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Authors: Kantha Siddhanth Gujjari, Shaani Singhal, Robert Andrew Danks, Adrian Praeger

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Background: Trigeminal neuralgia (TN) is a heterogenous pain syndrome characterised by short paroxysms of lancinating facial pain in the distribution of the trigeminal nerve, often triggered by usually innocuous stimuli. TN has a low prevalence of less than 0.1%, of which 80% to 90% is caused by compression of the trigeminal nerve from an adjacent artery or vein. The root entry zone of the trigeminal nerve is most sensitive to neurovascular conflict (NVC), causing dysmyelination. Whilst microvascular decompression (MVD) is an effective treatment for TN with NVC, all patients do not achieve long-term pain relief. Pre-operative scoring systems by Panczykowski and Hardaway have been proposed but have not been externally validated. These pre-operative scoring systems are composite scores calculated according to a subtype of TN, presence and degree of neurovascular conflict, and response to medical treatments. There is discordance in the assessment of NVC identified on pre-operative magnetic resonance imaging (MRI) between neurosurgeons and radiologists. To our best knowledge, the prognostic impact for MVD of this difference of interpretation has not previously been investigated in the form of a composite scoring system such as those suggested by Panczykowski and Hardaway. Aims: This study aims to identify prognostic factors and externally validate the proposed scoring systems by Panczykowski and Hardaway for TN. A secondary aim is to investigate the prognostic difference between a neurosurgeon's interpretation of NVC on MRI compared with a radiologist’s. Methods: This retrospective cohort study included 95 patients who underwent de novo MVD in a single neurosurgical unit in Melbourne. Data was recorded from patients’ hospital records and neurosurgeon’s correspondence from perioperative clinic reviews. Patient demographics, type of TN, distribution of TN, response to carbamazepine, neurosurgeon, and radiologist interpretation of NVC on MRI, were clearly described prospectively and preoperatively in the correspondence. Scoring systems published by Panczykowski et al. and Hardaway et al. were used to determine composite scores, which were compared with the recurrence of TN recorded during follow-up over 1-year. Categorical data analysed using Pearson chi-square testing. Independent numerical and nominal data analysed with logistical regression. Results: Logistical regression showed that a Panczykowski composite score of greater than 3 points was associated with a higher likelihood of pain-free outcome 1-year post-MVD with an OR 1.81 (95%CI 1.41-2.61, p=0.032). The composite score using neurosurgeon’s impression of NVC had an OR 2.96 (95%CI 2.28-3.31, p=0.048). A Hardaway composite score of greater than 2 points was associated with a higher likelihood of pain-free outcome 1 year post-MVD with an OR 3.41 (95%CI 2.58-4.37, p=0.028). The composite score using neurosurgeon’s impression of NVC had an OR 3.96 (95%CI 3.01-4.65, p=0.042). Conclusion: Composite scores developed by Panczykowski and Hardaway were validated for the prediction of response to MVD in TN. A composite score based on the neurosurgeon’s interpretation of NVC on MRI, when compared with the radiologist’s had a greater correlation with pain-free outcomes 1 year post-MVD.

Keywords: de novo microvascular decompression, neurovascular conflict, prognosis, trigeminal neuralgia

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Authors: Ayesha M. Facey

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The evaluation sought to determine the factors associated with the high failure rate among students taking a first-year introductory statistics course. By utilizing Tyler’s Objective Based Model, the main objectives were: to assess the effectiveness of the lecturer’s teaching strategies; to determine the proportion of students who attends lectures and tutorials frequently and to determine the impact of infrequent attendance on performance; to determine how the assigned activities assisted in students understanding of the course content; to ascertain the possible issues being faced by students in understanding the course material and obtain possible solutions to the challenges and to determine whether the learning outcomes have been achieved based on an assessment of the second in-course examination. A quantitative survey research strategy was employed and the study population was students enrolled in semester one of the academic year 2015/2016. A convenience sampling approach was employed resulting in a sample of 98 students. Primary data was collected using self-administered questionnaires over a one-week period. Secondary data was obtained from the results of the second in-course examination. Data were entered and analyzed in SPSS version 22 and both univariate and bivariate analyses were conducted on the information obtained from the questionnaires. Univariate analyses provided description of the sample through means, standard deviations and percentages while bivariate analyses were done using Spearman’s Rho correlation coefficient and Chi-square analyses. For secondary data, an item analysis was performed to obtain the reliability of the examination questions, difficulty index and discriminant index. The examination results also provided information on the weak areas of the students and highlighted the learning outcomes that were not achieved. Findings revealed that students were more likely to participate in lectures than tutorials and that attendance was high for both lectures and tutorials. There was a significant relationship between participation in lectures and performance on examination. However, a high proportion of students has been absent from three or more tutorials as well as lectures. A higher proportion of students indicated that they completed the assignments obtained from the lectures sometimes while they rarely completed tutorial worksheets. Students who were more likely to complete their assignments were significantly more likely to perform well on their examination. Additionally, students faced a number of challenges in understanding the course content and the topics of probability, binomial distribution and normal distribution were the most challenging. The item analysis also highlighted these topics as problem areas. Problems doing mathematics and application and analyses were their major challenges faced by students and most students indicated that some of the challenges could be alleviated if additional examples were worked in lectures and they were given more time to solve questions. Analysis of the examination results showed that a number of learning outcomes were not achieved for a number of topics. Based on the findings recommendations were made that suggested adjustments to grade allocations, delivery of lectures and methods of assessment.

Keywords: evaluation, item analysis, Tyler’s objective based model, university statistics

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Authors: Lalanthica Yogendran, Manassa Hany, Saira Pasha, Benjamin Chaucer, Simarpreet Kaur, Christopher Janusz

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Children and adolescent patients visit the Psychiatric Emergency Department (ED) for multiple reasons. Visiting the Psychiatric ED itself can be a traumatic experience that can affect an adolescents mental well-being, regardless of a history of mental illness. Despite this, limited research exists in this domain. Prospective studies have correlated adverse psychosocial determinants among adolescents to risk factors for poor well-being and unfavorable behavior outcomes. Studies have also shown that physiological stress is a contributor in the development of health problems and an increase in substance abuse in adolescents. This study aimed to retrospectively determine which psychosocial factors are associated with an increase in psychiatric ED visits. 600 charts of patients who had a psychiatric ED and inpatient admission visit from January 2014 through December 2014 were reviewed. Sociodemographics, diagnoses, ED visits and inpatient admissions were collected. Descriptive statistics, chi-square tests and independent t-test analyses were utilized to examine differences in the sample to determine which factors affected ED visits and admissions. The sample was 50% female, 35.2% self-identified black, and had a mean age of 13 years. The majority, 85%, went to public school and 17% were in special education. Attention Deficit Hyperactivity Disorder was the most common admitting diagnosis, found in 132(23%) responders. Most patients came from single parent household 305 (53%). The mean ages of patients that were sexually active, with legal issues, and reporting marijuana substance abuse were 15, 14.35, and 15 years respectively. Patients from two biological parent households had significantly fewer ED visits (1.2 vs. 1.7, p < 0.01) and admissions (0.09 vs. 0.26, p < 0.01). Among social factors, those who reported sexual, physical or emotional abuse had a significantly greater number of ED visits (2.1 vs. 1.5, p < 0.01) and admissions (0.61 vs. 0.14, p < 0.01) than those who did not. Patients that were sexually active or had legal issues or substance abuse with marijuana had a significantly greater number of admissions (0.43 vs. 0.17, p < 0.01), (0.54 vs. .18, p < 0.01) and (0.46 vs. 0.18, p < 0.01) respectively. This data supports the theory of the stability of a two parent home. Dual parenting plays a role in creating a safe space where a child can develop; this is shown by subsequent decreases in psychiatric ED visits and admissions. This may highlight the psychological protective role of a two parent household. Abuse can exacerbate existing psychiatric illness or initiate the onset of new disease. Substance abuse and legal issues result in early induction to the criminal system. Results show that this causes an increase in frequency of visits and severity of symptoms. Only marijuana, but not other illicit substances, correlated with higher incidence of psychiatric ED visits. This may speak to the psychotropic nature of tetrahydrocannabinols and their role in mental illness. This study demonstrates the array of psychosocial factors that lead to increased ED visits and admissions in children and adolescents.

Keywords: adolescent, child psychiatry, emergency department, substance abuse

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Authors: Minjung Maing, Sibei Liu

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This research discusses the results of a study of window opening behavior of large housing developments in the high-density megacity of Hong Kong. The methods used for the study involved field observations using photo documentation of the four cardinal elevations (north, south-east, and west) of two large housing developments in a very dense urban area of approx. 46,000 persons per square meter within the city of Hong Kong. The targeted housing developments (A and B) are large public housing with a population of about 13,000 in each development of lower income. However, the mean income level in development A is about 40% higher than development B and home ownership is 60% in development A and 0% in development B. Mapping of the surrounding amenities and layout of the developments were also studied to understand the available activities to the residents. The photo documentation of the elevations was taken from November 2016 to February 2018 to gather a full spectrum of different seasons and both in the morning and afternoon (am/pm) times. From the photograph, the window opening behavior was measured by counting the amount of windows opened as a percentage of all the windows on that façade. For each date of survey data collected, weather data was recorded from weather stations located in the same region to collect temperature, humidity and wind speed. To further understand the behavior, simulation studies of microclimate conditions of the housing development was conducted using the software ENVI-met, a widely used simulation tool by researchers studying urban climate. Four major conclusions can be drawn from the data analysis and simulation results. Firstly, there is little change in the amount of window opening during the different seasons within a temperature range of 10 to 35 degrees Celsius. This means that people who tend to open their windows have consistent window opening behavior throughout the year and high tolerance of indoor thermal conditions. Secondly, for all four elevations the lower-income development B opened more windows (almost two times more units) than higher-income development A meaning window opening behavior had strong correlations with income level. Thirdly, there is a lack of correlation between outdoor horizontal wind speed and window opening behavior, as the changes of wind speed do not seem to affect the action of opening windows in most conditions. Similar to the low correlation between horizontal wind speed and window opening percentage, it is found that vertical wind speed also cannot explain the window opening behavior of occupants. Fourthly, there is a slightly higher average of window opening on the south elevation than the north elevation, which may be due to the south elevation being well shaded from high angle sun during the summer and allowing heat into units from lower angle sun during the winter season. These findings are important to providing insight into how to better design urban environments and indoor thermal environments for a liveable high density city.

Keywords: high-density housing, subtropical climate, urban behavior, window opening

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Authors: Sanjana S. Mallya, Roshan Arvind Sivakumar

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Orthotics is the branch of medicine that deals with the provision and use of artificial casts or braces to alter the biomechanical structure of the limb and provide support for the limb. Custom-made orthoses provide more comfort and can correct issues better than those available over-the-counter. However, they are expensive and require intricate modelling of the limb. Traditional methods of modelling involve creating a plaster of Paris mould of the limb. Lately, CAD/CAM and 3D printing processes have improved the accuracy and reduced the production time. Ordinarily, digital cameras are used to capture the features of the limb from different views to create a 3D model. We propose a system to model the limb using Microsoft Kinect2 sensor. The Kinect can capture RGB and depth frames simultaneously up to 30 fps with sufficient accuracy. The region of interest is captured from three views, each shifted by 90 degrees. The RGB and depth data are fused into a single RGB-D frame. The resolution of the RGB frame is 1920px x 1080px while the resolution of the Depth frame is 512px x 424px. As the resolution of the frames is not equal, RGB pixels are mapped onto the Depth pixels to make sure data is not lost even if the resolution is lower. The resulting RGB-D frames are collected and using the depth coordinates, a three dimensional point cloud is generated for each view of the Kinect sensor. A common reference system was developed to merge the individual point clouds from the Kinect sensors. The reference system consisted of 8 coloured cubes, connected by rods to form a skeleton-cube with the coloured cubes at the corners. For each Kinect, the region of interest is the square formed by the centres of the four cubes facing the Kinect. The point clouds are merged by considering one of the cubes as the origin of a reference system. Depending on the relative distance from each cube, the three dimensional coordinate points from each point cloud is aligned to the reference frame to give a complete point cloud. The RGB data is used to correct for any errors in depth data for the point cloud. A triangular mesh is generated from the point cloud by applying Delaunay triangulation which generates the rough surface of the limb. This technique forms an approximation of the surface of the limb. The mesh is smoothened to obtain a smooth outer layer to give an accurate model of the limb. The model of the limb is used as a base for designing the custom orthotic brace or cast. It is transferred to a CAD/CAM design file to design of the brace above the surface of the limb. The proposed system would be more cost effective than current systems that use MRI or CT scans for generating 3D models and would be quicker than using traditional plaster of Paris cast modelling and the overall setup time is also low. Preliminary results indicate that the accuracy of the Kinect2 is satisfactory to perform modelling.

Keywords: 3d scanning, mesh generation, Microsoft kinect, orthotics, registration

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Authors: Yen-Fen Shen, Meng-Fan Li

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The study aims to investigate the effect of full-body vertical rhythmic training on fatigue, physical activity, and quality of life among middle-aged and elderly hemodialysis patients. The study adopted a quasi-experimental research method and recruited 43 long-term hemodialysis patients from a medical center in northern Taiwan, with 23 and 20 participants in the experimental and control groups, respectively. The experimental group received full-body vertical rhythmic training as an intervention, while the control group received standard hemodialysis care without any intervention. Both groups completed the measurements by using "Fatigue Scale", "Physical Activity Scale" and "Chinese version of the Kidney Disease Quality of Life Questionnaire" before and after the study. The experimental group underwent a 10-minute full-body vertical rhythmic training three times per week, which lasted for eight weeks before receiving regular hemodialysis treatment. The data were analyzed by SPSS 25 software, including descriptive statistics such as frequency distribution, percentages, means, and standard deviations, as well as inferential statistics, including chi-square, independent samples t-test, and paired samples t-test. The study results are summarized as follows: 1. There were no significant differences in demographic variables, fatigue, physical activity, and quality of life between the experimental and control groups in the pre-test. 2. After the intervention of the “full-body vertical rhythmic training,” the experimental group showed significantly better results in the category of "feeling tired and fatigued in the lower back", "physical functioning role limitation", "bodily pain", "social functioning", "mental health", and "impact of kidney disease on life quality." 3. The paired samples t-test results revealed that the control group experienced significant differences between the pre-test and post-test in the categories of feeling tired and fatigued in the lower back, bodily pain, social functioning mental health, and impact of kidney disease on life quality, with scores indicating a decline in life quality. Conversely, the experimental group only showed a significant worsening in bodily pain" and the impact of kidney disease on life quality, with lower change values compared to the control group. Additionally, there was an improvement in the condition of "feeling tired and fatigued in the lower back" for the experimental group. Conclusion: The intervention of the “full-body vertical rhythmic training” had a certain positive effect on the quality of life of the experimental group. While it may not entirely enhance patients' quality of life, it can mitigate the negative impact of kidney disease on certain aspects of the body. The study provides clinical practice, nursing education, and research recommendations based on the results and discusses the limitations of the research.

Keywords: hemodialysis, full-body vertical rhythmic training, fatigue, physical activity, quality of life

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Authors: Nikeshala Weerasekara, Roshan Ajward

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Contemporary business environment, given the circumstance of stringent scrutiny toward corporate behavior, organizations are under pressure to develop and implement solid overarching Corporate Social Responsibility (CSR) strategies. In that milieu, in order to differentiate themselves from competitors and maintain stakeholder confidence banks spend millions of dollars on CSR programmes. However, knowledge on how non-western bank employees perceive such activities is inconclusive. At the same time recently only researchers have shifted their focus on positive effects of compassion at work or the organizational conditions under which it arises. Nevertheless, mediation mechanisms between CSR and compassion at work have not been adequately examined leaving a vacuum to be explored. Despite finding a purpose in work that is greater than extrinsic outcomes of the work is important to employees, meaningful work has not been examined adequately. Thus, in addition to examining the direct relationship between CSR and compassion at work, this study examined the mediating capability of meaningful work between these variables. Specifically, the researcher explored how CSR enables employees to sense work as meaningful which in turn would enhance their level of compassion at work. Hypotheses were developed to examine the direct relationship between CSR and compassion at work and the mediating effect of meaningful work on the relationship between CSR and compassion at work. Both Social Identity Theory (SIT) and Social Exchange Theory (SET) were used to theoretically support the relationships. The sample comprised of 450 respondents covering different levels of the bank. A convenience sampling strategy was used to secure responses from 13 local licensed commercial banks in Sri Lanka. Data was collected using a structured questionnaire which was developed based on a comprehensive review of literature and refined using both expert opinions and a pilot survey. Structural equation modeling using Smart Partial Least Square (PLS) was utilized for data analysis. Findings indicate a positive and significant (p < .05) relationship between CSR and compassion at work. Also, it was found that meaningful work partially mediates the relationship between CSR and compassion at work. As per the findings it is concluded that bank employees’ perception of CSR engagement not only directly influence compassion at work but also impact such through meaningful work as well. This implies that employees consider working for a socially responsible bank since it creates greater meaningfulness of work to retain with the organization, which in turn trigger higher level of compassion at work. By utilizing both SIT and SET in explaining relationships between CSR and compassion at work it amounts to theoretical significance of the study. Enhance existing literature on CSR and compassion at work. Also, adds insights on mediating capability of psychologically related variables such as meaningful work. This study is expected to have significant policy implications in terms of increasing compassion at work where managers must understand the importance of including CSR activities into their strategy in order to thrive. Finally, it provides evidence of suitability of using Smart PLS to test models with mediating relationships involving non normal data.

Keywords: compassion at work, corporate social responsibility, employee commitment, meaningful work, positive affect

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Authors: Emine Umran Topcu

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In both urban design and architecture, the primary goal is considered to be looking for ways in which people feel and think about space and place. Humans, in general, see a place as security and space as freedom and feel attached to place and long for space. Contemporary urban design manifests itself by addressing basic physical and psychological human needs. Not much attention is paid to transcendence. There seems to be a gap in the hierarchy of human needs. Usually, social aspects of public space are addressed through urban design. More personal and intimately scaled needs of an individual are neglected. How does built form contribute to an individual’s growth, contemplation, and exploration? In other words, a greater meaning in the immediate environment. Architects love to talk about meaning, poetics, attachment and other ethereal aspects of space that are not visible attributes of places. This paper aims at describing spirituality through built form with a personal experience of Kamppi Chapel of Helsinki. Experience covers various modes through which a person unfolds or constructs reality. Perception, sensation, emotion, and thought can be counted as for these modes. To experience is to get to know. What can be known is a construct of experience. Feelings and thoughts about space and place are very complex in human beings. They grow out of life experiences. The author had the chance of visiting Kamppi Chapel in April 2017, out of which the experience grew. The Kamppi Chapel is located on the South side of the busy Narinnka Square in central Helsinki. It offers a place to quiet down and compose oneself in a most lively urban space. With its curved wooden facade, the small building looks more like a museum than a chapel. It can be called a museum for contemplation. With its gently shaped interior, it embraces visitors and shields them from the hustle bustle of the city outside. Places of worship in all faiths signify sacred power. The author, having origins in a part of the world where domes and minarets dominate the cityscape, was impressed by the size and the architectural visibility of the Chapel. Anyone born and trained in such a tradition shares the inherent values and psychological mechanisms of spirituality, sacredness and the modest realities of their environment. Spirituality in all cultural traditions has not been analyzed and reinterpreted in new conceptual frameworks. Fundamentalists may reject this positivist attitude, but Kamppi Chapel as it stands does not look like it has a say like “I’m a model to be followed”. It just faces the task of representing a religious facility in an urban setting largely shaped by modern urban planning, which seems to the author as looking for a new definition of individual status. The quest between the established and the new is the demand for modern efficiency versus dogmatic rigidity. The architecture here has played a very promising and rewarding role for spirituality. The designers have been the translators for human desire for better life and aesthetic environment for an optimal satisfaction of local citizens and the visitors alike.

Keywords: architecture, Kamppi Chapel, spirituality, urban

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Authors: Kunyaporn Pipithsangchan, Alongkorn Korntong, Assanee Songserm, Phatchara Piriyavinit, Saowanee Dechakampoo

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The Kingdom of Thailand is one of the South East Asian countries. From its area of 514,000 square kilometers (51 million ha), at least 18,000 plant species (8% of the world total) have been estimated to be found in the country. As a result, the conservation of plant genetic diversity, particularly food crops, is becoming important and is an assurance for the national food security. Department of Agriculture Genebank or DOA Genebank, Thailand is responsible for the conservation of plant germplasm by participating and accomplishing several collaborative projects both at national and international levels. Integrated Management System of Plant Genetic Resources or IMPGR is one of the most outstandingly successful cooperation. It is a multilateral project under the Asian Food and Agriculture Cooperation Initiative (AFACI) supported by the Rural Development Administration (RDA) of South Korea. The member countries under the project consist of 11 nations namely Bangladesh, Cambodia, Indonesia, Laos PDR, Mongolia, Nepal, Philippines, Sri Lanka, Thailand, Vietnam and South Korea. The project enabled the members to jointly address the global issues in plant genetic resource (PGR) conservation and strengthen their network in this aspect. The 1st phase of IMPGR project, entitled 'Collection, Conservation, Regeneration and Characterization of Cucurbitaceae and Solanaceae 2012-2014', comprises three main objectives that are: 1) To improve management in storage facilities, collection, and regeneration, 2) To improve linkage between Genebank and material sources (for regeneration), and 3) To improve linkage between Genebank and other field crop or/and horticultural research centers. The project was done for three years from 2012 to 2014. The activities of the project can be described as following details: In the 1st year, there were 9 target provinces for completing plant genetic resource survey and collection. 108 accessions of PGR were collected. In the 2nd year, PGR were continuously surveyed and collected from 9 provinces. The total number of collection was 140 accessions. In addition, the process of regeneration of 237 accessions collected from 1st and 2nd year was started at several sites namely Biotechnology Research and Development Office, Sukothai Horticultural Research Center, Tak Research, and Development Center and Nakhon Ratchasima Research and Development Center. In the 3rd year, besides survey and collection of 115 accessions from 9 target provinces, PGR characterization and evaluation were done for 206 accessions. Moreover, safety duplication of 253 PGR at the World Seed Vault, RDA, was also done according to Standard Agreement on Germplasm Safety Duplication between Department of Agriculture, Ministry of Agriculture and Cooperatives, the Kingdom of Thailand and the National Agrobiodiversity Center, Rural Development Administration of the Republic of Korea. The success of the 1st phase project led to the second phase which entitled 'Collection and Characterization for Effective Conservation of Local Capsicum spp., Solanum spp. and Lycopersicon spp. in Thailand 2015-2017'.

Keywords: characterization, conservation, DOA genebank, plant genetic resources

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Authors: Ishan Naidu, Jessica Ryvlin, Devin Videlefsky

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Introduction: Back pain is a leading cause of years lived with disability and economic burden, exceeding over $20 billion in healthcare costs not including indirect costs such as absence from work and caregiving. The multifactorial nature of back pain leads to treatment modalities administered by a variety of specialists, which are often disjointed. Multiple studies have found that patients receiving delayed physical therapy for lower back pain had higher medical-related costs from increased health service utilization as well as a reduced improvement in pain severity compared to early management. Uncoordinated health care delivery can exacerbate the physical and economic toll of the chronic condition, thus improvements in interdisciplinary, shared decision-making may improve outcomes. Objective: To assess whether a multidisciplinary spine clinic (MSC), consisting of orthopedic surgery, neurosurgery, pain medicine, and physiatry, alters interventional and non-interventional planning and treatment compared to a traditional unidisciplinary spine clinic (USC) including only orthopedic surgery. Methods: We conducted a retrospective cohort study with patients initially presenting for spine care to orthopedic surgeons between July 1, 2018 to June 30, 2019. Time to treatment recommendation, time to treatment and rates of treatment recommendations were assessed, including physical therapy, injections and surgery. Treatment rates were compared between MSC and USC using Pearson’s chi-square test logistic regression. Time to treatment recommendation and time to treatment were compared using log-rank test and Cox proportional hazard regression. All analyses were repeated for the propensity score (PS) matched subsample. Results: This study included 1,764 patients, with 692 at MSC and 1,072 at USC. Patients in MSC were more likely to be recommended injection when compared to USC (8.5% vs. 5.4%, p=0.01). When adjusted for confounders, the likelihood of injection recommendation remained greater in MSC than USC (Odds ratio [OR]=2.22, 95% CI: (1.39, 3.53), p=0.001). MSC was also associated with a shorter time to receiving injection recommendation versus USC (median: 21 vs. 32 days, log-rank: p<0.001; hazard ratio [HR]=1.90, 95% CI: (1.25, 2.90), p=0.003). MSC was associated with a higher likelihood of injection treatment (OR=2.27, 95% CI: (1.39, 3.73), p=0.001) and shorter lead time (HR=1.98, 95% CI: (1.27, 3.09), p=0.003). PS-matched analyses yielded similar conclusions. Conclusions: Care delivered at a multidisciplinary spine clinic was associated with a higher likelihood of recommending injection and a shorter lead time to injection administration when compared to a traditional unidisciplinary spine surgery clinic. Multidisciplinary clinics may facilitate coordinated care amongst different specialties resulting in increased utilization of less invasive treatment modalities while also improving care efficiency. The multidisciplinary clinic model is an important advancement in care delivery and communication, which can be used as a powerful method of improving patient outcomes as treatment guidelines evolve.

Keywords: coordinated care, epidural steroid injection, multi-disciplinary, non-invasive

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Authors: I. Hosni, L. Bennaceur Farah, N. Saber, R Bennaceur

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Soil moisture content is a key variable in many environmental sciences. Even though it represents a small proportion of the liquid freshwater on Earth, it modulates interactions between the land surface and the atmosphere, thereby influencing climate and weather. Accurate modeling of the above processes depends on the ability to provide a proper spatial characterization of soil moisture. The measurement of soil moisture content allows assessment of soil water resources in the field of hydrology and agronomy. The second parameter in interaction with the radar signal is the geometric structure of the soil. Most traditional electromagnetic models consider natural surfaces as single scale zero mean stationary Gaussian random processes. Roughness behavior is characterized by statistical parameters like the Root Mean Square (RMS) height and the correlation length. Then, the main problem is that the agreement between experimental measurements and theoretical values is usually poor due to the large variability of the correlation function, and as a consequence, backscattering models have often failed to predict correctly backscattering. In this study, surfaces are considered as band-limited fractal random processes corresponding to a superposition of a finite number of one-dimensional Gaussian process each one having a spatial scale. Multiscale roughness is characterized by two parameters, the first one is proportional to the RMS height, and the other one is related to the fractal dimension. Soil moisture is related to the complex dielectric constant. This multiscale description has been adapted to two-dimensional profiles using the bi-dimensional wavelet transform and the Mallat algorithm to describe more correctly natural surfaces. We characterize the soil surfaces and sub-surfaces by a three layers geo-electrical model. The upper layer is described by its dielectric constant, thickness, a multiscale bi-dimensional surface roughness model by using the wavelet transform and the Mallat algorithm, and volume scattering parameters. The lower layer is divided into three fictive layers separated by an assumed plane interface. These three layers were modeled by an effective medium characterized by an apparent effective dielectric constant taking into account the presence of air pockets in the soil. We have adopted the 2D multiscale three layers small perturbations model including, firstly air pockets in the soil sub-structure, and then a vegetable canopy in the soil surface structure, that is to simulate the radar backscattering. A sensitivity analysis of backscattering coefficient dependence on multiscale roughness and new soil moisture has been performed. Later, we proposed to change the dielectric constant of the multilayer medium because it takes into account the different moisture values of each layer in the soil. A sensitivity analysis of the backscattering coefficient, including the air pockets in the volume structure with respect to the multiscale roughness parameters and the apparent dielectric constant, was carried out. Finally, we proposed to study the behavior of the backscattering coefficient of the radar on a soil having a vegetable layer in its surface structure.

Keywords: multiscale, bidimensional, wavelets, backscattering, multilayer, SPM, air pockets

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Authors: Ajay Kumar Pandey

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White grub (Coleoptera: Scarabaeidae), locally known as Kurmula, Pagra, Chinchu, is a major destructive pest in western Himalayan region of Uttarakhand state of India. Various crops like cereals (up land paddy, wheat, and barley), vegetables (capsicum, cabbage, tomato, cauliflower, carrot etc) and some pulse (like pigeon pea, green gram, black gram) are grown with limited availability of primary resources. Among the various limitations in successful cultivation of these crops, white grub has been proved a major constraint in for all crops grown in hilly area. The losses incurred due to white grubs are huge in case of commercial crops like sugarcane, groundnut, potato, maize and upland rice. Moreover, it has been proved major constraint in potato production in mid and higher hills of India. Adults emerge in May-June following the onset of monsoon and thereafter defoliate the apple, apricot, plum, and walnut during night while 2nd and 3rd instar grubs feed on live roots of cultivated as well as non cultivated crops from August to January. Survey was conducted in hilly (Pauri and Tehri) as well as plain area (Haridwar district) of Uttarakhand state. Collection of beetle was done from various locations from August to September of five consecutive years with the help of light trap and directly from host plant. The grub was also collected by excavating one square meter area from different locations and reared in laboratory to find out adult. During the collection, the diseased or dead cadaver were also collected and brought in the laboratory and identified the causal organisms. Total 25 species of white grub was identified out of which Holotrichia longipennis, Anomala dimidiata, Holotrichia lineatopennis, Maladera insanabilis, Brahmina sp. make complex problem in different area of Uttarakhand where they cause severe damage to various crops. During the survey, it was observed that white grubs beetles have variation in preference of host plant, even in choice of fruit and leaves of host plant. It was observed that, a white grub species, which identified as Lepidiota mansueta Burmeister., was causing severe havoc to sugarcane crop grown in major sugarcane growing belt of Haridwar district. The study also revealed that Bacillus cereus, Beauveria bassiana, Metarhizium anisopliae, Steinernema, Heterorhabditis are major disease causing agents in immature stage of white grub under rain-fed condition of Uttarakhand which caused 15.55 to 21.63 percent natural mortality of grubs with an average of 18.91 percent. However, among the microorganisms, B. cereus found to be significantly more efficient (7.03 percent mortality) then the entomopathogenic fungi (3.80 percent mortality) and nematodes (3.20 percent mortality).

Keywords: Lepidiota, profiling, Uttarakhand, whitegrub

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Authors: Arkadiusz P. Wójcik, Tetsuya Sato, Shin-Ichiro Shima, Mateusz Malanowski

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Over the last decades, new technologies have significantly changed the way information is transmitted and stored. Renewable energy sources have become prevalent and affordable. Cooperation of the Information and Communication Technology industry and Renewable Energy industry makes it possible to create a next generation, decentralized power grid. In this context, the study seeks to identify the wider benefits to the local Japanese economy as a result of the development of a decentralised electricity market. Our general approach aims to integrate an economic analysis (monetary appraisal of costs and benefits to society) with externalities that are not quantifiable in monetary terms (e.g. social impact, environmental impact). The study also highlights opportunities and sets out recommendations for the citizens of the island and the local government. The simulation is the scientific basis for economic impact analysis. Various types of sources of energy have been taken into account: residential wind farm, residential wind turbine, solar farm, residential solar panels and private solar farms. Analysis of local geographic and economic conditions allowed creating a customized business model. Very often farmers on Awaji Island are using crop cycle. During each cycle, one part of the field is resting and replenishing nutrients. In the next year another part of the field is resting. Portable solar panels could be freely set up in this part of the field. At the end of the crop cycle, portable solar panels would be moved to the next resting part. Because of spacious area, for a single household 500 square meters of portable solar panels has been proposed and simulated. The devised simulation shows that the Rate of Return on Investment for solar panels, which are on the island, could reach up to 37.21%. Supposing that about 20% of households install solar panels they could produce 49.11% of the electric energy consumed by households on the island. The analysis shows that rest of the energy supply can be produced by currently existing one huge solar farm and two wind farms to meet 97.59% of demand on electricity for households on the island. Although there are more than 7,000 agricultural fields on the island, young people tend to avoid agricultural work and prefer to move from the island to big cities, live there in little mansions and work until late night. The business model proposed in this study could increase farmer’s monthly income by ¥200,000 - ¥300,000 (1,600 euro – 2,400 euro). Young people could work less and have a higher standard of living than in a city. Creation of a decentralized electricity market can unlock significant benefits in other industries (e.g. electric vehicles), providing a welcome boost to economic growth, jobs and quality of life.

Keywords: digital twin, Matlab, model-based systems engineering, simulink, smart grid, systems engineering

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Authors: Tesfaldet Mekonnen Estifanos, Chen Hui, Afewerki Weldezgi

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Background: Intimate partner violence (hereafter IPV) is a major global public health challenge that tortures and disables women in the place where they are ought to be most secure within their own families. The fact that the family unit is commonly viewed as a private circle, violent acts towards women remains undermined. There are limited research and knowledge about the influencing factors linked to IPV in Sierra Leone. This study, therefore, estimates the prevalence rate and the predicting factors associated with IPV. Methods: Data were taken from Sierra-Leone Demographic and Health Survey (SDHS, 2013): the first in its form to incorporate information on domestic violence. Multistage cluster sampling research design was used, and information was gathered by a standard questionnaire. A total of 5185 respondents selected were interviewed, out of whom 870 were never been in union, thus excluded. To analyze the two dependent variables: experience of IPV, ‘ever’ and 'last 12 months prior to the survey', a total of 4315 (currently or formerly married) and 4029 women (currently in union) were included respectively. These dependent variables were constructed from the three forms of violence namely physical, emotional and sexual. Data analysis was applied using SPSS version 23, comprising three-step process. First, descriptive statistics were used to show the frequency distribution of both the outcome and explanatory variables. Second, bivariate analysis adopting chi-square test was applied to assess the individual relationship between the outcome and explanatory variables. Third, multivariate logistic regression analysis was undertaken using hierarchical modeling strategy to identify the influence of the explanatory variables on the outcome variables. Odds ratio (OR) and 95% confidence interval (CI) were utilized to examine the association of the variables considering p-values less than 0.05 statistically significant. Results: The prevalence of lifetime IPV among ever married women was 48.4%, while 39.8% of those currently married experienced IPV in the previous year preceding the survey. Women having 1 to 4 and more than 5 number of ever born babies were almost certain to encounter lifetime IPV. However, women who own a property, and those who referenced 3-5 reasons for which wife-beating is acceptable were less probably to experience lifetime IPV. Attesting parental violence, partner’s dominant marital behavior, and women afraid of their partner were the variables related to both experience of IPV ‘ever’ and ‘the previous year prior to the survey’. Respondents who concur that wife-beating is sensible in certain situations and occupations under the professional category had diminished chances of revealing IPV in the year prior to the data collection. Conclusion: This study indicated that factors significantly correlated with IPV in Sierra-Leone are mostly linked with husband related factors specifically, marital controlling behaviors. Addressing IPV in Sierra-Leone requires joint efforts that target men raise awareness to address controlling behavior and empower security in affiliations.

Keywords: husband behavior, married women, partner violence, Sierra Leone

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Authors: S. Sabatino, V. Calderaro, V. Galdi, G. Graber, L. Ippolito

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Climate change is a rapidly growing global threat caused mainly by increased emissions of carbon dioxide (CO₂) into the atmosphere. These emissions come from multiple sources, including industry, power generation, and the transport sector. The need to tackle climate change and reduce CO₂ emissions is indisputable. A crucial solution to achieving decarbonization in the transport sector is the adoption of electric vehicles (EVs). These vehicles use lithium (Li-Ion) batteries as an energy source, making them extremely efficient and with low direct emissions. However, Li-Ion batteries are not without problems, including the risk of overheating and performance degradation. To ensure its safety and longevity, it is essential to use a battery management system (BMS). The BMS constantly monitors battery status, adjusts temperature and cell balance, ensuring optimal performance and preventing dangerous situations. From the monitoring carried out, it is also able to optimally manage the battery to increase its life. Among the parameters monitored by the BMS, the main ones are State of Charge (SoC), State of Health (SoH), and State of Power (SoP). The evaluation of these parameters can be carried out in two ways: offline, using benchtop batteries tested in the laboratory, or online, using batteries installed in moving vehicles. Online estimation is the preferred approach, as it relies on capturing real-time data from batteries while operating in real-life situations, such as in everyday EV use. Actual battery usage conditions are highly variable. Moving vehicles are exposed to a wide range of factors, including temperature variations, different driving styles, and complex charge/discharge cycles. This variability is difficult to replicate in a controlled laboratory environment and can greatly affect performance and battery life. Online estimation captures this variety of conditions, providing a more accurate assessment of battery behavior in real-world situations. In this article, a hybrid approach based on a neural network and a statistical method for real-time estimation of SoC, SoH, and SoP parameters of interest is proposed. These parameters are estimated from the analysis of a one-day driving profile of an electric vehicle, assumed to be divided into the following four phases: (i) Partial discharge (SoC 100% - SoC 50%), (ii) Partial discharge (SoC 50% - SoC 80%), (iii) Deep Discharge (SoC 80% - SoC 30%) (iv) Full charge (SoC 30% - SoC 100%). The neural network predicts the values of ohmic resistance and incremental capacity, while the statistical method is used to estimate the parameters of interest. This reduces the complexity of the model and improves its prediction accuracy. The effectiveness of the proposed model is evaluated by analyzing its performance in terms of square mean error (RMSE) and percentage error (MAPE) and comparing it with the reference method found in the literature.

Keywords: electric vehicle, Li-Ion battery, BMS, state-of-charge, state-of-health, state-of-power, artificial neural networks

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Authors: Rosyellen Rabelo Szvarça, Pedro Fialho, Auristela Duarte de Lima Moser

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Background: New ways of working, such as teleworking or hybrid working, have changed and have impacted both employees and organizations. To understand the individuals' perceptions among different working models, this study aimed to investigate levels of psychological safety among employees working in person, hybrid, and remote environments and the correlation of demographic or professional characteristics. Methods: A cross-sectional survey was distributed electronically. A self-administered questionnaire was composed of sociodemographic data, academic status, professional contexts, working models, and the seven-item instrument of psychological safety. The psychological safety instrument was computed to determine its reliability, showing a Cronbach’s 0.75, considering a good scale when compared to the original, analyzed with 51 teams from a North American company, with a Cronbach's alpha coefficient of 0.82. Results: The survey was completed by 328 individuals, 60% of whom were in-person, 29.3% hybrid, and 10.7% remote. The Chi-Square test with the Bonferroni post-test for qualitative variables associated with the working models indicates a significant association (p 0.001) for academic qualifications. In-person models present 29.4% of individuals with secondary education and 38.1% undergraduate; hybrid present 51% postgraduate and 35.4% undergraduate. This was similar to remote workers, with 48.6% postgraduate and 34.3% undergraduate. There were no significant differences in gender composition between work models (p = 0.738), with most respondents being female in all three work groups. Remote workers predominated in areas such as commerce, marketing, and services; education and the public sector were common in the in-person group, while technology and the financial sector were predominant among hybrid workers (p < 0.001). As for leadership roles, there was no significant association with working models (p = 0.126). The decision on the working model was predominantly made by the organization for in-person and hybrid workers (p < 0.001). Preference for the working model was in line with the workers' scenario at that time (p < 0.001). Kruskal-Wallis test with Bonferroni's post hoc test compared the psychological safety scores between working groups, reveling statistically higher scores in hybrid group x̃ = 5.64 compared to in-person group x̃ = 5, with remote workers showing scores similar to other groups x̃ = 5.43 (p = 0.004). Age demonstrated no significant difference between the working groups (p = 0.052). On the other hand, organization tenure and job tenure were higher in in-person groups compared to the hybrid and remote groups (p < 0.001). The hybrid model illustrates a balance between in-person and remote models. The results highlight that higher levels of psychological safety can be correlated with the flexibility of hybrid work, as well as physical interaction, spontaneity, and informal relationships, which are considered determinants of high levels of psychological safety. Conclusions: Psychological safety at the group level using the seven-item scale is widely employed in comparison to other commonly employed measures. Despite psychological safety having been around for decades, primarily studied in in-person work contexts, the current findings contribute to expanding research with hybrid or remote settings. Ultimately, this investigation has demonstrated the significance of work models in assessing psychological safety levels.

Keywords: hybrid work, new ways of working, psychological safety, workplace, working models

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Authors: Tesfaldet Mekonnen Estifanos, Chen Hui, Afewerki Weldezgi

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Background: Youth in general and young females in particular, remain at the center of the HIV/AIDS epidemic. Sexual risk-taking among young unmarried women is relatively high and are the most vulnerable and highly exposed to HIV/AIDS. Improvements in the status of HIV/AIDS knowledge and acceptance attitude towards people living with HIV (PLWHIV) plays a great role in averting the incidence of HIV/AIDS. Thus, the aim of the study was to explore the level and correlates of HIV/AIDS knowledge and accepting attitude toward PLWHIV. Methods: A cross-sectional study was conducted using data from the Uganda Demographic Health Survey 2016 (UDHS-2016). National level representative household surveys using a multistage cluster probability sampling method, face to face interviews with standard questionnaires were performed. Unmarried women aged 15-24 years with a sample size of 2019 were selected from the total sample of 8674 women aged 15-49 years and were analyzed using SPSS version 23. Independent variables such as age, religion, educational level, residence, and wealth index were included. Two binary outcome variables (comprehensive HIV/AIDS knowledge and acceptance attitude toward PLWHIV) were utilized. We used the chi-square test as well as multivariate regression analysis to explore correlations of explanatory variables with the outcome variables. The results were reported by odds ratios (OR) with 95% confidence interval (95% CI), taking a p-value less than 0.05 as significant. Results: Almost all (99.3%) of the unmarried women aged 15-24 years were aware of HIV/AIDS, but only 51.2% had adequate comprehensive knowledge on HIV/AIDS. Only 69.4% knew both methods: using a condom every time had sex, and having only one faithful uninfected partner can prevent HIV/AIDS transmission. About 66.6% of the unmarried women reject at least two common local misconceptions about HIV/AIDS. Moreover, an alarmingly few (20.3%) of the respondents had a positive acceptance attitude to PLWHIV. On multivariate analysis, age (20-24 years), living in urban, being educated and wealthier, were predictors of having adequate comprehensive HIV/AIDS knowledge. On the other hand, research participants with adequate comprehensive knowledge about HIV/AIDS were highly likely (OR, 1.94 95% CI, 1.52-2.46) to have a positive acceptance attitude to PLWHIV than those with inadequate knowledge. Respondents with no education, Muslim, and Pentecostal religion were emerged less likely to have a positive acceptance attitude to PLWHIV. Conclusion: This study found out the highly accepted level of awareness, but the knowledge and positive acceptance attitude are not encouraging. Thus, expanding access to comprehensive sexuality and strengthening educational campaigns on HIV/AIDS in communities, health facilities, and schools is needed with a greater focus on disadvantaged women having low educational level, poor socioeconomic status, and those residing in rural areas. Sexual risk behaviors among the most affected people - young women have also a role in the spread of HIV/AIDS. Hence, further research assessing the significant contributing factors for sexual risk-taking might have a positive impact on the fight against HIV/AIDS.

Keywords: acceptance attitude, HIV/AIDS, knowledge, unmarried women

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Authors: Dayron Camilo Bermudez Mendoza

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Road transportation is a significant source of externalities, notably in terms of environmental degradation and the emission of pollutants. These emissions adversely affect public health, attributable to criteria pollutants like particulate matter (PM2.5 and PM10) and carbon monoxide (CO), and also contribute to climate change through the release of greenhouse gases, such as carbon dioxide (CO2). It is, therefore, crucial to quantify the emissions from mobile sources and develop a methodological framework for their economic valuation, aiding in the assessment of associated costs and informing policy decisions. The forthcoming congress will shed light on the externalities of transportation in Bogotá, showcasing methodologies and findings from the construction of emission inventories and their spatial analysis within the city. This research focuses on the economic valuation of emissions from mobile sources in Bogotá, employing methods like hedonic pricing and contingent valuation. Conducted within the urban confines of Bogotá, the study leverages demographic, transportation, and emission data sourced from the Mobility Survey, official emission inventories, and tailored estimates and measurements. The use of hedonic pricing and contingent valuation methodologies facilitates the estimation of the influence of transportation emissions on real estate values and gauges the willingness of Bogotá's residents to invest in reducing these emissions. The findings are anticipated to be instrumental in the formulation and execution of public policies aimed at emission reduction and air quality enhancement. In compiling the emission inventory, innovative data sources were identified to determine activity factors, including information from automotive diagnostic centers and used vehicle sales websites. The COPERT model was utilized to ascertain emission factors, requiring diverse inputs such as data from the national transit registry (RUNT), OpenStreetMap road network details, climatological data from the IDEAM portal, and Google API for speed analysis. Spatial disaggregation employed GIS tools and publicly available official spatial data. The development of the valuation methodology involved an exhaustive systematic review, utilizing platforms like the EVRI (Environmental Valuation Reference Inventory) portal and other relevant sources. The contingent valuation method was implemented via surveys in various public settings across the city, using a referendum-style approach for a sample of 400 residents. For the hedonic price valuation, an extensive database was developed, integrating data from several official sources and basing analyses on the per-square meter property values in each city block. The upcoming conference anticipates the presentation and publication of these results, embodying a multidisciplinary knowledge integration and culminating in a master's thesis.

Keywords: economic valuation, transport economics, pollutant emissions, urban transportation, sustainable mobility

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Authors: Jiaying Zhang, Xin Mu, Chang Ni, Jeff L. Zhang

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Magnetic resonance elastography (MRE) non-invasively assesses tissue elastic properties, such as shear modulus, by measuring tissue’s displacement in response to mechanical waves. The estimated metrics on tissue elasticity or stiffness have been shown to be valuable for monitoring physiologic or pathophysiologic status of tissue, such as a tumor or fatty liver. To quantify tissue shear modulus from MRE-acquired displacements (essentially an inverse problem), multiple approaches have been proposed, including Local Frequency Estimation (LFE) and Direct Inversion (DI). However, one common problem with these methods is that the estimates are severely noise-sensitive due to either the inverse-problem nature or noise propagation in the pixel-by-pixel process. With the advent of deep learning (DL) and its promise in solving inverse problems, a few groups in the field of MRE have explored the feasibility of using DL methods for quantifying shear modulus from MRE data. Most of the groups chose to use real MRE data for DL model training and to cut training images into smaller patches, which enriches feature characteristics of training data but inevitably increases computation time and results in outcomes with patched patterns. In this study, simulated wave images generated by Finite Differential Time Domain (FDTD) simulation are used for network training, and U-Net is used to extract features from each training image without cutting it into patches. The use of simulated data for model training has the flexibility of customizing training datasets to match specific applications. The proposed method aimed to estimate tissue shear modulus from MRE data with high robustness to noise and high model-training efficiency. Specifically, a set of 3000 maps of shear modulus (with a range of 1 kPa to 15 kPa) containing randomly positioned objects were simulated, and their corresponding wave images were generated. The two types of data were fed into the training of a U-Net model as its output and input, respectively. For an independently simulated set of 1000 images, the performance of the proposed method against DI and LFE was compared by the relative errors (root mean square error or RMSE divided by averaged shear modulus) between the true shear modulus map and the estimated ones. The results showed that the estimated shear modulus by the proposed method achieved a relative error of 4.91%±0.66%, substantially lower than 78.20%±1.11% by LFE. Using simulated data, the proposed method significantly outperformed LFE and DI in resilience to increasing noise levels and in resolving fine changes of shear modulus. The feasibility of the proposed method was also tested on MRE data acquired from phantoms and from human calf muscles, resulting in maps of shear modulus with low noise. In future work, the method’s performance on phantom and its repeatability on human data will be tested in a more quantitative manner. In conclusion, the proposed method showed much promise in quantifying tissue shear modulus from MRE with high robustness and efficiency.

Keywords: deep learning, magnetic resonance elastography, magnetic resonance imaging, shear modulus estimation

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Authors: Mehwish Jawaad

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Purpose: The concept of GrSCM (Green Supply Chain Management) in the academic and research field is still thought to be in the development stage especially in Asian Emerging Economies. The purpose of this paper is to contribute significantly to the first wave of empirical investigation on GrSCM Practices and Firm Performance measures in Pakistan. The aim of this research is to develop a more holistic approach towards investigating the impact of Green Supply Chain Management Practices (Ecodesign, Internal Environmental Management systems, Green Distribution, Green Purchasing and Cooperation with Customers) on multiple dimensions of Firm Performance Measures (Economic Performance, Environmental Performance and Operational Performance) with a mediating role of Investment Recovery and Competitiveness. This paper also serves as an initiative to identify if the relationship between Investment Recovery and Firm Performance Measures is mediated by Competitiveness. Design/ Methodology/Approach: This study is based on survey Data collected from 272, ISO (14001) Certified Textile Firms Based in Lahore, Faisalabad, and Karachi which are involved in Spinning, Dyeing, Printing or Bleaching. A Theoretical model was developed incorporating the constructs representing Green Activities and Firm Performance Measures of a firm. The data was analyzed using Partial Least Square Structural Equation Modeling. Senior and Mid-level managers provided the data reflecting the degree to which their organizations deal with both internal and external stakeholders to improve the environmental sustainability of their supply chain. Findings: Of the 36 proposed Hypothesis, 20 are considered valid and significant. The statistics result reveal that GrSCM practices positively impact Environmental Performance followed by Economic and Operational Performance. Investment Recovery acts as a strong mediator between Intra organizational Green activities and performance outcomes. The relationship of Reverse Logistics influencing outcomes is significantly mediated by Competitiveness. The pressure originating from customers exert significant positive influence on the firm to adopt Green Practices consequently leading to higher outcomes. Research Contribution/Originality: Underpinning the Resource dependence theory and as a first wave of investigating the impact of Green Supply chain on performance outcomes in Pakistan, this study intends to make a prominent mark in the field of research. Investment and Competitiveness together are tested as a mediator for the first time in this arena. Managerial implications: Practitioner is provided with a framework for assessing the synergistic impact of GrSCM practices on performance. Upgradation of Accreditations and Audit Programs on regular basis are the need of the hour. Making the processes leaner with the sale of excess inventories and scrap helps the firm to work more efficiently and productively.

Keywords: economic performance, environmental performance, green supply chain management practices, operational performance, sustainability, a textile sector of Pakistan

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Authors: Gulhan Sen

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Disasters could result in many deaths and injuries. In these difficult times, accessible resources are limited, demand and supply balance is distorted, and there is a need to make urgent interventions. Disproportionateness between accessible resources and intervention capacity makes triage a necessity in every stage of disaster response. Healthcare professionals, who are in charge of triage, have to evaluate swiftly and make ethical decisions about which patients need priority and urgent intervention given the limited available resources. For such critical times in disaster triage, 'doing the greatest good for the greatest number of casualties' is adopted as a code of practice. But there is no guide for healthcare professionals about ethical decision-making during disasters, and this study is expected to use as a source in the preparation of the guide. This study aimed to examine whether the qualities healthcare professionals in Izmir related to disaster triage were adequate and whether these qualities influence their capacity to make ethical decisions. The researcher used a survey developed for data collection. The survey included two parts. In part one, 14 questions solicited information about socio-demographic characteristics and knowledge levels of the respondents on ethical principles of disaster triage and allocation of scarce resources. Part two included four disaster scenarios adopted from existing literature and respondents were asked to make ethical decisions in triage based on the provided scenarios. The survey was completed by 215 healthcare professional working in Emergency-Medical Stations, National Medical Rescue Teams and Search-Rescue-Health Teams in Izmir. The data was analyzed with SPSS software. Chi-Square Test, Mann-Whitney U Test, Kruskal-Wallis Test and Linear Regression Analysis were utilized. According to results, it was determined that 51.2% of the participants had inadequate knowledge level of ethical principles of disaster triage and allocation of scarce resources. It was also found that participants did not tend to make ethical decisions on four disaster scenarios which included ethical dilemmas. They stayed in ethical dilemmas that perform cardio-pulmonary resuscitation, manage limited resources and make decisions to die. Results also showed that participants who had more experience in disaster triage teams, were more likely to make ethical decisions on disaster triage than those with little or no experience in disaster triage teams(p < 0.01). Moreover, as their knowledge level of ethical principles of disaster triage and allocation of scarce resources increased, their tendency to make ethical decisions also increased(p < 0.001). In conclusion, having inadequate knowledge level of ethical principles and being inexperienced affect their ethical decision-making during disasters. So results of this study suggest that more training on disaster triage should be provided on the areas of the pre-impact phase of disaster. In addition, ethical dimension of disaster triage should be included in the syllabi of the ethics classes in the vocational training for healthcare professionals. Drill, simulations, and board exercises can be used to improve ethical decision making abilities of healthcare professionals. Disaster scenarios where ethical dilemmas are faced should be prepared for such applied training programs.

Keywords: disaster triage, medical ethics, ethical principles of disaster triage, ethical decision-making

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Authors: Yi Jen Wang, Yu Ju Chen

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Background: Heart rate variability (HRV) biofeedback can promote autonomic nervous function, sleep quality and reduce psychological stress. In HRV biofeedback training, it is hoped that through the guidance of machine video or audio, the patient can breathe slowly according to his own heart rate changes so that the heart and lungs can achieve resonance, thereby promoting the related effects of autonomic nerve function; while, it is also pointed out that if slow breathing of 6 times per minute can also guide the case to achieve the effect of cardiopulmonary resonance. However, there is no relevant research to explore the comparison of the effectiveness of cardiopulmonary resonance by using video or audio HRV biofeedback training and metronome-guided slow breathing. Purpose: To compare the promotion of autonomic nervous function performance between using HRV biofeedback and slow breathing guided by a metronome. Method: This research is a kind of experimental design with convenient sampling; the cases are randomly divided into the heart rate variability biofeedback training group and the slow breathing training group. The HRV biofeedback training group will conduct HRV biofeedback training in a four-week laboratory and use the home training device for autonomous training; while the slow breathing training group will conduct slow breathing training in the four-week laboratory using the mobile phone APP breathing metronome to guide the slow breathing training, and use the mobile phone APP for autonomous training at home. After two groups were enrolled and four weeks after the intervention, the autonomic nervous function-related performance was repeatedly measured. Using the chi-square test, student’s t-test and other statistical methods to analyze the results, and use p <0.05 as the basis for statistical significance. Results: A total of 27 subjects were included in the analysis. After four weeks of training, the HRV biofeedback training group showed significant improvement in the HRV indexes (SDNN, RMSSD, HF, TP) and sleep quality. Although the stress index also decreased, it did not reach statistical significance; the slow breathing training group was not statistically significant after four weeks of training, only sleep quality improved significantly, while the HRV indexes (SDNN, RMSSD, TP) all increased. Although HF and stress indexes decreased, they were not statistically significant. Comparing the difference between the two groups after training, it was found that the HF index improved significantly and reached statistical significance in the HRV biofeedback training group. Although the sleep quality of the two groups improved, it did not reach that level in a statistically significant difference. Conclusion: HRV biofeedback training is more effective in promoting autonomic nervous function than slow breathing training, but the effects of reducing stress and promoting sleep quality need to be explored after increasing the number of samples. The results of this study can provide a reference for clinical or community health promotion. In the future, it can also be further designed to integrate heart rate variability biological feedback training into the development of AI artificial intelligence wearable devices, which can make it more convenient for people to train independently and get effective feedback in time.

Keywords: autonomic nervous function, HRV biofeedback, heart rate variability, slow breathing

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Authors: A.H.Y. Lai, C. Teyra

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In Taiwan, there are 16 official indigenous groups, accounting for 2.3% of the total population. Like other indigenous populations worldwide, indigenous peoples in Taiwan have poorer mental health because of their history of oppression and colonisation. Amid the negative narratives, the ethnic identity of cultural minorities is their unique psychological and cultural asset. Moreover, positive socialisation is found to be related to strong ethnic identity. Based on Phinney’s theory on ethnic identity development and social support theory, this study adopted a strength-based approach conceptualising ethnic identity as the central organising principle that linked perceived social support and mental health among indigenous adults in Taiwan. Aims. Overall aim is to examine the effect of ethnic identity and social support on mental health. Specific aims were to examine : (1) the association between ethnic identity and mental health; (2) the association between perceived social support and mental health ; (3) the indirect effect of ethnic identity linking perceived social support and mental health. Methods. Participants were indigenous adults in Taiwan (n=200; mean age=29.51; Female=31%, Male=61%, Others=8%). A cross-sectional quantitative design was implemented using data collected in the year 2020. Respondent-driven sampling was used. Standardised measurements were: Ethnic Identity Scale(6-item); Social Support Questionnaire-SF(6 items); Patient Health Questionnaire(9-item); and Generalised Anxiety Disorder(7-item). Covariates were age, gender and economic satisfaction. A four-stage structural equation modelling (SEM) with robust maximin likelihood estimation was employed using Mplus8.0. Step 1: A measurement model was built and tested using confirmatory factor analysis (CFA). Step 2: Factor covariates were re-specified as direct effects in the SEM. Covariates were added. The direct effects of (1) ethnic identity and social support on depression and anxiety and (2) social support on ethnic identity were tested. The indirect effect of ethnic identity was examined with the bootstrapping technique. Results. The CFA model showed satisfactory fit statistics: x^2(df)=869.69(608), p<.05; Comparative ft index (CFI)/ Tucker-Lewis fit index (TLI)=0.95/0.94; root mean square error of approximation (RMSEA)=0.05; Standardized Root Mean Squared Residual (SRMR)=0.05. Ethnic identity is represented by two latent factors: ethnic identity-commitment and ethnic identity-exploration. Depression, anxiety and social support are single-factor latent variables. For the SEM, model fit statistics were: x^2(df)=779.26(527), p<.05; CFI/TLI=0.94/0.93; RMSEA=0.05; SRMR=0.05. Ethnic identity-commitment (b=-0.30) and social support (b=-0.33) had direct negative effects on depression, but ethnic identity-exploration did not. Ethnic identity-commitment (b=-0.43) and social support (b=-0.31) had direct negative effects on anxiety, while identity-exploration (b=0.24) demonstrated a positive effect. Social support had direct positive effects on ethnic identity-exploration (b=0.26) and ethnic identity-commitment (b=0.31). Mediation analysis demonstrated the indirect effect of ethnic identity-commitment linking social support and depression (b=0.22). Implications: Results underscore the role of social support in preventing depression via ethnic identity commitment among indigenous adults in Taiwan. Adopting the strength-based approach, mental health practitioners can mobilise indigenous peoples’ commitment to their group to promote their well-being.

Keywords: ethnic identity, indigenous population, mental health, perceived social support

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Authors: M. F. Abreu, A. I. Aguiar, R. Gaio, R. Duarte

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Background: Prison establishments constitute high-risk environments for the transmission and spread of tuberculosis (TB), given their epidemiological context and the difficulty of implementing preventive and control measures. Guidelines for control and prevention of tuberculosis in prisons have been described as incomplete and heterogeneous internationally, due to several identified obstacles, for example scarcity of human resources and funding of prisoner health services. In Portugal, a protocol was created in 2014 with the aim to define and standardize procedures of detection and prevention of tuberculosis within prisons. Objective: The main objective of this study was to identify and describe barriers to tuberculosis detection in prisons of Porto and Lisbon districts in Portugal. Methods: A cross-sectional study was conducted from 2ⁿᵈ January 2018 till 30ᵗʰ June 2018. Semi-structured questionnaires were applied to health care professionals working in the prisons of the districts of Porto (n=6) and Lisbon (n=8). As inclusion criteria we considered having work experience in the area of tuberculosis (either in diagnosis, treatment, or follow up). The questionnaires were self-administered, in paper format. Descriptive analyses of the questionnaire variables were made using frequencies and median. Afterwards, a hierarchical agglomerative clusters analysis was performed. After obtaining the clusters, the chi-square test was applied to study the association between the variables collected and the clusters. The level of significance considered was 0.05. Results: From the total of 186 health professionals, 139 met the criteria of inclusion and 82 health professionals were interviewed (62,2% of participation). Most were female, nurses, with a median age of 34 years, with term employment contract. From the cluster analysis, two groups were identified with different characteristics and behaviors for the procedures of this protocol. Statistically significant results were found in: elements of cluster 1 (78% of the total participants) work in prisons for a longer time (p=0.003), 45,3% work > 4 years while 50% of the elements of cluster 2 work for less than a year, and more frequently answered they know and apply the procedures of the protocol (p=0.000). Both clusters answered frequently the need of having theoretical-practical training for TB (p=0.000), especially in the areas of diagnosis, treatment and prevention and that there is scarcity of funding to prisoner health services (p=0.000). Regarding procedures for TB screening (periodic and contact screening) and procedures for transferring a prisoner with this disease, cluster 1 also answered more frequently to perform them (p=0.000). They also referred that the material/equipment for TB screening is accessible and available (p=0.000). From this clusters we identified as barriers scarcity of human resources, the need to theoretical-practical training for tuberculosis, inexperience in working in health services prisons and limited knowledge of protocol procedures. Conclusions: The barriers found in this study are the same described internationally. This protocol is mostly being applied in portuguese prisons. The study also showed the need to invest in human and material resources. This investigation bridged gaps in knowledge that could help prison health services optimize the care provided for early detection and adherence of prisoners to treatment of tuberculosis.

Keywords: barriers, health care professionals, prisons, protocol, tuberculosis

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Authors: Jessica Arthur, Duke Amegah, Kingsley Akenten Wiafe

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Background: Vanilla planifolia is the only edible fruit of the orchid family (Orchidaceae) among the over 35,000 Orchidaceae species found worldwide. In Ghana, Vanilla was discovered in the wild, but it is underutilized for commercial production, most likely due to a lack of knowledge on the best NAA and BAP combinations for in vitro propagation to promote successfully regenerated plant acclimatization. The growing interest and global demand for elite Vanilla planifolia plants and natural vanilla flavour emphasize the need for an effective industrial-scale micropropagation protocol. Tissue culture systems are increasingly used to grow disease-free plants and reliable in vitro methods can also produce plantlets with typically modest proliferation rates. This study sought to develop an efficient protocol for in vitro propagation of vanilla using nodal explants by testing different concentrations of NAA and BAP, for the proliferation of the entire plant. Methods: Nodal explants with dormant axillary buds were obtained from year-old laboratory-grown Vanilla planifolia plants. MS media was prepared with a nutrient stock solution (containing macronutrients, micronutrients, iron solution and vitamins) and semi-solidified using phytagel. It was supplemented with different concentrations of NAA and BAP to induce multiple shoots and roots (0.5mg/L BAP with NAA at 0, 0.5, 1, 1.5, 2.0mg/L and vice-versa). The explants were sterilized, cultured in labelled test tubes and incubated at 26°C ± 2°C with 16/8 hours light/dark cycle. Data on shoot and root growth, leaf number, node number, and survival percentage were collected over three consecutive two-week periods. The data were square root transformed and subjected to ANOVA and LSD at a 5% significance level using the R statistical package. Results: Shoots emerged at 8 days and roots at 12 days after inoculation with 94% survival rate. It was discovered that for the NAA treatments, MS media supplemented with 2.00 mg/l NAA resulted in the highest shoot length (10.45cm), maximum root number (1.51), maximum shoot number (1.47) and the highest number of leaves (1.29). MS medium containing 1.00 mg/l NAA produced the highest number of nodes (1.62) and root length (14.27cm). Also, a similar growth pattern for the BAP treatments was observed. MS medium supplemented with 1.50 mg/l BAP resulted in the highest shoot length (14.98 cm), the highest number of nodes (4.60), the highest number of leaves (1.75) and the maximum shoot number (1.57). MS medium containing 0.50 mg/l BAP and 1.0 mg/l BAP generated a maximum root number (1.44) and the highest root length (13.25cm), respectively. However, the best concentration combination for maximizing shoot and root was media containing 1.5mg/l BAP combined with 0.5mg/l NAA, and 1.0mg/l NAA combined with 0.5mg/l of BAP respectively. These concentrations were optimum for in vitro growth and production of Vanilla planifolia. Significance: This study presents a standardized protocol for labs to produce clean vanilla plantlets, enhancing cultivation in Ghana and beyond. It provides insights into Vanilla planifolia's growth patterns and hormone responses, aiding future research and cultivation.

Keywords: Vanilla planifolia, In vitro propagation, plant hormones, MS media

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Authors: Chalise Kiran

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The prime idea of inclusive education is to mainstream every child in education. However, it will be challenging for implementation when there are policy and practice gaps. It will be even more challenging when children have disabilities. Generally, the focus will be on the policy gap, but the problem may not always be with policy. The proper practice could be a challenge in the countries like Nepal. In determining practice, the teachers’ perceptions toward inclusive will play a vital role. Nepal has categorized disability in 7 types (physical, visual, hearing, vision/hearing, speech, mental, and multiple). Out of these, hearing impairment is the study realm. In the context of a limited number of researches on children with disabilities and rare researches on CWHI and their education in Nepal, this study is a pioneering effort in knowing basically the problems and challenges of CWHI focused on inclusive education in the schools including gaps and barriers in its proper implementation. Philosophically, the paradigm of the study is post-positivism. In the post-positivist worldview, the quantitative approach with the description of the situation and inferential relationship are revealed out in the study. This is related to the natural model of objective reality. The data were collected from an individual survey with the teachers and head teachers of 35 schools in Nepal. The survey questionnaire was prepared and filled by the respondents from the schools where the CWHI study in 7 provincial 20 districts of Nepal. Through these considerations, the perceptions of CWHI focused inclusive education were explored in the study. The data were analyzed using both descriptive and inferential tools on which the Likert scale-based analysis was done for descriptive analysis, and chi-square mathematical tool was used to know the significant relationship between dependent variables and independent variables. The descriptive analysis showed that the majority of teachers have positive perceptions toward implementing CWHI focused inclusive education, and the majority of them have positive perceptions toward CWHI focused inclusive education, though there are some problems and challenges. The study has found out the major challenges and problems categorically. Some of them are: a large number of students in a single class; availability of generic textbooks for CWHI and no availability of textbooks to all students; less opportunity for teachers to acquire knowledge on CWHI; not adequate teachers in the schools; no flexibility in the curriculum; less information system in schools; no availability of educational consular; disaster-prone students; no child abuse control strategy; no disabled-friendly schools; no free health check-up facility; no participation of the students in school activities and in child clubs and so on. By and large, it is found that teachers’ age, gender, years of experience, position, employment status, and disability with him or her show no statistically significant relation to successfully implement CWHI focused inclusive education and perceptions to CWHI focused inclusive education in schools. However, in some of the cases, the set null hypothesis was rejected, and some are completely retained. The study has suggested policy implications, implications for educational authority, and implications for teachers and parents categorically.

Keywords: children with hearing impairment, disability, inclusive education, perception

Procedia PDF Downloads 113

Authors: Ludmila Polechonska, Agnieszka Klink

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The biogeochemical studies of macrophytes shed light on elements bioavailability, transfer through the food webs and their possible effects on the biota, and provide a basis for their practical application in aquatic monitoring and remediation. Measuring the accumulation of elements in plants can provide time-integrated information about the presence of chemicals in aquatic ecosystems. The aim of the study was to determine and compare the contents of micro- and macroelements in two cosmopolitan macrophytes, submerged Ceratophyllum demersum (hornworth) and free-floating Hydrocharis morsus-ranae (European frog-bit), in order to assess their bioaccumulation potential, elements stock accumulated in each plant and their role in nutrients cycling in small water reservoirs. Sampling sites were designated in 25 oxbow lakes in urban areas in Lower Silesia (SW Poland). In each sampling site, fresh whole plants of C. demersum and H. morsus-ranae were collected from squares of 1x1 meters each where the species coexisted. European frog-bit was separated into leaves, stems and roots. For biomass measurement all plants growing on 1 square meter were collected, dried and weighed. At the same time, water samples were collected from each reservoir and their pH and EC were determined. Water samples were filtered and acidified and plant samples were digested in concentrated nitric acid. Next, the content of Ca, Cu, Fe, K, Mg, Mn, Ni and Zn was determined using atomic absorption method (AAS). Statistical analysis showed that C. demersum and organs of H. morsus-ranae differed significantly in respect of metals content (Kruskal-Wallis Anova, p<0.05). Contents of Cu, Mn, Ni and Zn were higher in hornwort, while European frog-bit contained more Ca, Fe, K, Mg. Bioaccumulation Factors (BCF=content in plant/concentration in water) showed similar pattern of metal bioaccumulation – microelements were more intensively accumulated by hornwort and macroelements by frog-bit. Based on BCF values both species may be positively evaluated as good accumulators of Cu, Fe, Mn, Ni and Zn. However, the distribution of metals in H. morsus-ranae was uneven – the majority of studied elements were retained in roots, which may indicate to existence of physiological barriers developed for dealing with toxicity. Some percent of Ca and K was actively transported to stems, but to leaves Mg only. Although the biomass of C. demersum was two times greater than biomass of H. morsus-ranae, the element off-take was greater only for Cu, Mn, Ni and Zn. Nevertheless, it can be stated that despite a relatively small biomass, compared to other macrophytes, both species may have an influence on the removal of trace elements from aquatic ecosystems and, as they serve as food for some animals, also on the incorporation of toxic elements into food chains. There was a significant positive correlation between content of Mn and Fe in water and roots of H. morus-ranae (R=0.51 and R=0.60, respectively) as well as between Cu concentration in water and in C. demersum (R=0.41) (Spearman rank correlation, p<0.05). High bioaccumulation rates and correlation between plants and water elements concentrations point to their possible use as passive biomonitors of aquatic pollution.

Keywords: aquatic plants, bioaccumulation, biomonitoring, macroelements, phytoremediation, trace metals

Procedia PDF Downloads 189

Authors: Susmita Ghosh

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Catchment area of Damodar River, India experiences seasonal rains due to the south-west monsoon every year and depending upon the intensity of the storms, floods occur. During the monsoon season, the rainfall in the area is mainly due to active monsoon conditions. The upstream reach of Damodar river system has five dams store the water for utilization for various purposes viz, irrigation, hydro-power generation, municipal supplies and last but not the least flood moderation. But, in the downstream reach of Damodar River, known as Lower Damodar region, is severely and frequently suffering from flood due to heavy monsoon rainfall and also release from upstream reservoirs. Therefore, an effective flood management study is required to know in depth the nature and extent of flood, water logging, and erosion related problems, affected area, and damages in the Lower Damodar region, by conducting mathematical model study. The design flood or discharge is needed to decide to assign the respective model for getting several scenarios from the simulation runs. The ultimate aim is to achieve a sustainable flood management scheme from the several alternatives. there are various methods for estimating flood discharges to be carried through the rivers and their tributaries for quick drainage from inundated areas due to drainage congestion and excess rainfall. In the present study, the flood frequency analysis is performed to decide the design flood discharge of the study area. This, on the other hand, has limitations in respect of availability of long peak flood data record for determining long type of probability density function correctly. If sufficient past records are available, the maximum flood on a river with a given frequency can safely be determined. The floods of different frequency for the Damodar has been calculated by five candidate distributions i.e., generalized extreme value, extreme value-I, Pearson type III, Log Pearson and normal. Annual peak discharge series are available at Durgapur barrage for the period of 1979 to 2013 (35 years). The available series are subjected to frequency analysis. The primary objective of the flood frequency analysis is to relate the magnitude of extreme events to their frequencies of occurrence through the use of probability distributions. The design flood for return periods of 10, 15 and 25 years return period at Durgapur barrage are estimated by flood frequency method. It is necessary to develop flood hydrographs for the above floods to facilitate the mathematical model studies to find the depth and extent of inundation etc. Null hypothesis that the distributions fit the data at 95% confidence is checked with goodness of fit test, i.e., Chi Square Test. It is revealed from the goodness of fit test that the all five distributions do show a good fit on the sample population and is therefore accepted. However, it is seen that there is considerable variation in the estimation of frequency flood. It is therefore considered prudent to average out the results of these five distributions for required frequencies. The inundated area from past data is well matched using this flood.

Keywords: design discharge, flood frequency, goodness of fit, sustainable flood management

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Authors: Ehsan Javanmardemamgheisi, Javad Mehr, Jason Ali-Lavroff, Damien Holloway, Michael Davis

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During the last decades, a growing interest in faster and more efficient waterborne transportation has led to the development of high-speed vessels for both commercial and military applications. To satisfy this global demand, a wide variety of arrangements of high-speed crafts have been proposed by designers. Among them, high-speed catamarans have proven themselves to be a suitable Roll-on/Roll-off configuration for carrying passengers and cargo due to widely spaced demi hulls, a wide deck zone, and a high ratio of deadweight to displacement. To improve passenger comfort and crew workability and enhance the operability and performance of high-speed catamarans, mitigating the severity of motions and structural loads using Ride Control Systems (RCS) is essential.In this paper, a set of towing tank tests was conducted on a 2.5 m scaled model of a 112 m Incat Tasmania high-speed catamaran in irregular head seas to investigate the effect of different ride control algorithms including linear and nonlinear versions of the heave control, pitch control, and local control on motion responses and passenger comfort of the full-scale ship. The RCS included a centre bow-fitted T-Foil and two transom-mounted stern tabs. All the experiments were conducted at the Australian Maritime College (AMC) towing tank at a model speed of 2.89 m/s (37 knots full scale), a modal period of 1.5 sec (10 sec full scale) and two significant wave heights of 60 mm and 90 mm, representing full-scale wave heights of 2.7 m and 4 m, respectively. Spectral analyses were performed using Welch’s power spectral density method on the vertical motion time records of the catamaran model to calculate heave and pitch Response Amplitude Operators (RAOs). Then, noting that passenger discomfort arises from vertical accelerations and that the vertical accelerations vary at different longitudinal locations within the passenger cabin due to the variations in amplitude and relative phase of the pitch and heave motions, the vertical accelerations were calculated at three longitudinal locations (LCG, T-Foil, and stern tabs). Finally, frequency-weighted Root Mean Square (RMS) vertical accelerations were calculated to estimate Motion Sickness Dose Value (MSDV) of the ship based on ISO 2631-recommendations. It was demonstrated that in small seas, implementing a nonlinear pitch control algorithm reduces the peak pitch motions by 41%, the vertical accelerations at the forward location by 46%, and motion sickness at the forward position by around 20% which provides great potential for further improvement in passenger comfort, crew workability, and operability of high-speed catamarans.

Keywords: high-speed catamarans, ride control system, response amplitude operators, vertical accelerations, motion sickness, irregular waves, towing tank tests.

Procedia PDF Downloads 84

Authors: Hsueh Ping Peng

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End-stage renal disease most commonly occurs in the elderly population. Elderly people are approaching the end of their lives, and when facing major life-threatening situations, apart from aggressive medical treatment, they can also choose treatment methods such as hospice care to improve their quality of life. The purpose of this study was to investigate factors associated with the awareness and willingness to sign hospice and palliative care consent forms in elderly with end-stage renal disease. This study used both quantitative, cross-sectional study designs. In the quantitative section, 110 elderly patients (aged 65 or above) with end-stage renal disease receiving conventional hemodialysis were recruited as study participants from a medical center in Taipei City. Data were collected using structured questionnaires. Study tools included basic demographic data, questionnaires on the awareness and perception of hospice and palliative care, etc. After collecting the data, data analysis was conducted using SPSS 20.0 statistical software, including descriptive statistics, chi-square test, logistic regression, and other inferential statistics. The results showed that the average age of participants was 71.6 years old, more males than females, average years of dialysis was 6.1 years and most subjects rated their self-perceived health status as fair. Results of the study are summarized as follows: Elderly people with end-stage renal disease did not have sufficient knowledge and awareness about hospice and palliative care. Influencing factors included level of education, marital status, years of dialysis and age, etc. Demographic factors influencing the signing of consent forms included gender, marital status, and age, which all showed significant impacts. Factors taken into consideration when signing consent forms included awareness of hospice care, understanding the relevant definitions of hospice care, and understanding that consent may be modified or cancelled at any time; it was predicted that people who knew more about ways to receive hospice care or more related definitions were more willing to sign the consent forms. In the qualitative study section, 10 participants who signed the consent form, five male, and 5 female, between the ages of 65-90, have completed the semi-structured interviews. Analysis of the interviews revealed six themes: (1) passing away peacefully, (2) autonomy on arrangements of life and death, (3) unwillingness to increase family and social burden, (4) friends and relatives’ experience influencing the decision to give consent, (5) sharing information to facilitate the giving of consent, (6) facing each day with ease, to reflect the experience and factors of consideration for elderly with end-stage renal disease when signing consent forms. The results of this study provides the awareness, thoughts and feelings of elderly with end-stage renal disease on signing consent forms, and serve as a future reference for the dialysis unit to enhance the promotion of hospice and palliative care and related caregiving measures, thereby improving the quality of life and care for elderly people with end-stage renal disease.

Keywords: end-stage renal disease, hemodialysis, hospice and palliative care, awareness, willingness

Procedia PDF Downloads 168