Search results for: North American ice service
3912 The Impact of Hospital Strikes on Patient Care: Evidence from 135 Strikes in the Portuguese National Health System
Authors: Eduardo Costa
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Hospital strikes in the Portuguese National Health Service (NHS) are becoming increasingly frequent, raising concerns in what respects patient safety. In fact, data shows that mortality rates for patients admitted during strikes are up to 30% higher than for patients admitted in other days. This paper analyses the effects of hospital strikes on patients’ outcomes. Specifically, it analyzes the impact of different strikes (physicians, nurses and other health professionals), on in-hospital mortality rates, readmission rates and length of stay. The paper uses patient-level data containing all NHS hospital admissions in mainland Portugal from 2012 to 2017, together with a comprehensive strike dataset comprising over 250 strike days (19 physicians-strike days, 150 nurses-strike days and 50 other health professionals-strike days) from 135 different strikes. The paper uses a linear probability model and controls for hospital and regional characteristics, time trends, and changes in patients’ composition and diagnoses. Preliminary results suggest a 6-7% increase in in-hospital mortality rates for patients exposed to physicians’ strikes. The effect is smaller for patients exposed to nurses’ strikes (2-5%). Patients exposed to nurses strikes during their stay have, on average, higher 30-days urgent readmission rates (4%). Length of stay also seems to increase for patients exposed to any strike. Results – conditional on further testing, namely on non-linear models - suggest that hospital operations and service levels are partially disrupted during strikes.Keywords: health sector strikes, in-hospital mortality rate, length of stay, readmission rate
Procedia PDF Downloads 1353911 Resolving Urban Mobility Issues through Network Restructuring of Urban Mass Transport
Authors: Aditya Purohit, Neha Bansal
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Unplanned urbanization and multidirectional sprawl of the cities have resulted in increased motorization and deteriorating transport conditions like traffic congestion, longer commuting, pollution, increased carbon footprint, and above all increased fatalities. In order to overcome these problems, various practices have been adopted including– promoting and implementing mass transport; traffic junction channelization; smart transport etc. However, these methods are found to be primarily focusing on vehicular mobility rather than people accessibility. With this research gap, this paper tries to resolve the mobility issues for Ahmedabad city in India, which being the economic capital Gujarat state has a huge commuter and visitor inflow. This research aims to resolve the traffic congestion and urban mobility issues focusing on Gujarat State Regional Transport Corporation (GSRTC) for the city of Ahmadabad by analyzing the existing operations and network structure of GSRTC followed by finding possibilities of integrating it with other modes of urban transport. The network restructuring (NR) methodology is used with appropriate variations, based on commuter demand and growth pattern of the city. To do these ‘scenarios’ based on priority issues (using 12 parameters) and their best possible solution, are established after route network analysis for 2700 population sample of 20 traffic junctions/nodes across the city. Approximately 5% sample (of passenger inflow) at each node is considered using random stratified sampling technique two scenarios are – Scenario 1: Resolving mobility issues by use of Special Purpose Vehicle (SPV) in joint venture to GSRTC and Private Operators for establishing feeder service, which shall provide a transfer service for passenger for movement from inner city area to identified peripheral terminals; and Scenario 2: Augmenting existing mass transport services such as BRTS and AMTS for using them as feeder service to the identified peripheral terminals. Each of these has now been analyzed for the best suitability/feasibility in network restructuring. A desire-line diagram is constructed using this analysis which indicated that on an average 62% of designated GSRTC routes are overlapping with mass transportation service routes of BRTS and AMTS in the city. This has resulted in duplication of bus services causing traffic congestion especially in the Central Bus Station (CBS). Terminating GSRTC services on the periphery of the city is found to be the best restructuring network proposal. This limits the GSRTC buses at city fringe area and prevents them from entering into the city core areas. These end-terminals of GSRTC are integrated with BRTS and AMTS services which help in segregating intra-state and inter-state bus services. The research concludes that absence of integrated multimodal transport network resulted in complexity of transport access to the commuters. As a further scope of research comparing and understanding of value of access time in total travel time and its implication on generalized cost on trip and how it varies city wise may be taken up.Keywords: mass transportation, multi-modal integration, network restructuring, travel behavior, urban transport
Procedia PDF Downloads 1973910 Emotions Evoked by Robots - Comparison of Older Adults and Students
Authors: Stephanie Lehmann, Esther Ruf, Sabina Misoch
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Background: Due to demographic change and shortage of skilled nursing staff, assistive robots are built to support older adults at home and nursing staff in care institutions. When assistive robots facilitate tasks that are usually performed by humans, user acceptance is essential. Even though they are an important aspect of acceptance, emotions towards different assistive robots and different situations of robot-use have so far not been examined in detail. The appearance of assistive robots can trigger emotions that affect their acceptance. Acceptance of robots is assumed to be greater when they look more human-like; however, too much human similarity can be counterproductive. Regarding different groups, it is assumed that older adults have a more negative attitude towards robots than younger adults. Within the framework of a simulated robot study, the aim was to investigate emotions of older adults compared to students towards robots with different appearances and in different situations and so contribute to a deeper view of the emotions influencing acceptance. Methods: In a questionnaire study, vignettes were used to assess emotions toward robots in different situations and of different appearance. The vignettes were composed of two situations (service and care) shown by video and four pictures of robots varying in human similarity (machine-like to android). The combination of the vignettes was randomly distributed to the participants. One hundred forty-two older adults and 35 bachelor students of nursing participated. They filled out a questionnaire that surveyed 30 positive and 30 negative emotions. For each group, older adults and students, a sum score of “positive emotions” and a sum score of “negative emotions” was calculated. Mean value, standard deviation, or n for sample size and % for frequencies, according to the scale level, were calculated. For differences in the scores of positive and negative emotions for different situations, t-tests were calculated. Results: Overall, older adults reported significantly more positive emotions than students towards robots in general. Students reported significantly more negative emotions than older adults. Regarding the two different situations, the results were similar for the care situation, with older adults reporting more positive emotions than students and less negative emotions than students. In the service situation, older adults reported significantly more positive emotions; negative emotions did not differ significantly from the students. Regarding the appearance of the robot, there were no significant differences in emotions reported towards the machine-like, the mechanical-human-like and the human-like appearance. Regarding the android robot, students reported significantly more negative emotions than older adults. Conclusion: There were differences in the emotions reported by older adults compared to students. Older adults reported more positive emotions, and students reported more negative emotions towards robots in different situations and with different appearances. It can be assumed that older adults have a different attitude towards the use of robots than younger people, especially young adults in the health sector. Therefore, the use of robots in the service or care sector should not be rejected rashly based on the attitudes of younger persons, without considering the attitudes of older adults equally.Keywords: emotions, robots, seniors, young adults
Procedia PDF Downloads 4653909 The Agroclimatic Atlas of Croatia for the Periods 1981-2010 and 1991-2020
Authors: Višnjica Vučetić, Mislav Anić, Jelena Bašić, Petra Sviličić, Ivana Tomašević
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The Agroclimatic Atlas of Croatia (Atlas) for the periods 1981–2010 and 1991–2020 is monograph of six chapters in digital form. Detailed descriptions of particular agroclimatological data are given in separate chapters as follows: agroclimatic indices based on air temperature (degree days, Huglin heliothermal index), soil temperature, water balance components (precipitation, potential evapotranspiration, actual evapotranspiration, soil moisture content, runoff, recharge and soil moisture loss) and fire weather indices. The last chapter is a description of the digital methods for the spatial interpolations (R and GIS). The Atlas comprises textual description of the relevant climate characteristic, maps of the spatial distribution of climatological elements at 109 stations (26 stations for soil temperature) and tables of the 30-year mean monthly, seasonal and annual values of climatological parameters at 24 stations. The Atlas was published in 2021, on the seventieth anniversary of the agrometeorology development at the Meteorological and Hydrological Service of Croatia. It is intended to support improvement of sustainable system of agricultural production and forest protection from fire and as a rich source of information for agronomic and forestry experts, but also for the decision-making bodies to use it for the development of strategic plans.Keywords: agrometeorology, agroclimatic indices, soil temperature, water balance components, fire weather index, meteorological and hydrological service of Croatia
Procedia PDF Downloads 1273908 Load Balancing Technique for Energy - Efficiency in Cloud Computing
Authors: Rani Danavath, V. B. Narsimha
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Cloud computing is emerging as a new paradigm of large scale distributed computing. Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., three service models, and four deployment networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model is composed of five essential characteristics models. Load balancing is one of the main challenges in cloud computing, which is required to distribute the dynamic workload across multiple nodes, to ensure that no single node is overloaded. It helps in optimal utilization of resources, enhancing the performance of the system. The goal of the load balancing is to minimize the resource consumption and carbon emission rate, that is the direct need of cloud computing. This determined the need of new metrics energy consumption and carbon emission for energy-efficiency load balancing techniques in cloud computing. Existing load balancing techniques mainly focuses on reducing overhead, services, response time and improving performance etc. In this paper we introduced a Technique for energy-efficiency, but none of the techniques have considered the energy consumption and carbon emission. Therefore, our proposed work will go towards energy – efficiency. So this energy-efficiency load balancing technique can be used to improve the performance of cloud computing by balancing the workload across all the nodes in the cloud with the minimum resource utilization, in turn, reducing energy consumption, and carbon emission to an extent, which will help to achieve green computing.Keywords: cloud computing, distributed computing, energy efficiency, green computing, load balancing, energy consumption, carbon emission
Procedia PDF Downloads 4493907 Low Electrical Energy Access Rate in Burundi as a Barrier to Achieving the United Nations' Sustainable Development Goals
Authors: Gatoto Placide, Michel Roddy Lollchund, Gace Athanase Dalson
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This paper first presents a review of the current situation of energy access rate in Burundi, which is relatively low compared to other countries. The paper aims to identify the key gaps in improving the electrical energy access in Burundi and proposes a solution to overcome these gaps. It is shown that the electrical power grid is old and concentrated in north-west and in Bujumbura city while other regions lack access to national grids. Next to that, the link between electricity access and sustainable development in Burundi is clarified. Further, some solutions are suggested to solve energy access problems such as the electricity transmission lines extension and renovation, diversification of energy sources.Keywords: Burundi, energy access, hydropower, sustainable development
Procedia PDF Downloads 1873906 The Experiences of Claiming Welfare Benefits for People with Disabilities in the UK
Authors: Jennifer McNeill
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Over the years UK Governments have extended the use of welfare conditionality to more marginalised groups. Whereas in the past, disabled people’s rights to unconditional welfare were defended, significant numbers of disabled people have in recent years been re-classified as ‘fit for work’ as a result of this policy shift towards increased conditionality targeting more welfare service user groups. This paper discusses findings from a five-year project exploring the ethics and efficacy of welfare conditionality. Drawing on repeat interviews over three years with 58 disabled welfare service users across England and Scotland, the paper explores the experience of, and impact of conditionality upon, disabled participants. In particular, participants described the process of claiming disability-related benefits as stigmatising, with some describing the medical assessments as demeaning, traumatic and even painful. The medical assessments are conducted by private contractors and participants felt they were treated unfairly, under suspicion and under surveillance. This finding is important in line with a recent UN report concerned with the practice of such assessments. The findings reveal that notions of ‘deservedness’ are embedded in this system as disabled recipients argue for their entitlement to welfare claims relative to what are deemed to be less deserving groups of benefit claimants. This indicates an increasing competition ethic within different sections of the most marginalised social groups that facilitate further forms of social fragmentation, particularly in relation to opposition to benefit cuts and other changes requiring concerted and organised forms of resistance. The impact of media and political scapegoating of the most marginal has generated divisions within even those who position themselves as legitimate recipients.Keywords: disability, medical assessments, stigma, welfare conditionality
Procedia PDF Downloads 2023905 Supply Side Readiness for Universal Health Coverage: Assessing the Availability and Depth of Essential Health Package in Rural, Remote and Conflict Prone District
Authors: Veenapani Rajeev Verma
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Context: Assessing facility readiness is paramount as it can indicate capacity of facilities to provide essential care for resilience to health challenges. In the context of decentralization, estimation of supply side readiness indices at sub national level is imperative for effective evidence based policy but remains a colossal challenge due to lack of dependable and representative data sources. Setting: District Poonch of Jammu and Kashmir was selected for this study. It is remote, rural district with unprecedented topographical barriers and is identified as high priority by government. It is also a fragile area as is bounded by Line of Control with Pakistan bearing the brunt of cease fire violations, military skirmishes and sporadic militant attacks. Hilly geographical terrain, rudimentary/absence of road network and impoverishment are quintessential to this area. Objectives: Objective of the study is to a) Evaluate the service readiness of health facilities and create a concise index subsuming plethora of discrete indicators and b) Ascertain supply side barriers in service provisioning via stakeholder’s analysis. Study also strives to expand analytical domain unravelling context and area specific intricacies associated with service delivery. Methodology: Mixed method approach was employed to triangulate quantitative analysis with qualitative nuances. Facility survey encompassing 90 Subcentres, 44 Primary health centres, 3 Community health centres and 1 District hospital was conducted to gauge general service availability and service specific availability (depth of coverage). Compendium of checklist was designed using Indian Public Health Standards (IPHS) in form of standard core questionnaire and scorecard generated for each facility. Information was collected across dimensions of amenities, equipment, medicines, laboratory and infection control protocols as proposed in WHO’s Service Availability and Readiness Assesment (SARA). Two stage polychoric principal component analysis employed to generate a parsimonious index by coalescing an array of tracer indicators. OLS regression method used to determine factors explaining composite index generated from PCA. Stakeholder analysis was conducted to discern qualitative information. Myriad of techniques like observations, key informant interviews and focus group discussions using semi structured questionnaires on both leaders and laggards were administered for critical stakeholder’s analysis. Results: General readiness score of health facilities was found to be 0.48. Results indicated poorest readiness for subcentres and PHC’s (first point of contact) with composite score of 0.47 and 0.41 respectively. For primary care facilities; principal component was characterized by basic newborn care as well as preparedness for delivery. Results revealed availability of equipment and surgical preparedness having lowest score (0.46 and 0.47) for facilities providing secondary care. Presence of contractual staff, more than 1 hr walk to facility, facilities in zone A (most vulnerable) to cross border shelling and facilities inaccessible due to snowfall and thick jungles was negatively associated with readiness index. Nonchalant staff attitude, unavailability of staff quarters, leakages and constraint in supply chain of drugs and consumables were other impediments identified. Conclusions/Policy Implications: It is pertinent to first strengthen primary care facilities in this setting. Complex dimensions such as geographic barriers, user and provider behavior is not under precinct of this methodology.Keywords: effective coverage, principal component analysis, readiness index, universal health coverage
Procedia PDF Downloads 1213904 The Effect of Artificial Intelligence on Banking Development and Progress
Authors: Mina Malak Hanna Saad
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New strategies for supplying banking services to the customer have been brought, which include online banking. Banks have begun to recall electronic banking (e-banking) as a manner to replace some conventional department features by means of the usage of the internet as a brand-new distribution channel. A few clients have at least one account at multiple banks and get admission to those debts through online banking. To test their present-day internet worth, customers need to log into each of their debts, get particular statistics, and paint closer to consolidation. Not only is it time-ingesting; however, but it is also a repeatable activity with a certain frequency. To solve this problem, the idea of account aggregation was delivered as a solution. Account consolidation in e-banking as a form of digital banking appears to build stronger dating with clients. An account linking service is usually known as a service that permits customers to manipulate their bank accounts held at exceptional institutions through a common online banking platform that places a high priority on safety and statistics protection. The object affords an outline of the account aggregation approach in e-banking as a distinct carrier in the area of e-banking. The advanced facts generation is becoming a vital thing in the improvement of financial services enterprise, specifically the banking enterprise. It has brought different ways of delivering banking to the purchaser, which includes net Banking. Banks began to study electronic banking (e-banking) as a means to update some of their traditional branch functions and the use of the net as a distribution channel. Some clients have at least multiple accounts throughout banks and get the right of entry to that money owed through the usage of e-banking offerings. To examine the contemporary internet's well-worth position, customers have to log in to each of their money owed, get the information and work on consolidation. This no longer takes sufficient time; however, it is a repetitive interest at a specified frequency. To address this point, an account aggregation idea is brought as an answer. E-banking account aggregation, as one of the e-banking kinds, appeared to construct a more potent dating with clients. Account Aggregation carrier usually refers to a service that allows clients to control their bank bills maintained in one-of-a-kind institutions via a common Internet banking working platform, with an excessive subject to protection and privateness. This paper offers an overview of an e-banking account aggregation technique as a new provider in the e-banking field.Keywords: compatibility, complexity, mobile banking, observation, risk banking technology, Internet banks, modernization of banks, banks, account aggregation, security, enterprise developmente-banking, enterprise development
Procedia PDF Downloads 353903 Microstructure and Hardness Changes on T91 Weld Joint after Heating at 560°C
Authors: Suraya Mohamad Nadzir, Badrol Ahmad, Norlia Berahim
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T91 steel has been used as construction material for superheater tubes in sub-critical and super critical boiler. This steel was developed with higher creep strength property as compared to conventional low alloy steel. However, this steel is also susceptible to materials degradation due to its sensitivity to heat treatment especially Post Weld Heat Treatment (PWHT) after weld repair process. Review of PWHT process shows that the holding temperature may different from one batch to other batch of samples depending on the material composition. This issue was reviewed by many researchers and one of the potential solutions is the development of weld repair process without PWHT. This process is possible with the use of temper bead welding technique. However, study has shown the hardness value across the weld joint with exception of PWHT is much higher compare to recommended hardness value. Based on the above findings, a study to evaluate the microstructure and hardness changes of T91 weld joint after heating at 560°C at varying duration was carried out. This study was carried out to evaluate the possibility of self-tempering process during in-service period. In this study, the T91 weld joint was heat-up in air furnace at 560°C for duration of 50 and 150 hours. The heating process was controlled with heating rate of 200°C/hours, and cooling rate about 100°C/hours. Following this process, samples were prepared for the microstructure examination and hardness evaluation. Results have shown full tempered martensite structure and acceptance hardness value was achieved after 50 hours heating. This result shows that the thin component such as T91 superheater tubes is able to self-tempering during service hour.Keywords: T91, weld-joint, tempered martensite, self-tempering
Procedia PDF Downloads 3793902 Improving the Budget Distribution Procedure to Ensure Smooth and Efficient Public Service Delivery
Authors: Rizwana Tabassum
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Introductive Statement: Delay in budget releases is often cited as one of the biggest bottlenecks to smooth and efficient service delivery. While budget release from the ministry of finance to the line ministries has been expedited by simplifying the procedure, budget distribution within the line ministries remains one of the major causes of slow budget utilization. While the budget preparation is a bottom-up process where all DDOs submit their proposals to their controlling officers (such as Upazila Civil Surgeon sends it to Director General Health), who consolidate the budget proposals in iBAS++ budget preparation module, the approved budget is not disaggregated by all DDOs. Instead, it is left to the discretion of the controlling officers to distribute the approved budget to their sub-ordinate offices over the course of the year. Though there are some need-based criteria/formulae to distribute the approved budget among DDOs in some sectors, there is little evidence that these criteria are actually used. This means that majority of the DDOs don’t know their yearly allocations upfront to enable yearly planning of activities and expenditures. This delays the implementation of critical activities and the payment to the suppliers of goods and services and sometimes leads to undocumented arrears to suppliers for essential goods/services. In addition, social sector budgets are fragmented because of the vertical programs and externally financed interventions that pose several management challenges at the level of the budget holders and frontline service providers. Slow procurement processes further delay the provision of necessary goods and services. For example, it takes an average of 15–18 months for drugs to reach the Upazila Health Complex and below, while it should not take more than 9 months in procuring and distributing these. Aim of the Study: This paper aims to investigate the budget distribution practices of an emerging economy, Bangladesh. The paper identifies challenges of timely distribution and ways to deal with problems as well. Methodology: The study draws conclusions on the basis of document analysis which is a branch of the qualitative research method. Major Findings: Upon approval of the National Budget, the Ministry of Finance is required to distribute the budget to budget holders at the department level; however, budget is distributed to drawing and disbursing officers much later. Conclusions: Timely and predictable budget releases assist completion of development schemes on time and on budget, with sufficient recurrent resources for effective operation. ADP implementation is usually very low at the beginning of the fiscal year and expedited dramatically during the last few months, leading to inefficient use of resources. The timely budget release will resolve this issue and deliver economic benefits faster, better, and more reliably. This will also give the project directors/DDOs the freedom to think and plan the budget execution in a predictable manner, thereby ensuring value for money by reducing time overrun and expediting the completion of capital investments, and improving infrastructure utilization through timely payment of recurrent costs.Keywords: budget distribution, challenges, digitization, emerging economy, service delivery
Procedia PDF Downloads 803901 Geopolitical Architecture: The Strategic Complex in Indo Pacific Region
Authors: Muzammil Dar
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The confluence of trans-national interests and divergent approaches followed by multiple actors has surrounded the Indo-Pacific region with myriad of strategic complexes- Geo-Political, Geo-economic, and security. This paper has thus made a humble attempt to understand the Indo-Pacific strategic predicament from Asia-Pacific perspective. The portmanteau of Indo-Pacific strategic gamble has multiple actors from global powers to regional actors. On the indo-pacific waters, not only flow trade relations, but the tides of conflicts and controversies are striking these actors against each other. The alliance formation and infrastructure building has built-in threat perceptions from rivals vice-versa. The assertiveness of China as a reality and India’s ideological doctrine of peace and friendship, as well as American rebalancing against China, could be seen as clear and bright on the Indo-Pacific strategic portmanteau. ASEAN and Japan, too, have oscillating posturing in the strategic dilemma. The aim and objective of the paper are to sketch out the prospectus and prejudices of Indo-pacific strategic complex.Keywords: Indo Pacific, Asia Pacific, security and growth for all in the region, SAGAR, ASEAN China
Procedia PDF Downloads 1533900 DWDM Network Implementation in the Honduran Telecommunications Company "Hondutel"
Authors: Tannia Vindel, Carlos Mejia, Damaris Araujo, Carlos Velasquez, Darlin Trejo
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The DWDM (Dense Wavelenght Division Multiplexing) is in constant growth around the world by consumer demand to meet their needs. Since its inception in this operation arises the need for a system which enable us to expand the communication of an entire nation to improve the computing trends of their societies according to their customs and geographical location. The Honduran Company of Telecommunications (HONDUTEL), provides the internet services and data transport technology with a PDH and SDH, which represents in the Republic of Honduras C. A., the option of viability for the consumer in terms of purchase value and its ease of acquisition; but does not have the efficiency in terms of technological advance and represents an obstacle that limits the long-term socio-economic development in comparison with other countries in the region and to be able to establish a competition between telecommunications companies that are engaged in this heading. For that reason we propose to establish a new technological trend implemented in Europe and that is applied in our country that allows us to provide a data transfer in broadband as it is DWDM, in this way we will have a stable service and quality that will allow us to compete in this globalized world, and that must be replaced by one that would provide a better service and which must be in the forefront. Once implemented the DWDM is build upon the existing resources, such as the equipment used, and you will be given life to a new stage providing a business image to the Republic of Honduras C,A, as a nation, to ensure the data transport and broadband internet to a meaningful relationship. Same benefits in the first instance to existing customers and to all the institutions were bidden to these public and private need of such services.Keywords: demultiplexers, light detectors, multiplexers, optical amplifiers, optical fibers, PDH, SDH
Procedia PDF Downloads 2633899 The Relationship Between Teachers’ Attachment Insecurity and Their Classroom Management Efficacy
Authors: Amber Hatch, Eric Wright, Feihong Wang
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Research suggests that attachment in close relationships affects one’s emotional processes, mindfulness, conflict-management behaviors, and interpersonal interactions. Attachment insecurity is often associated with maladaptive social interactions and suboptimal relationship qualities. Past studies have considered how the nature of emotion regulation and mindfulness in teachers may be related to student or classroom outcomes. Still, no research has examined how the relationship between such internal experiences and classroom management outcomes may also be related to teachers’ attachment insecurity. This study examined the interrelationships between teachers’ attachment insecurity, mindfulness tendencies, emotion regulation abilities, and classroom management efficacy as indexed by students’ classroom behavior and teachers’ response effectiveness. Teachers’ attachment insecurity was evaluated using the global ECRS-SF, which measures both attachment anxiety and avoidance. The present study includes a convenient sample of 357 American elementary school teachers who responded to a survey regarding their classroom management efficacy, attachment in/security, dispositional mindfulness, emotion regulation strategies, and difficulties in emotion regulation, primarily assessed via pre-existing instruments. Good construct validity was demonstrated for all scales used in the survey. Sample demographics, including gender (94% female), race (92% White), age (M = 41.9 yrs.), years of teaching experience (M = 15.2 yrs.), and education level were similar to the population from which it was drawn, (i.e., American elementary school teachers). However, white women were slightly overrepresented in our sample. Correlational results suggest that teacher attachment insecurity is associated with poorer classroom management efficacy as indexed by students’ disruptive behavior and teachers’ response effectiveness. Attachment anxiety was a much stronger predictor of adverse student behaviors and ineffective teacher responses to adverse behaviors than attachment avoidance. Mindfulness, emotion regulation abilities, and years of teaching experience predicted positive classroom management outcomes. Attachment insecurity and mindfulness were more strongly related to frequent adverse student behaviors, while emotion regulation abilities were more strongly related to teachers’ response effectiveness. The teaching experience was negatively related to attachment insecurity and positively related to mindfulness and emotion regulation abilities. Although the data were cross-sectional, path analyses revealed that attachment insecurity is directly related to classroom management efficacy. Through two routes, this relationship is further mediated by emotion regulation and mindfulness in teachers. The first route of indirect effect suggests double mediation by teacher’s emotion regulation and then teacher mindfulness in the relationship between teacher attachment insecurity and classroom management efficacy. The second indirect effect suggests mindfulness directly mediated the relationship between attachment insecurity and classroom management efficacy, resulting in improved model fit statistics. However, this indirect effect is much smaller than the double mediation route through emotion regulation and mindfulness in teachers. Given the significant predication of teacher attachment insecurity, mindfulness, and emotion regulation on teachers’ classroom management efficacy both directly and indirectly, the authors recommend improving teachers’ classroom management efficacy via a three-pronged approach aiming at enhancing teachers’ secure attachment and supporting their learning adaptive emotion regulation strategies and mindfulness techniques.Keywords: Classroom management efficacy, student behavior, teacher attachment, teacher emotion regulation, teacher mindfulness
Procedia PDF Downloads 853898 Legal Pluralism and Ideology: The Recognition of the Indigenous Justice Administration in Bolivia through the "Indigenismo" and "Decolonisation" Discourses
Authors: Adriana Pereira Arteaga
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In many Latin American countries the transition towards legal pluralism - has developed as part of what is called Latin-American-Constitutionalism over the last thirty years. The aim of this paper is to discuss how legal pluralism in its current form in Bolivia may produce exclusion and violence. Legal sources and discourse analysis - as an approach to examine written language on discourse documentation- will be used to develop this paper. With the constitution of 2009, Bolivia was symbolically "re-founded" into a multi-nation state. This shift goes hand in hand with the "indigenista" and "decolonisation" ideologies developing since the early 20th century. Discourses based on these ideologies reflect the rejection of liberal and western premises on which the Bolivian republic was originally built after independence. According to the "indigenista" movements, the liberal nation-state generates institutions corresponding to a homogenous society. These liberal institutions not only ignore the Bolivian multi-nation reality, but also maintain the social structures originating form the colony times, based on prejudices against the indigenous. The described statements were elaborated through the image: the indigenous people humiliated by a cruel western system as highlighted by the constitution's preamble. This narrative had a considerable impact on the sensitivity of people and received great social support. Therefore the proposal for changing structures of the nation-state, is charged with an emancipatory message of restoring even the pre-Columbian order. An order at times romantically described as the perfect order. Legally this connotes a rejection of the positivistic national legal system based on individual rights and the promotion of constitutional recognition of indigenous justice administration. The pluralistic Constitution is supposed to promote tolerance and a peaceful coexistence among nations, so that the unity and integrity of the country could be maintained. In its current form, legal pluralism in Bolivia is justified on pre-existing rights contained for example in the International - Labour - Organization - Convention 169, but it is more developed on the described discursive constructions. Over time these discursive constructions created inconsistencies in terms of putting indigenous justice administration into practice: First, because legal pluralism has been more developed on level of political discourse, so a real interaction between the national and the indigenous jurisdiction cannot be observed. There are no clear coordination and cooperation mechanisms. Second, since the recently reformed constitution is based on deep sensitive experiences, little is said about the general legal principles on which a pluralistic administration of justice in Bolivia should be based. Third, basic rights, liberties, and constitutional guarantees are also affected by the antagonized image of the national justice administration. As a result, fundamental rights could be violated on a large scale because many indigenous justice administration practices run counter to these constitutional rules. These problems are not merely Bolivian but may also be encountered in other regional countries with similar backgrounds, like Ecuador.Keywords: discourse, indigenous justice, legal pluralism, multi-nation
Procedia PDF Downloads 4453897 Residential and Care Model for Elderly People Based on “Internet Plus”
Authors: Haoyi Sheng
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China's aging tendency is becoming increasingly severe, which leads to the embarrassing situation of "getting old before getting wealthy". The traditional pension model does not comply with the need of today. Relying on "Internet Plus", it can efficiently integrate information and resources and meet the personalized needs of elderly care. It can reduce the operating cost of community elderly care facilities and lay a technical foundation for providing better services for the elderly. The key for providing help for the elderly in the future is to effectively integrate technology, make good use of technology, and improve the efficiency of elderly care services. The effective integration of traditional home care, community care, intelligent elderly care equipment and medical resources to create the "Internet Plus" community intelligent pension service mode has become the future development trend of aging care. The research method of this paper is to collect literature and conduct theoretical research on community pension firstly. Secondly, the combination of suitable aging design and "Internet Plus" is elaborated through research. Finally, this paper states the current level of intelligent technology in old-age care and looks into the future by understanding multiple levels of "Internet Plus". The development of community intelligent pension mode and content under "Internet Plus" has enormous development potential. In addition to the characteristics and functions of ordinary houses, residential design of endowment housing has higher requirements for comfort and personalization, and the people-oriented is the principle of design.Keywords: ageing tendency, 'Internet Plus', community intelligent elderly care, elderly care service model, technology
Procedia PDF Downloads 1373896 Design and Implementation of Low-code Model-building Methods
Authors: Zhilin Wang, Zhihao Zheng, Linxin Liu
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This study proposes a low-code model-building approach that aims to simplify the development and deployment of artificial intelligence (AI) models. With an intuitive way to drag and drop and connect components, users can easily build complex models and integrate multiple algorithms for training. After the training is completed, the system automatically generates a callable model service API. This method not only lowers the technical threshold of AI development and improves development efficiency but also enhances the flexibility of algorithm integration and simplifies the deployment process of models. The core strength of this method lies in its ease of use and efficiency. Users do not need to have a deep programming background and can complete the design and implementation of complex models with a simple drag-and-drop operation. This feature greatly expands the scope of AI technology, allowing more non-technical people to participate in the development of AI models. At the same time, the method performs well in algorithm integration, supporting many different types of algorithms to work together, which further improves the performance and applicability of the model. In the experimental part, we performed several performance tests on the method. The results show that compared with traditional model construction methods, this method can make more efficient use, save computing resources, and greatly shorten the model training time. In addition, the system-generated model service interface has been optimized for high availability and scalability, which can adapt to the needs of different application scenarios.Keywords: low-code, model building, artificial intelligence, algorithm integration, model deployment
Procedia PDF Downloads 293895 The Relationships among Self-Efficacy, Critical Thinking and Communication Skills Ability in Oncology Nurses for Cancer Immunotherapy in Taiwan
Authors: Yun-Hsiang Lee
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Cancer is the main cause of death worldwide. With advances in medical technology, immunotherapy, which is a newly developed advanced treatment, is currently a crucial cancer treatment option. For better quality cancer care, the ability to communicate and critical thinking plays a central role in clinical oncology settings. However, few studies have explored the impact of communication skills on immunotherapy-related issues and their related factors. This study was to (i) explore the current status of communication skill ability for immunotherapy-related issues, self-efficacy for immunotherapy-related care, and critical thinking ability; and (ii) identify factors related to communication skill ability. This is a cross-sectional study. Oncology nurses were recruited from the Taiwan Oncology Nursing Society, in which nurses came from different hospitals distributed across four major geographic regions (North, Center, South, East) of Taiwan. A total of 123 oncology nurses participated in this study. A set of questionnaires were used for collecting data. Communication skill ability for immunotherapy issues, self-efficacy for immunotherapy-related care, critical thinking ability, and background information were assessed in this survey. Independent T-test and one-way ANOVA were used to examine different levels of communication skill ability based on nurses having done oncology courses (yes vs. no) and education years (< 1 year, 1-3 years, and > 3 years), respectively. Spearman correlation was conducted to understand the relationships between communication skill ability and other variables. Among the 123 oncology nurses in the current study, the majority of them were female (98.4%), and most of them were employed at a hospital in the North (46.8%) of Taiwan. Most of them possessed a university degree (78.9%) and had at least 3 years of prior work experience (71.7%). Forty-three of the oncology nurses indicated in the survey that they had not received oncology nurses-related training. Those oncology nurses reported moderate to high levels of communication skill ability for immunotherapy issues (mean=4.24, SD=0.7, range 1-5). Nurses reported moderate levels of self-efficacy for immunotherapy-related care (mean=5.20, SD=1.98, range 0-10) and also had high levels of critical thinking ability (mean=4.76, SD=0.60, range 1-6). Oncology nurses who had received oncology training courses had significantly better communication skill ability than those who had not received oncology training. Oncology nurses who had higher work experience (1-3 years, or > 3 years) had significantly higher levels of communication skill ability for immunotherapy-related issues than those with lower work experience (<1 year). When those nurses reported better communication skill ability, they also had significantly better self-efficacy (r=.42, p<.01) and better critical thinking ability (r=.47, p<.01). Taken altogether, courses designed to improve communication skill ability for immunotherapy-related issues can make a significant impact in clinical settings. Communication skill ability for oncology nurses is the major factor associated with self-efficacy and critical thinking, especially for those with lower work experience (< 1 year).Keywords: communication skills, critical thinking, immunotherapy, oncology nurses, self-efficacy
Procedia PDF Downloads 1053894 Introduction to Multi-Agent Deep Deterministic Policy Gradient
Authors: Xu Jie
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As a key network security method, cryptographic services must fully cope with problems such as the wide variety of cryptographic algorithms, high concurrency requirements, random job crossovers, and instantaneous surges in workloads. Its complexity and dynamics also make it difficult for traditional static security policies to cope with the ever-changing situation. Cyber Threats and Environment. Traditional resource scheduling algorithms are inadequate when facing complex decisionmaking problems in dynamic environments. A network cryptographic resource allocation algorithm based on reinforcement learning is proposed, aiming to optimize task energy consumption, migration cost, and fitness of differentiated services (including user, data, and task security). By modeling the multi-job collaborative cryptographic service scheduling problem as a multiobjective optimized job flow scheduling problem, and using a multi-agent reinforcement learning method, efficient scheduling and optimal configuration of cryptographic service resources are achieved. By introducing reinforcement learning, resource allocation strategies can be adjusted in real time in a dynamic environment, improving resource utilization and achieving load balancing. Experimental results show that this algorithm has significant advantages in path planning length, system delay and network load balancing, and effectively solves the problem of complex resource scheduling in cryptographic services.Keywords: multi-agent reinforcement learning, non-stationary dynamics, multi-agent systems, cooperative and competitive agents
Procedia PDF Downloads 243893 Perceptions of Students toward ODL Services Quality in Facilitating Their Study: Experience of Universitas Terbuka in Managing ODL in Cultural Diversity Areas
Authors: Ribut Alam Malau, Durri Andriani, C. B. Supartomo
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Universitas Terbuka (UT) as a higher education institution implements open and distance education is responsible to provide higher education to all Indonesian citizen wherever they live, including those reside in cultural diversity aras. Operate from Jakarta Head Office and 37 regional centers (ROs), UT is accustomed to the challenge. UT-Kupang and UT-Ambon which oversee East Nusa Tenggara and Maluku have successfully provided quality educational services for students. The two ROs have provided educational facilities which could assist the students to cope with their study in spite of the diversity situations. In order to analyze the effectiveness of the facilities provided, questionnaires focusing on tutorial services were sent to 90 students in the two ROs asking them to assess the facilities which best fulfills students’ needs in terms of their culture diversity. The results showed that UT-Kupang and UT-Ambon have successful in providing education for students in their areas as reflected in more than 80% of respondents aware of the facilities concerning tutorial service except for tutorial mechanism where only 34,5% of respondents aware of. However, despite lower rate of awareness in tutorial mechanism, majority of respondent 90.8% of respondents registered in tutorials and 95.4% will register in tutorials next semester. The majority of respondents showed appreciation for the ROs efforts to provide tutorials on weekdays which could accommodate their beliefs. In addition, conducting tutorials in all islands also perceived highly since students did not have to commute between islands. Efforts done by UT-Kupang and UT-Ambon have proven to be appreciated by students.Keywords: archipelago, cultural diversity, ODL, service quality, Universitas Terbuka
Procedia PDF Downloads 4723892 A Method of Manufacturing Low Cost Utility Robots and Vehicles
Authors: Gregory E. Ofili
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Introduction and Objective: Climate change and a global economy mean farmers must adapt and gain access to affordable and reliable automation technologies. Key barriers include a lack of transportation, electricity, and internet service, coupled with costly enabling technologies and limited local subject matter expertise. Methodology/Approach: Resourcefulness is essential to mechanization on a farm. This runs contrary to the tech industry practice of planned obsolescence and disposal. One solution is plug-and-play hardware that allows farmer to assemble, repair, program, and service their own fleet of industrial machines. To that end, we developed a method of manufacturing low-cost utility robots, transport vehicles, and solar/wind energy harvesting systems, all running on an open-source Robot Operating System (ROS). We demonstrate this technology by fabricating a utility robot and an all-terrain (4X4) utility vehicle. Constructed of aluminum trusses and weighing just 40 pounds, yet capable of transporting 200 pounds of cargo, on sale for less than $2,000. Conclusions & Policy Implications: Electricity, internet, and automation are essential for productivity and competitiveness. With planned obsolescence, the priorities of technology suppliers are not aligned with the farmer’s realities. This patent-pending method of manufacturing low-cost industrial robots and electric vehicles has met its objective. To create low-cost machines, the farmer can assemble, program, and repair with basic hand tools.Keywords: automation, robotics, utility robot, small-hold farm, robot operating system
Procedia PDF Downloads 703891 Urban Transport Demand Management Multi-Criteria Decision Using AHP and SERVQUAL Models: Case Study of Nigerian Cities
Authors: Suleiman Hassan Otuoze, Dexter Vernon Lloyd Hunt, Ian Jefferson
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Urbanization has continued to widen the gap between demand and resources available to provide resilient and sustainable transport services in many fast-growing developing countries' cities. Transport demand management is a decision-based optimization concept for both benchmarking and ensuring efficient use of transport resources. This study assesses the service quality of infrastructure and mobility services in the Nigerian cities of Kano and Lagos through five dimensions of quality (i.e., Tangibility, Reliability, Responsibility, Safety Assurance and Empathy). The methodology adopts a hybrid AHP-SERVQUAL model applied on questionnaire surveys to gauge the quality of satisfaction and the views of experts in the field. The AHP results prioritize tangibility, which defines the state of transportation infrastructure and services in terms of satisfaction qualities and intervention decision weights in the two cities. The results recorded ‘unsatisfactory’ indices of quality of performance and satisfaction rating values of 48% and 49% for Kano and Lagos, respectively. The satisfaction indices are identified as indicators of low performances of transportation demand management (TDM) measures and the necessity to re-order priorities and take proactive steps towards infrastructure. The findings pilot a framework for comparative assessment of recognizable standards in transport services, best ethics of management and a necessity of quality infrastructure to guarantee both resilient and sustainable urban mobility.Keywords: transportation demand management, multi-criteria decision support, transport infrastructure, service quality, sustainable transport
Procedia PDF Downloads 2243890 Traditional Farming Practices and Climate Change Adaptation among the Dumagats of Tanay, Rizal and Their Implications to the Delivery of Extension and Advisory Services
Authors: Janika Vien K. Valsorable, Filma C. Calalo
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Climate change is one of the most damaging and serious environmental threats worldwide being faced today. While almost everyone highly depends and puts their trust on what technology, innovations, and initiatives from hard-core science can do to cope with the changing climate, there are still people who find hope on indigenous knowledge systems. The study aimed to analyze the traditional farming practices of the Dumagats in Tanay, Rizal and how these relate to their adaptation and mitigation of climate change. The analysis is based on interviews with 17 members of the Dumagat tribe specifically residing in Barangay Cuyambay, San Andres, and Mamuyao, and supported by Key Informant Interview and Focus Group Discussion as well as document reviews. Results of the study showed that the Dumagats adopt indigenous knowledge systems and their high sensitivity and resilience to climate change aid them in their farming system and activities. These traditional farming practices are exemplified from land preparation to planting, fertilizer application, weed and pest management, harvesting and post-harvest activities. Owing to their dependence upon, and close relationship with the environment and its resources, the Dumagats have learned to interpret and react to the impacts of climate change in creative ways, drawing on their traditional knowledge to cope with the impending changes. With the increasing trend at all levels of government to service the needs of rural communities, there is the need for the extension to contextualize advisory service delivery for indigenous communities.Keywords: climate change, Dumagat tribe, indigenous knowledge systems, traditional farming practices
Procedia PDF Downloads 2643889 Using a Simulated Learning Environment to Teach Pre-Service Special Educators Behavior Management
Authors: Roberta Gentry
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A mixed methods study that examined candidate’s perceptions of the use of computerized simulation as an effective tool to learn classroom management will be presented. The development, implementation, and assessment of the simulation and candidate data on the feasibility of the approach in comparison to other methods will be presented.Keywords: behavior management, simulations, teacher preparation, teacher education
Procedia PDF Downloads 4023888 Rapid Sexual and Reproductive Health Pathways for Women Accessing Drug and Alcohol Treatment
Authors: Molly Parker
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Unintended pregnancy rates in Australia are amongst the highest in the developed world. Women with Substance Use Disorder often have riskier sexual behavior with nil contraceptive use and face disproportionately higher unintended pregnancies and Sexually Transmitted Infections, alongside Substance Use in Pregnancy (SUP) climbing at an alarming rate. In an inner-city Drug and Alcohol (D&A) service, significant barriers to sexual and reproductive health services have been identified, aligning with research. Rapid pathways were created for women seeking D&A treatment to be referred to Sexual and Reproductive Health services for the administration of Long-acting reversible contraception (LARC) and sexual health screening. For clients attending a D&A service, this is an opportunistic time to offer sexual and reproductive health services. Collaboration and multidisciplinary team input between D&A and sexual health and reproductive services are paramount, with rapid referral pathways being identified as the main strategy to improve access to sexual and reproductive health support for this population. With this evidence, a rapid referral pathway was created for women using the D&A service to access LARC, particularly in view of fertility often returning once stable on D&A treatment. A closed-ended survey was used for D&A staff to identify gaps in reproductive health knowledge and views of referral accessibility. Results demonstrated a lack of knowledge of contraception and appropriate referral processes. A closed-ended survey for clients was created to establish the need and access to services and to quantify data. A follow-up data collection will be reviewed to access uptake and satisfaction of the intervention from clients. Sexual health screening access was also identified as a deficit, particularly concerning due to the higher rates of STIs in this cohort. A rapid referral pathway will be undergoing implementation, reducing risks of untreated STIS both pre and post-conception. Similarly, pre and post-intervention structured surveys will be used to identify client satisfaction from the pathway. Although currently in progress, the research and pathway aim to be completed by December 2023. This research and implementation of sexual and reproductive health pathways from the D&A service have significant health and well-being benefits to clients and the wider community, including possible fetal/infancy outcomes. Women now have rapid access to sexual and reproductive health services, with the aim of reducing unplanned pregnancies, poor outcomes associated with SUP, client/staff trauma from termination of pregnancy, and client/staff trauma following the assumption of care of the child due to substance use, the financial cost for out of home care as required, the poor outcomes of untreated STIs to the fetus in pregnancy and the spread of STIs in the wider community. As evidence suggests, the implementation of a streamlined referral process is required between D&A and sexual and reproductive health services and has positive feedback from both clinicians and clients in improving care.Keywords: substance use in pregnancy, drug and alcohol, substance use disorder, sexual health, reproductive health, contraception, long-acting reversible contraception, neonatal abstinence syndrome, FASD, sexually transmitted infections, sexually transmitted infections pregnancy
Procedia PDF Downloads 653887 Procedure to Use Quantitative Bone-Specific SPECT/CT in North Karelia Central Hospital
Authors: L. Korpinen, P. Taskinen, P. Rautio
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This study aimed to describe procedures that we developed to use in the quantitative, bone-specific SPECT/CT at our hospital. Our procedures included the following questions for choosing imaging protocols, which were based on a clinical doctor's referral: (1) Is she/he a cancer patient or not? (2) Are there any indications of inflammatory rheumatoid arthritis? We performed about 1,106 skeletal scintigraphies over two years. About 394 patients were studied with quantitative bone-specific single-photon emission computed tomography/computerized tomography (SPECT/CT) (i.e., about 36% of all bone scintigraphies). Approximately 64% of the patients were studied using the conventional Anterior-Posterior/Posterior-Anterior imaging. Our procedure has improved efficiency and decreased cycle times.Keywords: skeletal scintigraphy, SPECT/CT, imaging, procedure
Procedia PDF Downloads 1523886 Health Care using Queuing Theory
Authors: S. Vadivukkarasi, K. Karthi, M. Karthick, C. Dinesh, S. Santhosh, A. Yogaraj
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The appointment system was designed to minimize patient’s idle time overlooking patients waiting time in hospitals. This is no longer valid in today’s consumer oriented society. Long waiting times for treatment in the outpatient department followed by short consultations has long been a complaint. Nowadays, customers use waiting time as a decisive factor in choosing a service provider. Queuing theory constitutes a very powerful tool because queuing models require relatively little data and are simple and fast to use. Because of this simplicity and speed, modelers can be used to quickly evaluate and compare various alternatives for providing service. The application of queuing models in the analysis of health care systems is increasingly accepted by health care decision makers. Timely access to care is a key component of high-quality health care. However, patient delays are prevalent throughout health care systems, resulting in dissatisfaction and adverse clinical consequences for patients as well as potentially higher costs and wasted capacity for providers. Arguably, the most critical delays for health care are the ones associated with health care emergencies. The allocation of resources can be divided into three general areas: bed management, staff management, and room facility management. Effective and efficient patient flow is indicated by high patient throughput, low patient waiting times, a short length of stay at the hospital and overtime, while simultaneously maintaining adequate staff utilization rates and low patient’s idle times.Keywords: appointment system, patient scheduling, bed management, queueing calculation, system analysis
Procedia PDF Downloads 3003885 Potentials of Underutilised Crops in the Nigerian Farming Systems for Sustainable Food Production and Economic Empowerment
Authors: Jesse Silas Mshelia, Michael Mamman Degri, Akeweta Emmanuel Samaila
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This review was conducted in the North-Eastern part of Nigeria where there are a lot of challenges of poverty and low level of productivity of farmlands as a result of dwindling soil fertility and dependence on crops that are not so much adopted to the soil and climatic condition and the prevailing farming systems of the area which is predominantly mixed cropping. The crops that are neglected are well fitted into this system of production and yield better with the low level of input and management and give a higher profit margin. These crops, the farmers have mastered the production techniques, but do not have the scientific knowledge to improve the quality of the seed and the products hence need the intervention of modern technologies to benefit maximally from the full potentials of these crops.Keywords: farming systems, neglected crops, potentials, underutilised
Procedia PDF Downloads 3753884 Exploration of a Blockchain Assisted Framework for Through Baggage Interlining: Blocklining
Authors: Mary Rose Everan, Michael McCann, Gary Cullen
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International travel journeys, by their nature, incorporate elements provided by multiple service providers such as airlines, rail carriers, airports, and ground handlers. Data needs to be stored by and exchanged between these parties in the process of managing the journey. The fragmented nature of this shared management of mutual clients is a limiting factor in the development of a seamless, hassle-free, end-to-end travel experience. Traditional interlining agreements attempt to facilitate many separate aspects of co-operation between service providers, typically between airlines and, to some extent, intermodal travel operators, including schedules, fares, ticketing, through check-in, and baggage handling. These arrangements rely on pre-agreement. The development of Virtual Interlining - that is, interlining facilitated by a third party (often but not always an airport) without formal pre-agreement by the airlines or rail carriers - demonstrates an underlying demand for a better quality end-to-end travel experience. Blockchain solutions are being explored in a number of industries and offer, at first sight, an immutable, single source of truth for this data, avoiding data conflicts and misinterpretation. Combined with Smart Contracts, they seemingly offer a more robust and dynamic platform for multi-stakeholder ventures, and even perhaps the ability to join and leave consortia dynamically. Applying blockchain to the intermodal interlining space – termed Blocklining in this paper - is complex and multi-faceted because of the many aspects of cooperation outlined above. To explore its potential, this paper concentrates on one particular dimension, that of through baggage interlining.Keywords: aviation, baggage, blocklining, intermodal, interlining
Procedia PDF Downloads 1463883 Tele-Rehabilitation for Multiple Sclerosis: A Case Study
Authors: Sharon Harel, Rachel Kizony, Yoram Feldman, Gabi Zeilig, Mordechai Shani
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Multiple Sclerosis (MS) is a neurological disease that may cause restriction in participation in daily activities of young adults. Main symptoms include fatigue, weakness and cognitive decline. The appearance of symptoms, their severity and deterioration rate, change between patients. The challenge of health services is to provide long-term rehabilitation services to people with MS. The objective of this presentation is to describe a course of tele-rehabilitation service of a woman with MS. Methods; R is a 48 years-old woman, diagnosed with MS when she was 22. She started to suffer from weakness of her non-dominant left upper extremity about ten years after the diagnosis. She was referred to the tele-rehabilitation service by her rehabilitation team, 16 years after diagnosis. Her goals were to improve ability to use her affected upper extremity in daily activities. On admission her score in the Mini-Mental State Exam was 30/30. Her Fugl-Meyer Assessment (FMA) score of the left upper extremity was 48/60, indicating mild weakness and she had a limitation of her shoulder abduction (90 degrees). In addition, she reported little use of her arm in daily activities as shown in her responses to the Motor Activity Log (MAL) that were equal to 1.25/5 in amount and 1.37 in quality of use. R. received two 30 minutes on-line sessions per week in the tele-rehabilitation service, with the CogniMotion system. These were complemented by self-practice with the system. The CogniMotion system provides a hybrid (synchronous-asynchronous), the home-based tele-rehabilitation program to improve the motor, cognitive and functional status of people with neurological deficits. The system consists of a computer, large monitor, and the Microsoft’s Kinect 3D sensor. This equipment is located in the client’s home and connected to a clinician’s computer setup in a remote clinic via WiFi. The client sits in front of the monitor and uses his body movements to interact with games and tasks presented on the monitor. The system provides feedback in the form of ‘knowledge of results’ (e.g., the success of a game) and ‘knowledge of performance’ (e.g., alerts for compensatory movements) to enhance motor learning. The games and tasks were adapted for R. motor abilities and level of difficulty was gradually increased according to her abilities. The results of her second assessment (after 35 on-line sessions) showed improvement in her FMA score to 52 and shoulder abduction to 140 degrees. Moreover, her responses to the MAL indicated an increased amount (2.4) and quality (2.2) of use of her left upper extremity in daily activities. She reported high level of enjoyment from the treatments (5/5), specifically the combination of cognitive challenges while moving her body. In addition, she found the system easy to use as reflected by her responses to the System Usability Scale (85/100). To-date, R. continues to receive treatments in the tele-rehabilitation service. To conclude, this case report shows the potential of using tele-rehabilitation for people with MS to provide strategies to enhance the use of the upper extremity in daily activities as well as for maintaining motor function.Keywords: motor function, multiple-sclerosis, tele-rehabilitation, daily activities
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