Authors: Y. Salfati, D. Sharef Bussel, J. Zamir

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In this paper, we present an Evaluation Case Study implementing the eight principles of Collaborative Approaches to Evaluation (CAE) as designed by Brad Cousins in the past decade. The focus of this paper is sharing a rich experience in which we achieved two main goals. The first was the development of a valuable and meaningful new teacher training program, and the second was a successful implementation of the CAE principles. The innovative teacher training program is based on the idea of including physical movement during the process of teaching and learning academic themes. The program is called Learning through Movement. This program is a response to a call from the Ministry of Education, claiming that today children sit in front of screens and do not exercise any physical activity. In order to contribute to children’s health, physical, and cognitive development, the Ministry of Education promotes learning through physical activities. Research supports the idea that sports and physical exercise improve academic achievements. The Learning through Movement program is operated by Kaye Academic College. Students in the Elementary School Training Program, together with students in the Physical Education Training Program, implement the program in collaboration with two mentors from the College. The program combines academic learning with physical activity. The evaluation began at the beginning of the program. During the evaluation process, data was collected by means of qualitative tools, including interviews with mentors, observations during the students’ collaborative planning, class observations at school and focus groups with students, as well as the collection of documentation related to the teamwork and to the program itself. The data was analyzed using content analysis and triangulation. The preliminary results show outcomes relating to the Teacher Training Programs, the student teachers, the pupils in class, the role of Physical Education teachers, and the evaluation. The Teacher Training Programs developed a collaborative approach to lesson planning. The students' teachers demonstrated a change in their basic attitudes towards the idea of integrating physical activities during the lessons. The pupils indicated higher motivation through full participation in classes. These three outcomes are indicators of the success of the program. An additional significant outcome of the program relates to the status and role of the physical education teachers, changing their role from marginal to central in the school. Concerning evaluation, a deep sense of trust and confidence was achieved, between the evaluator and the whole team. The paper includes the perspectives and challenges of the heads and mentors of the two programs as well as the evaluator’s conclusions. The evaluation unveils challenges in conducting a CAE evaluation in such a complex setting.

Keywords: collaborative evaluation, training teachers, learning through movement

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Authors: Ibrahim Musa, Mohammed Abdul-Aziz Mabrouk, Yusuf Tanko

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Introduction: Long term physical training affect the performance of athletes especially the females. Soccer which is a team sport, played in an outdoor field, require adequate oxygen transport system for the maximal aerobic power during exercise in order to complete 90 minutes of competitive play. Suboptimal haematological status has often been recorded in athletes with intensive physical activity. It may be due to the iron depletion caused by hemolysis or haemodilution results from plasma volume expansion. There is lack of data regarding the dynamics of red blood cell variables, in male football players. We hypothesized that, a long competitive season involving frequent matches and intense training could influence red blood cell variables, as a consequence of applying repeated physical loads when compared with sedentary. Methods: This cross sectional study was carried on 40 adult males (20 athletes and 20 non athletes) between 18-25 years of age. The 20 apparently healthy male non athletes were taken as sedentary and 20 male footballers comprise the study group. The university institutional review board (ABUTH/HREC/TRG/36) gave approval for all procedures in accordance with the Declaration of Helsinki. Red blood cell (RBC) concentration, packed cell volume (PCV), and plasma volume were measured in fasting state and immediately after exercise. Statistical analysis was done by using SPSS/ win.20.0 for comparison within and between the groups, using student’s paired and unpaired “t” test respectively. Results: The finding from our study shows that, immediately after termination of exercise, the mean RBC counts and PCV significantly (p<0.005) decreased with significant increased (p<0.005) in plasma volume when compared with pre-exercised values in both group. In addition the post exercise RBC was significantly higher in untrained (261.10±8.5) when compared with trained (255.20±4.5). However, there was no significant differences in the post exercise hematocrit and plasma volume parameters between the sedentary and the footballers. Moreover, beside changes in pre-exercise values among the sedentary and the football players, the resting red blood cell counts and Plasma volume (PV %) was significantly (p < 0.05) higher in the sedentary group (306.30±10.05 x 104 /mm3; 58.40±0.54%) when compared with football players (293.70±4.65 x 104 /mm3; 55.60±1.18%). On the other hand, the sedentary group exhibited significant (p < 0.05) decrease in PCV (41.60±0.54%) when compared with the football players (44.40±1.18%). Conclusions: It is therefore proposed that the acute football exercise induced reduction in RBC and PCV is entirely due to plasma volume expansion, and not of red blood cell hemolysis. In addition, the training status also influenced haematological indices of male football players differently from the sedentary at rest due to adaptive response. This is novel.

Keywords: Haematological Indices, Performance Status, Sedentary, Male Football Players

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Authors: Bronwyn Griffin, Caroline Acton, Tona Gillen, Roy Kimble

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Background: Bicycle riding is a common recreational activity enjoyed by many children throughout Australia that has been associated with the usual caveat of benefits related to exercise and recreation. Given Australia was the first country in the world to introduce cyclist helmet laws in 1991, very few publications have reviewed paediatric cycling injuries (fatal or non-fatal) since. Objectives: To identify trends in children (0-16 years) who required admission for greater than 24 hours following a bicycle-related injury (fatal and non-fatal) in Queensland. Further, to discuss changes that have occurred in paediatric cycling injury trends in Queensland since a prominent local study/publication in 1995. This paper aims to establish evidence to inform interventions promoting safer riding to parents, children and communities. Methods: Data on paediatric (0-16 years) cycling injuries in Queensland resulting in hospital admission more than 24 hours across three tertiary paediatric hospitals in Brisbane between November 2008-June 2015 was compiled by the Paediatric Trauma Data Registry for non-fatal injuries. The Child Death Review Team at the Queensland Families and Childhood Commission provided data on fatalities in children <17years from (June 2004 –June 2015). Comparing trends to a local study published in 1995 Results: Between 2008-2015 there were 197 patients admitted for greater than 24 hours following a cycling injury. The median age was 11 years, with males more frequently involved (n=139, 87%) compared to females. Mean length of stay was three days, with 47 (28%) children admitted to PICU, location of injury was most often the street (n=63, 37%). Between 2004 –2015 there were 15 fatalities (Incidence rate 0.25/100,000); all were male, 14/15 occurred on the street, with eight stated to have not been wearing a helmet, 11/15 children came from the least advantaged socio-economic group (SEIFA) compared to a local publication in 1995, finding of 94 fatalities between (1981-1992). Conclusions: There has been a notable decrease in incidence of fatalities between the two time periods with incidence rates dropping from 1.75-0.25/100,000. More statistics need to be run to ascertain if this is a true reduction or perhaps a decrease in children riding bicycles. Injuries that occur on the street that come in contact with a car remain of serious concern. The purpose of this paper is not to discourage bicycle riding among child and adolescent populations, rather, inform parents and the wider community about the risks associated with cycling in order to reduce injuries associated with this sport, whilst promoting safe cycling.

Keywords: paediatric, cycling, trauma, prevention, emergency

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Authors: Igone Guerra, Xabier Barandiaran

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The deep crisis (economic, social and cultural) in which Europe and Gipuzkoa, in the Basque Country (Spain), have been immersed in since 2008 forces governments to face a necessary transformation. These challenges demand different solutions and answers to meet the needs of the citizens. Adapting to continuous and sometimes abrupt changes in the social and political landscape requires an undeniable will to reinvent the way in which governments practice politics. This reinvention of government should help us build different organizations that, first, develop challenging public services, second, respond effectively to the needs of the citizens, and third, manage scarce resources, ultimately offering a contemporary concept of public value. In this context, the Etorkizuna Eraikiz initiative was designed to face the future challenges of the territory in a collaborative way. The aim of the initiative is to promote an alternative form of governance to generate common good and greater public value. In Etorkizuna Eraikiz democratic values, such as collaboration, participation, and accountability are prominent. This government approach is based on several features such as the creation of relational spaces to design and deliberate about the public politics or the promotion of a team-working approach, breaking down the silos between and within organizations, as an exercise in defining a shared vision regarding the Future of the Territory. A future in which the citizens are becoming actors in the problem-solving process and in the construction of a culture of participation and collective learning. In this paper, the Etorkizuna Eraikiz initiative will be presented (vision and methodology) as a model of a local approach to public policy innovation resulting in a way of governance that is more open and collaborative. Based on this case study, this paper explores the way in which collaborative governance leads to better decisions, better leadership, and better citizenry. Finally, the paper also describes some preliminary findings of this local approach, such as the level of knowledge of the citizenry about the projects promoted within Etorkizuna Eraikiz as well as the link between the challenges of the territory, as identified by the citizenry, and the political agenda promoted by the provincial government. Regarding the former, the Survey on the socio-political situation of Gipuzkoa showed that 27.9% of the respondents confirmed that they knew about the projects promoted within the initiative and gave it a mark of 5.71. In connection with the latter, over the last three years, 65 millions of euros have been allocated for a total of 73 projects that have covered socio-economic and political challenges such as aging, climate change, mobility, participation in democratic life, and so on. This governance approach of Etorkizuna Eraikiz has allowed the local government to match the needs of citizens to the political agenda fostering in this way a shared vision about the public value.

Keywords: collaborative governance, citizen participation, public good, social listening, public innovation

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Authors: Francisco Julio Batle Lorente

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The present paper aims at presenting a new category of role for academia: proactive creator/promoter of communities of practice in emerging areas of innovation. It is based in research among practitioners in three different areas: social entrepreneurship, alumni engaged in entrepreneurship and innovation, and digital nomads. The concept of CoP is related to an intentionally created space to share experiences and collectively reflect on the cases arising from practice. Such an endeavour is not contemplated in the literature on academic roles in an explicit way. The goal of the paper is providing a framework for this function and throw some light on the perception and priorities of members of emerging communities (78 alumni, 154 social entrepreneurs, and 231 digital nomads) regarding community, learning, engagement, and networking, areas in which the university can help and, by doing so, contributing to signal the emerging area and creating new opportunities for the academia. The research methodology was based in Survey research. It is a specific type of field study that involves the collection of data from a sample of elements drawn from a well-defined population through the use of a questionnaire. It was considered that survey research might be valuable to the present project and help outline the utility of various study designs and future projects with the emerging communities that are the object of the investigation. Open questions were used for different topics, as well as critical incident technique. It was used a standard technique for survey sampling and questionnaire design. Finally, it was defined a procedure for pretesting questionnaires and for data collection. The questionnaire was channelled by means of google forms. The results indicate that the members of emerging, innovative CoPs and learning such the ones that were selected for this investigation lack cohesion, inspiration, networking, opportunities for creation of social capital, opportunities for collaboration beyond their existing and close network. The opportunity that arises for the academia from proactively helping articulate CoP (and Communities of learning) are related to key elements of any CoP/ CoL: community construction approaches, technological infrastructure, benefits, participation issues and urgent challenges, trust, networking, technical ability/training/development and collaboration. Beyond training, other three areas (networking, collaboration and urgent challenges) were the ones in which the contribution of universities to the communities were considered more interesting and workable to practitioners. The analysis of the responses for the open questions related to perception of the universities offer options for terra incognita to be explored for universities (signalling new areas, establishing broader collaborations with research, government, media and corporations, attracting investment). Based on the findings from this research, there is some evidence that CoPs can offer a formal and informal method of professional and interprofessional development for member of any emerging and innovative community and can decrease social and professional isolation. The opportunity that it offers to academia can increase the entrepreneurial and engaged university identity. It also moves to academia into a realm of civic confrontation of present and future challenges in a more proactive way.

Keywords: social innovation, new roles of academia, community of learning, community of practice

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Authors: Heena Dabas, Anju Paul, Suman Chaurasia, Ramesh Agarwal, M. Jeeva Sankar, Anurag Bajpai, Manju Saksena

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Background: Traumatic lumbar puncture (LP) is a common occurrence and causes substantial diagnostic ambiguity. There is paucity of data regarding its epidemiology. Objective: To assess the incidence and risk factors of traumatic LP in newborns. Design/Methods: In a prospective cohort study, all inborn neonates admitted in NICU and planned to undergo LP for a clinical indication of sepsis were included. Neonates with diagnosed intraventricular hemorrhage (IVH) of grade III and IV were excluded. The LP was done by operator - often a fellow or resident assisted by bedside nurse. The unit has policy of not routinely using any sedation/analgesia during the procedure. LP is done by 26 G and 0.5-inch-long hypodermic needle inserted in third or fourth lumbar space while the infant is in lateral position. The infants were monitored clinically and by continuous measurement of vital parameters using multipara monitor during the procedure. The occurrence of traumatic tap along with CSF parameters and other operator and assistant characteristics were recorded at the time of procedure. Traumatic tap was defined as presence of visible blood or more than 500 red blood cells on microscopic examination. Microscopic trauma was defined when CSF is not having visible blood but numerous RBCs. The institutional ethics committee approved the study protocol. A written informed consent from the parents and the health care providers involved was obtained. Neonates were followed up till discharge/death and final diagnosis was assigned along with treating team. Results: A total of 362 (21%) neonates out of 1726 born at the hospital were admitted during the study period (July 2016 to January, 2017). Among these neonates, 97 (26.7%) were suspected of sepsis. A total of 54 neonates were enrolled who met the eligibility criteria and parents consented to participate in the study. The mean (SD) birthweight was 1536 (732) grams and gestational age 32.0 (4.0) weeks. All LPs were indicated for late onset sepsis at the median (IQR) age of 12 (5-39) days. The traumatic LP occurred in 19 neonates (35.1%; 95% C.I 22.6% to 49.3%). Frank blood was observed in 7 (36.8%) and in the remaining, 12(63.1%) CSF was detected to have microscopic trauma. The preliminary risk factor analysis including birth weight, gestational age and operator/assistant and other characteristics did not demonstrate clinically relevant predictors. Conclusion: A significant number of neonates requiring lumbar puncture in our study had high incidence of traumatic tap. We were not able to identify modifiable risk factors. There is a need to understand the reasons and further reduce this issue for improving management in NICUs.

Keywords: incidence, newborn, traumatic, lumbar puncture

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Authors: John Zanetich

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Designing an educational activity that encourages inquiry and collaboration is key to engaging students in meaningful learning. Educational Information and Communications Technology (EICT) plays an important role in facilitating cooperative and collaborative learning in the classroom. The EICT also facilitates students’ learning and development of the critical thinking skills needed to solve real world problems. Projects and activities based on constructivism encourage students to embrace complexity as well as find relevance and joy in their learning. It also enhances the students’ capacity for creative and responsible real-world problem solving. Classroom activities based on constructivism offer students an opportunity to develop the higher–order-thinking skills of defining problems and identifying solutions. Participating in a classroom project is an activity for both acquiring experiential knowledge and applying new knowledge to practical situations. It also provides an opportunity for students to integrate new knowledge into a skill set using reflection. Classroom projects can be developed around a variety of learning objects including social media, knowledge management and learning communities. The construction of meaning through project-based learning is an approach that encourages interaction and problem-solving activities. Projects require active participation, collaboration and interaction to reach the agreed upon outcomes. Projects also serve to externalize the invisible cognitive and social processes taking place in the activity itself and in the student experience. This paper describes a classroom project designed to elicit interactions by helping students to unfreeze existing knowledge, to create new learning experiences, and then refreeze the new knowledge. Since constructivists believe that students construct their own meaning through active engagement and participation as well as interactions with others. knowledge management can be used to guide the exchange of both tacit and explicit knowledge in interpersonal interactions between students and guide the construction of meaning. This paper uses an action research approach to the development of a classroom project and describes the use of technology, social media and the active use of tacit knowledge in the college classroom. In this project, a closed group Facebook page becomes the virtual classroom where interaction is captured and measured using engagement analytics. In the virtual learning community, the principles of knowledge management are used to identify the process and components of the infrastructure of the learning process. The project identifies class member interests and measures student engagement in a learning community by analyzing regular posting on the Facebook page. These posts are used to foster and encourage interactions, reflect a student’s interest and serve as reaction points from which viewers of the post convert the explicit information in the post to implicit knowledge. The data was collected over an academic year and was provided, in part, by the Google analytic reports on Facebook and self-reports of posts by members. The results support the use of active tacit knowledge activities, knowledge management and social media to enhance the student learning experience and help create the knowledge that will be used by students to construct meaning.

Keywords: constructivism, knowledge management, tacit knowledge, social media

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Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Swadha Singh

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International Solar Alliance is the foremost treaty-based global organization concerned with tapping the potential of sun-abundant nations between the Tropics of Cancer and Capricorn and enables co-operation among them. As a founding member of the International Solar Alliance, India exhibits its positioning as an upcoming leader in clean energy. India has set ambitious goals and targets to expand the share of solar in its energy mix and is playing a proactive role both at the regional and global levels. ISA aims to serve multiple goals- bring about scale commercialization of solar power, boost domestic manufacturing, and leverage solar diplomacy in African countries, amongst others. Against this backdrop, this paper attempts to examine the ways in which ISA as an intergovernmental organization under Indian leadership can leverage the cause of clean energy (solar) diplomacy and effectively shape partnerships and collaborations with other developing countries in terms of sharing solar technology, capacity building, risk mitigation, mobilizing financial investment and providing an aggregate market. A more specific focus of ISA is on the developing countries, which in the absence of a collective, are constrained by technology and capital scarcity, despite being naturally endowed with solar resources. Solar rich but finance-constrained economies face political risk, foreign exchange risk, and off-taker risk. Scholars argue that aligning India’s climate change discourse and growth prospects in its engagements, collaborations, and partnerships at the bilateral, multilateral and regional level can help promote trade, attract investments, and promote resilient energy transition both in India and in partner countries. For developing countries, coming together in an action-oriented way on issues of climate and clean energy is particularly important since it is developing and underdeveloped countries that face multiple and coalescing challenges such as the adverse impact of climate change, uneven and low access to reliable energy, and pressing employment needs. Investing in green recovery is agreed to be an assured way to create resilient value chains, create sustainable livelihoods, and help mitigate climate threats. If India is able to ‘green its growth’ process, it holds the potential to emerge as a climate leader internationally. It can use its experience in the renewable sector to guide other developing countries in balancing multiple similar objectives of development, energy security, and sustainability. The challenges underlying solar expansion in India have lessons to offer other developing countries, giving India an opportunity to assume a leadership role in solar diplomacy and expand its geopolitical influence through inter-governmental organizations such as ISA. It is noted that India has limited capacity to directly provide financial funds and support and is not a leading manufacturer of cheap solar equipment, as does China; however, India can nonetheless leverage its large domestic market to scale up the commercialization of solar power and offer insights and learnings to similarly placed abundant solar countries. The paper examines the potential of and limits placed on India’s solar diplomacy.

Keywords: climate diplomacy, energy security, solar diplomacy, renewable energy

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Authors: Scott Wysong

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Qatar will spend billions of dollars to host the 2022 World Cup. While football fans around the globe get excited to cheer on their favorite team every four years, critics debate the merits of a country hosting such an expensive and large-scale event. That is, the host countries spend billions of dollars on stadiums and infrastructure to attract these mega sporting events with the hope of equitable returns in economic impact and creating jobs. Yet, in many cases, the host countries are left in debt with decaying venues. There are benefits beyond the economic impact of hosting mega-events. For example, citizens are often proud of their city/country to host these famous events. Yet, often overlooked in the literature is the proposition that serving as the host for a mega-event may enhance the country’s brand image, not only as a tourist destination but for the products made in that country of origin. This research aims to explore this phenomenon by taking an exploratory look at consumer perceptions of three host countries of a mega-event in sports. In 2014, the U.S., Chinese and Finn (Finland) consumer attitudes toward Brazil and its products were measured before and after the World Cup via surveys (n=89). An Analysis of Variance (ANOVA) revealed that there were no statistically significant differences in the pre-and post-World Cup perceptions of Brazil’s brand personality or country-of-origin image. After the World Cup in 2018, qualitative interviews were held with U.S. sports fans (n=17) in an effort to further explore consumer perceptions of products made in the host country: Russia. A consistent theme of distrust and corruption with Russian products emerged despite their hosting of this prestigious global event. In late 2021, U.S. football (soccer) fans (n=42) and non-fans (n=37) were surveyed about the upcoming 2022 World Cup. A regression analysis revealed that how much an individual indicated that they were a soccer fan did not significantly influence their desire to visit Qatar or try products from Qatar in the future even though the country was hosting the World Cup—in the end, hosting a mega-event as grand as the World Cup showcases the country to the world. However, it seems to have little impact on consumer perceptions of the country, as a whole, or its brands. That is, the World Cup appeared to enhance already pre-existing stereotypes about Brazil (e.g., beaches, partying and fun, yet with crime and poverty), Russia (e.g., cold weather, vodka and business corruption) and Qatar (desert and oil). Moreover, across all three countries, respondents could rarely name a brand from the host country. Because mega-events cost a lot of time and money, countries need to do more to market their country and its brands when hosting. In addition, these countries would be wise to measure the impact of the event from different perspectives. Hence, we put forth a comprehensive future research agenda to further the understanding of how countries, and their brands, can benefit from hosting a mega sporting event.

Keywords: branding, country-of-origin effects, mega sporting events, return on investment

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Authors: Linda Fellag, Arlene Caney

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E-learning has earned an essential place in academia because it promotes learner autonomy, student engagement, and technological aptitude, and allows for flexible learning. However, despite advantages, educators have been slower to embrace e-learning for ESL and other non-traditional students for fear that such students will not succeed without the direct faculty contact and academic support of face-to-face classrooms. This study aims to determine if a non-traditional student-friendly online course can produce student retention and performance rates that compare favorably with those of students in standard online sections of the same course aimed at traditional college-level students. One Music faculty member is currently collaborating with an English instructor to redesign an online college-level Music Appreciation course for non-traditional college students. At Community College of Philadelphia, Introduction to Music Appreciation was recently designated as one of the few college-level courses that advanced ESL, and developmental English students can take while completing their language studies. Beginning in Fall 2017, the course will be critical for international students who must maintain full-time student status under visa requirements. In its current online format, however, Music Appreciation is designed for traditional college students, and faculty who teach these sections have been reluctant to revise the course to address the needs of non-traditional students. Interestingly, presenters maintain that the online platform is the ideal place to develop language and college readiness skills in at-risk students while maintaining the course's curricular integrity. The two faculty presenters describe how curriculum rather than technology drives the redesign of the digitized music course, and self-study materials, guided assignments, and periodic assessments promote independent learning and comprehension of material. The 'scaffolded' modules allow ESL and developmental English students to build on prior knowledge, preview key vocabulary, discuss content, and complete graded tasks that demonstrate comprehension. Activities and assignments, in turn, enhance college success by allowing students to practice academic reading strategies, writing, speaking, and student-faculty and peer-peer communication and collaboration. The course components facilitate a comparison of student performance and retention in sections of the redesigned and existing online sections of Music Appreciation as well as in previous sections with at-risk students. Indirect, qualitative measures include student attitudinal surveys and evaluations. Direct, quantitative measures include withdrawal rates, tests of disciplinary knowledge, and final grades. The study will compare the outcomes of three cohorts in the two versions of the online course: ESL students, at-risk developmental students, and college-level students. These data will also be compared with retention and student outcomes data of the three cohorts in f2f Music Appreciation, which permitted non-traditional student enrollment from 1998-2005. During this eight-year period, the presenter addressed the problems of at-risk students by adding language and college success support, which resulted in strong retention and outcomes. The presenters contend that the redesigned course will produce favorable outcomes among all three cohorts because it contains components which proved successful with at-risk learners in f2f sections of the course. Results of their study will be published in 2019 after the redesigned online course has met for two semesters.

Keywords: college readiness, e-learning, music appreciation, online courses

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Authors: Arvind Kumar

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The city of Kanpur is located in the terrestrial plain area on the bank of the river Ganges and is the second largest city in the state of Uttar Pradesh. The city generates approximately 1400-1600 tons per day of MSW. Kanpur has been known as a major point and non-points-based pollution hotspot for the river Ganges. The city has a major industrial hub, probably the largest in the state, catering to the manufacturing and recycling of plastic and other dry waste streams. There are 4 to 5 major drains flowing across the city, which receive a significant quantity of waste leakage, which subsequently adds to the Ganges flow and is carried to the Bay of Bengal. A river-to-sea flow approach has been established to account for leaked waste into urban drains, leading to the build-up of marine litter. Throughout its journey, the river accumulates plastic – macro, meso, and micro, from various sources and transports it towards the sea. The Ganges network forms the second-largest plastic-polluting catchment in the world, with over 0.12 million tonnes of plastic discharged into marine ecosystems per year and is among 14 continental rivers into which over a quarter of global waste is discarded 3.150 Kilo tons of plastic waste is generated in Kanpur, out of which 10%-13% of plastic is leaked into the local drains and water flow systems. With the Support of Kanpur Municipal Corporation, 1TPD capacity MRF for drain waste management was established at Krishna Nagar, Kanpur & A German startup- Plastic Fisher, was identified for providing a solution to capture the drain waste and achieve its recycling in a sustainable manner with a circular economy approach. The team at Plastic Fisher conducted joint surveys and identified locations on 3 drains at Kanpur using GIS maps developed during the survey. It suggested putting floating 'Boom Barriers' across the drains with a low-cost material, which reduced their cost to only 2000 INR per barrier. The project was built upon the self-sustaining financial model. The project includes activities where a cost-efficient model is developed and adopted for a socially self-inclusive model. The project has recommended the use of low-cost floating boom barriers for capturing waste from drains. This involves a one-time time cost and has no operational cost. Manpower is engaged in fishing and capturing immobilized waste, whose salaries are paid by the Plastic Fisher. The captured material is sun-dried and transported to the designated place, where the shed and power connection, which act as MRF, are provided by the city Municipal corporation. Material aggregation, baling, and transportation costs to end-users are borne by Plastic Fisher as well.

Keywords: Kanpur, marine environment, drain waste management, plastic fisher

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Authors: Kavita Khoiwal, Vatsla Dadhwal, K. Aparna Sharma, Dipika Deka, Plabani Sarkar

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Introduction: About 2.4 million (1.93 - 3.04 million) people are living with HIV/AIDS in India. Of all HIV infections, 39% (9,30,000) are among women. 5.4% of infections are from mother to child transmission (MTCT), 25,000 infected children are born every year. Besides the risk of mother to child transmission of HIV, these women are at risk of the higher adverse pregnancy outcome. The objectives of the study were to compare the obstetric and neonatal outcome in women who are HIV positive with low-risk HIV negative women and effect of antiretroviral drugs on preterm birth and IUGR. Materials and Methods: This is a retrospective case record analysis of 212 HIV-positive women delivering between 2002 to 2015, in a tertiary health care centre which was compared with 238 HIV-negative controls. Women who underwent medical termination of pregnancy and abortion were excluded from the study. Obstetric outcome analyzed were pregnancy induced hypertension, HIV positive intrauterine growth restriction, preterm birth, anemia, gestational diabetes and intrahepatic cholestasis of pregnancy. Neonatal outcome analysed were birth weight, apgar score, NICU admission and perinatal transmission.HIV-positiveOut of 212 women, 204 received antiretroviral therapy (ART) to prevent MTCT, 27 women received single dose nevirapine (sdNVP) or sdNVP tailed with 7 days of zidovudine and lamivudine (ZDV + 3TC), 15 received ZDV, 82 women received duovir and 80 women received triple drug therapy depending upon the time period of presentation. Results: Mean age of 212 HIV positive women was 25.72+3.6 years, 101 women (47.6 %) were primigravida. HIV positive status was diagnosed during pregnancy in 200 women while 12 women were diagnosed prior to conception. Among 212 HIV positive women, 20 (9.4 %) women had preterm delivery (< 37 weeks), 194 women (91.5 %) delivered by cesarean section and 18 women (8.5 %) delivered vaginally. 178 neonates (83.9 %) received exclusive top feeding and 34 neonates (16.03 %) received exclusive breast feeding. When compared to low risk HIV negative women (n=238), HIV positive women were more likely to deliver preterm (OR 1.27), have anemia (OR 1.39) and intrauterine growth restriction (OR 2.07). Incidence of pregnancy induced hypertension, diabetes mellitus and ICP was not increased. Mean birth weight was significantly lower in HIV positive women (2593.60+499 gm) when compared to HIV negative women (2919+459 gm). Complete follow up is available for 148 neonates till date, rest are under evaluation. Out of these 7 neonates found to have HIV positive status. Risk of preterm birth (P value = 0.039) and IUGR (P value = 0.739) was higher in HIV positive women who did not receive any ART during pregnancy than women who received ART. Conclusion: HIV positive pregnant women are at increased risk of adverse pregnancy outcome. Multidisciplinary team approach and use of highly active antiretroviral therapy can optimize the maternal and perinatal outcome.

Keywords: antiretroviral therapy, HIV infection, IUGR, preterm birth

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Authors: Sofia Maria Poulimenou, Ioannis Deliyannis, Elisavet Filippidou, Stamatella Laboura

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Smart technologies are being actively used to improve the experience of travel and promote or demote a destination’s reputation via a wide variety of social media applications and platforms. This paper conceptualises the design and deployment of smart management apps to promote culture, sustainability and accessibility within two destinations in Greece that represent the extremes of visiting scale. One is the densely visited Corfu, which is a UNESCO’s heritage site. The problems caused by the lack of organisation of the visiting experience and infrastructures affect all parties interacting within the site: visitors, citizens, public and private sector. Second is Kilkis, a low tourism destination with high seasonality and mostly inbound tourism. Here the issue faced is that traditional approaches to inform and motivate locals and visitors to explore and taste of the culture have not flourished. The problem is apprehended via the design and development of two systems named “Hologrammatic Corfu” for Corfu old town and “BRENDA” for the area of Kilkis. Although each system is designed independently, featuring different solutions to the problems, both approaches have been designed by the same team and a novel gaming and gamification methodology. The “Hologramatic Corfu” application has been designed, for the exploration of the site covering user requirments before, during and after the trip, with the use of transmedia content such as photos, 360-degree videos, augmented reality and hologrammatic videos. Also, a statistical analysis of travellers’ visits to specific points of interest is actively utilized enabling visitors to dynamically re-rooted during their visit, safeguarding sustainability and accessibility and inclusivity along the entire tourism cycle. “BRENDA” is designed specifically to promote gastronomic and historical tourism. This serious game implements and combines gaming and gamification elements in order to connect local businesses with cultural points of interest. As the environment of the project has a strong touristic orientation, “BRENDA” supports food-related gamified processes and historical games involving active participation of both local communities (content providers) and visitors (players) which are more likely to be successfully performed in the informal environment of travelling and promote sustainable tourism experiences. Finally, the paper presents the ability to re-use existing gaming components within new areas of interest via minimal adaptation and the use of transmedia aspects that enables destinations to be rebranded into smart destinations.

Keywords: smart tourism, gamification, user experience, transmedia content

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Authors: D. Scarpanti, M. Brondino, M. Pasini

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Background: the present study explores the role of light and restorativeness on work. According with the Attention Restoration Theory (ART) and a Model of Work Environment, the main idea is that some features of environment, i.e., lighting, influences the direct attention, and so, the performance. Restorativeness refers to the presence/absence level of all the characteristics of physical environment that help to regenerate direct attention. Specifically, lighting can affect level of fascination and attention in one hand; and in other hand promotes several biological functions via pineal gland. Different reviews on this topic show controversial results. In order to bring light on this topic, the hypotheses of this study are that lighting can affect the construct of restorativeness and, in the second time, the restorativeness can affect the performance. Method: the participants are 30 workers of a mechatronic company in the North Italy. Every subject answered to a questionnaire valuing their subjective perceptions of environment in a different way: some objective features of environment, like lighting, temperature and air quality; some subjective perceptions of this environment; finally, the participants answered about their perceived performance. The main attention is on the features of light and his components: visual comfort, general preferences and pleasantness; and the dimensions of the construct of restorativeness; fascination, coherence and being away. The construct of performance per se is conceptualized in three level: individual, team membership and organizational membership; and in three different components: proficiency, adaptability, and proactivity, for a total of 9 subcomponents. Findings: path analysis showed that some characteristics of lighting respectively affected the dimension of fascination; and, as expected, the dimension of fascination affected work performance. Conclusions: The present study is a first pilot step of a wide research. These first results can be summarized with the statement that lighting and restorativeness contribute to explain work performance variability: in details perceptions of visual comfort, satisfaction and pleasantness, and fascination respectively. Results related to fascination are particularly interesting because fascination is conceptualized as the opposite of the construct of direct attention. The main idea is, in order to regenerate attentional capacity, it’s necessary to provide a lacking of attention (fascination). The sample size did not permit to test simultaneously the role of the perceived characteristics of light to see how they differently contribute to predict fascination of the work environment. However, the results highlighted the important role that light could have in predicting restorativeness dimensions and probably with a larger sample we could find larger effects also on work performance. Furthermore, longitudinal data will contribute to better analyze the causal model along time. Applicative implications: the present pilot study highlights the relevant role of lighting and perceived restorativeness in the work environment and the importance to focus attention on light features and the restorative characteristics in the design of work environments.

Keywords: lighting, performance, restorativeness, workplace

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Authors: Maria Fontenele, Claude-Gilles Dussap, Vincent Dumouilla, Baptiste Boit

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Roquette Frères is a producer of plant-based ingredients that employs many processes to extract relevant molecules and often transforms them through chemical and physical processes to create desired ingredients with specific functionalities. In this context, Roquette encounters numerous multi-component complex systems in their processes, including fibers, proteins, and carbohydrates, in an aqueous environment. To develop, control, and optimize both new and old processes, Roquette aims to develop new in silico tools. Currently, Roquette uses process modelling tools which include specific thermodynamic models and is willing to develop computational methodologies such as molecular dynamics simulations to gain insights into the complex interactions in such complex media, and especially hydrogen bonding interactions. The issue at hand concerns aqueous mixtures of polyols with high dry matter content. The polyols mannitol and sorbitol molecules are diastereoisomers that have nearly identical chemical structures but very different physicochemical properties: for example, the solubility of sorbitol in water is 2.5 kg/kg of water, while mannitol has a solubility of 0.25 kg/kg of water at 25°C. Therefore, predicting liquid-solid equilibrium properties in this case requires sophisticated solution models that cannot be based solely on chemical group contributions, knowing that for mannitol and sorbitol, the chemical constitutive groups are the same. Recognizing the significance of solvation phenomena in polyols, the GePEB (Chemical Engineering, Applied Thermodynamics, and Biosystems) team at Institut Pascal has developed the COSMO-UCA model, which has the structural advantage of using quantum mechanics tools to predict formation and phase equilibrium properties. In this work, we use molecular dynamics simulations to elucidate the behavior of polyols in aqueous solution. Specifically, we employ simulations to compute essential metrics such as radial distribution functions and hydrogen bond autocorrelation functions. Our findings illuminate a fundamental contrast: sorbitol and mannitol exhibit disparate hydrogen bond lifetimes within aqueous environments. This observation serves as a cornerstone in elucidating the divergent physicochemical properties inherent to each compound, shedding light on the nuanced interplay between their molecular structures and water interactions. We also present a methodology to predict the physicochemical properties of complex solutions, taking as sole input the three-dimensional structure of the molecules in the medium. Finally, by developing knowledge models, we represent some physicochemical properties of aqueous solutions of sorbitol and mannitol.

Keywords: COSMO models, hydrogen bond, molecular dynamics, thermodynamics

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Authors: Fernando Cabo Aseguinolaza, Víctor Bouzas Blanco, Alberto Martí Ezpeleta

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Santiago de Compostela became a stable object of literary representation during the period between 1840 and 1915, approximately. This study offers a partial cartographical look at this process, suggesting that a cultural space like Compostela’s becoming an object of literary representation paralleled the first stages of its becoming a tourist destination. We use maps as a method of analysis to show the interaction between a corpus of novels and the emerging tradition of tourist guides on Compostela during the selected period. Often, the novels constitute ways to present a city to the outside, marking it for the gaze of others, as guidebooks do. That leads us to examine the ways of constructing and rendering communicable the local in other contexts. For that matter, we should also acknowledge the fact that a good number of the narratives in the corpus evoke the representation of the city through the figure of one who comes from elsewhere: a traveler, a student or a professor. The guidebooks coincide in this with the emerging fiction, of which the mimesis of a city is a key characteristic. The local cannot define itself except through a process of symbolic negotiation, in which recognition and self-recognition play important roles. Cartography shows some of the forms that these processes of symbolic representation take through the treatment of space. The research uses GIS to find significant models of representation. We used the program ArcGIS for the mapping, defining the databases starting from an adapted version of the methodology applied by Barbara Piatti and Lorenz Hurni’s team at the University of Zurich. First, we designed maps that emphasize the peripheral position of Compostela from a historical and institutional perspective using elements found in the texts of our corpus (novels and tourist guides). Second, other maps delve into the parallels between recurring techniques in the fictional texts and characteristic devices of the guidebooks (sketching itineraries and the selection of zones and indexicalization), like a foreigner’s visit guided by someone who knows the city or the description of one’s first entrance into the city’s premises. Last, we offer a cartography that demonstrates the connection between the best known of the novels in our corpus (Alejandro Pérez Lugín’s 1915 novel La casa de la Troya) and the first attempt to create package tourist tours with Galicia as a destination, in a joint venture of Galician and British business owners, in the years immediately preceding the Great War. Literary cartography becomes a crucial instrument for digging deeply into the methods of cultural production of places. Through maps, the interaction between discursive forms seemingly so far removed from each other as novels and tourist guides becomes obvious and suggests the need to go deeper into a complex process through which a city like Compostela becomes visible on the contemporary cultural horizon.

Keywords: compostela, literary geography, literary cartography, tourism

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Authors: S. M. Ashikur Elahee, Md. Zahidur Rahman, Md. Shofiqur Rahman

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This study evaluated the impact of different water interventions under WASH program on access of household's to safe drinking water. Following survey method, the study was carried out in two Upazila of South-west coastal region of Bangladesh namely Koyra from Khulna and Shymnagar from Satkhira district. Being an explanatory study, a total of 200 household's selected applying random sampling technique were interviewed using a structured interview schedule. The predicted probability suggests that around 62 percent household's are out of year-round access to safe drinking water whereby, only 25 percent household's have access at SPHERE standard (913 Liters/per person/per year). Besides, majority (78 percent) of the household's have not accessed at both indicators simultaneously. The distance from household residence to the water source varies from 0 to 25 kilometer with an average distance of 2.03 kilometers. The study also reveals that the increase in monthly income around BDT 1,000 leads to additional 11 liters (coefficient 0.01 at p < 0.1) consumption of safe drinking water for a person/year. As expected, lining up time has significant negative relationship with dependent variables i.e., for higher lining up time, the probability of getting access for both SPHERE standard and year round access variables becomes lower. According to ordinary least square (OLS) regression results, water consumption decreases at 93 liters for per person/year of a household if one member is added to that household. Regarding water consumption intensity, ordered logistic regression (OLR) model shows that one-minute increase of lining up time for water collection tends to reduce water consumption intensity. On the other hand, as per OLS regression results, for one-minute increase of lining up time, the water consumption decreases by around 8 liters. Considering access to Deep Tube Well (DTW) as a reference dummy, in OLR, the household under Pond Sand Filter (PSF), Shallow Tube Well (STW), Reverse Osmosis (RO) and Rainwater Harvester System (RWHS) are respectively 37 percent, 29 percent, 61 percent and 27 percent less likely to ensure year round access of water consumption. In line of health impact, different type of water born diseases like diarrhea, cholera, and typhoid are common among the coastal community caused by microbial impurities i.e., Bacteria, Protozoa. High turbidity and TDS in pond water caused by reduction of water depth, presence of suspended particle and inorganic salt stimulate the growth of bacteria, protozoa, and algae causes affecting health hazard. Meanwhile, excessive growth of Algae in pond water caused by excessive nitrate in drinking water adversely effects on child health. In lieu of ensuring access at SPHERE standard, we need to increase the number of water interventions at reasonable distance, preferably a half kilometer away from the dwelling place, ensuring community peoples involved with its installation process where collectively owned water intervention is found more effective than privately owned. In addition, a demand-responsive approach to supply of piped water should be adopted to allow consumer demand to guide investment in domestic water supply in future.

Keywords: access, impact, safe drinking water, Sphere standard, water interventions

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