Search results for: vital sign

Authors: Farah Vierra

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Following the 2016 US presidential election and the advancement of the Brexit referendum, the concept of “post-truth,” defined by the Oxford Dictionary as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief,” came into prominent use in public, political and educational circles. What this essentially entails is that in this age, individuals are increasingly confronted with subjective perpetuations of truth in their discourse spheres that are informed by beliefs and opinions as opposed to any form of coherence to the reality of those to who this truth claims concern. In principle, a subjective delineation of truth is progressive and liberating – especially considering its potential to provide marginalised groups in the diverse communities of our globalised world with the voice to articulate truths that are representative of themselves and their experiences. However, any form of human flourishing that seems to be promised here collapses as the tenets of subjective truths initially in place to liberate have been distorted through post-truth to allow individuals to purport selective and individualistic truth claims that further oppress and silence certain groups within society without due accountability. The evidence of this is prevalent through the conception of terms such as "alternative facts" and "fake news" that we observe individuals declare when their problematic truth claims are being questioned. Considering the pervasiveness of post-truth and the ethical issues that accompany it, educators and scholars alike have increasingly noted the need to adapt educational practices and pedagogies to account for the diminishing objectivity of truth in the twenty-first century, especially because students, as digital natives, find themselves in the firing line of post-truth; engulfed in digital societies that proliferate post-truth through the surge of truth claims allowed in various media sites. In an attempt to equip students with the vital skills to navigate the post-truth age and oppose its proliferation of social injustices, English educators find themselves having to contend with a complex question: how can the teaching of English equip students with the ability to critically and ethically scrutinise truth claims whilst also mediating the subjectivity of truth in a manner that does not undermine the voices of diverse communities. In order to address this question, this paper will first examine the challenges that confront students as a result of post-truth. Following this, the paper will elucidate the role English education can play in helping students overcome the complex demands of the post-truth age. Scholars have consistently touted the affordances of literary texts in providing students with imagined spaces to explore societal issues through a critical discernment of language and an ethical engagement with its narrative developments. Therefore, this paper will explain and demonstrate how literary texts, when used alongside a critical-ethical post-truth pedagogy that equips students with interpretive strategies informed by literary traditions such as literary and ethical criticism, can be effective in helping students develop the pertinent skills to comprehensively examine truth claims and overcome the challenges of the post-truth age.

Keywords: post-truth, pedagogy, ethics, english, education

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Authors: Scott M. Black, Craig Maclean, Pauline Hall Barrientos, Konstantinos Ritos, Asimina Kazakidi

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Aortic aneurysms and dissections are leading causes of death in cardiovascular disease. Both inevitably lead to hemodynamic instability without surgical intervention in the form of vascular stent-graft deployment. An accurate description of the aortic geometry and blood flow in patient-specific cases is vital for treatment planning and long-term success of such grafts, as they must generate physiological branch perfusion and in-stent hemodynamics. The aim of this study was to create patient-specific computational fluid dynamics (CFD) models through a multi-modality, multi-dimensional approach with boundary condition optimization to predict branch flow rates and in-stent hemodynamics in custom stent-graft configurations. Three-dimensional (3D) thoracoabdominal aortae were reconstructed from four-dimensional flow-magnetic resonance imaging (4D Flow-MRI) and computed tomography (CT) medical images. The former employed a novel approach to generate and enhance vessel lumen contrast via through-plane velocity at discrete, user defined cardiac time steps post-hoc. To produce patient-specific boundary conditions (BCs), the aortic geometry was reduced to a one-dimensional (1D) model. Thereafter, a zero-dimensional (0D) 3-Element Windkessel model (3EWM) was coupled to each terminal branch to represent the distal vasculature. In this coupled 0D-1D model, the 3EWM parameters were optimized to yield branch flow waveforms which are representative of the 4D Flow-MRI-derived in-vivo data. Thereafter, a 0D-3D CFD model was created, utilizing the optimized 3EWM BCs and a 4D Flow-MRI-obtained inlet velocity profile. A sensitivity analysis on the effects of stent-graft configuration and BC parameters was then undertaken using multiple stent-graft configurations and a range of distal vasculature conditions. 4D Flow-MRI granted unparalleled visualization of blood flow throughout the cardiac cycle in both the pre- and postsurgical states. Segmentation and reconstruction of healthy and stented regions from retrospective 4D Flow-MRI images also generated 3D models with geometries which were successfully validated against their CT-derived counterparts. 0D-1D coupling efficiently captured branch flow and pressure waveforms, while 0D-3D models also enabled 3D flow visualization and quantification of clinically relevant hemodynamic parameters for in-stent thrombosis and graft limb occlusion. It was apparent that changes in 3EWM BC parameters had a pronounced effect on perfusion distribution and near-wall hemodynamics. Results show that the 3EWM parameters could be iteratively changed to simulate a range of graft limb diameters and distal vasculature conditions for a given stent-graft to determine the optimal configuration prior to surgery. To conclude, this study outlined a methodology to aid in the prediction post-surgical branch perfusion and in-stent hemodynamics in patient specific cases for the implementation of custom stent-grafts.

Keywords: 4D flow-MRI, computational fluid dynamics, vascular stent-grafts, windkessel

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Authors: Adino Andaregie, Isao Takagi, Hirohisa Shimura, Mitsuko Chikasada, Shinjiro Sato, Solomon Addisu

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Context: The prevalence of undernutrition in developing countries like Ethiopia has become a significant issue. In this regard, finding alternative nutritional supplements seems to be a practical solution. Spirulina, a highly nutritious microalgae, offers a valuable option as it is a rich source of various essential nutrients. The study aimed to establish the factors affecting urban Ethiopian consumers' consumption intention of Spirulina-fortified bread. Research Aim: The primary purpose of this research is to identify the behavioral and socioeconomic factors impacting the intention of urban Ethiopian consumers to eat Spirulina-fortified bread. Methodology: The research utilized a quantitative approach wherein a structured questionnaire was created and distributed among 361 urban consumers via an online platform. The theory of planned behavior (TPB) was used as a conceptual framework, and confirmatory factor analysis (CFA) and structural equation modelling (SEM) were employed for data analysis. Findings: The study results revealed that attitude towards the supplement, subjective norms, and perceived behavioral control were the critical factors influencing the consumption intention of Spirulina-fortified bread. Moreover, age, physical exercise, and prior knowledge of Spirulina as a food ingredient were also found to have a significant influence. Theoretical Importance: The study contributes towards the understanding of consumer behavior and factors affecting the purchase intentions of Spirulina-fortified bread in urban Ethiopia. The use of TPB as a theoretical framework adds a vital aspect to the study as it provides helpful insights into the factors affecting intentions towards this functional food. Data Collection and Analysis Procedures: The data collection process involved the creation of a structured questionnaire, which was distributed online to urban Ethiopian consumers. Once data was collected, CFA and SEM were utilized to analyze the data and identify the factors impacting consumer behavior. Questions Addressed: The study aimed to address the following questions: (1) What are the behavioral and socioeconomic factors impacting urban Ethiopian consumers' consumption intention of Spirulina-fortified bread? (2) To what extent do attitude towards the supplement, subjective norms, and perceived behavioral control affect the purchase intention of Spirulina-fortified bread? (3) What role does age, education, income, physical exercise, and prior knowledge of Spirulina as a food ingredient play in the purchase intention of Spirulina-fortified bread among urban Ethiopian consumers? Conclusion: The study concludes that attitude towards the supplement, subjective norms, and perceived behavioral control are significant factors influencing urban Ethiopian consumers’ consumption intention of Spirulina-fortified bread. Moreover, age, education, income, physical exercise, and prior knowledge of Spirulina as a food ingredient also play a significant role in determining purchase intentions. The findings provide valuable insights for developing effective marketing strategies for Spirulina-fortified functional foods targeted at different consumer segments.

Keywords: spirulina, consumption, factors, intention, consumers, behavior

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Authors: Thanduxolo Elford Fana

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Rationale and Purpose: Performance management and development system are central to effective and efficient service delivery, especially in highly labour intensive sectors such as South African public health. Performance management and development systems seek to ensure that good employee performance is rewarded accordingly, while those who underperform are developed so that they can reach their full potential. An effective and efficiently implemented performance management system motivates and improves employee engagement. The purpose of this study is to examine the implementation of the performance management and development system and the challenges that are encountered during its implementation in the Eastern Cape Provincial Department of Health. Methods: A qualitative research approach and a case study design was adopted in this study. The primary data were collected through observations, focus group discussions with employees, a group interview with shop stewards, and in-depth interviews with supervisors and managers, from April 2019 to September 2019. There were 45 study participants. In-depth interviews were held with 10 managers at facility level, which included chief executive officer, chief medical officer, assistant director’s in human resources management, patient admin, operations, finance, and two area manager and two operation managers nursing. A group interview was conducted with five shop stewards and an in-depth interview with one shop steward from the group. Five focus group discussions were conducted with clinical and non-clinical staff. The focus group discussions were supplemented with an in-depth interview with one person from each group in order to counter the group effect. Observations included moderation committee, contracting, and assessment meetings. Findings: The study shows that the performance management and development system was not properly implemented. There was non-compliance to performance management and development system policy guidelines in terms of time lines for contracting, evaluation, payment of incentives to good performers, and management of poor performance. The study revealed that the system is ineffective in raising the performance of employees and unable to assist employees to grow. The performance bonuses were no longer paid to qualifying employees. The study also revealed that lack of capacity and commitment, poor communication, constant policy changes, financial constraints, weak and highly bureaucratic management structures, union interference were challenges that were encountered during the implementation of the performance management and development system. Lastly, employees and supervisors were rating themselves three irrespective of how well or bad they performed. Conclusion: Performance management is regarded as vital to improved performance of the health workforce and healthcare service delivery among populations. Effective implementation of performance management and development system depends on well-capacitated and unbiased management at facility levels. Therefore, there is an urgent need to improve communication, link performance management to rewards, and capacitate staff on performance management and development system, as it is key to improved public health sector outcomes or performance.

Keywords: challenges, implementation, performance management and development system, public hospital

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Authors: S. B. R. Slagmulder

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Monitoring inspiratory effort and dynamic lung stress in patients on pressure support ventilation in the ICU is important for protecting against self inflicted lung injury (P-SILI) and diaphragm dysfunction. Strategies to address the detrimental effects of respiratory drive and effort can lead to improved patient outcomes. Two non-invasive estimation methods, occlusion pressure (Pocc) and P0.1, have been proposed for achieving lung and diaphragm protective ventilation. However, their relationship and interpretation in neuro ICU patients is not well understood. P0.1 is the airway pressure measured during a 100-millisecond occlusion of the inspiratory port. It reflects the neural drive from the respiratory centers to the diaphragm and respiratory muscles, indicating the patient's respiratory drive during the initiation of each breath. Occlusion pressure, measured during a brief inspiratory pause against a closed airway, provides information about the inspiratory muscles' strength and the system's total resistance and compliance. Research Objective: Understanding the relationship between Pocc and P0.1 in brain-injured patients can provide insights into the interpretation of these values in pressure support ventilation. This knowledge can contribute to determining extubation readiness and optimizing ventilation strategies to improve patient outcomes. The central goal is to asses a study protocol for determining the relationship between Pocc and P0.1 in brain-injured patients on pressure support ventilation and their ability to predict successful extubation. Additionally, comparing these values between brain-damaged and non-brain-damaged patients may provide valuable insights. Key Areas of Inquiry: 1. How do Pocc and P0.1 values correlate within brain injury patients undergoing pressure support ventilation? 2. To what extent can Pocc and P0.1 values serve as predictive indicators for successful extubation in patients with brain injuries? 3. What differentiates the Pocc and P0.1 values between patients with brain injuries and those without? Methodology: P0.1 and occlusion pressures are standard measurements for pressure support ventilation patients, taken by attending doctors as per protocol. We utilize electronic patient records for existing data. Unpaired T-test will be conducted to compare P0.1 and Pocc values between both study groups. Associations between P0.1 and Pocc and other study variables, such as extubation, will be explored with simple regression and correlation analysis. Depending on how the data evolve, subgroup analysis will be performed for patients with and without extubation failure. Results: While it is anticipated that neuro patients may exhibit high respiratory drive, the linkage between such elevation, quantified by P0.1, and successful extubation remains unknown The analysis will focus on determining the ability of these values to predict successful extubation and their potential impact on ventilation strategies. Conclusion: Further research is pending to fully understand the potential of these indices and their impact on mechanical ventilation in different patient populations and clinical scenarios. Understanding these relationships can aid in determining extubation readiness and tailoring ventilation strategies to improve patient outcomes in this specific patient population. Additionally, it is vital to account for the influence of sedatives, neurological scores, and BMI on respiratory drive and occlusion pressures to ensure a comprehensive analysis.

Keywords: brain damage, diaphragm dysfunction, occlusion pressure, p0.1, respiratory drive

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Authors: Orit Wolf

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Classical music performance is undergoing a profound transformation, marked by a confluence of technological advancements and evolving cultural dynamics. This academic paper explores the multifaceted changes and challenges faced by classical music performance, considering the impact of artificial intelligence (AI) along with other vital factors shaping this evolution. In the contemporary era, classical music is experiencing shifts in performance practices. This paper delves into these changes, emphasizing the need for adaptability within the classical music world. From repertoire selection and concert formats to artistic expression, performers and institutions navigate a delicate balance between tradition and innovation. We explore how these changes impact the authenticity and vitality of classical music performances. Furthermore, the influence of AI in the classical music concert world cannot be underestimated. AI technologies are making inroads into various aspects, from composition assistance to rehearsal and live performances. This paper examines the transformative effects of AI, considering how it enhances precision, adaptability, and creative exploration for musicians. We explore the implications for composers, performers, and the overall concert experience while addressing ethical concerns and creative opportunities. In addition to AI, there is the importance of cross-genre interactions within the classical music sphere. Mash-ups and collaborations with artists from diverse musical backgrounds are redefining the boundaries of classical music and creating works that resonate with a wider and more diverse audience. The benefits of cross-pollination in classical music seem crucial, offering a fresh perspective to listeners. As an active concert artist, Orit Wolf will share how the expectations of classical music audiences are evolving. Modern concertgoers seek not only exceptional musical performances but also immersive experiences that may involve technology, multimedia, and interactive elements. This paper examines how classical musicians and institutions are adapting to these changing expectations, using technology and innovative concert formats to deliver a unique and enriched experience to their audiences. As these changes and challenges reshape the classical music world, the need for a harmonious coexistence of tradition, technology, and innovation becomes evident. Musicians, composers, and institutions are striving to find a balance that ensures classical music remains relevant in a rapidly changing cultural landscape while maintaining the value it brings to compositions and audiences. This paper, therefore, aims to explore the evolving trends in classical music performance. It considers the influence of AI as one element within the broader context of change, highlighting the necessity of adaptability, cross-genre interactions, and a response to evolving audience expectations. By doing so, the classical music world can navigate this transformative period while preserving its timeless traditions and adding value to both performers and listeners. Orit Wolf, an international concert pianist, fulfils her vision to bring this music in new ways to mass audiences and will share her personal and professional experience as an artist who goes on stage and makes disruptive concerts.

Keywords: cross culture collaboration, music performance and ai, classical music in the digital age, classical concerts, innovation and technology, performance innovation, audience engagement in classical concerts

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Authors: Zografou Konstantina, Anagnostellis Konstantinos, Brokaki Marina, Kaltsouni Eleftheria, Dimaki Maria, Kati Vassiliki

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Body size is crucial to ecology, influencing everything from individual reproductive success to the dynamics of communities and ecosystems. Understanding how temperature affects variations in body size is vital for both theoretical and practical purposes, as changes in size can modify trophic interactions by altering predator-prey size ratios and changing the distribution and transfer of biomass, which ultimately impacts food web stability and ecosystem functioning. Notably, a decrease in body size is frequently mentioned as the third "universal" response to climate warming, alongside shifts in distribution and changes in phenology. This trend is backed by ecological theories like the temperature-size rule (TSR) and Bergmann's rule, which have been observed in numerous species, indicating that many species are likely to shrink in size as temperatures rise. However, the thermal responses related to body size are still contradictory, and further exploration is needed. To tackle this challenge, we developed the MEIOSIS project, aimed at providing valuable insights into the relationship between the body size of species, species’ traits, environmental factors, and their response to climate change. We combined a digitized collection of butterflies from the Swiss Federal Institute of Technology in Zürich with our newly digitized butterfly collection from Goulandris Natural History Museum in Greece to analyse trends in time. For a total of 23868 images, the length of the right forewing was measured using ImageJ software. Each forewing was measured from the point at which the wing meets the thorax to the apex of the wing. The forewing length of museum specimens has been shown to have a strong correlation with wing surface area and has been utilized in prior studies as a proxy for overall body size. Temperature data corresponding to the years of collection were also incorporated into the datasets. A second dataset was generated when a custom computer vision tool was implemented for the automated morphological measuring of samples for the digitized collection in Zürich. Using the second dataset, we corrected manual measurements with ImageJ, and a final dataset containing 31922 samples was used for analysis. Setting time as a smoother variable, species identity as a random factor, and the length of right-wing size (a proxy for body size) as the response variable, we ran a global model for a maximum period of 110 years (1900 – 2010). Then, we investigated functional variability between different terrestrial biomes in a second model. Both models confirmed our initial hypothesis and resulted in a decreasing trend in body size over the years. We expect that this first output can be provided as basic data for the next challenge, i.e., to identify the ecological traits that influence species' temperature-size responses, enabling us to predict the direction and intensity of a species' reaction to rising temperatures more accurately.

Keywords: butterflies, shrinking body size, museum specimens, climate change

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Authors: Shereen Yehia El Ezabi

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The transition from the advanced to the superior level of Arabic proficiency is widely known to pose considerable challenges for English speaking students of Arabic as a Foreign Language (AFL). Apart from the increasing complexity of the grammar at this juncture, together with the sprawling vocabulary, to name but two of those challenges, there is also the somewhat less studied hurdle along the way to superior level proficiency, namely, the seeming opacity of many aspects of Arab/ic culture to such learners. This presentation tackles one specific dimension of such issues: religious references in literary texts. It illustrates how carefully constructed translation activities may be used to expand and deepen students’ understanding and use of them. This is shown to be vital for making the leap to the desired competency, given that such elements, as reflected in customs, traditions, institutions, worldviews, and formulaic expressions lie at the very core of Arabic culture and, as such, pervade all modes and levels of Arabic discourse. A short story from the collection “Stories from Our Alley”, by preeminent novelist Naguib Mahfouz is selected for use in this context, being particularly replete with such religious references, of which religious expressions will form the focus of the presentation. As a miniature literary work, it provides an organic whole, so to speak, within which to explore with the class the most precise denotation, as well as the subtlest connotation of each expression in an effort to reach the ‘best’ English rendering. The term ‘best’ refers to approximating the meaning in its full complexity from the source text, in this case Arabic, to the target text, English, according to the concept of equivalence in translation theory. The presentation will show how such a process generates the sort of thorough discussion and close text analysis which allows students to gain valuable insight into this central idiom of Arabic. A variety of translation methods will be highlighted, gleaned from the presenter’s extensive work with advanced/superior students in the Center for Arabic Study Abroad (CASA) program at the American University in Cairo. These begin with the literal rendering of expressions, with the purpose of reinforcing vocabulary learning and practicing the rules of derivational morphology as they form each word, since the larger context remains that of an AFL class, as opposed to a translation skills program. However, departures from the literal approach are subsequently explored by degrees, moving along the spectrum of functional and pragmatic freer translations in order to transmit the ‘real’ meaning in readable English to the target audience- no matter how culture/religion specific the expression- while remaining faithful to the original. Samples from students’ work pre and post discussion will be shared, demonstrating how class consensus is formed as to the final English rendering, proposed as the closest match to the Arabic, and shown to be the result of the above activities. Finally, a few examples of translation work which students have gone on to publish will be shared to corroborate the effectiveness of this teaching practice.

Keywords: superior level proficiency in Arabic as a foreign language, teaching Arabic as a foreign language, teaching idiomatic expressions, translation in foreign language teaching

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Authors: S. Nishat Fatima Rizvi, Tulika Chandra, Abbas Ali Mahdi, Devisha Agarwal

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Introduction: Blood components are an unexplored area prone to numerous discoveries which influence patient’s care. Experiments at different levels will further change the present concept of blood banking. Hyperlipidemia is a condition of elevated plasma level of low-density lipoprotein (LDL) as well as decreased plasma level of high-density lipoprotein (HDL). Studies show that platelets play a vital role in the progression of atherosclerosis and thrombosis, a major cause of death worldwide. They are activated by many triggers like elevated LDL in the blood resulting in aggregation and formation of plaques. Hyperlipidemic platelets are frequently transfused to patients with various disorders. Screening the random donor platelets for hyperlipidemia and correlating the condition with other donor criteria such as lipid rich diet, oral contraceptive pills intake, weight, alcohol intake, smoking, sedentary lifestyle, family history of heart diseases will lead to further deciding the exclusion criteria for donor selection. This will help in making the patients safe as well as the donor deferral criteria more stringent to improve the quality of blood supply. Technical evaluation and assessment will enable blood bankers to supply safe blood and improve the guidelines for blood safety. Thus, we try to study the correlation between hyperlipidemic platelets with platelets parameters, weight, and specific history of the donors. Methodology: This case control study included 100 blood samples of Blood donors, out of 100 only 30 samples were found to be hyperlipidemic and were included as cases, while rest were taken as controls. Lipid Profile were measured by fully automated analyzer (TRIGL:triglycerides),(LDL-C:LDL –Cholesterol plus 2nd generation),CHOL 2: Cholesterol Gen 2), HDL C 3: HDL-Cholesterol plus 3rdgeneration)-(Cobas C311-Roche Diagnostic).And Platelets parameters were analyzed by the Sysmex KX21 automated hematology analyzer. Results: A significant correlation was found amongst hyperlipidemic level in single time donor. In which 80% donors have history of heart disease, 66.66% donors have sedentary life style, 83.3% donors were smokers, 50% donors were alcoholic, and 63.33% donors had taken lipid rich diet. Active physical activity was found amongst 40% donors. We divided donors sample in two groups based on their body weight. In group 1, hyperlipidemic samples: Platelet Parameters were 75% in normal 25% abnormal in >70Kg weight while in 50-70Kg weight 90% were normal 10% were abnormal. In-group 2, Non Hyperlipidemic samples: platelet Parameters were 95% normal and 5% abnormal in >70Kg weight, while in 50-70Kg Weight, 66.66% normal and 33.33% abnormal. Conclusion: The findings indicate that Hyperlipidemic status of donors may affect the platelet parameters and can be distinguished on history by their weight, Smoking, Alcoholic intake, Sedentary lifestyle, Active physical activity, Lipid rich diet, Oral contraceptive pills intake, and Family history of heart disease. However further studies on a large sample size will affirm this finding.

Keywords: blood donors, hyperlipidemia, platelet, weight

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Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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Authors: Magdalena Orth, Gunnar Gotz

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Background: Domestic accountability, budget transparency and public financial management (PFM) are considered vital components of good governance in developing countries. The aid modality budget support (BS) promotes these governance functions in developing countries. BS engages in political decision-making and provides financial and technical support to poverty reduction strategies of the partner countries. Nevertheless, many donors have withdrawn their support from this modality due to cases of corruption, fraud or human rights violations. This exit from BS is leaving a finance and governance vacuum in the countries. The evaluation team analyzed the consequences of terminating the use of this modality and found particularly negative effects for good governance outcomes. Methodology: The evaluation uses a qualitative (theory-based) approach consisting of a comparative case study design, which is complemented by a process-tracing approach. For the case studies, the team conducted over 100 semi-structured interviews in Malawi, Uganda, Rwanda and Zambia and used four country-specific, tailor-made budget analysis. In combination with a previous DEval evaluation synthesis on the effects of BS, the team was able to create a before-and-after comparison that yields causal effects. Main Findings: In all four countries domestic accountability and budget transparency declined if other forms of pressure are not replacing BS´s mutual accountability mechanisms. In Malawi a fraud scandal created pressure from the society and from donors so that accountability was improved. In the other countries, these pressure mechanisms were absent so that domestic accountability declined. BS enables donors to actively participate in political processes of the partner country as donors transfer funds into the treasury of the partner country and conduct a high-level political dialogue. The results confirm that the exit from BS created a governance vacuum that, if not compensated through external/internal pressure, leads to a deterioration of good governance. For example, in the case of highly aid dependent Malawi did the possibility of a relaunch of BS provide sufficient incentives to push for governance reforms. Overall the results show that the three good governance areas are negatively affected by the exit from BS. This stands in contrast to positive effects found before the exit. The team concludes that the relationship is causal, because the before-and-after comparison coherently shows that the presence of BS correlates with positive effects and the absence with negative effects. Conclusion: These findings strongly suggest that BS is an effective modality to promote governance and its abolishment is likely to cause governance disruptions. Donors and partner governments should find ways to re-engage in closely coordinated policy-based aid modalities. In addition, a coordinated and carefully managed exit-strategy should be in place before an exit from similar modalities is considered. Particularly a continued framework of mutual accountability and a high-level political dialogue should be aspired to maintain pressure and oversight that is required to achieve good governance.

Keywords: budget support, domestic accountability, public financial management and budget transparency, Sub-Sahara Africa

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Authors: Babatunde Kolawole

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This paper embarks on an exploration of the compelling interplay between documentary filmmaking and activism, delving into their symbiotic relationship and profound impact on advocacy and social justice causes. Through an in-depth analysis of diverse case studies, it seeks to illuminate the instances where documentary films have emerged as potent tools for effecting social change and advancing the principles of justice. This research underscores the vital role played by documentary filmmakers in harnessing the medium's unique capacity to engage, educate, and mobilize audiences while advocating for societal transformation. The primary focus of this study is on a selection of compelling case studies spanning various topics and causes, each exemplifying the marriage between documentary filmmaking and activism. These case studies encompass a broad spectrum of subjects, from environmental conservation and climate change to civil rights movements and human rights struggles. By examining these real-world instances, this paper endeavors to provide a comprehensive understanding of the strategies, challenges, and ethical considerations that underpin the practice of documentary filmmaking as a form of activism. Throughout the paper, it becomes evident that the potency of documentary filmmaking lies in its ability to blend artistry with social impact. The selected case studies vividly demonstrate how documentary filmmakers, armed with cameras and a passion for change, have emerged as critical agents of societal transformation. Whether it be exposing environmental atrocities, shedding light on systemic inequalities, or giving voice to marginalized communities, these documentaries have played a pivotal role in pushing the boundaries of advocacy and social justice. One of the key themes explored in this paper is the evolving nature of documentary filmmaking as a tool for activism. It delves into the shift from traditional observational documentaries to more participatory and immersive approaches, highlighting the dynamic ways in which filmmakers engage with their subjects and audiences. This evolution is exemplified in case studies where filmmakers have collaborated with the communities they document, fostering a sense of agency and empowerment among those whose stories are being told. Furthermore, this research underscores the ethical considerations inherent in the intersection of documentary filmmaking and activism. It scrutinizes questions surrounding representation, objectivity, and the responsibility of filmmakers in portraying complex social issues. By dissecting ethical dilemmas faced by documentary filmmakers in these case studies, this paper encourages a critical examination of the ethical boundaries and obligations in the realm of advocacy-driven filmmaking. In conclusion, this paper aims to shed light on the remarkable potential of documentary filmmaking as a catalyst for activism and social justice. Through the lens of compelling case studies, it illustrates the transformative power of the medium in effecting change, amplifying underrepresented voices, and mobilizing global audiences. It is hoped that this research will not only inform the discourse on documentary activism but also inspire filmmakers, scholars, and advocates to continue leveraging the cinematic art form as a formidable force for a more just and equitable world.

Keywords: film, filmmaker, documentary, human right

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Authors: Matthew Arnaouti, Michael Baird, Gabrielle Cahill, Tamara Worlton, Michelle Joseph

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Introduction: Over ten years after the 7.0 magnitude Earthquake struck the capital of Haiti, impacting over three million people and leading to the deaths of over two hundred thousand, the multinational humanitarian response remains the largest disaster relief effort to date. This study critically evaluates the multi-sector and multinational disaster response to the Earthquake, looking at how the lessons learned from this analysis can be applied to future disaster response efforts. We put particular emphasis on assessing the interaction between civilian and military sectors during this humanitarian relief effort, with the hopes of highlighting how concrete guidelines are essential to improve future responses. Methods: An extensive scoping review of the relevant literature was conducted - where library scientists conducted reproducible, verified systematic searches of multiple databases. Grey literature and hand searches were utilised to identify additional unclassified military documents, for inclusion in the study. More than 100 documents were included for data extraction and analysis. Key domains were identified, these included: Humanitarian and Military Response, Communication, Coordination, Resources, Needs Assessment and Pre-Existing Policy. Corresponding information and lessons-learned pertaining to these domains was then extracted - detailing the barriers and facilitators to an effective response. Results: Multiple themes were noted which stratified all identified domains - including the lack of adequate pre-existing policy, as well as extensive ambiguity of actors’ roles. This ambiguity was continually influenced by the complex role the United States military played in the disaster response. At a deeper level, the effects of neo-colonialism and concern about infringements on Haitian sovereignty played a substantial role at all levels: setting the pre-existing conditions and determining the redevelopment efforts that followed. Furthermore, external factors significantly impacted the response, particularly the loss of life within the political and security sectors. This was compounded by the destruction of important infrastructure systems - particularly electricity supplies and telecommunication networks, as well as air and seaport capabilities. Conclusions: This study stands as one of the first and most comprehensive evaluations, systematically analysing the civilian and military response - including their collaborative efforts. This study offers vital information for improving future combined responses and provides a significant opportunity for advancing knowledge in disaster relief efforts - which remains a more pressing issue than ever. The categories and domains formulated serve to highlight interdependent factors that should be applied in future disaster responses, with significant potential to aid the effective performance of humanitarian actors. Further studies will be grounded in these findings, particularly the need for greater inclusion of the Haitian perspective in the literature, through additional qualitative research studies.

Keywords: civilian and military collaboration, combined response, disaster, disaster response, earthquake, Haiti, humanitarian response

Procedia PDF Downloads 127

Authors: Andreas Kerstan, Darren Robey, Wesam Alvan, David Troiani

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Over the last 3.5 years, Quantum Cascade Lasers (QCL) technology has become increasingly important in infrared (IR) microscopy. The advantages over fourier transform infrared (FTIR) are that large areas of a few square centimeters can be measured in minutes and that the light intensive QCL makes it possible to obtain spectra with excellent S/N, even with just one scan. A firmly established solution of the laser direct infrared imaging (LDIR) 8700 is the analysis of microplastics. The presence of microplastics in the environment, drinking water, and food chains is gaining significant public interest. To study their presence, rapid and reliable characterization of microplastic particles is essential. Significant technical hurdles in microplastic analysis stem from the sheer number of particles to be analyzed in each sample. Total particle counts of several thousand are common in environmental samples, while well-treated bottled drinking water may contain relatively few. While visual microscopy has been used extensively, it is prone to operator error and bias and is limited to particles larger than 300 µm. As a result, vibrational spectroscopic techniques such as Raman and FTIR microscopy have become more popular, however, they are time-consuming. There is a demand for rapid and highly automated techniques to measure particle count size and provide high-quality polymer identification. Analysis directly on the filter that often forms the last stage in sample preparation is highly desirable as, by removing a sample preparation step it can both improve laboratory efficiency and decrease opportunities for error. Recent advances in infrared micro-spectroscopy combining a QCL with scanning optics have created a new paradigm, LDIR. It offers improved speed of analysis as well as high levels of automation. Its mode of operation, however, requires an IR reflective background, and this has, to date, limited the ability to perform direct “on-filter” analysis. This study explores the potential to combine the filter with an infrared reflective surface filter. By combining an IR reflective material or coating on a filter membrane with advanced image analysis and detection algorithms, it is demonstrated that such filters can indeed be used in this way. Vibrational spectroscopic techniques play a vital role in the investigation and understanding of microplastics in the environment and food chain. While vibrational spectroscopy is widely deployed, improvements and novel innovations in these techniques that can increase the speed of analysis and ease of use can provide pathways to higher testing rates and, hence, improved understanding of the impacts of microplastics in the environment. Due to its capability to measure large areas in minutes, its speed, degree of automation and excellent S/N, the LDIR could also implemented for various other samples like food adulteration, coatings, laminates, fabrics, textiles and tissues. This presentation will highlight a few of them and focus on the benefits of the LDIR vs classical techniques.

Keywords: QCL, automation, microplastics, tissues, infrared, speed

Procedia PDF Downloads 66

Authors: Fahui Jiang, Xinwei Xue, Liyan Zhang, Yanyan Zuo, Hao Zhang, Wei Zheng, Limei Bian, Lingling Hu, Chunlei Hao, Jianghong Du, Yanhua Ci, Ruibao Cheng, Ciren Dawa, Mithun Biswas, Mahbub Ul Islam, Fansheng Meng, Xinhua Peng

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Context: Soil erosion is a global issue that poses a significant threat to agricultural sustainability, particular in northern of China, which experiences the most severe wind erosion worldwide. Conservation tillage is vital in arid regions for preserving soil, enhancing water retention, and sustaining agricultural productivity in the face of limited rainfall. However, the long-term impacts of conservation tillage in semi-arid regions, especially its effects on soil health, wind erosion, and crop productivity, are poorly understood. Objective: Assess the impacts of conservation tillage on soil hydrothermal properties, wind erosion rates, nutrient dynamics, and crop yield, as well as elucidating the underlying mechanisms driving these impacts. Methods: A 9-year in-situ study was conducted in Chifeng, Inner Mongolia Province, comparing conventional rotary tillage (CK) with two conservation tillage methods: no-tillage with straw mulching (CT-1) and no-tillage with standing straw (CT-2). Results: Soil bulk density increased significantly under CT-1 and CT-2 in the topsoil layer (0–20 cm) compared with CK. Soil moisture content exhibited a significant increase pattern under CT-1 and CT-2, while soil temperature decreased under CT-1 but increased under CT-2, relative to CK. These variations in soil hydrothermal properties were more pronounced during the early (critical) crop growth stages and higher temperature conditions (afternoon). Soil loss due to wind erosion, accumulated from a height of 0–50 cm on the land surface, was reduced by 31.3 % and 25.5 % under CT-1 and by 51.5 % and 38.2 % under CT-2 in 2021 and 2022, respectively, compared to CK. Furthermore, the proportion of soil finer particles (clay and silt) increased under CT due to reduced wind erosion. Soil organic carbon significantly increased throughout the soil profile (0–60 cm), particularly in the deeper layers (20–40 cm and 40–60 cm), compared to the surface layer (0–20 cm), with corresponding increases of +57.0 % and +0.18 %, +66.2 % and +80.3 %, and +27.1 % and +14.2 % under CT-1 and CT-2, respectively, relative to CK in 2021. The concentrations of soil nutrients such as total nitrogen, available nitrogen, and available phosphorus and potassium, consistently increased under CT-1 and CT-2 compared to CK, with notable enhancements observed in the topsoil layer (0–20 cm) before seedling time, albeit declining after crop harvest. Generally, CT treatments significantly increased dry matter accumulation (+4.8 % to +30.8 %) and grain yield (+2.22 % to +0.44 %) of maize compared to CK in the semi-arid region over the 9-year study period, particularly notable in dry years and with long-term application. Conclusions and implications: Conservation tillage in semi-arid regions enhanced soil properties, reduced soil erosion, and increased soil nutrient dynamics and crop yield, promising sustainable agricultural practices with environmental benefits. Furthermore, our findings suggest that no-tillage with straw mulching is more suitable for dry and wind erosion sensitive regions.

Keywords: no tillage, conventional tillage, soil water, soil temperature, soil physics

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Authors: Demet Devrimsel Dogan, Ecem Deniz Kirkpantur, Muharrem Dogan, Ahmet Aykut, Ebru Unal Akoglu, Ozge Ecmel Onur

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Introduction: Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to external compression of the celiac trunk by a fibrous arch that unites diaphragmatic crura on each side of the aortic hiatus. While 10-24% of the population may suffer from compression of celiac trunk, it rarely causes patients to develop symptoms. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The diagnosis can be made using thin section multi-detector computed tomography (CT) scans which delineate the ligament and the compressed vessel. The treatment of MALS is aimed at relieving the compression of the celiac artery to restore adequate blood flow through the vessel and neurolysis to address chronic pain. Case: A 68-year-old male presented to our clinic with acute postprandial epigastric pain. This was patients’ first attack, and the pain was the worst pain of his life. The patient did not have any other symptoms like nausea, vomiting, chest pain or dyspnea. In his medical history, the patient has had an ischemic cerebrovascular stroke 5 years ago which he recovered with no sequel, and he was using 75 mg clopidogrel and 100 mg acetylsalicylic acid. He was not using any other medication and did not have a story of cardiovascular disease. His vital signs were stable (BP:113/72 mmHg, Spo2:97, temperature:36.3°C, HR:90/bpm). In his electrocardiogram, there was ST depression in leads II, III and AVF. In his physical examination, there was only epigastric tenderness, other system examinations were normal. Physical examination through his upper gastrointestinal system showed no bleeding. His laboratory results were as follows: creatinine:1.26 mg/dL, AST:42 U/L, ALT:17 U/L, amylase:78 U/L, lipase:26 U/L, troponin:10.3 pg/ml, WBC:28.9 K/uL, Hgb:12.7 gr/dL, Plt:335 K/uL. His serial high-sensitive troponin levels were also within normal limits, his echocardiography showed no segmental wall motion abnormalities, an acute myocardial infarction was excluded. In his abdominal ultrasound, no pathology was founded. Contrast-enhanced abdominal CT and CT angiography reported ‘thickened diaphragmatic cruras are compressing and stenosing truncus celiacus superior, this is likely compatible with MALS’. The patient was consulted to general surgery, and they admitted the patient for laparoscopic ligament release. Results: MALS is a syndrome that causes postprandial pain, nausea and vomiting as its most common symptoms. Affected patients are normally young, slim women between the ages of 30 and 50 who have undergone extensive examinations to find the source of their symptoms. To diagnose MALS, other underlying pathologies should initially be excluded. The gold standard is aortic angiography. Although diagnosis and treatment of MALS are unclear, symptom resolution has been achieved with multiple surgical modalities, including open, laparoscopic or robotic ligament release as well as celiac ganglionectomy, which often requires celiac artery revascularisation.

Keywords: differential diagnosis, epigastric pain, median arcuate ligament syndrome, celiac trunk

Procedia PDF Downloads 261

Authors: Zhenyu Zhang, Hsi-Hsien Wei

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Highway network systems play a vital role in disaster response for disaster-damaged areas. Damaged bridges in such network systems can impede disaster response by disrupting transportation of rescue teams or humanitarian supplies. Therefore, emergency inspection and repair of bridges to quickly collect damage information of bridges and recover the functionality of highway networks is of paramount importance to disaster response. A widely used measure of a network’s capability to recover from disasters is resilience. To enhance highway network resilience, plenty of studies have developed various repair scheduling methods for the prioritization of bridge-repair tasks. These methods assume that repair activities are performed after the damage to a highway network is fully understood via inspection, although inspecting all bridges in a regional highway network may take days, leading to the significant delay in repairing bridges. In reality, emergency repair activities can be commenced as soon as the damage data of some bridges that are crucial to emergency response are obtained. Given that emergency bridge inspection and repair (EBIR) activities are executed simultaneously in the response phase, the real-time interactions between these activities can occur – the blockage of highways due to repair activities can affect inspection routes which in turn have an impact on emergency repair scheduling by providing real-time information on bridge damages. However, the impact of such interactions on the optimal emergency inspection routes (EIR) and emergency repair schedules (ERS) has not been discussed in prior studies. To overcome the aforementioned deficiencies, this study develops a routing and scheduling model for EBIR while accounting for real-time inspection-repair interactions to maximize highway network resilience. A stochastic, time-dependent integer program is proposed for the complex and real-time interacting EBIR problem given multiple inspection and repair teams at locations as set post-disaster. A hybrid genetic algorithm that integrates a heuristic approach into a traditional genetic algorithm to accelerate the evolution process is developed. Computational tests are performed using data from the 2008 Wenchuan earthquake, based on a regional highway network in Sichuan, China, consisting of 168 highway bridges on 36 highways connecting 25 cities/towns. The results show that the simultaneous implementation of bridge inspection and repair activities can significantly improve the highway network resilience. Moreover, the deployment of inspection and repair teams should match each other, and the network resilience will not be improved once the unilateral increase in inspection teams or repair teams exceeds a certain level. This study contributes to both knowledge and practice. First, the developed mathematical model makes it possible for capturing the impact of real-time inspection-repair interactions on inspection routing and repair scheduling and efficiently deriving optimal EIR and ERS on a large and complex highway network. Moreover, this study contributes to the organizational dimension of highway network resilience by providing optimal strategies for highway bridge management. With the decision support tool, disaster managers are able to identify the most critical bridges for disaster management and make decisions on proper inspection and repair strategies to improve highway network resilience.

Keywords: disaster management, emergency bridge inspection and repair, highway network, resilience, uncertainty

Procedia PDF Downloads 109

Authors: Amanda Kavner, Richard Lamb

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Faster growth in science and technology of other nations may make staying globally competitive more difficult without shifting focus on how science is taught in US classes. An integral part of learning science involves visual and spatial thinking since complex, and real-world phenomena are often expressed in visual, symbolic, and concrete modes. The primary barrier to spatial thinking and visual literacy in Science, Technology, Engineering, and Math (STEM) fields is representational competence, which includes the ability to generate, transform, analyze and explain representations, as opposed to generic spatial ability. Although the relationship is known between the foundational visual literacy and the domain-specific science literacy, science literacy as a function of science learning is still not well understood. Moreover, the need for a more reliable measure is necessary to design resources which enhance the fundamental visuospatial cognitive processes behind scientific literacy. To support the improvement of students’ representational competence, first visualization skills necessary to process these science representations needed to be identified, which necessitates the development of an instrument to quantitatively measure visual literacy. With such a measure, schools, teachers, and curriculum designers can target the individual skills necessary to improve students’ visual literacy, thereby increasing science achievement. This project details the development of an artificial neural network capable of measuring science literacy using functional Near-Infrared Spectroscopy (fNIR) data. This data was previously collected by Project LENS standing for Leveraging Expertise in Neurotechnologies, a Science of Learning Collaborative Network (SL-CN) of scholars of STEM Education from three US universities (NSF award 1540888), utilizing mental rotation tasks, to assess student visual literacy. Hemodynamic response data from fNIRsoft was exported as an Excel file, with 80 of both 2D Wedge and Dash models (dash) and 3D Stick and Ball models (BL). Complexity data were in an Excel workbook separated by the participant (ID), containing information for both types of tasks. After changing strings to numbers for analysis, spreadsheets with measurement data and complexity data were uploaded to RapidMiner’s TurboPrep and merged. Using RapidMiner Studio, a Gradient Boosted Trees artificial neural network (ANN) consisting of 140 trees with a maximum depth of 7 branches was developed, and 99.7% of the ANN predictions are accurate. The ANN determined the biggest predictors to a successful mental rotation are the individual problem number, the response time and fNIR optode #16, located along the right prefrontal cortex important in processing visuospatial working memory and episodic memory retrieval; both vital for science literacy. With an unbiased measurement of science literacy provided by psychophysiological measurements with an ANN for analysis, educators and curriculum designers will be able to create targeted classroom resources to help improve student visuospatial literacy, therefore improving science literacy.

Keywords: artificial intelligence, artificial neural network, machine learning, science literacy, neuroscience

Procedia PDF Downloads 119

Authors: Sohrab Donyavi

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The global construction market is experiencing significant shifts, particularly for micro, small, and medium enterprises (MSMEs), driven by the dual imperatives of technological advancement and sustainability. MSMEs play a crucial role in the construction industry, often being the backbone of economic development and fostering entrepreneurial skills. However, their dominance has also led to industry fragmentation and challenges such as technological lag and declining profit margins, which threaten their global competitiveness. This paper explores the integration of technology and sustainability in reshaping the paradigms for MSMEs in the construction sector. The adoption of advanced technologies, such as building information modeling (BIM) and AI, are pivotal for promoting sustainable construction practices. These tools enable MSMEs to design and construct environmentally responsible buildings, thereby contributing to the industry's sustainability goals. The research highlights that achieving sustainability in construction involves significant efforts in conservation, recycling, and the development of new materials and technologies. This approach aligns with the broader goal of integrating economic, environmental, and social aims into firm objectives to create long-term value while ensuring the protection of natural resources for future generations. Critical factors for implementing sustainable oriented innovation (SOI) practices in MSMEs include top management support, government initiatives, and financial resources. These factors are essential for fostering an environment conducive to innovation and sustainability. Furthermore, the empowerment of MSMEs through improved governance, market-oriented programs, sustainable productivity growth, and access to financing is vital. In developing regions like Indonesia, these strategies are crucial for enabling MSMEs to thrive in the face of globalization. The tendency of large firms to grow larger with the help of technology and globalization has led to the emergence of a high-technology oligopoly, posing a significant challenge to traditional construction practices. This shift necessitates that MSMEs adapt by leveraging technology and embracing sustainable practices to remain competitive. The research underscores the importance of integrating technology and sustainability not only as a competitive strategy but also as a means to contribute to the global effort of environmental conservation and sustainable development. This paper concludes that the successful integration of technology and sustainability in MSMEs requires a multifaceted approach. It involves the adoption of advanced technological tools, strong support from top management, proactive government policies, and access to financial resources. By addressing these factors, MSMEs can overcome the challenges of industry fragmentation, technological lag, and declining profit margins. Ultimately, this integration will enable MSMEs to play a pivotal role in driving the construction industry towards a more sustainable and technologically advanced future. The findings and recommendations are based on a comprehensive case study utilizing semi-structured interviews, observations, questionnaires, and document reviews.

Keywords: MSMEs, construction, technology, sustainability, innovation

Procedia PDF Downloads 38

Authors: Su Yen Chen

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ChatGPT has shown both strengths and limitations in clinical, educational, and research settings, raising important concerns about accuracy, transparency, and ethical use. Despite an improved understanding of user acceptance and satisfaction, there is still a gap in how general AI perceptions translate into practical applications within healthcare. This study focuses on examining the perceptions of ChatGPT's impact among 266 healthcare majors in Taiwan, exploring its implications for their career development, as well as its utility in clinical practice, medical education, and research. By employing a structured survey with precisely defined subscales, this research aims to probe the breadth of ChatGPT's applications within healthcare, assessing both the perceived benefits and the challenges it presents. Additionally, to further enhance the comprehensiveness of our methodology, we have incorporated qualitative data collection methods, which provide complementary insights to the quantitative findings. The findings from the survey reveal that perceptions and usage of ChatGPT among healthcare majors vary significantly, influenced by factors such as its perceived utility, risk, novelty, and trustworthiness. Graduate students and those who perceive ChatGPT as more beneficial and less risky are particularly inclined to use it more frequently. This increased usage is closely linked to significant impacts on personal career development. Furthermore, ChatGPT's perceived usefulness and novelty contribute to its broader impact within the healthcare domain, suggesting that both innovation and practical utility are key drivers of acceptance and perceived effectiveness in professional healthcare settings. Trust emerges as an important factor, especially in clinical settings where the stakes are high. The trust that healthcare professionals place in ChatGPT significantly affects its integration into clinical practice and influences outcomes in medical education and research. The reliability and practical value of ChatGPT are thus critical for its successful adoption in these areas. However, an interesting paradox arises with regard to the ease of use. While making ChatGPT more user-friendly is generally seen as beneficial, it also raises concerns among users who have lower levels of trust and perceive higher risks associated with its use. This complex interplay between ease of use and safety concerns necessitates a careful balance, highlighting the need for robust security measures and clear, transparent communication about how AI systems work and their limitations. The study suggests several strategic approaches to enhance the adoption and integration of AI in healthcare. These include targeted training programs for healthcare professionals to increase familiarity with AI technologies, reduce perceived risks, and build trust. Ensuring transparency and conducting rigorous testing are also vital to foster trust and reliability. Moreover, comprehensive policy frameworks are needed to guide the implementation of AI technologies, ensuring high standards of patient safety, privacy, and ethical use. These measures are crucial for fostering broader acceptance of AI in healthcare, as the study contributes to enriching the discourse on AI's role by detailing how various factors affect its adoption and impact.

Keywords: ChatGPT, healthcare, survey study, IT adoption, behaviour, applcation, concerns

Procedia PDF Downloads 28

Authors: Xu Qian

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This abstract examines the concept of resilience in adolescents from both adolescent medicine and child psychology perspectives. It discusses the role of healthcare providers in fostering resilience among adolescents, encompassing physical, psychological, and social aspects. The paper highlights evidence-based interventions and practical strategies for promoting resilience in this population. Introduction: Resilience plays a crucial role in the healthy development of adolescents, enabling them to navigate through the challenges of this transitional period. This abstract explores the concept of resilience from the perspectives of adolescent medicine and child psychology, shedding light on the collective efforts of healthcare providers in fostering resilience. By integrating the principles and practices of these two disciplines, this abstract emphasizes the multidimensional nature of resilience and its significance in the overall well-being of adolescents. Methods: A comprehensive literature review was conducted, encompassing research articles, empirical studies, and expert opinions from both adolescent medicine and child psychology fields. The search included databases such as PubMed, PsycINFO, and Google Scholar, focusing on publications from the past decade. The review aimed to identify evidence-based interventions and practical strategies employed by healthcare providers to promote resilience among adolescents. Results: The review revealed several key findings regarding the promotion of resilience in adolescents. Firstly, resilience is a dynamic process influenced by individual characteristics, environmental factors, and the interaction between the two. Secondly, healthcare providers play a critical role in fostering resilience by addressing the physical, psychological, and social needs of adolescents. This entails comprehensive healthcare services that integrate medical care, mental health support, and social interventions. Thirdly, evidence-based interventions such as cognitive-behavioral therapy, social skills training, and positive youth development programs have shown promising outcomes in enhancing resilience. Discussion: The integration of adolescent medicine and child psychology perspectives provides a comprehensive framework for promoting resilience in adolescents. By acknowledging the interplay between physical health, psychological well-being, and social functioning, healthcare providers can tailor interventions to address the specific needs and challenges faced by adolescents. Collaborative efforts between medical professionals, psychologists, educators, and families are vital in creating a supportive environment that fosters resilience. Additionally, the findings highlight the importance of early identification and intervention, emphasizing the need for routine screening and assessment to identify adolescents at risk and provide timely support. Conclusion: Promoting resilience in adolescents requires a holistic approach that integrates adolescent medicine and child psychology perspectives. By recognizing the multifaceted nature of resilience, healthcare providers can implement evidence-based interventions and practical strategies to enhance the well-being of adolescents. The collaboration between healthcare professionals from different disciplines, alongside the involvement of families and communities, is crucial for creating a resilient support system. By investing in the promotion of resilience during adolescence, we can empower young individuals to overcome adversity and thrive in their journey toward adulthood.

Keywords: psychology, clinical psychology, child psychology, adolescent psychology, adolescent

Procedia PDF Downloads 77

Authors: Jonathan Kissi, Baozhen Dai, Wisdom W. K. Pomegbe, Abdul-Basit Kassim

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Protecting patient’s digital information is a growing concern for healthcare institutions as people nowadays perpetually live their lives through telemedicine services. These telemedicine services have been confronted with several determinants that hinder their successful implementations, especially in developing countries. Identifying such determinants that influence the acceptance of telemedicine services is also a problem for healthcare professionals. Despite the tremendous increase in telemedicine services, its adoption, and use has been quite slow in some healthcare settings. Generally, it is accepted in today’s globalizing world that the success of telemedicine services relies on users’ satisfaction. Satisfying health professionals and patients are one of the crucial objectives of telemedicine success. This study seeks to investigate the determinants that influence health professionals’ intention to utilize telemedicine services in clinical activities in a sub-Saharan African country in West Africa (Ghana). A hybridized model comprising of health adoption models, including technology acceptance theory, diffusion of innovation theory, and protection of motivation theory, were used to investigate these quandaries. The study was carried out in four government health institutions that apply and regulate telemedicine services in their clinical activities. A structured questionnaire was developed and used for data collection. Purposive and convenience sampling methods were used in the selection of healthcare professionals from different medical fields for the study. The collected data were analyzed based on structural equation modeling (SEM) approach. All selected constructs showed a significant relationship with health professional’s behavioral intention in the direction expected from prior literature including perceived usefulness, perceived ease of use, management strategies, financial sustainability, communication channels, patients security threat, patients privacy risk, self efficacy, actual service use, user satisfaction, and telemedicine services systems securities threat. Surprisingly, user characteristics and response efficacy of health professionals were not significant in the hybridized model. The findings and insights from this research show that health professionals are pragmatic when making choices for technology applications and also their willingness to use telemedicine services. They are, however, anxious about its threats and coping appraisals. The identified significant constructs in the study may help to increase efficiency, quality of services, quality patient care delivery, and satisfactory user satisfaction among healthcare professionals. The implantation and effective utilization of telemedicine services in the selected hospitals will aid as a strategy to eradicate hardships in healthcare services delivery. The service will help attain universal health access coverage to all populace. This study contributes to empirical knowledge by identifying the vital factors influencing health professionals’ behavioral intentions to adopt telemedicine services. The study will also help stakeholders of healthcare to formulate better policies towards telemedicine service usage.

Keywords: telemedicine service, perceived usefulness, perceived ease of use, management strategies, security threats

Procedia PDF Downloads 140

Authors: Deepak Loura

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Production and productivity of several crops in the country continue to be adversely affected by biotic (e.g., Insect-pests and diseases) and abiotic (e.g., water temperature and salinity) stresses. Over-dependence on pesticides and other chemicals is economically non-viable for the resource-poor farmers of our country. Further, pesticides can potentially affect human and environmental safety. While traditional breeding techniques and proper- management strategies continue to play a vital role in crop improvement, we need to judiciously use biotechnology approaches for the development of genetically modified crops addressing critical problems in the improvement of crop plants for sustainable agriculture. Modern biotechnology can help to increase crop production, reduce farming costs, and improve food quality and the safety of the environment. Genetic engineering is a new technology which allows plant breeders to produce plants with new gene combinations by genetic transformation of crop plants for improvement of agronomic traits. Advances in recombinant DNA technology have made it possible to have genes between widely divergent species to develop genetically modified or genetically engineered plants. Plant genetic engineering provides the strength to harness useful genes and alleles from indigenous microorganisms to enrich the gene pool for developing genetically modified (GM) crops that will have inbuilt (inherent) resistance to insect pests, diseases, and abiotic stresses. Plant biotechnology has made significant contributions in the past 20 years in the development of genetically engineered or genetically modified crops with multiple benefits. A variety of traits have been introduced in genetically engineered crops which include (i) herbicide resistance. (ii) pest resistance, (iii) viral resistance, (iv) slow ripening of fruits and vegetables, (v) fungal and bacterial resistance, (vi) abiotic stress tolerance (drought, salinity, temperature, flooding, etc.). (vii) quality improvement (starch, protein, and oil), (viii) value addition (vitamins, micro, and macro elements), (ix) pharmaceutical and therapeutic proteins, and (x) edible vaccines, etc. Multiple genes in transgenic crops can be useful in developing durable disease resistance and a broad insect-control spectrum and could lead to potential cost-saving advantages for farmers. The development of transgenic to produce high-value pharmaceuticals and the edible vaccine is also under progress, which requires much more research and development work before commercially viable products will be available. In addition, molecular-aided selection (MAS) is now routinely used to enhance the speed and precision of plant breeding. Newer technologies need to be developed and deployed for enhancing and sustaining agricultural productivity. There is a need to optimize the use of biotechnology in conjunction with conventional technologies to achieve higher productivity with fewer resources. Therefore, genetic modification/ engineering of crop plants assumes greater importance, which demands the development and adoption of newer technology for the genetic improvement of crops for increasing crop productivity.

Keywords: biotechnology, plant genetic engineering, genetically modified, biotic, abiotic, disease resistance

Procedia PDF Downloads 71

Authors: Carlos M. Parra, Matthew Sutherland, Ranjita Poudel

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Reduced mental-bandwidth related to low socioeconomic status (low-SES) might lead to impulsivity and risk-taking behavior, which poses as a major hurdle towards asset building (savings) behavior. Understanding the relationship between risk-related personality metrics as well as laboratory risk behavior and real-life savings behavior can help facilitate the development of effective asset building programs, which are vital for mitigating financial vulnerability and income inequality. As such, this study explored the relationship between personality metrics, laboratory behavior in a risky decision-making task and real-life asset building (savings) behaviors among individuals with low-SES from Miami, Florida (FL). Study participants (12 male, 15 female) included racially and ethnically diverse adults (mean age 41.22 ± 12.65 years), with incomplete higher education (18% had High School Diploma, 30% Associates, and 52% Some College), and low annual income (mean $13,872 ± $8020.43). Participants completed eight self-report surveys and played a widely used risky decision-making paradigm called the Balloon Analogue Risk Task (BART). Specifically, participants played three runs of BART (20 trials in each run; total 60 trials). In addition, asset building behavior data was collected for 24 participants who opened and used savings accounts and completed a 6-month savings program that involved monthly matches, and a final reward for completing the savings program without any interim withdrawals. Each participant’s total savings at the end of this program was the main asset building indicator considered. In addition, a new effective use of average pump bet (EUAPB) indicator was developed to characterize each participant’s ability to place winning bets. This indicator takes the ratio of each participant’s total BART earnings to average pump bet (APB) in all 60 trials. Our findings indicated that EUAPB explained more than a third of the variation in total savings among participants. Moreover, participants who managed to obtain BART earnings of at least 30 cents out of their APB, also tended to exhibit better asset building (savings) behavior. In particular, using this criterion to separate participants into high and low EUAPB groups, the nine participants with high EUAPB (mean BART earnings of 35.64 cents per APB) ended up with higher mean total savings ($255.11), while the 15 participants with low EUAPB (mean BART earnings of 22.50 cents per APB) obtained lower mean total savings ($40.01). All mean differences are statistically significant (2-tailed p  .0001) indicating that the relation between higher EUAPB and higher total savings is robust. Overall, these findings can help refine asset building interventions implemented by policy makers and practitioners interested in reducing financial vulnerability among low-SES population. Specifically, by helping identify individuals who are likely to readily take advantage of savings opportunities (such as matched savings programs) and avoiding the stipulation of unnecessary and expensive financial coaching programs to these individuals. This study was funded by J.P. Morgan Chase (JPMC) and carried out by scientists from Florida International University (FIU) in partnership with Catalyst Miami.

Keywords: balloon analogue risk task (BART), matched savings programs, asset building capability, low-SES participants

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Authors: Yujie Yuan, Yiyang Fan, Hong Fan

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Objective: The RNA methylation recognition protein Aly/REF export factor (ALYREF) is considered one type of “reader” protein acting as a recognition protein of m5C, has been reported involved in several biological progresses including cancer initiation and progression. 5-methylcytosine (m5C) is a conserved and prevalent RNA modification in all species, as accumulating evidence suggests its role in the promotion of tumorigenesis. It has been claimed that ALYREF mediates nuclear export of mRNA with m5C modification and regulates biological effects of cancer cells. However, the systematical regulatory pathways of ALYREF in cancer tissues have not been clarified, yet. Methods: The expression level of ALYREF in pan-cancer and their normal tissues was compared through the data acquired from The Cancer Genome Atlas (TCGA). The University of Alabama at Birmingham Cancer data analysis Portal UALCAN was used to analyze the relationship between ALYREF and clinical pathological features. The relationship between the expression level of ALYREF and prognosis of pan-cancer, and the correlation genes of ALYREF were figured out by using Gene Expression Correlation Analysis database GEPIA. Immune related genes were obtained from TISIDB (an integrated repository portal for tumor-immune system interactions). Immune-related research was conducted by using Estimation of STromal and Immune cells in MAlignant Tumor tissues using Expression data (ESTIMATE) and TIMER. Results: Based on the data acquired from TCGA, ALYREF has an obviously higher-level expression in various types of cancers compared with relevant normal tissues excluding thyroid carcinoma and kidney chromophobe. The immunohistochemical images on The Human Protein Atlas showed that ALYREF can be detected in cytoplasm, membrane, but mainly located in nuclear. In addition, a higher expression level of ALYREF in tumor tissue generates a poor prognosis in majority of cancers. According to the above results, cancers with a higher expression level of ALYREF compared with normal tissues and a significant correlation between ALYREF and prognosis were selected for further analysis. By using TISIDB, we found that portion of ALYREF co-expression genes (such as BIRC5, H2AFZ, CCDC137, TK1, and PPM1G) with high Pearson correlation coefficient (PCC) were involved in anti-tumor immunity or affect resistance or sensitivity to T cell-mediated killing. Furthermore, based on the results acquired from GEPIA, there was significant correlation between ALYREF and PD-L1. It was exposed that there is a negative correlation between the expression level of ALYREF and ESTIMATE score. Conclusion: The present study indicated that ALYREF plays a vital and universal role in cancer initiation and progression of pan-cancer through regulating mitotic progression, DNA synthesis and metabolic process, and RNA processing. The correlation between ALYREF and PD-L1 implied ALYREF may affect the therapeutic effect of immunotherapy of tumor. More evidence revealed that ALYREF may play an important role in tumor immunomodulation. The correlation between ALYREF and immune cell infiltration level indicated that ALYREF can be a potential therapeutic target. Exploring the regulatory mechanism of ALYREF in tumor tissues may expose the reason for poor efficacy of immunotherapy and offer more directions of tumor treatment.

Keywords: ALYREF, pan-cancer, immunotherapy, PD-L1

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Authors: Azhar Naila, Steuer Benjamin

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Over-exploitation of resources and the burden on natural systems have provoked worldwide concerns about the potential resource as well as supply risks in the future. It has been estimated that the consumption of materials and resources will double by 2060, substantially mounting the amount of waste and emissions produced by individuals, organizations, and businesses, which necessitates sustainable technological innovations to address the problem. Therefore, there is a need to design products and services purposefully for material resource efficiency. This directs us toward the conceptualization and implementation of the ‘Circular Economy (CE),’ which has gained considerable attention among policymakers, researchers, and businesses in the past decade. A large amount of literature focuses on the concept of CE. However, contextual empirical research on the need to embrace CE in an emerging economy like Pakistan is still scarce, where the traditional economic model of take-make-dispose is quite common. Textile exports account for approximately 61% of Pakistan's total exports, and the industry provides employment for about 40% of the country's total industrial workforce. The industry provides job opportunities to above 10 million farmers, with cotton as the main crop of Pakistan. Consumers, companies, as well as the government have explored very limited CE potential in the country. This gap has motivated us to carry out the present study. The study is based on a mixed method approach, for which key informant interviews have been conducted to get insight into the present situation of the ecosystem readiness for the adoption of CE in 20 textile manufacturing industries. The subject study has been conducted on the following areas i) the level of understanding of the CE concept among key stakeholders in the textile manufacturing industry ii) Companies are pushing boundaries to invest in circularity-based initiatives, exploring the depths of risk-taking iii) the current national policy framework support the adoption of CE. Qualitative assessment has been undertaken using MAXQDA to analyze the data received after the key informant interviews. The data has been transcribed and coded for further analysis. The results show that most of the key stakeholders have a clear understanding of the concept, whereas few consider it to be only relevant to the end-of-life treatment of waste generated from the industry. Non-governmental organizations have been observed to be key players in creating awareness among the manufacturing industries. Maximum companies have shown their consent to invest in initiatives related to the adoption of CE. Whereas a few consider themselves far behind the race due to a lack of financial resources and support from responsible institutions. Mostly, the industries have an ambitious vision for integrating CE into the company’s policy but seem not to be ready to take any significant steps to nurture a culture for experimentation. However, the government is not playing any vital role in the transition towards CE; rather, they have been busy with the state’s uncertain political situation. Presently, Pakistan does not have any policy framework that supports the transition towards CE. Acknowledging the present landscape a well-informed CE transition is immediately required.

Keywords: circular economy, textile supply chain, textile manufacturing industries, resource efficiency, ecosystem readiness, multi-case study analysis

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Authors: Sarah Hazelwood, Janice Hay

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Methoxyflurane is an inhaled analgesic administered via a disposable inhaler, which has been used in Australia for 40 years for the management of pain in children & adults. However, there is a lack of data for methoxyflurane as a frontline analgesic medication within the emergency department (ED). This study will investigate the usefulness of methoxyflurane in a private inner-city ED. The study concluded that the inclusion of all key stakeholders in the prescribing, administering & use of this new process led to comprehensive uptake & vastly positive outcomes for consumer & health professionals. Method: A 12-week prospective pilot study was completed utilizing patients presenting to the ED in pain (numeric pain rating score > 4) that fit the requirement of methoxyflurane use (as outlined in the Australian Prescriber information package). Nurses completed a formatted spreadsheet for each interaction where methoxyflurane was used. Patient demographics, day, time, initial numeric pain score, analgesic response time, the reason for use, staff concern (free text), & patient feedback (free text), & discharge time was documented. When clinical concern was raised, the researcher retrieved & reviewed patient notes. Results: 140 methoxyflurane inhalers were used. 60% of patients were 31 years of age & over (n=82) with 16% aged 70+. The gender split; 51% male: 49% female. Trauma-related pain (57%) saw the highest use of administration, with the evening hours (1500-2259) seeing the greatest numbers used (39%). Tuesday, Thursday & Sunday shared the highest daily use throughout the study. A minimum numerical pain score of 4/10 (n=13, 9%), with the ranges of 5 - 7/10 (moderate pain) being given by almost 50% of patients. Only 3 instances of pain scores increased post use of methoxyflurane (all other entries showed pain score < initial rating). Patients & staff noted obvious analgesic response within 3 minutes (n= 96, 81%, of administration). Nurses documented a change in patient vital signs for 4 of the 15 patient-related concerns; the remaining concerns were due to “gagging” on the taste, or “having a coughing episode”; one patient tried to leave the department before the procedure was attended (very euphoric state). Upon review of the staff concerns – no adverse events occurred & return to therapeutic vitals occurred within 10 minutes. Length of stay for patients was compared with similar presentations (such as dislocated shoulder or ankle fracture) & saw an average 40-minute decrease in time to discharge. Methoxyflurane treatment was rated “positively” by > 80% of patients – with remaining feedback related to mild & transient concerns. Staff similarly noted a positive response to methoxyflurane as an analgesic & as an added tool for frontline analgesic purposes. Conclusion: Methoxyflurane should be used on suitable patient presentations requiring immediate, short term pain relief. As a highly portable, non-narcotic avenue to treat pain this study showed obvious therapeutic benefit, positive feedback, & a shorter length of stay in the ED. By partnering with key stake holders, this study determined methoxyflurane use decreased work load, decreased wait time to analgesia, and increased patient satisfaction.

Keywords: analgesia, benefits, emergency, methoxyflurane

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Authors: Martin Bloomfield

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This paper examines frictions that lie at the heart of any pragmatist conception of religion and moral progress. I take moral progress to require the ability to correctly analyse social problems, provide workable solutions to these problems, and then rationally justify the analyses and solutions used. I take religion here to involve, as a minimal requirement, belief in the existence of God, a god, or gods, such that they are recognisable to most informed observers within the Western tradition. I take pragmatism to belong to, and borrow from, the philosophical traditions of non-absolutism, anti-realism, historicism, and voluntarism. For clarity, the relevant brands of each of these traditions will be examined during the paper. The friction identified in the title may be summed up as follows: those who, like Cornel West (and, when he was alive, Hilary Putnam), are theistic pragmatists with an interest in realising moral progress, have all been aware of a problem inherent in their positions. Assuming it can be argued that religion and moral progress are compatible, a non-absolutist, anti-realist, historicist position nevertheless raises problems that, as Leon Wieseltier pointed out, the pragmatist still believes in a God who isn’t real, and that the truth of any religious statement (including “God exists”) is relative not to any objective reality but to communities of engaged interlocutors; and that, where there are no absolute standards of right and wrong, any analysis of (and solution to) social problems can only be rationally justified relative to one or another community or moral and epistemic framework. Attempts made to universalise these frameworks, notably by Dewey, Gadamer, and Bernstein, through democracy and hermeneutics, fall into either a vicious and infinite regress, or (taking inspiration from Habermas) the problem of moral truths being decided through structures of power. The paper removes this friction by highlighting the work of Christian pragmatist Cornel West through the lens of the philosopher of religion Eleanore Stump. While West recognises that for the pragmatist, the correctness of any propositions about God or moral progress is impossible to rationally justify to any outside the religious, moral or epistemic framework of the speakers themselves without, as he calls it, a ‘locus of truth’ (which is itself free from the difficulties Dewey, Gadamer and Bernstein fall victim to), Stump identifies routes to knowledge which provide such a locus while avoiding the problems of relativism, power dynamics, and regress. She describes “Dominican” and “Franciscan” knowledge (roughly characterised as “propositional” and “non-propositional”), and uses this distinction to identify something Bernstein saw as missing from Gadamer: culture-independent norms, upon which universal agreement can be built. The “Franciscan knowledge” Stump identifies as key is second-personal knowledge of Christ. For West, this allows the knower to access vital culture-independent norms. If correct, instead of the classical view (religion is incompatible with pragmatism), Christianity becomes key to pragmatist knowledge and moral-knowledge claims. Rather than being undermined by pragmatism, Christianity enables pragmatists to make moral and epistemic claims, free from troubling power dynamics and cultural relativism.

Keywords: Cornel West, Cultural Relativism, Gadamer, Philosophy of Religion, Pragmatism

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Authors: S. MacDougall-Davis, S. Wysling, R. Willmore

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Background: The application of good non-technical skills, also known as crew resource management (CRM), is central to the delivery of safe, effective healthcare. The authors have been running remote trauma courses for over 10 years, primarily focussing on developing participants’ CRM in time-critical, high-stress clinical situations. The course has undergone an iterative process over the past 10 years. We employ a number of experiential learning techniques for improving CRM, including small group workshops, military command tasks, high fidelity simulations with reflective debriefs, and a ‘flipped classroom’, where participants are asked to create their own simulations and assess and debrief their colleagues’ CRM. We created a randomised simulation study to assess the impact of our course on UK medical students’ CRM, both at an individual and a teams level. Methods: Sixteen students took part. Four clinical scenarios were devised, designed to be of similar urgency and complexity. Professional moulage effects and experienced clinical actors were used to increase fidelity and to further simulate high-stress environments. Participants were block randomised into teams of 4; each team was randomly assigned to one pre-course simulation. They then underwent our 5 day remote trauma CRM course. Post-course, students were re-randomised into four new teams; each was randomly assigned to a post-course simulation. All simulations were videoed. The footage was reviewed by two independent CRM-trained assessors, who were blinded to the before/after the status of the simulations. Assessors used the internationally validated team emergency assessment measure (TEAM) to evaluate key areas of team performance, as well as a global outcome rating. Prior to the study, assessors had scored two unrelated scenarios using the same assessment tool, demonstrating 89% concordance. Participants also completed pre- and post-course questionnaires. Likert scales were used to rate individuals’ perceived NTS ability and their confidence to work in a team in time-critical, high-stress situations. Results: Following participation in the course, a significant improvement in CRM was observed in all areas of team performance. Furthermore, the global outcome rating for team performance was markedly improved (40-70%; mean 55%), thus demonstrating an impact at Level 4 of Kirkpatrick’s hierarchy. At an individual level, participants’ self-perceived CRM improved markedly after the course (35-70% absolute improvement; mean 55%), as did their confidence to work in a team in high-stress situations. Conclusion: Our study demonstrates that with a short, cost-effective course, using easily reproducible teaching sessions, it is possible to significantly improve participants’ CRM skills, both at an individual and, perhaps more importantly, at a teams level. The successful functioning of multi-disciplinary teams is vital in a healthcare setting, particularly in high-stress, time-critical situations. Good CRM is of paramount importance in these scenarios. The authors believe that these concepts should be introduced from the earliest stages of medical education, thus promoting a culture of effective CRM and embedding an early appreciation of the importance of these skills in enabling safe and effective healthcare.

Keywords: crew resource management, non-technical skills, training, simulation

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Authors: M. Fry, L. Fitzpatrick, Julie Considine, R. Z. Shaban, Kate Curtis

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Introduction: The vast majority of older Australians lives independently and are self-managing at home, despite a growing number living with a chronic illness that requires health intervention. Evidence shows that between 50% and 80% of people presenting to the emergency department (ED) are in pain. Australian EDs manage 7.2 million attendances every year and 1.4 million of these are people aged 65 years or more. Research shows that 28% of ED patients aged 65 years or more have Cognitive impairment (CI) associated with dementia, delirium and neurological conditions. Background: Traditional ED service delivery may not be suitable for older people who present with multiple, complex and ongoing illnesses. Likewise, ED clinical staff often perceive that their role should be focused more on immediate and potential lifethreatening illness and conditions which are episodic in nature. Therefore, the needs of older people and their family/carers may not be adequately addressed in the context of an ED presentation. Aim: We aimed to explore the utilisation and characteristics of older people presenting to four metropolitan EDs. Method: The findings being presented are part of a program of research exploring pain management practices for older persons with long bone fractures. The study was conducted across four metropolitan emergency departments of older patients (65years and over) and involved a 12-month randomised medical record audit (n=255). Results: ED presentations across four ED sites in 2012 numbered 168021, with 44778 (26.6%) patients aged 65 and over. Of the 44778 patients, the average age was 79.1 years (SD 8.54). There were more females 23932 (53.5%). The majority (26925: 85.0%) of older persons self-referred to the ED and lived independently. The majority arrived by ambulance (n=18553: 41.4%) and were allocated triage category was 3 (n=19,507:43.65%) or Triage category 4 at (n=15,389: 34.43%). The top five triage symptom presentations involved pain (n=8088; 18.25%), dyspnoea (n=4735; 10.7%), falls (n=4032; 9.1%), other (n=3984; 9.0%), cardiac (n=2987; 6.7%). The top five system based diagnostic presentations involved musculoskeletal (n=8902; 20.1%), cardiac (n=6704:15.0%), respiratory (n=4933; 11.0%), neurological (n=4909; 11.0%), gastroenterology (n=4321; 9.7%). On review of one tertiary hospital database the vital signs on average at time triage: Systolic Blood Pressure 143.6mmHg. Heart Rate 83.4 beats/minute; Respiratory Rate 18.5 breaths/ minute; Oxygen saturation 97.0% and Tympanic temperature 36.7 and Blood Glucose Level 7.4mmols/litre. The majority presented with a Glasgow Coma Score of 14 or higher. On average the older person stayed in the ED 4:56 (SD 3:28minutes).The average time to be seen was 39 minutes (SD 48 minutes). The majority of older persons were admitted (n=27562: 61.5%), did not wait for treatment (n= 8879: 0.02%) discharged home (n=16256: 36.0%). Conclusion: The vast majority of older persons are living independently, although many require admission on arrival to the ED. Many arrived in pain and with musculoskeletal injuries and or conditions. New models of care need to be considered, which may better support self-management and independent living of the older person and the National Emergency Access Targets.

Keywords: chronic, older person, aged care, emergency department

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