Search results for: Patient-related outcomes

Authors: Sukwoong Kang

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Background: The application of light-emitting diode (LED)-dependent photobiomodulation (PBM) in promoting post-tendon injury healing has been recently reported. Despite the establishment of a theoretical basis for ligament restoration through PBM, the lack of any empirical evidence deems this therapeutic strategy contentious. Therefore, the aim of this study was to investigate the potency of LED-based PBM in facilitating tendon healing in a murine model. Methods: Migration kinetics were analyzed at two specific wavelengths: 630 and 880 nm. The Achilles tendon in the hind limbs of Balb/c mice was severed via Achilles tendon transection. Subsequently, the mice were randomized into LED non-irradiation and LED irradiation groups. Mice with intact tendons were employed as healthy controls. The wounds were LED-irradiated for 20 min daily for two days. Histological properties, tendon healing mediators, and inflammatory mediators were screened on day 14. Results: The roundness of the nuclei and fiber structure, indicating the degree of infiltrated inflammatory cells and severity of fiber fragmentation, respectively, were considerably lower in the LED irradiation group than in the LED non-irradiation group. Immunohistochemical analysis depicted an increase in tenocytes (SCX+ cells) and a recovery of wounds with reduced fibrosis (lower collagen 3 and TGF-β1) in the LED irradiation group during healing; conversely, the LED non-irradiation group exhibited tissue fibrosis. The ratio of M2 macrophages to total macrophages was higher in the LED irradiation group than in the injured group. Conclusion: LED-based PBM in the Achilles tendon rupture murine model effectuated a rapid restoration of histological and immunochemical outcomes. The aforementioned findings suggest that LED-based PBM presents remarkable potential as an adjunct therapeutic for tendon healing and warrants further research to standardize various parameters to advance and establish it as a reliable treatment regime.

Keywords: photobiomodulation, light-emitting diode, tendon, regeneration

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Authors: Kyngäs Helvi, Patala-Pudas, Kaakinen Pirjo

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It has been reported that COPD -patients may experience much emotional distress, which can compromise positive health outcomes. The aim of this study was to explore disease-related uncertainty as reported by Chronic Obstructive Pulmonary Disease (COPD) patients. Uncertainty was defined as a lack of confidence; negative feelings; a sense of confidence; and awareness of the sources of uncertainty. Research design was a non-experimental cross-sectional survey. The data (n=141) was collected by validated questionnaire during COPD -patients’ visits or admissions to a tertiary hospital. The response rate was 62%. The data was analyzed by statistical methods. Around 70% of the participants were male with COPD diagnosed many years ago. Fifty-four percent were under 65 years and used an electronic respiratory aid apparatus (52%) (oxygen concentrator, ventilator or electronic inhalation device). Forty-one percent of the participants smoked. Disease-related uncertainty was widely reported. Seventy-three percent of the participants had uncertainty about their knowledge of the disease, the pulmonary medication and nutrition. One-quarter (25%) did not feel sure about managing COPD exacerbation. About forty percent (43%) reported that they did not have a written exacerbation decision aid indicating how to act in relation to COPD symptoms. Over half of the respondents were uncertain about self-management behavior related to health habits such as exercise and nutrition. Over a third of the participants (37%) felt uncertain about self-management skills related to giving up smoking. Support from the care providers was correlated significantly with the patients’ sense of confidence. COPD -patients who felt no confidence stated that they received significantly less support in care. Disease-related uncertainty should be considered more closely and broadly in the patient care context, and those strategies within patient education that enhance adherence should be strengthened and incorporated into standard practice.

Keywords: adherence, COPD, disease-management, uncertainty

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Authors: Wayne DeFehr

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This study is rooted in a pedagogical approach that emphasizes student engagement as fundamental to meaningful learning in the classroom. This approach creates a paradigmatic shift, from a teaching practice that reinforces the teacher’s central authority to a practice that disperses that authority among the students in the classroom through networks that they themselves develop. The methodology of this study about creating optimal conditions for learning in the classroom includes providing a conceptual framework within which the students work, as well as providing clearly stated expectations for work standards, content quality, group methodology, and learning outcomes. These learning conditions are nurtured in a variety of ways. First, nearly every class includes a lecture from the professor with key concepts that students need in order to complete their work successfully. Secondly, students build on this scholarly material by forming their own networks, where students face each other and engage with each other in order to collaborate their way to solving a particular problem relating to the course content. Thirdly, students are given short, medium, and long-term goals. Short term goals relate to the week’s topic and involve workshopping particular issues relating to that stage of the course. The medium-term goals involve students submitting term assignments that are evaluated according to a well-defined rubric. And finally, long-term goals are achieved by creating a capstone project, which is celebrated and shared with classmates and interested friends on the final day of the course. The essential conclusions of the study are drawn from courses that focus on video game narrative. Enthusiastic student engagement is created not only with the dynamic energy and expertise of the instructor, but also with the inter-dependence of the students on each other to build knowledge, acquire skills, and achieve successful results.

Keywords: collaboration, education, learning networks, video games

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Authors: Julia Brudzinski, Ashley Croswell, Jade Mardin, Hannah Shilling, Jennifer Berg-Carnegie

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Adults with brain injuries and mental illnesses commonly experience cognitive impairments that interfere with their participation in activities of daily living (ADLs). Prior research states that electronic reminder systems can support adults with cognitive impairments; however, previous studies focus primarily on one-way reminder systems. Research on adults with chronic diseases reported that two-way reminder systems yield better health outcomes and disease self-management compared to one-way reminder systems. Literature was identified through systematically searching 7 databases and hand-searching relevant reference lists. Retrieved studies were independently screened and reviewed by at least two members of the research team. Data was extracted on study design, participant characteristics, intervention details, study objectives, outcome measures, and important results. 574 articles were screened and reviewed. Nine articles met all inclusion criteria and were included. The literature focused on three main areas: system feasibility (n=8), stakeholder satisfaction (n=6), and efficacy of the two-way reminder systems (n=6). Participants in eight of the studies had brain injuries, with participants in only one study having a mental illness (i.e., schizophrenia). Two-way reminder systems were used to support participation in a wide range of ADLs. The current literature on two-way reminder systems to support ADLs for adults with cognitive impairments focuses on feasibility, stakeholder satisfaction, and system efficacy. Future research should focus on addressing the barriers to accessing and implementing two-way reminder systems and identifying specific client characteristics that would benefit most from using these systems.

Keywords: brain injury, digital health, occupational therapy, activities of daily living, two-way reminder systems

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Authors: Ayeshmanthe Rathnayake, Siew Goh, Carmel Fenton, Ashutosh Hardikar

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Post-Operative Atrial Fibrillation (POAF) is the most frequent complication of cardiac surgery and is associated with reduced survival, increased rates of cognitive changes and cerebrovascular accident, heart failure, renal dysfunction, infection and length of stay, and hospital costs. Cardiac tamponade, although less common, carries high morbidity and mortality. Shed mediastinal blood in the pericardial space is a major source of intrapericardial oxidative stress and inflammation that triggers POAF. The utilisation of a left posterior pericardiotomy aims to shunt blood from the pericardium into the pleural space and have a role in the prevention of POAF as well as cardiac tamponade. 2118 patients had undergone isolated Coronary Artery Bypass Graft (CABG) at Royal Hobart Hospital from 2008-2021. They were divided into pericardiotomy vs control group. Patient baseline demographics, intraoperative data, and post-operative outcomes were reviewed retrospectively. Total incidence of new POAF and cardiac tamponade was 26.1% and 0.75%, respectively. Primary outcome of both the incidence of POAF(22.9% vs27.8%OR 0.77 p<0.05) and Cardiac Tamponade (0% vs 1.1% OR 0.85 p<0.05) were less in the pericardiotomy group.Increasing age, BMI, poor left ventricular function (EF <30%), and return to theatre were independent predictors of developing POAF. There were similar rates of return to theatre for bleeding however, no cases of tamponade in the pericardiotomy group. There were no complications attributable to left posterior pericardiotomy and the time added to the duration of surgery was minimal. Left posterior pericardiotomy is associated with a significant reduction in the incidence of POAFand cardiac tamponade and issafe and efficient.

Keywords: cardiac surgery, pericardiotomy, post-operative atrial fibrillation, cardiac tamponade

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Authors: Cheryl Teelucksingh

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Toronto is in the midst of an urban development and infrastructure boom. Population growth and concerns about urban sprawl and carbon emissions have led to pressure on the municipal and the provincial governments to re-think urban development. Toronto’s approach to climate change mitigation and adaptation has positioning of the emerging green economy as part of the solution. However, the emerging green economy many not benefit all Torontonians in terms of jobs, improved infrastructure, and enhanced quality of life. Community benefits agreements (CBAs) are comprehensive, negotiated commitments, in which founders and builders of major infrastructure projects formally agree to work with community interest groups based in the community where the development is taking place, toward mutually beneficial environmental and labor market outcomes. When community groups are equitably represented in the process, they stand not only to benefit from the jobs created from the project itself, but also from the longer-term community benefits related to the quality of the completed work, including advocating for communities’ environmental needs. It is believed that green employment initiatives in Toronto should give greater consideration to best practices learned from community benefits agreements. Drawing on the findings of a funded qualitative study in Toronto (Canada), “The Green Gap: Toward Inclusivity in Toronto’s Green Economy” (2013-2016), this paper examines the emergent CBA in Toronto in relation to the development of a light rail transit project. Theoretical and empirical consideration will be given to the research gaps around CBAs, the role of various stakeholders, and discuss the potential for CBAs to gain traction in the Toronto’s urban development context. The narratives of various stakeholders across Toronto’s green economy will be interwoven with a discussion of the CBA model in Toronto and other jurisdictions.

Keywords: green economy in Toronto, equity, community benefits agreements, environmental justice, community sustainability

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Authors: Paul J Yazaki, Michael Bouvet, John Shively

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Surgery for solid gastrointestinal (GI) cancers such as pancreatic, colorectal, and gastric adenocarcinoma remains the mainstay of curative therapy. Complete resection of the primary tumor with negative margins (R0 resection), its draining lymph nodes, and distant metastases offers the optimal surgical benefit. Real-time fluorescence guided surgery (FGS) promises to improve GI cancer outcomes and is rapidly advancing with tumor-specific antibody conjugated fluorophores that can be imaged using near infrared (NIR) technology. Carcinoembryonic Antigen (CEA) is a non-internalizing tumor antigen validated as a surface tumor marker expressed in >95% of colorectal, 80% of gastric, and 60% of pancreatic adenocarcinomas. Our humanized anti-CEA hT84.66-M5A (M5A) monoclonal antibody (mAb)was conjugated with the NHS-IRDye800CW fluorophore and shown it can rapidly and effectively NIRoptical imageorthotopically implanted human colon and pancreatic cancer in mouse models. A limitation observed is that these NIR-800 dye conjugated mAbs have a rapid clearance from the blood, leading to a narrow timeframe for FGS and requiring high doses for effective optical imaging. We developed a novel antibody-fluorophore conjugate by incorporating a PEGylated sidearm linker to shield or mask the IR800 dye’s hydrophobicity which effectively extended the agent’s blood circulation half-life leading to increased tumor sensitivity and lowered normal hepatic uptake. We hypothesized that our unique anti-CEA linked to the fluorophore, IR800 by PEGylated sidewinder, M5A-SW-IR800 will become the next generation optical imaging agent, safe, effective, and widely applicable for intraoperative image guided surgery in CEA expressing GI cancers.

Keywords: optical imaging, anti-CEA, cancer, fluorescence-guided surgery

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Authors: Sanjeev Singh

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Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-center prospective randomized and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross-clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Keywords: inhaled nitric oxide, milrinone, pulmonary artery hypertension, total anomalous pulmonary venous connection

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Authors: Hannah K. M. Tang, Muhammad Ateeq, Mark J. Lake, Badr Abdullah, Frederic A. Bezombes

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There is little research applying virtual reality (VR) to the treatment of musculoskeletal injury in athletes. This is despite their prevalence, and the implications for physical and psychological health. Nevertheless, developments of wireless VR headsets better facilitate dynamic movement in VR environments (VREs), and more research is expected in this emerging field. This systematic review identified publications that used VR interventions for the analysis or treatment of lower-limb musculoskeletal injury of athletes. It established a search protocol, and through narrative discussion, identified existing trends. Database searches encompassed four term sets: 1) VR systems; 2) musculoskeletal injuries; 3) sporting population; 4) movement outcome analysis. Overall, a total of 126 publications were identified through database searching, and twelve were included in the final analysis and discussion. Many of the studies were pilot and proof of concept work. Seven of the twelve publications were observational studies. However, this may provide preliminary data from which clinical trials will branch. If specified, the focus of the literature was very narrow, with very similar population demographics and injuries. The trends in the literature findings emphasised the role of VR and attentional focus, the strategic manipulation of movement outcomes, and the transfer of skill to the real-world. Causal inferences may have been undermined by flaws, as most studies were limited by the practicality of conducting a two-factor clinical-VR-based study. In conclusion, by assessing the exploratory studies, and combining this with the use of numerous developments, techniques, and tools, a novel application could be established to utilise VR with dynamic movement, for the effective treatment of specific musculoskeletal injuries of athletes.

Keywords: athletes, lower-limb musculoskeletal injury, rehabilitation, return-to-sport, virtual reality

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Authors: Pranil Kumar Upadhayaya

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While peace is dividend to tourism, tourism can also be a vital force for world peace. The existing body of knowledge on a tripartite complex nexus between tourism, peace and conflict reveals that tourism is benefactor to peace and sensitive to conflict. By contextualizing the ongoing sporadic structural conflict in the transitional phase in the aftermath of a decade long (1996-2006), Maoist armed conflict in Nepal, the purpose of this study is to explore the potentials of tourism in peace-building. The outcomes of this research paper is based on the mixed methods of research (qualitative and quantitative). Though the armed conflict ended with the comprehensive peace agreement in 2006 but there is constant manifestations of non-violent structural conflicts, which continue to threaten the sustainability of tourism industry. With the persistent application of coping strategies, tourism is found resilient during the ongoing structural political conflict. The strong coping abilities of the private sector of tourism industry have also intersected with peace-building efforts with more reactive and less proactive (pro-peace) engagements. This paper ascertains about the application of the ‘theory of tourism security’ by Nepalese tourism industry while coping with conflict and reviving, and sustaining. It reveals that the multiple verities of tourism at present has heterogeneous degree of peace potentials. The opportunities of ‘peace through tourism’ can be promoted subject to its molding with responsible, sustainable and participatory characteristics. This paper comes out with pragmatic policy recommendations for strengthening the position of tourism as a true peace-builder: (a) a broad shift from mainstream conventional tourism to the community based rural with local participation and ownership to fulfill Nepal’s potentials for peace, and (b) building and applications of the managerial and operational codes of conducts for owners and workers (labor unions) at all tourism enterprises and strengthen their practices.

Keywords: code of conduct, community based tourism, conflict, peace-building, tourism

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Authors: R. Suresh, C. B. Singh, A. K. Sarda

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Background: Over the decades, several surgical techniques have been developed to treat anal fistulas with variable success rates and complications. Large amount of work has been done in radiofrequency excision of the fistula for several years but no work has been done for ablating the tract. Therefore one can consider for obliteration ofanal fistula by Radiofrequency ablation (RFA). Material and Methods: A randomized controlled clinical trial was conducted at Lok Nayak Hospital, where a total of 40 patients were enrolled in the study and they were randomly assigned to Group I (fistulectomy)(n=20) and Group II (RFA) (n=20). Aim of the study was to compare the efficacy of RFA of fistula versus fistulectomy in the treatment of a low anal fistula and to evaluate RFA as an effective alternative to fistulectomy with respect to time taken for wound healing as primary outcome and post-operative pain, time taken to return to work as secondary outcomes. Patients with simple low anal fistulas, single internal and external opening, not more than two secondary tracts were included. Patients with high complex fistula, fistulas communicating with cavity, fistula due to condition like tuberculosis, Crohn's, malignancy were excluded from the study. Results: Both groups were comparable with respect to age, sex ratio, type of fistula. Themean healing time was significantly shorter in group II (41.02 days) than in group I(62.68 days).The mean operative time was significantly shorter in groupII (21.40 min) than in group I(28.50 min). The mean time taken to return to work was significantly shorter in group II(8.30 days)than in group I(12.01 days).There was no significant difference in the post operative hospital stay, mean postoperative pain score, wound infection and recurrence between the two groups. Conclusion: The patients who underwent RFA of fistula had shorter wound healing time, operative time and time taken to return to work when compared to those who underwent fistulectomy and therefore RFA shows outcome comparable to fistulectomy in the treatment of low anal fistula.

Keywords: fistulectomy, low anal fistula, radio frequency ablation, wound healing

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Authors: Dawit Abay Tesfamariam

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Ethiopia’s Climate- Resilient Green Economy (ECRGE) strategy focuses mainly on generating and proper utilization of renewable energy (RE). Nonetheless, the current electricity generation of the country is dominated by hydropower. The data collected in 2016 by Ethiopian Electric Power (EEP) indicates that the intermittent RE sources from solar and wind energy were only 8 %. On the other hand, the EEP electricity generation plan in 2030 indicates that 36.1 % of the energy generation share will be covered by solar and wind sources. Thus, a case study was initiated to model and compute the balance and consumption of electricity in three different scenarios: 2016, 2025, and 2030 using the EnergyPLAN Model (EPM). Initially, the model was validated using the 2016 annual power-generated data to conduct the EnergyPLAN (EP) analysis for two predictive scenarios. The EP simulation analysis using EPM for 2016 showed that there was no significant excess power generated. Thus, the EPM was applied to analyze the role of energy storage in RE in Ethiopian grid systems. The results of the EP simulation analysis showed there will be excess production of 402 /7963 MW average and maximum, respectively, in 2025. The excess power was in the three rainy months of the year (June, July, and August). The outcome of the model also showed that in the dry seasons of the year, there would be excess power production in the country. Consequently, based on the validated outcomes of EP indicates, there is a good reason to think about other alternatives for the utilization of excess energy and storage of RE. Thus, from the scenarios and model results obtained, it is realistic to infer that if the excess power is utilized with a storage system, it can stabilize the grid system and be exported to support the economy. Therefore, researchers must continue to upgrade the current and upcoming storage system to synchronize with potentials that can be generated from renewable energy.

Keywords: renewable energy, power, storage, wind, energy plan

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Authors: Sotiria Tzivinikou, Dimitra Kagkara

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Teacher’s sense of self-efficacy can affect significantly both teacher’s and student’s performance. More specific, self-efficacy is associated with the learning outcomes as well as student’s motivation and self-efficacy. For example, teachers with high sense of self-efficacy are more open to innovations and invest more effort in teaching. In addition to this, effective inclusive education is associated with higher levels of teacher’s self-efficacy. Pre-service teachers with high levels of self-efficacy could handle student’s behavior better and more effectively assist students with special educational needs. Teacher preparation programs are also important, because teacher’s efficacy beliefs are shaped early in learning, as a result the quality of teacher’s education programs can affect the sense of self-efficacy of pre-service teachers. Usually, a number of pre-service teachers do not consider themselves well prepared to work with students with special educational needs and do not have the appropriate sense of self-efficacy. This study aims to investigate the factors that contribute to the improvement of the sense of self-efficacy of pre-service special educators by using an academic practicum training program. The sample of this study is 159 pre-service special educators, who also participated in the academic practicum training program. For the purpose of this study were used quantitative methods for data collection and analysis. Teacher’s self-efficacy was assessed by the teachers themselves with the completion of a questionnaire which was based on the scale of Teacher’s Sense of Efficacy Scale. Pre and post measurements of teacher’s self-efficacy were taken. The results of the survey are consistent with those of the international literature. The results indicate that a significant number of pre-service special educators do not hold the appropriate sense of self-efficacy regarding teaching students with special educational needs. Moreover, a quality academic training program constitutes a crucial factor for the improvement of the sense of self-efficacy of pre-service special educators, as additional for the provision of high quality inclusive education.

Keywords: inclusive education, pre-service, self-efficacy, training program

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Authors: Sewe Silvanus Odhiambo

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Globally, many governments have publicly recognized private security firms as essential services providers. The private security firms face a lot of challenges, but the COVID-19 situation also has exacerbated them to another level. This paper locates its relevance in the post-coronavirus era. The COVID-19 pandemic has redefined the world operation, which shows a higher impact on the security field. Accordingly, the purpose of the study was to examine the role of corporate governance on the performance of private security firms in a post-covid pandemic era in Kenya. The study employed a descriptive research design, which included a quantitative approach and secondary data. The study was carried in the month of July 2021 from the registered private security firms. After targeting all private security firms, only 54 firms had disclosed their annual report by the time of conducting the study. The results depicted that pandemic has affected the performance of private security firms measures unfavorably. Further, boards of directors show a positive association with security firm performance. The study recommends that there is need board of directors to enhance management’s risk assessments in the midst of COVID-19; ensure that there are business continuity plans; there is organizational resilience; there is need for the development of new digital strategies; enabling the digital workforce in the firms and have effective communication plans with both internal and external stakeholders to deal with uncertainties and develop more post-COVID practices for boards of directors to improve performance of private security firms in Kenya. The practical implications of the study are that the research outcomes might assist regulatory bodies, investors, policymakers, and the security sector in general in their formulation of public and corporate governance strategies concerning future emergency preparedness and responses. This study also provides a unique contribution to the literature of COVID-19 and security firm performance in emerging economies context.

Keywords: COVID-19, corporate governance, firm performance, private security firms

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Authors: Fredrick Etyang

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This paper presents a Rapid Industrialization Model (RIM) designed to support existing industrialization policies, strategies and industrial development plans at National, Regional and Constituent level in Africa. The model will reinforce efforts to attainment of inclusive and sustainable industrialization of Africa by state and non-state actors. The overall objective of this model is to serve as a framework for rapid industrialization in developing economies and the specific objectives range from supporting rapid industrialization development to promoting a structural change in the economy, a balanced regional industrial growth, achievement of local, regional and international competitiveness in areas of clear comparative advantage in industrial exports and ultimately, the RIM will serve as a step-by-step guideline for the industrialization of African Economies. This model is a product of a scientific research process underpinned by desk research through the review of African countries development plans, strategies, datasets, industrialization efforts and consultation with key informants. The rigorous research process unearthed multi-directional and renewed efforts towards industrialization of Africa premised on collective commitment of individual states, regional economic communities and the African union commission among other strategic stakeholders. It was further, established that the inputs into industrialization of Africa outshine the levels of industrial development on the continent. The RIM comes in handy to serve as step-by-step framework for African countries to follow in their industrial development efforts of transforming inputs into tangible outputs and outcomes in the short, intermediate and long-run. This model postulates three stages of industrialization and three phases toward rapid industrialization of African economies, the model is simple to understand, easily implementable and contextualizable with high return on investment for each unit invested into industrialization supported by the model. Therefore, effective implementation of the model will result into inclusive and sustainable rapid industrialization of Africa.

Keywords: economic development, industrialization, economic efficiency, exports and imports

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Authors: Patricia M. Boechler, Heather M. Gautreau

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In this research study, postsecondary students completed an information learning task in an avatar-based 3D virtual learning environment. Three factors were of interest in relation to learning; 1) the influence of collaborative vs. independent conditions, 2) the influence of the spatial arrangement of the virtual environment (linear, random and clustered), and 3) the relationship of individual differences such as spatial skill, general computer experience and video game experience to learning. Students completed pretest measures of prior computer experience and prior spatial skill. Following the premeasure administration, students were given instruction to move through the virtual environment and study all the material within 10 information stations. In the collaborative condition, students proceeded in randomly assigned pairs, while in the independent condition they proceeded alone. After this learning phase, all students individually completed a multiple choice test to determine information retention. The overall results indicated that students in pairs did not perform any better or worse than independent students. As far as individual differences, only spatial ability predicted the performance of students. General computer experience and video game experience did not. Taking a closer look at the pairs and spatial ability, comparisons were made on pairs high/matched spatial ability, pairs low/matched spatial ability and pairs that were mismatched on spatial ability. The results showed that both high/matched pairs and mismatched pairs outperformed low/matched pairs. That is, if a pair had even one individual with strong spatial ability they would perform better than pairs with only low spatial ability individuals. This suggests that, in virtual environments, the specific individuals that are paired together are important for performance outcomes. The paper also includes a discussion of trends within the data that have implications for virtual environment education.

Keywords: avatar-based, virtual environment, paired learning, individual differences

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Authors: Sonto Maputle

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Background: Support during labour increase women's chances of having positive childbirth experiences as well as childbirth outcomes. The purpose of this study was to determine the support provided by midwives to women during labour at the public hospital in Limpopo Province. The study was conducted at the Tertiary hospital in Limpopo Province. Methods: A qualitative, participant observation approach was used. Population consisted of all women that were admitted to deliver their babies and the midwives who provided midwifery care in the obstetric unit of one tertiary public hospital in Limpopo Province. Non-probability, purposive and convenience sampling were used to sample 24 women and 12 midwives. Data were collected through participant observations which included unstructured conversations with the use of observational guide, field notes of events and conversations that occurred when women interact with midwives were recorded verbatim and a Visual Analog Scale to complement the observations. Data was analysed qualitatively but were presented in the tables and bar graphs. Results: Five themes emerged as support provided by midwives during labour, namely; communication between women and midwives, informational support, emotional support activities, interpretation of the experienced labour pain and supportive care activities during labour. Conclusion: The communication was occurring when the midwife was rendering midwifery care and very limited for empowering. The information sharing focused on the assistive actions rather than on the activities that would promote mothers’ participation. The emotional support activities indicated lack of respect and disregard cultural preferences and this contributed to inability to exercise choices in decision-making. The study recommended the implementation of Batho Pele principles in order to provide woman-centred care during labour.

Keywords: communication between women and midwives, labour pains, informational and emotional support, physical comforting measures

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Authors: Cornelius Michael Ekenta, Aderonke Bashirat Mohammed, Sefi Ahmed

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The research examined the impact of flooding on food calorie intake and health challenges among smallholder farm households in Koton Karfe Local Government Area of Kogi State, Nigeria. Purposive and random sampling techniques were used to select 130 farm households in selected villages in the area. Primary data were generated through the administration of a well-structured questionnaire. Data were analyzed with descriptive statistics, Double Difference Estimator (DDE), Calorie Intake Estimation Function, t-test, and multiple regressions. The result shows that farm households lost an average of 132, 950kg of selected crops amounting to about N20m ($56, 542) loose in income. Food daily calorie intake indicates a loss of an average of 715.18Kcal, showing a significant difference in calorie intake before and after flooding (t = 2.0629) at 5% probability. Furthermore, the health challenges most prevalent during flooding were malaria fever, typhoid fever, cholera, and dysentery. The determinants of daily calorie intake were age, household size, level of income, flooding, health challenges, and food price. The study concluded that flooding had negative impacts on crop output and income, daily food calorie intact, and health challenges of a farm household in the study area. It was recommended that the State Government should make adequate and proper arrangements to relocate residents of the area at the warning of possible flooding by the National Metrological Centre and should, through the State Emergency Management Agency (SEMA), provide relieve items to the residents to cushion the effects of the flooding.

Keywords: calorie, cholera, flooding, health challenges, impact

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Authors: Nadeesha Sewwandi, Dilini Shashikala, Rajarathnam Kanapathy, Shivakumaran Viyasan, Saman Kumara, Duminda Guruge

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Introduction: Nutrition is fundamental for good health and development during the early years of life. This study describes how rural community does interventions for improving the nutrition and health of children less than 5 year ages using health promotion approach and this study was conducted with children society and mothers groups in a rural village called Welankulama in Sri Lanka. Methodology: The details got from Public Health Midwife in this village showed there were malnourished children under 5 years age. So, we discussed this problem with the children society, mothers groups and identified the determinants with them. Then they wanted to address some of the determinants that they prioritized from their discussions. ‘Evening school’ was a new place to this village to do collective feeding for small children. ‘Mobile library’ was another new concept in this village and nutrition books, evidence collection were there to read for villagers. Mothers marked the foods given to their kids in a book called ‘Nutrition book’. And also mothers tend to mark the level of eating foods to motivate their children in a ‘Hapana calendar’. Results: In terms of results, malnourished children under 5 years age got reduced and the number of children having illnesses got reduced. Marking nutrition book and ‘Hapana calendar’ were become as trend among mothers. Apart from the above, there was good improvement of physical, social and emotional wellbeing of children. Children who received early stimulation with nutrition supplements had better outcomes than children who only received nutrition supplements, thereby amplifying the impact of nutrition. Conclusion: Health promotion interventions are helped to change nutritional behaviors of early childhood in rural community and it makes children healthier and better able to learn.

Keywords: early childhood, nutrition, determinants, health promotion process

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Authors: Ligia Nascimento, Manuela Faia Correia

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Nowadays, Information and Communication Technologies (ICT) are embedded in most professions. Technostress - or stress induced by the use of ICTs, has been studied in various sectors of activity and in different geographical areas, mainly from the perspective of its harmful impacts. In the context of work, the technological contexts capable of causing stress have been examined in-depth, as well as the type of individuals most likely to experience its negative effects. However, new lines of the research argue that the stress generated by the use of ICTs may not necessarily be detrimental (technodistress), admitting that, in contrast, and in addition, it may actually be beneficial to organizations and their employees (technoeustress). Any measures that succeed in reducing technodistress do not necessarily lead to the creation of technoeustress, justifying the study of this phenomenon in a focused and independent manner. Adopting the transactional model of stress as the basic theoretical framework, an ongoing research project aims to study technoeustress independently. Given the role played in the qualification and progress of society and the economy, it becomes particularly critical to care for the well-being of the higher education teacher. Particularly in recent times, when teleworking is prevalent, these professionals have made a huge, compulsive effort to adapt to a new teaching reality. Rather than limiting itself to mitigating adverse effects of ICT use, which featured earlier approaches, the present study seeks to understand how to activate the positive side of technostress in higher education teachers in order to obtain favorable personal and organizational outcomes from ICT use at work. The research model seeks to understand, upstream, the ICT characteristics that increase the perception of technoeustress among higher education teachers, studying the direct and moderating effects of individual and organizational variables and, downstream, the impacts that technoeustress has on job satisfaction and performance. This research contributes both to expanding the knowledge of the technostress phenomenon and to identify possible recommendations for management.

Keywords: higher education teachers, ICT, stress, technoeustress

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Authors: C. Peeper McDonald

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Despite the multiracial population growing exponentially in the world and especially in the U.S., there continues to be a lack of culturally responsive research addressing the unique experiences and needs of this population, especially within counseling and counselor education settings. It is evident that their unique racial microaggressive experiences need to be better understood within the field of professional counseling to not only underscore competent training and practice but also culturally responsive training and practice. The participants of this study were 13 (n=13) individuals from the United States who identified as multiracial and said they had a microaggressive experience with either their counselor or counseling professor. Data were gathered through one-on-one, semi-structured interviews. The analysis employed phenomenological methods based on the transcendental approach, resulting in themes that encapsulated the core of the participants' experiences, including multiracial microaggressions that are derogatory and perpetuate privilege/oppression; counselors and their training programs should embody safety, support, attentiveness, inter-personal sensitivity, and awareness of the impact on others; microaggressions negatively affect the counseling relationship and outcomes; awareness surrounding the emotional impact of microaggressions; strength-based responses and future responses to microaggressions; and advocacy and suggestions for counselors and counselor educators. These themes are discussed in detail, and recommendations for researchers, counselor educators, and professional counselors to improve training and practice are provided. This U.S. study's insights into the Multiracial experience of microaggressions within the mental health profession can inform global mental health practices by highlighting the need for culturally responsive counseling that recognizes and addresses racial nuances. Such knowledge is transferable to international settings where multiracial populations may also encounter similar challenges, aiding in the development of global standards for culturally competent counseling practices.

Keywords: culturally responsive training and practice, mental health, microaggressions, multiracial

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Authors: Jessy Rugeyo, William Donner

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This research delves into the resilience of Rwanda's public health infrastructure amidst natural disasters, a critical issue given that the Northern Province alone has witnessed no fewer than 1500 cases of disaster ranging from floods and landslides in the last five years, with more than 200 people killed and thousands of homes destroyed, according to MINEMA. In an era where climate change escalates the frequency and intensity of such disasters, fortifying the resilience of public health systems is paramount. This study offers a comprehensive analysis of the existing state of Rwanda's public health infrastructure and its ability to manage such crises. Employing a mix of literature review, case studies, and policy analysis, the study discerns key vulnerabilities and brings to light the intricacies of disaster management in Rwanda. Case studies centered around past natural disasters in Rwanda provide critical insights into the strengths and weaknesses of the existing disaster response mechanisms. A thorough critique of related disaster management and public health infrastructure policies reveals areas of commendable practice, along with gaps calling for policy enhancements. Findings guide the proposition of targeted strategies to bolster the resilience of Rwanda's public health infrastructure. This research serves as a significant contribution to the domains of disaster studies and public health, offering valuable insights for policymakers, public health and disaster management professionals in Rwanda and similar contexts. It presents actionable recommendations for improvement, underscoring the potential for enhancing Rwanda's disaster management capacity. By advocating for the strengthening of public health infrastructure resilience, the research highlights the potential for improved public health outcomes following natural disasters, thereby showcasing significant implications for public health and disaster management in the country, particularly in the face of a changing climate.

Keywords: public health infrastructure, disaster resilience, natural disaster, disaster management, emergency preparedness, health policy

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Authors: Stephanie Liu Lu

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With the proliferation of artificial intelligence tools in the field of education, it is crucial to explore their impact on language learning outcomes. This paper examines the use of AI tools, such as ChatGPT, in practical writing within business Chinese teaching to investigate how AI can enhance practical writing skills and teaching effectiveness. The study involved third and fourth-year university students majoring in accounting and finance from a university in Hong Kong within the context of a business correspondence writing class. Students were randomly assigned to a control group, who completed business letter writing independently, and an experimental group, who completed the writing with the assistance of AI. In the latter, the AI-assisted business letters were initially drafted by the students issuing commands and interacting with the AI tool, followed by the students' revisions of the draft. The paper assesses the performance of both groups in terms of grammatical expression, communicative effect, and situational awareness. Additionally, the study collected dialogue texts from interactions between students and the AI tool to explore factors that affect text generation and the potential impact of AI on enhancing students' communicative and identity awareness. By collecting and comparing textual performances, it was found that students assisted by AI showed better situational awareness, as well as more skilled organization and grammar. However, the research also revealed that AI-generated articles frequently lacked a proper balance of identity and writing purpose due to limitations in students' communicative awareness and expression during the instruction and interaction process. Furthermore, the revision of drafts also tested the students' linguistic foundation, logical thinking abilities, and practical workplace experience. Therefore, integrating AI tools and related teaching into the curriculum is key to the future of business Chinese teaching.

Keywords: AI-assistance, business Chinese, textual analysis, language education

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Authors: Parinyaporn Thanaboonpuang, Siridej Sujiva, Shotiga Pasiphul

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The higher education reform that integration of nursing programmes into the higher education system. Learning outcomes represent one of the essential building blocks for transparency within higher education systems and qualifications. The purpose of this study is to develop a toolkit of undergraduate nursing student’desirable characteristics assessment on Thai Qualifications Framework for Higher education and to test psychometric property for this instrument. This toolkit seeks to improve on the Computer Multimedia test. There are three skills to be examined: Cognitive skill, Responsibility and Interpersonal Skill, and Information Technology Skill. The study was conduct in 4 phases. In Phase 1. Based on developed a measurement model and Computer Multimedia test. Phase 2 two round focus group were conducted, to determine the content validity of measurement model and the toolkit. In Phase 3, data were collected using a multistage random sampling of 1,156 senior undergraduate nursing student were recruited to test psychometric property. In Phase 4 data analysis was conducted by descriptive statistics, item analysis, inter-rater reliability, exploratory factor analysis and confirmatory factor analysis. The resulting TNDC consists of 74 items across the following four domains: Cognitive skill, Interpersonal Skill, Responsibility and Information Technology Skill. The value of Cronbach’ s alpha for the four domains were .781, 807, .831, and .865, respectively. The final model in confirmatory factor analysis fit quite well with empirical data. The TNDC was found to be appropriate, both theoretically and statistically. Due to these results, it is recommended that the toolkit could be used in future studies for Nursing Program in Thailand.

Keywords: toolkit, nursing student’ desirable characteristics, Thai qualifications framework

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Authors: Beatriz Lafuente Alcázar, Yash Wani, Amit J. Nimunkar

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Cardiovascular Diseases (CVDs) are the leading cause of death globally, and around 80% of sudden cardiac deaths are due to arrhythmias or irregular heartbeats. The majority of these pathologies are revealed by either short-term or long-term alterations in the electrocardiogram (ECG) morphology. The ECG is the main diagnostic tool in cardiology. It is a non-invasive, pain free procedure that measures the heart’s electrical activity and that allows the detecting of abnormal rhythms and underlying conditions. A cardiologist can diagnose a wide range of pathologies based on ECG’s form alterations, but the human interpretation is subjective and it is contingent to error. Moreover, ECG records can be quite prolonged in time, which can further complicate visual diagnosis, and deeply retard disease detection. In this context, deep learning methods have risen as a promising strategy to extract relevant features and eliminate individual subjectivity in ECG analysis. They facilitate the computation of large sets of data and can provide early and precise diagnoses. Therefore, the cardiology field is one of the areas that can most benefit from the implementation of deep learning algorithms. In the present study, a deep learning algorithm is trained following a novel approach, using a combination of different databases as the training set. The goal of the algorithm is to achieve the detection of R-peaks in ECG signals. Its performance is further evaluated in ECG signals with different origins and features to test the model’s ability to generalize its outcomes. Performance of the model for detection of R-peaks for clean and noisy ECGs is presented. The model is able to detect R-peaks in the presence of various types of noise, and when presented with data, it has not been trained. It is expected that this approach will increase the effectiveness and capacity of cardiologists to detect divergences in the normal cardiac activity of their patients.

Keywords: arrhythmia, deep learning, electrocardiogram, machine learning, R-peaks

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Authors: Jeff Chak-Fu Wong, Tony Chun Yin Yip

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The transition from secondary school to university seems exciting for many first-year students but can be more challenging than expected. Enabling instructors to know students’ learning habits and styles enhances their understanding of the students’ learning backgrounds, allows teachers to provide better support for their students, and has therefore high potential to improve teaching quality and learning, especially in any mathematics-related courses. The aim of this research is to collect students’ data using online surveys, to analyze students’ factors using learning analytics and educational data mining and to discover the characteristics of the students at risk of falling behind in their studies based on students’ previous academic backgrounds and collected data. In this paper, we use correlation-based distance methods and mutual information for measuring student factor relationships. We then develop a factor network using the Minimum Spanning Tree method and consider further study for analyzing the topological properties of these networks using social network analysis tools. Under the framework of mutual information, two graph-based feature filtering methods, i.e., unsupervised and supervised infinite feature selection algorithms, are used to analyze the results for students’ data to rank and select the appropriate subsets of features and yield effective results in identifying the factors affecting students at risk of failing. This discovered knowledge may help students as well as instructors enhance educational quality by finding out possible under-performers at the beginning of the first semester and applying more special attention to them in order to help in their learning process and improve their learning outcomes.

Keywords: students' academic performance, correlation-based distance method, social network analysis, feature selection, graph-based feature filtering method

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Authors: Ayushi Modi, Eliot Bochet-Merand

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This study investigates the structural determinants of green strategies among Small and Medium Enterprises (SMEs) in the European Union and select countries, utilizing data from the Flash Eurobarometer 498 - SMEs, Resource Efficiency, and Green Markets. By applying sequential logit analysis, we explore the drivers behind the adoption and scaling of green actions, such as resource efficiency, waste management, and product innovation, while also examining the provision of green products and services. A key contribution of this research is the novel distinction between the process stage (green actions) and the product stage (green outputs), allowing for a deeper analysis of how green initiatives translate into sustainable business outcomes. Our findings reveal that structural characteristics, such as firm size, sector, and turnover growth, significantly influence the likelihood of both providing green products and implementing comprehensive green actions. Smaller, younger firms in high-impact sectors like construction and industry are more likely to engage in sustainability efforts, particularly when they have a green strategy and a dedicated green workforce. Furthermore, companies serving B2B and B2C clients and experiencing turnover growth are more inclined to offer green products. The study underscores the economic implications of these insights, suggesting that financial flexibility, strategic commitment, and human capital investments are critical for scaling green initiatives. By refining variables and excluding heterogeneous countries, our data management ensures robust results. This research provides novel insights into the distinct roles of process and product stages in sustainability, offering valuable policy recommendations for promoting environmental performance in SMEs.

Keywords: green strategy, resource efficiency, SMES, sustainability, product innovation, environmental performance

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Authors: Benoit Landi, Hervé Pingaud, Jean-Benoit Culie, Michel Galaup

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Serious games have been widely disseminated in the field of digital learning. They have proved their utility in improving skills through virtual environments that simulate the field where new competencies have to be improved and assessed. This paper describes how we created CLONE, a serious game whose purpose is to help nurses create an efficient work plan in a hospital care unit. In CLONE, the number of patients to take care of is similar to the reality of their job, going far beyond what is currently practiced in nurse school classrooms. This similarity with the operational field increases proportionally the number of activities to be scheduled. Moreover, very often, the team of nurses is composed of regular nurses and nurse assistants that must share the work with respect to the regulatory obligations. Therefore, on the one hand, building a short-term planning is a complex task with a large amount of data to deal with, and on the other, good clinical practices have to be systematically applied. We present how reference planning has been defined by addressing an optimization problem formulation using the expertise of teachers. This formulation ensures the gameplay feasibility for the scenario that has been produced and enhanced throughout the game design process. It was also crucial to steer a player toward a specific gaming strategy. As one of our most important learning outcomes is a clear understanding of the workload concept, its factual calculation for each caregiver along time and its inclusion in the nurse reasoning during planning elaboration are focal points. We will demonstrate how to modify the game scenario to create a digital environment in which these somewhat abstract principles can be understood and applied. Finally, we give input on an experience we had on a pilot of a thousand undergraduate nursing students.

Keywords: care planning, workload, game design, hospital nurse, organizational skills, digital learning, serious game

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Authors: Dmitry K. Shaytan, Georgy D. Laptev

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In our research we aimed to test a managerial approach for the fuzzy front end (FFE) of innovation by creating controlled experiment/ business case in a breakthrough innovation development. The experiment was in the sport industry and covered all aspects of the customer discovery stage from ideation to prototyping followed by patent application. In the paper we describe and analyze mile stones, tasks, management challenges, decisions made to create the break through innovation, evaluate overall managerial efficiency that was at the considered FFE stage. We set managerial outcome of the FFE stage as a valid product concept in hand. In our paper we introduce hypothetical construct “Q-factor” that helps us in the experiment to distinguish quality of FFE outcomes. The experiment simulated for entrepreneur the FFE of innovation and put on his shoulders responsibility for the outcome of valid product concept. While developing managerial approach to reach the outcome there was a decision to look on product concept from the cognitive psychology and cognitive science point of view. This view helped us to develop the profile of a person whose projection (mental representation) of a new product could optimize for a manager or entrepreneur FFE activities. In the experiment this profile was tested to develop breakthrough innovation for swimmers. Following the managerial approach the product concept was created to help swimmers to feel/sense water. The working prototype was developed to estimate the product concept validity and value added effect for customers. Based on feedback from coachers and swimmers there were strong positive effect that gave high value for customers, and for the experiment – the valid product concept being developed by proposed managerial approach for the FFE. In conclusions there is a suggestion of managerial approach that was derived from experiment.

Keywords: concept development, concept testing, customer discovery, entrepreneurship, entrepreneurial management, idea generation, idea screening, startup management

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Authors: Alvin Manuel Vazhayil, Chaozhong Tan, Karl M. Wantzen

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As local community participation in river restoration projects is increasingly recognized to be crucial for sustainable outcomes, researchers are exploring factors that motivate community participation globally. In India, while there is consensus in literature on the importance of community engagement in river restoration projects, research on what drives local communities to participate is limited, especially given the societal and economic challenges common in the Global South. This study addresses this gap by exploring the drivers of community participation in the local river restoration initiatives of the "Now Let Me Flow" campaign in Kerala, India. The project aimed to restore 87,000 kilometers of streams through the middle-ground governance approach that integrated bottom-up community efforts with top-down governmental support. The fieldwork involved interviews with 26 key agents, including local leaders, policy practitioners, politicians, and environmental activists associated with the project, and the collection of secondary data from 12 documents including project reports and news articles. The data was analyzed in NVivo (NVivo 11 Plus for Windows, version 11.3.0.773) using thematic analysis which included two cycles of systematic coding. The findings reveal two main drivers influencing community participation: top-down actions from local governments, and bottom-up drivers within the community. The study highlights the importance of local stakeholder collaboration, support of local governments, and local community engagement in successful river restoration projects. These findings are consistent with other empirical studies on participatory environmental problem-solving globally. The results offer crucial insights for policymakers and governments to better design and implement effective and sustainable participatory river restoration projects.

Keywords: community initiatives, drivers of participation, environmental governance, river restoration

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