Search results for: learners' difficulties
351 Intensive Multidisciplinary Feeding Intervention for a Toddler with In-Utero Drug Exposure
Authors: Leandra Prempeh, Emily Malugen
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Prenatal drug exposure can have a molecular impact on the hypothalamic and reward genes that regulate feeding behavior. This can impact feeding regulation, resulting in feeding difficulties and growth failure. This was potentially seen in “McKayla,” a 19- month old girl with a history of in-utero drug exposure, patent ductus arteriosus, and gastroesophageal reflux disease who presented for intensive day treatment feeding therapy. She was diagnosed with Avoidant Restrictive Food Intake Disorder, described as total food refusal and meeting 100% of her caloric needs from a gastrostomy tube. The primary goals during intensive feeding therapy were to increase her oral intake and decrease her reliance on supplementation with formula. Several behavioral antecedent manipulations were implemented to establish consistent responding and make progress towards treatment goals. This included multiple modified bolus placements (using underloaded and Nuk brush), reinforcement contingencies, and variety fading before stability was finally achieved. Following, increasing retention of bites then increasing volume and variety were goals targeted. From treatment onset to the last 3 days of treatment, McKayla's rate of rapid acceptance of bite presentations increased significantly from 33.33% to 93.13%, rapid swallowing went from 0.00% to 92.32%, and her percentage of inappropriate mealtime behavior and expels decreased from 58.33% and 100% to 2.31% and 7.68%, respectively. Overall, the treatment team successfully introduced and increased the bite size of 7 pureed foods, generalize the treatment to caregivers with high integrity, and began facilitating tube weaning. She was receiving about 33.42% of her needs by mouth at the time of discharge. Other nutritional concerns addressed during treatment included drinking a nutritionally complete drink out of an open cup and age appropriate growth. McKayla continued to have emesis almost daily, as was her baseline before starting treatment; however, the frequency during mealtime decreased. Overall, McKayla responded well to treatment. She had a very slow response to treatment and required a lot of antecedent manipulations to establish consistent responding. As the literature suggests, [drug]-exposed neonates, like McKayla, may be at increased risk for nutritional and growth challenges that may persist throughout development. This supports the need for longterm follow-up of infant growth.Keywords: behavioral intervention, feeding problems, in-utero drug exposure, intensive multidisciplinary intervention
Procedia PDF Downloads 57350 Israeli Households Caring for Children and Adults with Intellectual and Developmental Disabilities: An Explorative Study
Authors: Ayelet Gur
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Background: In recent years we are witnessing a welcome trend in which more children/persons with disabilities are living at home with their families and within their communities. This trend is related to various policy innovations as the UN Convention on the Rights of People with Disabilities that reflect a shift from the medical-institutional model to a human rights approach. We also witness the emergence of family centered approaches that perceive the family and not just the individual with the disability as a worthy target of policy planning, implementation and evaluation efforts. The current investigation aims to explore economic, psychological and social factors among households of families of children or adults with intellectual disabilities in Israel and to present policy recommendation. Methods: A national sample of 301 households was recruited through the education and employment settings of persons with intellectual disability. The main caregiver of the person with the disability (a parent) was interviewed. Measurements included the income and expense surveys; assets and debts questionnaire; the questionnaire on resources and stress; the social involvement questionnaire and Personal Wellbeing Index. Results: Findings indicate significant gaps in financial circumstances between households of families of children with intellectual disabilities and households of the general Israeli society. Households of families of children with intellectual disabilities report lower income and higher expenditures and loans than the general society. They experience difficulties in saving and coping with unexpected expenses. Caregivers (the parents) experience high stress, low social participation, low financial support from family, friend and non-governmental organizations and decreased well-being. They are highly dependent on social security allowances which constituted 40% of the household's income. Conclusions: Households' dependency on social security allowances may seem contradictory to the encouragement of persons with intellectual disabilities to favor independent living in light of the human rights approach to disability. New policy should aim at reducing caregivers' stress and enhance their social participation and support, with special emphasis on families of lower socio-economic status. Finally, there is a need to continue monitoring the economic and psycho-social needs of households of families of children with intellectual disabilities and other developmental disabilities.Keywords: disability policy, family policy, intellectual and developmental disabilities, Israel, households study, parents of children with disabilities
Procedia PDF Downloads 150349 Architecture for Hearing Impaired: A Study on Conducive Learning Environments for Deaf Children with Reference to Sri Lanka
Authors: Champa Gunawardana, Anishka Hettiarachchi
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Conducive Architecture for learning environments is an area of interest for many scholars around the world. Loss of sense of hearing leads to the assumption that deaf students are visual learners. Comprehending favorable non-hearing attributes of architecture can lead to effective, rich and friendly learning environments for hearing impaired. The objective of the current qualitative investigation is to explore the nature and parameters of a sense of place of deaf children to support optimal learning. The investigation was conducted with hearing-impaired children (age: between 8-19, Gender: 15 male and 15 female) of Yashodhara deaf and blind school at Balangoda, Sri Lanka. A sensory ethnography study was adopted to identify the nature of perception and the parameters of most preferred and least preferred spaces of the learning environment. The common perceptions behind most preferred places in the learning environment were found as being calm and quiet, sense of freedom, volumes characterized by openness and spaciousness, sense of safety, wide spaces, privacy and belongingness, less crowded, undisturbed, availability of natural light and ventilation, sense of comfort and the view of green colour in the surroundings. On the other hand, the least preferred spaces were found to be perceived as dark, gloomy, warm, crowded, lack of freedom, smells (bad), unsafe and having glare. Perception of space by deaf considering the hierarchy of sensory modalities involved was identified as; light - color perception (34 %), sight - visual perception (32%), touch - haptic perception (26%), smell - olfactory perception (7%) and sound – auditory perception (1%) respectively. Sense of freedom (32%) and sense of comfort (23%) were the predominant psychological parameters leading to an optimal sense of place perceived by hearing impaired. Privacy (16%), rhythm (14%), belonging (9%) and safety (6%) were found as secondary factors. Open and wide flowing spaces without visual barriers, transparent doors and windows or open port holes to ease their communication, comfortable volumes, naturally ventilated spaces, natural lighting or diffused artificial lighting conditions without glare, sloping walkways, wider stairways, walkways and corridors with ample distance for signing were identified as positive characteristics of the learning environment investigated.Keywords: deaf, visual learning environment, perception, sensory ethnography
Procedia PDF Downloads 223348 Visual Aid and Imagery Ramification on Decision Making: An Exploratory Study Applicable in Emergency Situations
Authors: Priyanka Bharti
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Decades ago designs were based on common sense and tradition, but after an enhancement in visualization technology and research, we are now able to comprehend the cognitive ability involved in the decoding of the visual information. However, many fields in visuals need intense research to deliver an efficient explanation for the events. Visuals are an information representation mode through images, symbols and graphics. It plays an impactful role in decision making by facilitating quick recognition, comprehension, and analysis of a situation. They enhance problem-solving capabilities by enabling the processing of more data without overloading the decision maker. As research proves that, visuals offer an improved learning environment by a factor of 400 compared to textual information. Visual information engages learners at a cognitive level and triggers the imagination, which enables the user to process the information faster (visuals are processed 60,000 times faster in the brain than text). Appropriate information, visualization, and its presentation are known to aid and intensify the decision-making process for the users. However, most literature discusses the role of visual aids in comprehension and decision making during normal conditions alone. Unlike emergencies, in a normal situation (e.g. our day to day life) users are neither exposed to stringent time constraints nor face the anxiety of survival and have sufficient time to evaluate various alternatives before making any decision. An emergency is an unexpected probably fatal real-life situation which may inflict serious ramifications on both human life and material possessions unless corrective measures are taken instantly. The situation demands the exposed user to negotiate in a dynamic and unstable scenario in the absence or lack of any preparation, but still, take swift and appropriate decisions to save life/lives or possessions. But the resulting stress and anxiety restricts cue sampling, decreases vigilance, reduces the capacity of working memory, causes premature closure in evaluating alternative options, and results in task shedding. Limited time, uncertainty, high stakes and vague goals negatively affect cognitive abilities to take appropriate decisions. More so, theory of natural decision making by experts has been understood with far more depth than that of an ordinary user. Therefore, in this study, the author aims to understand the role of visual aids in supporting rapid comprehension to take appropriate decisions during an emergency situation.Keywords: cognition, visual, decision making, graphics, recognition
Procedia PDF Downloads 263347 Small Community’s Proactive Thinking to Move from Zero to 100 Percent Water Reuse
Authors: Raj Chavan
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The City of Jal serves a population of approximately 3,500 people, including 2,100 permanent inhabitants and 1,400 oil and gas sector workers and RV park occupants. Over the past three years, Jal's population has increased by about 70 percent, mostly due to the oil and gas industry. The City anticipates that the population will exceed 4,200 by 2020, necessitating the construction of a new wastewater treatment plant (WWTP) because the old plant (aerated lagoon system) cannot accommodate such rapid population expansion without major renovations or replacement. Adhering to discharge permit restrictions has been challenging due to aging infrastructure and equipment replacement needs, as well as increasing nutrient loading to the wastewater collecting system from the additional oil and gas residents' recreational vehicles. The WWTP has not been able to maintain permit discharge standards for total nitrogen of less than 20 mg N/L and other characteristics in recent years. Based on discussions with the state's environmental department, it is likely that the future permit renewal would impose stricter conditions. Given its location in the dry, western part of the country, the City must rely on its meager groundwater supplies and scant annual precipitation. The city's groundwater supplies will be depleted sooner than predicted due to rising demand from the growing population for drinking, leisure, and other industrial uses (fracking). The sole type of reuse the city was engaging in (recreational reuse for a golf course) had to be put on hold because of an effluent water compliance issue. As of right now, all treated effluent is evaporated. The city's long-term goal is to become a zero-waste community that sends all of its treated wastewater effluent either to the golf course, Jal Lake, or the oil and gas industry for reuse. Hydraulic fracturing uses a lot of water, but if the oil and gas industry can use recycled water, it can reduce its impact on freshwater supplies. The City's goal of 100% reuse has been delayed by the difficulties of meeting the constraints of the regular discharge permit due to the large rise in influent loads and the aging infrastructure. The City of Jal plans to build a new WWTP that can keep up with the city's rapid population increase due to the oil and gas industry. Several treatment methods were considered in light of the City's needs and its long-term goals, but MBR was ultimately chosen recommended since it meets all of the permit's requirements while also providing 100 percent beneficial reuse. This talk will lay out the plan for the city to reach its goal of 100 percent reuse, as well as the various avenues for funding the small community that have been considered.Keywords: membrane bioreactor, nitrogent, reuse, small community
Procedia PDF Downloads 81346 Sexual Diversity Training for Hong Kong Teachers Preliminary Themes Identified from Qualitative Interviews
Authors: Diana K. Kwok
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Despite the fact that Hong Kong government aims to develop an inclusive society, sexual minority students continue to encounter sexual prejudice without legal protection. They also have difficulties accessing relevant services from mental health and educational professionals, who do not receive systematic training to work with sexual minority students. Informed by the literature on sexual prejudice, heterosexual hegemony, genderism, as well as code of practice for frontline practitioners, the authors explored self-perceived knowledge of teachers and sexual minorities on sexuality and sexual prejudice, and how they perceive prejudice towards sexual minorities in Chinese cultural context. Semi-structure qualitative interviews were carried out with 31 school personnel informants (school teachers and counseling team members) and 25 sexual minority informants on their understanding of sexuality knowledge, their perception of sexual prejudice within school context in Hong Kong, as well as their suggested themes on teachers training on sexual prejudice reduction. This presentation specifically focuses on transcripts from sexual minority informants. Data analysis was carried out through NVivo, and followed the procedures spelt out in the qualitative research literature. Trustworthiness of the study was addressed through various strategies. Preliminary themes emerged from transcript content analysis: 1) A gap of knowledge between sexual minority informants and teachers; 2) Perception on sexual prejudice within cultural context; 3) Heterosexual hegemony and genderism within school system; 4) Needs for mandatory training: contents and strategies. The sexual minority informants found that teachers they encountered were predominantly adopted concepts of binary sex and dichotomous gender. Informants also indicated that the teachings of Confucianism cultural values, religiosity in Hong Kong might well be important cultural forces contributing to sexual prejudice manifested in school context. Although human rights and social justice concepts were embedded in professional code of practice of teachers and school helping professionals, informants found that teachers they encountered may face a dilemma when supporting sexual minority students navigating heterosexual hegemony and genderism in, as a consequence of their personal, institutional, cultural and religious backgrounds. Acknowledgments: The sexual prejudice project was funded by the Hong Kong Research Grant Council (ECS28401614), 2015 to 2017.Keywords: sexual prejudice, Chinese teachers, Chinese sexual minorities, teacher training
Procedia PDF Downloads 278345 The Supply Chain Operation Reference Model Adaptation in the Developing Countries: An Empirical Study on the Egyptian Automotive Sector
Authors: Alaa Osman, Sara Elgazzar, Breksal Elmiligy
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The Supply Chain Operation Reference (SCOR) model is considered one of the most widely implemented supply chain performance measurement systems (SCPMSs). Several studies have been proposed on the SCOR model adaptation in developed countries context; while there is a limited availability of previous work on the SCPMSs application generally and the SCOR model specifically in developing nations. This paper presents a research agenda on the SCOR model adaptation in the developing countries. It aims at investigating the challenges of adapting the SCOR model to manage and measure supply chain performance in developing countries. The research will exemplify the system in the Egyptian automotive sector to gain a comprehensive understanding of how the application of the SCOR model can affect the performance of automotive companies in Egypt, with a necessary understanding of challenges and obstacles faced the adaptation of the model in the Egyptian supply chain context. An empirical study was conducted on the Egyptian automotive sector in three companies considering three different classes: BMW, Hyundai and Brilliance. First, in-depth interviews were carried out to gain an insight into the implementation and the relevance of the concepts of supply chain management and performance measurement in the Egyptian automotive industry. Then, a formal survey was designed based on the SCOR model five main processes (plan, source, make, deliver and return) and best practices to investigate the challenges and obstacles faced the adaptation of the SCOR model in the Egyptian automotive supply chain. Finally, based on the survey results, the appropriate best practices for each process were identified in order to overcome the SCOR model adaptation challenges. The results showed that the implementation of the SCOR model faced different challenges and unavailability of the required enablers. The survey highlighted the low integration of end-to-end supply chain, lacks commitment for the innovative ideas and technologies, financial constraints and lack of practical training and support as the main challenges faced the adaptation of the SCOR model in the Egyptian automotive supply chain. The research provides an original contribution to knowledge by proposing a procedure to identify challenges encountered during the process of SCOR model adoption which can pave a way for further research in the area of SCPMSs adaptation, particularly in the developing countries. The research can help managers and organizations to identify obstacles and difficulties of the SCOR model adaptation, subsequently this can facilitate measuring the improved performance or changes in the organizational performance.Keywords: automotive sector, developing countries, SCOR model, supply chain performance
Procedia PDF Downloads 364344 Empirical Studies of Indigenous Career Choice in Taiwan
Authors: Zichun Chu
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The issue of tribal poverty has always attracted attentions. Due to social and economic difficulties, the indigenous people's personal development and tribal development have been greatly restricted. Past studies have pointed out that poverty may come from a lack of education. The United Nations Sustainable Development Goals (SDGs) also stated that if we are to solve the poverty problem, providing education widely is an important key. According to the theory of intellectual capital adaptation, “being capable” and “willing to do” are the keys of development. Therefore, we can say that the "ability" and "will" of tribal residents for their tribal development is the core concern of the tribal development. This research was designed to investigate the career choice development model of indigenous tribe people by investigating the current status of human capital, social capital, and cultural capital of tribal residents. This study collected 327 questionnaires (70% of total households) from Truku tribe to answer the research question: Did education help them for job choosing decisions from the aspects of human capital, social capital, and cultural capital in tribal status. This project highlighted the ‘single tribal research approach’ to gain an in-depth understanding of the human capital formed under the unique culture of the tribe (Truku tribe). The results show that the education level of most research participants was high school, very few high school graduates chose to further their education to college level; due to the lack of education of their parents, the social capital was limited to support them for jobs choice, most of them work for labor and service industries; however, their culture capital was comparably rich for works, the sharing culture of Taiwanese indigenous people made their work status stable. The results suggested that we should emphasize more on the development of vocational education based on the tribe’s location and resources. The self-advocacy of indigenous people should be developed so that they would gain more power on making career decisions. This research project is part of a pilot project called “INDIGENOUS PEOPLES, POVERTY, AND DEVELOPMENT,” sponsored by the National Science and Technology Council of Taiwan. If this paper were accepted to present in the 2023 ICIP, it would be lovely if a panel is formed for me and other co-researchers (Chuanju Cheng, Chih-Yuan Weng, and YiXuan Chen), for the audience will be able to get a full picture of this pilot project.Keywords: career choices, career model, indegenous career development, indigenous education, tribe
Procedia PDF Downloads 73343 Knowledge about Dementia: Why Should Family Caregivers Know that Dementia is a Terminal Disease?
Authors: Elzbieta Sikorska-Simmons
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Dementia is a progressive terminal disease. Despite this recognition, research shows that most family caregivers do not know it, and it is unclear how this knowledge affects the quality of patient care. The aim of this qualitative study of 20 family caregivers for patients with advanced dementia is to examine how the caregiver's knowledge about dementia affects the quality of patient care in the context of healthcare decision-making, advanced care planning, and access to adequate support systems. Knowledge about dementia implies family caregivers' understanding of dementia trajectories, common symptoms/complications, and alternative treatment options (e.g., comfort feeding versus tube feeding). Data were collected in semi-structured interviews with 20 family caregivers. The interviews were conducted in person by the author and designed to elicit rich descriptions of family caregivers' experiences with healthcare decision-making and the management of common symptoms/complications of end-stage dementia as patient healthcare proxies. The study findings suggest that caregivers who recognize that dementia is a terminal disease are less likely to opt for life-extending treatments during the advanced stages. They are also more likely to seek palliative/hospice care, and consequently, they are better able to avoid unnecessary hospitalizations or medical procedures. For example, those who know that dementia is a terminal disease tend to opt for "comfort feeding" rather than "tube feeding" in managing the swallowing difficulties that accompany advanced dementia. In the context of advance care planning, family caregivers who know that dementia is a terminal disease tend to have more meaningful advance directives (e.g., Power of Attorney and Do Not Resuscitate orders). They are better prepared to anticipate common problems and pursue treatments that foster the best quality of patient life and care. Greater knowledge about advanced dementia helps them make more informed decisions that focus on enhancing the quality of patient life rather than just survival. In addition, those who know that dementia is a terminal disease are more likely to establish adequate support systems to help them cope with the complex demands of caregiving. For example, they are more likely to seek dementia-oriented primary care programs that offer house visits or respite services. Based on the study findings, knowledge about dementia as a terminal disease is critical in the optimal management of patient care needs and the establishment of adequate support systems. More research is needed to better understand what caregivers need to know to better prepare them for the complex demands of dementia caregiving.Keywords: dementia education, family caregiver, management of dementia, quality of care
Procedia PDF Downloads 92342 Genetic Advance versus Environmental Impact toward Sustainable Protein, Wet Gluten and Zeleny Sedimentation in Bread and Durum Wheat
Authors: Gordana Branković, Dejan Dodig, Vesna Pajić, Vesna Kandić, Desimir Knežević, Nenad Đurić
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The wheat grain quality properties are influenced by genotype, environmental conditions and genotype × environment interaction (GEI). The increasing request of more nutritious wheat products will direct future breeding programmes. Therefore, the aim of investigation was to determine: i) variability of the protein content (PC), wet gluten content (WG) and Zeleny sedimentation volume (ZS); ii) components of variance, heritability in a broad sense (hb2), and expected genetic advance as percent of mean (GAM) for PC, WG, and ZS; iii) correlations between PC, WG, ZS, and most important agronomic traits; in order to assess expected breeding success versus environmental impact for these quality traits. The plant material consisted of 30 genotypes of bread wheat (Triticum aestivum L. ssp. aestivum) and durum wheat (Triticum durum Desf.). The trials were sown at the three test locations in Serbia: Rimski Šančevi, Zemun Polje and Padinska Skela during 2010-2011 and 2011-2012. The experiments were set as randomized complete block design with four replications. The plot consisted of five rows of 1 m2 (5 × 0.2 m × 1 m). PC, WG and ZS were determined by the use of Near infrared spectrometry (NIRS) with the Infraneo analyser (Chopin Technologies, France). PC, WG and ZS, in bread wheat, were in the range 13.4-16.4%, 22.8-30.3%, and 39.4-67.1 mL, respectively, and in durum wheat, in the range 15.3-18.1%, 28.9-36.3%, 37.4-48.3 mL, respectively. The dominant component of variance for PC, WG, and ZS, in bread wheat, was genotype with the genetic variance/GEI variance (VG/VG × E) relation of 3.2, 2.9 and 1.0, respectively, and in durum wheat was GEI with the VG/VG × E relation of 0.70, 0.69 and 0.49, respectively. hb2 and GAM values for PC, WG and ZS, in bread wheat, were 94.9% and 12.6%, 93.7% and 18.4%, and 86.2% and 28.1%, respectively, and in durum wheat, 80.7% and 7.6%, 79.7% and 10.2%, and 74% and 11.2%, respectively. The most consistent through six environments, statistically significant correlations, for bread wheat, were between PC and spike length (-0.312 to -0.637); PC, WG, ZS and grain number per spike (-0.320 to -0.620; -0.369 to -0.567; -0.301 to -0.378, respectively); PC and grain thickness (0.338 to 0.566), and for durum wheat, were between PC, WG, ZS and yield (-0.290 to -0.690; -0.433 to -0.753; -0.297 to -0.660, respectively); PC and plant height (-0.314 to -0.521); PC, WG and spike length (-0.298 to -0.597; -0.293 to -0.627, respectively); PC, WG and grain thickness (0.260 to 0.575; 0.269 to 0.498, respectively); PC, WG and grain vitreousness (0.278 to 0.665; 0.357 to 0.690, respectively). Breeding success can be anticipated for ZS in bread wheat due to coupled high values for hb2 and GAM, suggesting existence of additive genetic effects, and also for WG in bread wheat, due to very high hb2 and medium high GAM. The small, and medium, negative correlations between PC, WG, ZS, and yield or yield components, indicate difficulties to select simultaneously for high quality and yield, depending on linkage for particular genetic arrangements to be broken by recombination.Keywords: bread and durum wheat, genetic advance, protein and wet gluten content, Zeleny sedimentation volume
Procedia PDF Downloads 243341 Comparison of Effectiveness When Ketamine was Used as an Adjuvant in Intravenous Patient-Controlled Analgesia Used to Control Cancer Pain
Authors: Donghee Kang
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Background: Cancer pain is very difficult to control as the mechanism of pain is varied, and the patient has several co-morbidities. The use of Intravenous Patient-Controlled Analgesia (IV-PCA) can effectively control underlying pain and breakthrough pain. Ketamine is used in many pain patients due to its unique analgesic effect. In this study, it was checked whether there was a difference in the amount of analgesic usage, pain control degree, and side effects between patients who controlled pain with fentanyl-based IV-PCA and those who added Ketamine for pain control. Methods: Among the patients referred to this department for cancer pain, IV-PCA was applied to patients who were taking sufficient oral analgesics but could not control them or had blood clotting disorders that made the procedure difficult, and this patient group was targeted. In IV-PCA, 3000 mcg of Fentanyl, 160 mg of Nefopam, and 0.3 mg of Ramosetrone were mixed with normal saline to make a total volume of 100 ml. Group F used this IV-PCA as it is, and group K mixed 250 mg of Ketamine with normal saline to make a total volume of 100 ml. For IV-PCA, the basal rate was 0.5ml/h, the bolus was set to 1ml when pressed once, and the lockout time was set to 15 minutes. If pain was not controlled after IV-PCA application, 500 mcg of Fentanyl was added, and if excessive sedation or breathing difficulties occurred, the use was stopped for one hour. After that, the degree of daily pain control, analgesic usage, and side effects were investigated for seven days using this IV-PCA. Results: There was no difference between the two groups in the demographic data. Both groups had adequate pain control. Initial morphine milligram equivalents did not differ between the two groups, but the total amount of Fentanyl used for seven days was significantly different between the two groups [p=0.014], and group F used more Fentanyl through IV-PCA. In addition, the amount of sleeping pills used during the seven days was higher in Group F [p<0.01]. Overall, there was no difference in the frequency of side effects between the two groups, but the nausea was more frequent in Group F [p=0.031]. Discussion: When the two groups were compared, pain control was good in both groups. This seems to be because Fentanyl-based IV-PCA showed an adequate pain control effect. However, there was a significant difference in the total amount of opioid (Fentanyl) used, which is thought to be the opioid-sparing effect of Ketamine. Also, among the side effects, nausea was significantly less, which is thought to be possible because the amount of opioids used in the Ketamine group was small. The frequency of requesting sleeping pills was significantly less in the group using Ketamine, and it seems that Ketamine also helped improve sleep quality. In conclusion, using Ketamine with an opioid to control pain seems to have advantages. IV-PCA, which can be used effectively when other procedures are difficult, is more effective and safer when used together with Ketamine than opioids alone.Keywords: cancer pain, intravenous patient-controlled analgesia, Ketamine, opioid
Procedia PDF Downloads 77340 Male-Youth-Related Sexual and Reproductive Health and Rights Interventions in Bangladesh: Challenges of Program Implementation
Authors: Nahela Nowshin, Rafia Sultana, Farzana Misha, Sabina F. Rashid
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Sexual and reproductive health and rights (SRHR) are currently an area of neglect for males (aged 15-24 years) in Bangladesh. The lack of focus on the male youth population has consequences not only for their own health and wellbeing, but the patriarchal structure of Bangladeshi society and socio-cultural norms mean that the male population’s SRH behavior can severely impact the lives of their female counterparts. A majority of sexual and reproductive health and rights-related research and interventions in the country are female-centric. Although the Government of Bangladesh has taken many initiatives to improve the SRHR of the general population, the male youth segment has not been prioritized in most of these interventions. There is an urgent need for male-youth-focused SRHR interventions in Bangladesh, but due to a lack of evidence-based research on this issue, there exist data gaps on how such interventions could be better designed and implemented. Therefore, to ascertain strategies for better program design and smoother implementation of male-youth-focused sexual and reproductive health and rights interventions, we carried out 25 key informant interviews with experts as well as focal persons involved in more than 20 ongoing and recently-ended SRHR-related interventions of national and international non-government organizations in which male youth were targeted or engaged. The results show that program implementers face several challenges at the field, organizational and policy levels. Some of the most common field challenges include high sensitivity to SRHR topics due to cultural reasons, difficulties in acquiring access to boys and young men due to their high mobility and engagement in labor for commercial purposes, as well as accessing them in hard-to-reach areas due to transportation and communication issues. Common organizational-level challenges include a lack of skilled manpower. Policy-level challenges include the prohibition of SRH service provision to unmarried adolescents and youth and lack of readiness of local governments to implement existing action plans. Some ways in which male-youth-focused SRHR interventions can be made more effective are through sensitization of service providers, awareness-raising at the community level to engage parents, advocacy to increase donor interest, and generating data on SRHR of male youth.Keywords: Bangladesh, intervention, male, SRHR
Procedia PDF Downloads 119339 Metadiscourse in EFL, ESP and Subject-Teaching Online Courses in Higher Education
Authors: Maria Antonietta Marongiu
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Propositional information in discourse is made coherent, intelligible, and persuasive through metadiscourse. The linguistic and rhetorical choices that writers/speakers make to organize and negotiate content matter are intended to help relate a text to its context. Besides, they help the audience to connect to and interpret a text according to the values of a specific discourse community. Based on these assumptions, this work aims to analyse the use of metadiscourse in the spoken performance of teachers in online EFL, ESP, and subject-teacher courses taught in English to non-native learners in higher education. In point of fact, the global spread of Covid 19 has forced universities to transition their in-class courses to online delivery. This has inevitably placed on the instructor a heavier interactional responsibility compared to in-class courses. Accordingly, online delivery needs greater structuring as regards establishing the reader/listener’s resources for text understanding and negotiating. Indeed, in online as well as in in-class courses, lessons are social acts which take place in contexts where interlocutors, as members of a community, affect the ways ideas are presented and understood. Following Hyland’s Interactional Model of Metadiscourse (2005), this study intends to investigate Teacher Talk in online academic courses during the Covid 19 lock-down in Italy. The selected corpus includes the transcripts of online EFL and ESP courses and subject-teachers online courses taught in English. The objective of the investigation is, firstly, to ascertain the presence of metadiscourse in the form of interactive devices (to guide the listener through the text) and interactional features (to involve the listener in the subject). Previous research on metadiscourse in academic discourse, in college students' presentations in EAP (English for Academic Purposes) lessons, as well as in online teaching methodology courses and MOOC (Massive Open Online Courses) has shown that instructors use a vast array of metadiscoursal features intended to express the speakers’ intentions and standing with respect to discourse. Besides, they tend to use directions to orient their listeners and logical connectors referring to the structure of the text. Accordingly, the purpose of the investigation is also to find out whether metadiscourse is used as a rhetorical strategy by instructors to control, evaluate and negotiate the impact of the ongoing talk, and eventually to signal their attitudes towards the content and the audience. Thus, the use of metadiscourse can contribute to the informative and persuasive impact of discourse, and to the effectiveness of online communication, especially in learning contexts.Keywords: discourse analysis, metadiscourse, online EFL and ESP teaching, rhetoric
Procedia PDF Downloads 123338 Influence of Maternal Factors on Growth Patterns of Schoolchildren in a Rural Health and Demographic Surveillance Site in South Africa: A Mixed Method Study
Authors: Perpetua Modjadji, Sphiwe Madiba
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Background: The growth patterns of children are good nutritional indicators of their nutritional status, health, and socioeconomic level. However, the maternal factors and the belief system of the society affect the growth of children promoting undernutrition. This study determined the influence of maternal factors on growth patterns of schoolchildren in a rural site. Methods: A convergent mixed method study was conducted among 508 schoolchildren and their mothers in Dikgale Health and Demographic Surveillance System Site, South Africa. Multistage sampling was used to select schools (purposive) and learners (random), who were paired with their mothers. Anthropometry was measured and socio-demographic, obstetrical, household information, maternal influence on children’s nutrition, and growth were assessed using an interviewer administered questionnaire (quantitative). The influence of the cultural beliefs and practices of mothers on the nutrition and growth of their children was explored using focus group discussions (qualitative). Narratives of mothers were used to best understand growth patterns of schoolchildren (mixed method). Data were analyzed using STATA 14 (quantitative) and Nvivo 11 (qualitative). Quantitative and qualitative data were merged for integrated mixed method analysis using a joint display analysis. Results: Mean age of children was 10 ± 2 years, ranging from 6 to 15 years. Substantial percentages of thinness (25%), underweight (24%), and stunting (22%) were observed among the children. Mothers had a mean age of 37 ± 7 years, and 75% were overweight or obese. A depressed socio-economic status indicated by a higher rate of unemployment with no income (82.3%), and dependency on social grants (86.8%) was observed. Determinants of poor growth patterns were child’s age and gender, maternal age, height and BMI, access to water supply, and refrigerator use. The narratives of mothers suggested that the children in most of their households were exposed to poverty and the inadequate intake of quality food. Conclusion: Poor growth patterns were observed among schoolchildren while their mothers were overweight or obese. Child’s gender, school grade, maternal body mass index, and access to water were the main determinants. Congruence was observed between most qualitative themes and quantitative constructs. A need for a multi sectoral approach considering an evidence based and feasible nutrition programs for schoolchildren, especially those in rural settings and educating mothers, cannot be over-emphasized.Keywords: growth patterns, maternal factors, rural context, schoolchildren, South Africa
Procedia PDF Downloads 157337 Noncovalent Antibody-Nanomaterial Conjugates: A Simple Approach to Produce Targeted Nanomedicines
Authors: Nicholas Fletcher, Zachary Houston, Yongmei Zhao, Christopher Howard, Kristofer Thurecht
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One promising approach to enhance nanomedicine therapeutic efficacy is to include a targeting agent, such as an antibody, to increase accumulation at the tumor site. However, the application of such targeted nanomedicines remains limited, in part due to difficulties involved with biomolecule conjugation to synthetic nanomaterials. One approach recently developed to overcome this has been to engineer bispecific antibodies (BsAbs) with dual specificity, whereby one portion binds to methoxy polyethyleneglycol (mPEG) epitopes present on synthetic nanomedicines, while the other binds to molecular disease markers of interest. In this way, noncovalent complexes of nanomedicine core, comprising a hyperbranched polymer (HBP) of primarily mPEG, decorated with targeting ligands are able to be produced by simple mixing. Further work in this area has now demonstrated such complexes targeting the breast cancer marker epidermal growth factor receptor (EGFR) to show enhanced binding to tumor cells both in vitro and in vivo. Indeed the enhanced accumulation at the tumor site resulted in improved therapeutic outcomes compared to untargeted nanomedicines and free chemotherapeutics. The current work on these BsAb-HBP conjugates focuses on further probing antibody-nanomaterial interactions and demonstrating broad applicability to a range of cancer types. Herein are reported BsAb-HBP materials targeted towards prostate-specific membrane antigen (PSMA) and study of their behavior in vivo using ⁸⁹Zr positron emission tomography (PET) in a dual-tumor prostate cancer xenograft model. In this model mice bearing both PSMA+ and PSMA- tumors allow for PET imaging to discriminate between nonspecific and targeted uptake in tumors, and better quantify the increased accumulation following BsAb conjugation. Also examined is the potential for formation of these targeted complexes in situ following injection of individual components? The aim of this approach being to avoid undesirable clearance of proteinaceous complexes upon injection limiting available therapeutic. Ultimately these results demonstrate BsAb functionalized nanomaterials as a powerful and versatile approach for producing targeted nanomedicines for a variety of cancers.Keywords: bioengineering, cancer, nanomedicine, polymer chemistry
Procedia PDF Downloads 134336 Identifying the Challenges of Subcontractors Management in Building Area Projects and Providing Solutions (Supply Chain Management Approach)
Authors: Hamideh Sadat Zekri, Seyed Mojtaba Hosseinalipour, Mohammadreza Hafezi
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Nowadays, an organization cannot usually overcome all tasks singly due to the increasing complexity and vast expanse of projects, increment in uncertainty of activities, fast advances in technology, advent and influence of various factors in decision-making and implication of projects, and competitive atmosphere of different affairs. Thus, firms proceed to outsource the tasks to subcontractors. Nevertheless, large Iranian contracting companies suffer from extra consumed costs and time owing to conflicts between the activities of suppliers and subcontractors. The paucity of coordination in planning and execution, scarcity of coordination among suppliers, subcontractors, and the main contractor during the implementation of construction activities and also the lack of proper management of the aforesaid situation result in the growth of contradictions, number of claims, and legal issues in a project and consequently impose enormous expenses on those companies. Regarding the prosperity of supply chain management in other industries, its importance is increasingly getting appreciated in the field of construction. The ultimate aim of supply chain management is an effective delivery of the best value for customers, which is achievable by encouraging the members to interact and collaborate. In the present research, there was an effort to obtain a set of relevant challenges in the managing of subcontractors by identifying the main contractors and subcontractors and their role in the execution of projects and the supply chain management in the construction industry. Then, some of those challenges were selected in accordance with the views of industry professionals and academic experts. In the next step, a questionnaire was prepared and completed based on the analytic hierarchy process (AHP) and the challenges were prioritized. When it comes to subcontractors, the findings of the research demonstrate that difficulties in timely payments, alterations in approved drawings and the lack of rectification of job after completion by the subcontractor, paucity of a predetermined and legal process for qualifications of subcontractors, neglecting the supply chain processes in material procurement from producers, and delays in delivery of works by a subcontractor are the most significant problems. Finally, some solutions for encountering, eradicating, or reducing of mentioned problems are presented in accordance with previous studies and a survey from specialists.Keywords: main contractors, subcontractors, supply chain management, construction supply chain, analytic hierarchy process, solution
Procedia PDF Downloads 53335 Challenges for Competency-Based Learning Design in Primary School Mathematics in Mozambique
Authors: Satoshi Kusaka
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The term ‘competency’ is attracting considerable scholarly attention worldwide with the advance of globalization in the 21st century and with the arrival of a knowledge-based society. In the current world environment, familiarity with varied disciplines is regarded to be vital for personal success. The idea of a competency-based educational system was mooted by the ‘Definition and Selection of Competencies (DeSeCo)’ project that was conducted by the Organization for Economic Cooperation and Development (OECD). Further, attention to this topic is not limited to developed countries; it can also be observed in developing countries. For instance, the importance of a competency-based curriculum was mentioned in the ‘2013 Harmonized Curriculum Framework for the East African Community’, which recommends key competencies that should be developed in primary schools. The introduction of such curricula and the reviews of programs are actively being executed, primarily in the East African Community but also in neighboring nations. Taking Mozambique as a case in point, the present paper examines the conception of ‘competency’ as a target of frontline education in developing countries. It also aims to discover the manner in which the syllabus, textbooks and lessons, among other things, in primary-level math education are developed and to determine the challenges faced in the process. This study employs the perspective of competency-based education design to analyze how the term ‘competency’ is defined in the primary-level math syllabus, how it is reflected in the textbooks, and how the lessons are actually developed. ‘Practical competency’ is mentioned in the syllabus, and the description of the term lays emphasis on learners' ability to interactively apply socio-cultural and technical tools, which is one of the key competencies that are advocated in OECD's ‘Definition and Selection of Competencies’ project. However, most of the content of the textbooks pertains to ‘basic academic ability’, and in actual classroom practice, teachers often impart lessons straight from the textbooks. It is clear that the aptitude of teachers and their classroom routines are greatly dependent on the cultivation of their own ‘practical competency’ as it is defined in the syllabus. In other words, there is great divergence between the ‘syllabus’, which is the intended curriculum, and the content of the ‘textbooks’. In fact, the material in the textbooks should serve as the bridge between the syllabus, which forms the guideline, and the lessons, which represent the ‘implemented curriculum’. Moreover, the results obtained from this investigation reveal that the problem can only be resolved through the cultivation of ‘practical competency’ in teachers, which is currently not sufficient.Keywords: competency, curriculum, mathematics education, Mozambique
Procedia PDF Downloads 183334 Indirect Genotoxicity of Diesel Engine Emission: An in vivo Study Under Controlled Conditions
Authors: Y. Landkocz, P. Gosset, A. Héliot, C. Corbière, C. Vendeville, V. Keravec, S. Billet, A. Verdin, C. Monteil, D. Préterre, J-P. Morin, F. Sichel, T. Douki, P. J. Martin
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Air Pollution produced by automobile traffic is one of the main sources of pollutants in urban atmosphere and is largely due to exhausts of the diesel engine powered vehicles. The International Agency for Research on Cancer, which is part of the World Health Organization, classified in 2012 diesel engine exhaust as carcinogenic to humans (Group 1), based on sufficient evidence that exposure is associated with an increased risk for lung cancer. Amongst the strategies aimed at limiting exhausts in order to take into consideration the health impact of automobile pollution, filtration of the emissions and use of biofuels are developed, but their toxicological impact is largely unknown. Diesel exhausts are indeed complex mixtures of toxic substances difficult to study from a toxicological point of view, due to both the necessary characterization of the pollutants, sampling difficulties, potential synergy between the compounds and the wide variety of biological effects. Here, we studied the potential indirect genotoxicity of emission of Diesel engines through on-line exposure of rats in inhalation chambers to a subchronic high but realistic dose. Following exposure to standard gasoil +/- rapeseed methyl ester either upstream or downstream of a particle filter or control treatment, rats have been sacrificed and their lungs collected. The following indirect genotoxic parameters have been measured: (i) telomerase activity and telomeres length associated with rTERT and rTERC gene expression by RT-qPCR on frozen lungs, (ii) γH2AX quantification, representing double-strand DNA breaks, by immunohistochemistry on formalin fixed-paraffin embedded (FFPE) lung samples. These preliminary results will be then associated with global cellular response analyzed by pan-genomic microarrays, monitoring of oxidative stress and the quantification of primary DNA lesions in order to identify biological markers associated with a potential pro-carcinogenic response of diesel or biodiesel, with or without filters, in a relevant system of in vivo exposition.Keywords: diesel exhaust exposed rats, γH2AX, indirect genotoxicity, lung carcinogenicity, telomerase activity, telomeres length
Procedia PDF Downloads 386333 Adopting New Knowledge and Approaches to Sustainable Urban Drainage in Saudi Arabia
Authors: Ali Alahmari
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Urban drainage in Saudi Arabia is an increasingly challenging issue due to factors such as climate change and rapid urban expansion. The existing infrastructure, based on traditional drainage systems, is not always able to cope with the increased precipitation, sometimes leading to rainwater runoff and floods causing disturbances and damage to property. Therefore, there is a need to find new ways of managing drainage, such as Sustainable Urban Drainage Systems (SUDS). The research has highlighted the main driving forces behind the need for change, revealed by the participants, to the need to adopt new ideas and approaches for urban drainage. However, while moving towards this, certain factors that may hinder the aim of using the experiences of other countries and taking advantage of innovative solutions. The research illustrates an initial conceptual model for these factors emerging from the analysis. It identifies some of the fundamental issues affecting the resistance to change towards the adoption of the concept of sustainability in Saudi Arabia, with Riyadh city as a case study. This was by using a qualitative approach, whereby, through two phases of fieldwork during 2013 and 2014, twenty-six semi-structured interviews were conducted with a number of representative officials and professionals from key government departments and organisations related to urban drainage management. Grounded Theory approach was followed to analyse the qualitative data obtained. Resistance to change was classified to: firstly: individual inertia (e.g. familiarity with the conventional solutions and approaches, lack of awareness, and considering sustainability as a marginal matter in urban planning). This resulted in not paying the desired attention, and impact on planning and setting priorities for development. Secondly: institutionalised inertia (e.g. lack of technical and design specifications for other unconventional drainage solutions, lack of consideration by decision makers in other disciplines such as contributions from environmental and geographical studies, and routine work and bureaucracy). This contributes to the weakness of decision-making, weakness in the role of research, and a lack of human resources. It seems that attitudes towards change may have reduced the ability to move forward towards sustainable development, in addition to contributing towards difficulties in some aspects of the decision-making process. Thus, the chapter provides insights into the current situation in Saudi Arabia and contributes to understanding the decisions that are made regarding change.Keywords: climate change, new knowledge and approaches, resistance to change, Saudi Arabia, SUDS, urban drainage, urban expansion
Procedia PDF Downloads 168332 Symmetric Corticobasal Degeneration: Case Report
Authors: Sultan Çağırıcı, Arsida Bajrami, Beyza Aslan, Hacı Ali Erdoğan, Nejla Sözer Topçular, Dilek Bozkurt, Vildan Yayla
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Objective: Corticobasal syndrome (CBS) is phenotypically characterized by asymmetric rigidity, apraxia, alien-limb phenomenon, cortical sensory loss, dystonia and myoclonus. The underlying pathologies consists of corticobasal degeneration (CBD), progressive supra nuclear palsy, Alzheimer's, Creutzfeldt-Jakob and frontotemporal degeneration. CBD is a degenerative disease with clinical symptoms related to the prominent involvement of cerebral cortex and basal ganglia. CBD is a pathological diagnosis and antemortem clinical diagnosis may change many times. In this paper, we described the clinical features and discussed a cases diagnosed with symmetric CBS because of its rarity. Case: Seventy-five-year-old woman presented with a three years history of difficulty in speaking and reading. Involuntary hand jerks and slowness of movement also had began in the last six months. In the neurological examination the patient was alert but not fully oriented. The speech was non-fluent, word finding difficulties were present. Bilateral limited upgaze, bradimimia, bilateral positive cogwheel' rigidity but prominent in the right side, postural tremor and negative myoclonus during action on the left side were detected. Receptive language was normal but expressive language and repetition were impaired. Acalculia, alexia, agraphia and apraxia were also present. CSF findings were unremarkable except for elevated protein level (75 mg/dL). MRI revealed bilateral symmetric cortical atrophy prominent in the frontoparietal region. PET showed hypometabolism in the left caudate nucleus. Conclusion: The increase of data related to neurodegenerative disorders associated with dementia, movement disorders and other findings results in an expanded range of diagnosis and transitions between clinical diagnosis. When considered the age of onset, clinical symptoms, imaging findings and prognosis of this patient, clinical diagnosis was CBS and pathologic diagnosis as probable CBD. Imaging of CBD usually consist of typical asymmetry between hemispheres. Still few cases with clinical appearance of CBD may show symmetrical cortical cerebral atrophy. It is presented this case who was diagnosed with CBD although we found symmetrical cortical cerebral atrophy in MRI.Keywords: symmetric cortical atrophy, corticobasal degeneration, corticobasal syndrome
Procedia PDF Downloads 448331 Pathway Linking Early Use of Electronic Device and Psychosocial Wellbeing in Early Childhood
Authors: Rosa S. Wong, Keith T.S. Tung, Winnie W. Y. Tso, King-Wa Fu, Nirmala Rao, Patrick Ip
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Electronic devices have become an essential part of our lives. Various reports have highlighted the alarming usage of electronic devices at early ages and its long-term developmental consequences. More sedentary screen time was associated with increased adiposity, worse cognitive and motor development, and psychosocial health. Apart from the problems caused by children’s own screen time, parents today are often paying less attention to their children due to hand-held device. Some anecdotes suggest that distracted parenting has negative impact on parent-child relationship. This study examined whether distracted parenting detrimentally affected parent-child activities which may, in turn, impair children’s psychosocial health. In 2018/19, we recruited a cohort of preschoolers from 32 local kindergartens in Tin Shui Wai and Sham Shui Po for a 5-year programme aiming to build stronger foundations for children from disadvantaged backgrounds through an integrated support model involving medical, education and social service sectors. A comprehensive set of questionnaires were used to survey parents on their frequency of being distracted while parenting and their frequency of learning and recreational activities with children. Furthermore, they were asked to report children’s screen time amount and their psychosocial problems. Mediation analyses were performed to test the direct and indirect effects of electronic device-distracted parenting on children’s psychosocial problems. This study recruited 873 children (448 females and 425 males, average age: 3.42±0.35). Longer screen time was associated with more psychosocial difficulties (Adjusted B=0.37, 95%CI: 0.12 to 0.62, p=0.004). Children’s screen time positively correlated with electronic device-distracted parenting (r=0.369, p < 01). We also found that electronic device-distracted parenting was associated with more hyperactive/inattentive problems (Adjusted B=0.66, p < 0.01), fewer prosocial behavior (Adjusted B=-0.74, p < 0.01), and more emotional symptoms (Adjusted B=0.61, p < 0.001) in children. Further analyses showed that electronic device-distracted parenting exerted influences both directly and indirectly through parent-child interactions but to different extent depending upon the outcome under investigation (38.8% for hyperactivity/inattention, 31.3% for prosocial behavior, and 15.6% for emotional symptoms). We found that parents’ use of devices and children’s own screen time both have negative effects on children’s psychosocial health. It is important for parents to set “device-free times” each day so as to ensure enough relaxed downtime for connecting with children and responding to their needs.Keywords: early childhood, electronic device, psychosocial wellbeing, parenting
Procedia PDF Downloads 156330 Nondestructive Electrochemical Testing Method for Prestressed Concrete Structures
Authors: Tomoko Fukuyama, Osamu Senbu
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Prestressed concrete is used a lot in infrastructures such as roads or bridges. However, poor grout filling and PC steel corrosion are currently major issues of prestressed concrete structures. One of the problems with nondestructive corrosion detection of PC steel is a plastic pipe which covers PC steel. The insulative property of pipe makes a nondestructive diagnosis difficult; therefore a practical technology to detect these defects is necessary for the maintenance of infrastructures. The goal of the research is a development of an electrochemical technique which enables to detect internal defects from the surface of prestressed concrete nondestructively. Ideally, the measurements should be conducted from the surface of structural members to diagnose non-destructively. In the present experiment, a prestressed concrete member is simplified as a layered specimen to simulate a current path between an input and an output electrode on a member surface. The specimens which are layered by mortar and the prestressed concrete constitution materials (steel, polyethylene, stainless steel, or galvanized steel plates) were provided to the alternating current impedance measurement. The magnitude of an applied electric field was 0.01-volt or 1-volt, and the frequency range was from 106 Hz to 10-2 Hz. The frequency spectrums of impedance, which relate to charge reactions activated by an electric field, were measured to clarify the effects of the material configurations or the properties. In the civil engineering field, the Nyquist diagram is popular to analyze impedance and it is a good way to grasp electric relaxation using a shape of the plot. However, it is slightly not suitable to figure out an influence of a measurement frequency which is reciprocal of reaction time. Hence, Bode diagram is also applied to describe charge reactions in the present paper. From the experiment results, the alternating current impedance method looks to be applicable to the insulative material measurement and eventually prestressed concrete diagnosis. At the same time, the frequency spectrums of impedance show the difference of the material configuration. This is because the charge mobility reflects the variety of substances and also the measuring frequency of the electric field determines migration length of charges which are under the influence of the electric field. However, it could not distinguish the differences of the material thickness and is inferred the difficulties of prestressed concrete diagnosis to identify the amount of an air void or a layer of corrosion product by the technique.Keywords: capacitance, conductance, prestressed concrete, susceptance
Procedia PDF Downloads 407329 The Effects of Physician-Family Communication from the Point View of Clinical Staff
Authors: Lu-Chiu Huang, Pei-Pei Chen, Li-Chin Yu, Chiao-Wen Kuo, Tsui-Tao Liu, Rung-Chuang Feng
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Purpose: People put increasing emphasis on demands of medical quality and protecting their interests. Patients' or family's dissatisfaction with medical care may easily lead to medical dispute. Physician-family communication plays an essential role in medical care. A sound communication cannot only strengthen patients' belief in the medical team but make patient have definite insight into treatment course of the disease. A family meeting provides an effective platform for communication between clinical staff, patients and family. Decisions and consensuses formed in family meetings can promote patients' or family's satisfaction with medical care. Clinical staff's attitudes toward family meeting may determine behavioral intentions to hold family meeting. This study aims to explore clinical staff's difficulties in holding family meeting and evaluate how their attitudes and behavior influence the effect of family meetings. Methods: This was a cross-sectional study. It was conducted at a regional teaching hospital in Taipei city. The research team developed its own structural questionnaires, whose expert validity was checked by the nursing experts. Participants filled in the questionnaires online. Data were collected by convenience sampling. A total of 568 participants were invited. They included doctors, nurses, social workers, and so on. Results: 1) The average score of ‘clinical staff’s attitudes to family meetings’ was 5.15 (SD=0.898). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It indicated that clinical staff had positive attitudes toward family meetings, 2) The average score of ‘clinical staff’s behavior to family meetings’ was 5.61 (SD=0.937). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. It meant clinical staff tended to have positive behavior at the family meeting, and 3) The average score of ‘Difficulty in conducting family meetings’ was 5.15 (SD=0.897). It fell between ‘somewhat agree’ and ‘mostly agree’ on the 7-point likert scale. The higher the score was, the less difficulty the clinical staff felt. It demonstrated clinical staff felt less difficulty in conducting family meetings. Clinical staff's identification with family meetings brought favored effects. Persistent and active promotion for family meetings can bring patients and family more benefits. Implications for practice: Understanding clinical staff's difficulty in participating family meeting and exploring their attitudes or behavior toward physician-family communication are helpful to develop modes of interaction. Consequently, quality and satisfaction of physician-family communication can be increased.Keywords: clinical staff, communication, family meeting, physician-family
Procedia PDF Downloads 324328 Corporate Social Responsibility and Career Education: An International Case Study
Authors: Cristina Costa-Lobo, Ana Martins, Maria Das Dores Formosinho, Ana Campina, Filomena Ponte
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This paper is a report on the findings of a study conducted at an international leading food group. Documentary analysis and discourse analysis techniques were used to examine how corporate social responsibility and career education are valued by this international group. The Survey on Corporate Social Responsibility and Career Education was used, with 18 open-ended questions, the first six related to Corporate Social Responsibility and the last 12 related to Education for the Career. The Survey on the Social Emergency Fund was made up of 16 open-ended questions. The Social Welfare Survey was used to investigate the contribution of social workers in this area, as well as to understand their status. The sample of this investigation is composed by the Director of the development area, by the Coordinator and two Social Assistants of the Social Emergency Fund. Their collaboration was the provision of information in the form of an interview where the two main axes of this study were explored: Corporate Social Responsibility and Career Education. With regard to the analysis of data obtained from interviews, it was accomplished through the content analysis according to the Bardin's method (2004), through the pre-analytical, exploratory and qualitative treatment and interpretation of responses. Critical review of documents was also used. The success and effectiveness of this international group are marked by ambition, ability to resist difficulties, sharing of values, spirit of unity and team sense that is shared in its different companies, its leadership position is also due to the concern to see reinforced and developed values of work, discipline, rigor and competence, its management is geared towards responding to immediate challenges from a Corporate Social Responsibility perspective that is characteristic of it, incorporating concerns about impacts both in the medium and long term. In addition to internal training, it directs investments for external training by promoting actions such as participation in seminars and congresses worldwide and the creation of partnerships in various areas of management with prestigious teaching entities. Findings indicate the creation of a training school, with initiatives for internal and external training, in partnerships with prestigious teaching entities. Of particular note is the Management Trainees Program, developed for more than 25 years, characterized by building a career by obtaining knowledge and skills acquired in the combination of on-the-job experience and a training program.Keywords: career education, corporate social responsibility, training school, management trainees program
Procedia PDF Downloads 220327 Kinetic Modelling of Fermented Probiotic Beverage from Enzymatically Extracted Annona Muricata Fruit
Authors: Calister Wingang Makebe, Wilson Ambindei Agwanande, Emmanuel Jong Nso, P. Nisha
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Traditional liquid-state fermentation processes of Annona muricata L. juice can result in fluctuating product quality and quantity due to difficulties in control and scale up. This work describes a laboratory-scale batch fermentation process to produce a probiotic Annona muricata L. enzymatically extracted juice, which was modeled using the Doehlert design with independent extraction factors being incubation time, temperature, and enzyme concentration. It aimed at a better understanding of the traditional process as an initial step for future optimization. Annona muricata L. juice was fermented with L. acidophilus (NCDC 291) (LA), L. casei (NCDC 17) (LC), and a blend of LA and LC (LCA) for 72 h at 37 °C. Experimental data were fitted into mathematical models (Monod, Logistic and Luedeking and Piret models) using MATLAB software, to describe biomass growth, sugar utilization, and organic acid production. The optimal fermentation time was obtained based on cell viability, which was 24 h for LC and 36 h for LA and LCA. The model was particularly effective in estimating biomass growth, reducing sugar consumption, and lactic acid production. The values of the determination coefficient, R2, were 0.9946, 0.9913 and 0.9946, while the residual sum of square error, SSE, was 0.2876, 0.1738 and 0.1589 for LC, LA and LCA, respectively. The growth kinetic parameters included the maximum specific growth rate, µm, which was 0.2876 h-1, 0.1738 h-1 and 0.1589 h-1 as well as the substrate saturation, Ks, with 9.0680 g/L, 9.9337 g/L and 9.0709 g/L respectively for LC, LA and LCA. For the stoichiometric parameters, the yield of biomass based on utilized substrate (YXS) was 50.7932, 3.3940 and 61.0202, and the yield of product based on utilized substrate (YPS) was 2.4524, 0.2307 and 0.7415 for LC, LA, and LCA, respectively. In addition, the maintenance energy parameter (ms) was 0.0128, 0.0001 and 0.0004 with respect to LC, LA and LCA. With the kinetic model proposed by Luedeking and Piret for lactic acid production rate, the growth associated, and non-growth associated coefficients were determined as 1.0028 and 0.0109, respectively. The model was demonstrated for batch growth of LA, LC, and LCA in Annona muricata L. juice. The present investigation validates the potential of Annona muricata L. based medium for heightened economical production of a probiotic medium.Keywords: L. acidophilus, L. casei, fermentation, modelling, kinetics
Procedia PDF Downloads 64326 School and Family Impairment Associated with Childhood Anxiety Disorders: Examining Differences in Parent and Child Report
Authors: Melissa K. Hord, Stephen P. Whiteside
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Impairment in functioning is a requirement for diagnosing psychopathology, identifying individuals in need of treatment, and documenting improvement with treatment. Further, identifying different types of functional impairment can guide educators and treatment providers. However, most assessment tools focus on symptom severity and few measures assess impairment associated with childhood anxiety disorders. The child- and parent-report versions of the Child Sheehan Disability Scale (CSDS) are measures that may provide useful information regarding impairment. The purpose of the present study is to examine whether children diagnosed with different anxiety disorders have greater impairment in school or home functioning based on self or parent report. The sample consisted of 844 children ages 5 to 19 years of age (mean 13.43, 61% female, 90.9% Caucasian), including 281 children diagnosed with obsessive compulsive disorder (OCD), 200 with generalized anxiety disorder (GAD), 176 with social phobia, 83 with separation anxiety, 61 with anxiety not otherwise specified (NOS), 30 with panic disorder, and 13 with panic with agoraphobia. To assess whether children and parents reported greater impairment in school or home functioning, a multivariate analysis of variance was conducted. (The assumptions of independence and homogeneity of variance were checked and met). A significant difference was found, Pillai's trace = .143, F (4, 28) = 4.19, p < .001, partial eta squared = .04. Post hoc comparisons using the Tukey HSD test indicated that children report significantly greater impairment in school with panic disorder (M=5.18, SD=3.28), social phobia (M=4.95, SD=3.20), and OCD (M=4.62, SD=3.32) compared to other diagnoses; whereas parents endorse significantly greater school impairment when their child has a social phobia (M=5.70, SD=3.39) diagnosis. Interestingly, both children and parents reported greater impairment in family functioning for an OCD (child report M=5.37, SD=3.20; parent report M=5.59, SD=3.38) diagnosis compared to other anxiety diagnoses. (Additional findings for the anxiety disorders associated with less impairment will also be presented). The results of the current study have important implications for educators and treatment providers who are working with anxious children. First, understanding that differences exist in how children and parents view impairment related to childhood anxiety can help those working with these families to be more sensitive during interactions. Second, evidence suggests that difficulties in one environment do not necessarily translate to another environment, thus caregivers may benefit from careful explanation of observations obtained by educators. Third, results support the use of the CSDS measure by treatment providers to identify impairment across environments in order to more effectively target interventions.Keywords: anxiety, childhood, impairment, school functioning
Procedia PDF Downloads 269325 A Rare Case Report of Non-Langerhans Cell Cutaneous Histiocytosis in a 6-Month Old Infant
Authors: Apoorva D. R.
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INTRODUCTION: Hemophagocytic lymphohistiocytosis (HLH) is a severe, potentially fatal syndrome in which there is excessive immune activation. The disease is seen in children and people of all ages, but infants from birth to 18 months are most frequently affected. HLH is a sporadic or familial condition that can be triggered by various events that disturb immunological homeostasis. In cases with a genetic predisposition and sporadic occurrences, infection is a frequent trigger. Because of the rarity of this disease, the diverse clinical presentation, and the lack of specificity in the clinical and laboratory results, prompt treatment is essential, but the biggest obstacle to a favorable outcome is frequently a delay in identification. CASE REPORT: Here we report a case of a 6-month-old male infant who presented to the dermatology outpatient with disseminated skin lesions present over the face, abdomen, scalp, and bilateral upper and lower limbs for the past month. The lesions were insidious in onset, initially started over the abdomen, and gradually progressed to involve other body parts. The patient also had a history of fever which was moderate in grade, on and off in nature for 1 month. There were no significant complaints in the past, family, or drug history. There was no history of feeding difficulties in the baby. Parents gave a history of developmental milestones appropriate for age. Examination findings include multiple well-defined monomorphic erythematous papules with a central crater present over bilateral cheeks. Few lichenoid shiny papules present over bilateral arms, legs, and abdomen. Ultrasound of the abdomen and pelvis showed mild degree hepatosplenomegaly, intraabdominal lymphadenopathy, and bilateral inguinal lymphadenopathy. Routine blood investigations showed anemia and lymphopenia. Multiple X-rays of the skull, chest, and bilateral upper and lower limbs were done and were normal. Histopathology features were suggestive of non-Langerhans cell cutaneous histiocytosis. CONCLUSION: HLH is a fatal and rare disease. A high level of suspicion and an interdisciplinary approach among experienced clinicians, pathologists, and microbiologists to define the diagnosis and causative disease are key to diagnosing this case. Early detection and treatment can reduce patient morbidity and mortality.Keywords: histiocytosis, non langerhans cell, case report, fatal, rare
Procedia PDF Downloads 83324 Compact, Lightweight, Low Cost, Rectangular Core Power Transformers
Authors: Abidin Tortum, Kubra Kocabey
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One of the sectors where the competition is experienced at the highest level in the world is the transformer sector, and sales can be made with a limited profit margin. For this reason, manufacturers must develop cost-cutting designs to achieve higher profits. The use of rectangular cores and coils in transformer design is one of the methods that can be used to reduce costs. According to the best knowledge we have obtained, we think that we are the first company producing rectangular core power transformers in our country. BETA, to reduce the cost of this project, more compact products to reveal, as we know it to increase the alleviate and competitiveness of the product, will perform cored coil design and production rectangle for the first-time power transformers in Turkey. The transformer to be designed shall be 16 MVA, 33/11 kV voltage level. With the rectangular design of the transformer core and windings, no-load losses can be reduced. Also, the least costly transformer type is rectangular. However, short-circuit forces on rectangular windings do not affect every point of the windings in the same way. Whereas more force is applied inwards to the mid-points of the low-voltage winding, the opposite occurs in the high-voltage winding. Therefore, the windings tend to deteriorate in the event of a short circuit. While trying to reach the project objectives, the difficulties in the design should be overcome. Rectangular core transformers to be produced in our country offer a more compact structure than conventional transformers. In other words, both height and width were smaller. Thus, the reducer takes up less space in the center. Because the transformer boiler is smaller, less oil is used, and its weight is lower. Biotemp natural ester fluid is used in rectangular transformer and the cooling performance of this oil is analyzed. The cost was also reduced with the reduction of dimensions. The decrease in the amount of oil used has also increased the environmental friendliness of the developed product. Transportation costs have been reduced by reducing the total weight. The amount of carbon emissions generated during the transportation process is reduced. Since the low-voltage winding is wound with a foil winding technique, a more resistant structure is obtained against short circuit forces. No-load losses were lower due to the use of a rectangular core. The project was handled in three phases. In the first stage, preliminary research and designs were carried out. In the second stage, the prototype manufacturing of the transformer whose designs have been completed has been started. The prototype developed in the last stage has been subjected to routine, type and special tests.Keywords: rectangular core, power transformer, transformer, productivity
Procedia PDF Downloads 114323 Predictors of Quality of Life among Older Refugees Aging out of Place
Authors: Jonix Owino, Heather Fuller
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Refugees flee from their home countries due to civil unrest, war, persecution and migrate to Western countries such as the United States in search of a safe haven. Transitioning into a new society and culture can be challenging, thereby affecting refugee’s quality of life and well-being in the host communities. Moreover, as individuals age, they experience physical, cognitive and socioemotional changes that may impact their quality of life. However, little is known about the predictors of quality of life among aging refugees. It is not clear how quality of life varies by age, that is, between midlife refugees in comparison to their older counterparts. In addition to age, other sociodemographic factors such as gender, socioeconomic status, or country of origin are likely to have differential associations to quality of life, yet research on such variations among older refugees is sparse. Thus the present study seeks to explore factors associated with quality of life by asking the following research questions: 1) Do sociodemographic factors (such as age and gender) predict quality of life among older refugees, 2) Is there an association between social integration and quality of life, and 3) Is there an association between migratory related experiences (such as post migratory adjustments) and quality of life. The present study recruited 90 refugees (primarily originating from Bhutan, Somalia, Burundi, and Sudan) aged 50 or older living in the US. The participants completed a structured questionnaire which assessed factors such as participant’s sociodemographic attributes (e.g., age, gender, length of residence in the US, country of origin, employment, level of education, and marital status), and validated measures of social integration, post-migration living difficulties, and quality of life. Preliminary results suggest sociodemographic variability in quality of life among these refugees. Further analyses will be conducted using hierarchical regression analyses to address the following hypotheses: first, it is hypothesized that quality of life will vary by age and gender such that younger refugees and men will report higher quality of life. Second, it is expected that refugees with greater levels of social integration will also report better quality of life. Finally, post-migration factors such as language barriers and family stress are hypothesized to predict poorer quality of life. Further results will be analyzed, including potential moderating effects of age and gender, and resulting findings will be interpreted and discussed. The findings from this study have potential implications for communities on how they can better support older refugees as well as develop social programs that can effectively cater to their well-being. Conclusions will be drawn and discussed in light of policies related to both aging and refugee migration within the context of the US.Keywords: aging out of place, migration, older refugees, quality of life, social integration
Procedia PDF Downloads 94322 Plasma Arc Burner for Pulverized Coal Combustion
Authors: Gela Gelashvili, David Gelenidze, Sulkhan Nanobashvili, Irakli Nanobashvili, George Tavkhelidze, Tsiuri Sitchinava
Abstract:
Development of new highly efficient plasma arc combustion system of pulverized coal is presented. As it is well-known, coal is one of the main energy carriers by means of which electric and heat energy is produced in thermal power stations. The quality of the extracted coal decreases very rapidly. Therefore, the difficulties associated with its firing and complete combustion arise and thermo-chemical preparation of pulverized coal becomes necessary. Usually, other organic fuels (mazut-fuel oil or natural gas) are added to low-quality coal for this purpose. The fraction of additional organic fuels varies within 35-40% range. This decreases dramatically the economic efficiency of such systems. At the same time, emission of noxious substances in the environment increases. Because of all these, intense development of plasma combustion systems of pulverized coal takes place in whole world. These systems are equipped with Non-Transferred Plasma Arc Torches. They allow practically complete combustion of pulverized coal (without organic additives) in boilers, increase of energetic and financial efficiency. At the same time, emission of noxious substances in the environment decreases dramatically. But, the non-transferred plasma torches have numerous drawbacks, e.g. complicated construction, low service life (especially in the case of high power), instability of plasma arc and most important – up to 30% of energy loss due to anode cooling. Due to these reasons, intense development of new plasma technologies that are free from these shortcomings takes place. In our proposed system, pulverized coal-air mixture passes through plasma arc area that burns between to carbon electrodes directly in pulverized coal muffler burner. Consumption of the carbon electrodes is low and does not need a cooling system, but the main advantage of this method is that radiation of plasma arc directly impacts on coal-air mixture that accelerates the process of thermo-chemical preparation of coal to burn. To ensure the stability of the plasma arc in such difficult conditions, we have developed a power source that provides fixed current during fluctuations in the arc resistance automatically compensated by the voltage change as well as regulation of plasma arc length over a wide range. Our combustion system where plasma arc acts directly on pulverized coal-air mixture is simple. This should allow a significant improvement of pulverized coal combustion (especially low-quality coal) and its economic efficiency. Preliminary experiments demonstrated the successful functioning of the system.Keywords: coal combustion, plasma arc, plasma torches, pulverized coal
Procedia PDF Downloads 155