Search results for: SPI threshold setting

Authors: Melissa Dorsey

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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.

Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership

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Authors: Veli Durmus, Mert Uydaci

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Every patient who needs to get a medical treatment should share health-related personal data with healthcare providers. Therefore, personal health data plays an important role to make health decisions and identify health threats during every encounter between a patient and caregivers. In other words, health data can be defined as privacy and sensitive information which is protected by various health laws and regulations. In many cases, the data are an outcome of the confidential relationship between patients and their healthcare providers. Globally, almost all nations have own laws, regulations or rules in order to protect personal data. There is a variety of instruments that allow authorities to use the health data or to set the barriers data sharing across international borders. For instance, Directive 95/46/EC of the European Union (EU) (also known as EU Data Protection Directive) establishes harmonized rules in European borders. In addition, the General Data Protection Regulation (GDPR) will set further common principles in 2018. Because of close policy relationship with EU, this study provides not only information on regulations, directives but also how they play a role during the legislative process in Turkey. Even if the decision is controversial, the Board has recently stated that private or public healthcare institutions are responsible for the patient call system, for doctors to call people waiting outside a consultation room, to prevent unlawful processing of personal data and unlawful access to personal data during the treatment. In Turkey, vast majority private and public health organizations provide a service that ensures personal data (i.e. patient’s name and ID number) to call the patient. According to the Board’s decision, hospital or other healthcare institutions are obliged to take all necessary administrative precautions and provide technical support to protect patient privacy. However, this application does not effectively and efficiently performing in most health services. For this reason, it is important to draw a legal framework of personal health data by stating what is the main purpose of this regulation and how to deal with complicated issues on personal health data in Turkey. The research is descriptive on data protection law for health care setting in Turkey. Primary as well as secondary data has been used for the study. The primary data includes the information collected under current national and international regulations or law. Secondary data include publications, books, journals, empirical legal studies. Consequently, privacy and data protection regimes in health law show there are some obligations, principles and procedures which shall be binding upon natural or legal persons who process health-related personal data. A comparative approach presents there are significant differences in some EU member states due to different legal competencies, policies, and cultural factors. This selected study provides theoretical and practitioner implications by highlighting the need to illustrate the relationship between privacy and confidentiality in Personal Data Protection in Health Law. Furthermore, this paper would help to define the legal framework for the health law case studies on data protection and privacy.

Keywords: data protection, personal data, privacy, healthcare, health law

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Authors: Vijaya Kumar, Vidayasagar Pagilla, Abraham Joshua, Rakshith Kedambadi, Prasanna Mithra

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Background: Post stroke rehabilitation are aimed to accelerate for optimal sensorimotor recovery, functional gain and to reduce long-term dependency. Intensive physical therapy interventions can enhance this recovery as experience-dependent neural plastic changes either directly act at cortical neural networks or at distal peripheral level (muscular components). Neuromuscular Electrical Stimulation (NMES), a traditional bottom-up approach, mirror therapy (MT), a relatively new top down approach have found to be an effective adjuvant treatment methods for lower extremity motor and functional recovery in stroke rehabilitation. However there is a scarcity of evidence to compare their therapeutic gain in stroke recovery.Aim: To compare the efficacy of neuromuscular electrical stimulation (NMES) and mirror therapy (MT) in very early phase of post stroke rehabilitation addressed to lower extremity motor recovery and balance. Design: observer blinded Randomized Clinical Trial. Setting: Neurorehabilitation Unit, Department of Physical Therapy, Tertiary Care Hospitals. Subjects: 32 acute stroke subjects with first episode of unilateral stroke with hemiparesis, referred for rehabilitation (onset < 3 weeks), Brunnstorm lower extremity recovery stages ≥3 and MMSE score more than 24 were randomized into two group [Group A-NMES and Group B-MT]. Interventions: Both the groups received eclectic approach to remediate lower extremity recovery which includes treatment components of Roods, Bobath and Motor learning approaches for 30 minutes a day for 6 days. Following which Group A (N=16) received 30 minutes of surface NMES training for six major paretic muscle groups (gluteus maximus and medius,quadriceps, hamstrings, tibialis anterior and gastrocnemius). Group B (N=16) was administered with 30 minutes of mirror therapy sessions to facilitate lower extremity motor recovery. Outcome measures: Lower extremity motor recovery, balance and activities of daily life (ADLs) were measured by Fugyl Meyer Assessment (FMA-LE), Berg Balance Scale (BBS), Barthel Index (BI) before and after intervention. Results: Pre Post analysis of either group across the time revealed statistically significant improvement (p < 0.001) for all the outcome variables for the either group. All parameters of NMES had greater change scores compared to MT group as follows: FMA-LE (25.12±3.01 vs. 23.31±2.38), BBS (35.12±4.61 vs. 34.68±5.42) and BI (40.00±10.32 vs. 37.18±7.73). Between the groups comparison of pre post values showed no significance with FMA-LE (p=0.09), BBS (p=0.80) and BI (p=0.39) respectively. Conclusion: Though either groups had significant improvement (pre to post intervention), none of them were superior to other in lower extremity motor recovery and balance among acute stroke subjects. We conclude that eclectic approach is an effective treatment irrespective of NMES or MT as an adjunct.

Keywords: balance, motor recovery, mirror therapy, neuromuscular electrical stimulation, stroke

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Authors: Krupali Mukeshkumar, Jinesh Shah

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Background: Bilateral Sagittal Split Osteotomy (BSSO), used for the correction of mandibular deformities, is a common oral and maxillofacial surgical procedure. Inferior alveolar nerve dysfunction is commonly reported post-operatively by patients as paresthesia or anesthesia. The current literature lacks a consensus on the incidence of inferior alveolar nerve dysfunction as patients are not routinely assessed pre and post-operatively with an objective assessment. The range of incidence varies from 9% to 85% of patients, with some authors arguing that 100% of patients experience nerve dysfunction immediately post-surgery. Systematic reviews have shown a difference between incidence rates at different follow-up periods using objective and subjective methods. Aim: To identify the incidence of inferior alveolar nerve dysfunction following BSSO. Gold standard: Nerve dysfunction incidence rates similar or lower than current literature of 83% day one post-operatively and 18.4% at one year follow up. Setting: A retrospective cross-sectional audit of patients treated between 2017-2019 at the Royal Stoke University Hospital, Maxillofacial and Orthodontic departments. Sample: All patients who underwent a BSSO (with or without le fort one osteotomy) between 2017–2019 were identified from the database. Patients with pre-existing neurosensory disturbance, those who had a genioplasty at the same time and those with no follow-up were excluded. The sample consisted of 121 patients, 37 males and 84 females between the ages of 17-50 years at the time of surgery. Methods: Clinical records of 121 cases were reviewed to assess the age, sex, type of mandibular osteotomy, status of the nerve during the surgical procedure, type of bony split and incidence of nerve dysfunction at follow-up appointments. The surgical procedure was carried out by three Maxillo-facial surgeons and follow-up appointments were carried out in the Orthodontic and Oral and Maxillo-facial departments. Results: 120 patients were treated to correct the mandibular facial deformity and 1 patient was treated for sleep apnoea. Seventeen patients had a mandibular setback and 104 patients had mandibular advancement. 68 patients reported inferior alveolar nerve dysfunction at one week following their surgery. Seventy-six patients had temporary paresthesia present between 2 weeks and 12 months post-surgery. 13 patients had persistent nerve dysfunction at 12 months, of which 1 had a bad bony split during the BSSO. The incidence of nerve dysfunction postoperatively was 6.6% after 1 day, 56.1% at 1 week, 62.8% at 2 weeks, 59.5% between 3-6 weeks, 43.0% between 8-16 weeks and 10.7% at 1 year. Conclusions: The results of this audit show a similar incidence rate to the research gold standard at the one-year follow-up. Future Recommendations: No changes to surgical procedure or technique are indicated, but a need for improved documentation and a standardized approach for assessment of post-operative nerve dysfunction would be beneficial.

Keywords: bilateral sagittal split osteotomy, inferior alveolar nerve, mandible, nerve dysfunction

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Authors: Léa Caban, Lucile Soudani, Julien Berger, Armelle Nouviaire, Emilio Bastidas-Arteaga

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Improvement of the thermal performance of buildings is a high concern for the construction industry. With the increase in environmental issues, new types of construction materials are being developed. These include bio-based insulation materials. They capture carbon dioxide, can be produced locally, and have good thermal performance. However, their behavior with respect to moisture transfer is still facing some issues. With a high porosity, the mass transfer is more important in those materials than in mineral insulation ones. Therefore, they can be more sensitive to moisture disorders such as mold growth, condensation risks or decrease of the wall energy efficiency. For this reason, the initial moisture content on the construction site is a piece of crucial knowledge. Measuring moisture content in a laboratory is a mastered task. Diverse methods exist but the easiest and the reference one is gravimetric. A material is weighed dry and wet, and its moisture content is mathematically deduced. Non-destructive methods (NDT) are promising tools to determine in an easy and fast way the moisture content in a laboratory or on construction sites. However, the quality and reliability of the measures are influenced by several factors. Classical NDT portable devices usable on-site measure the capacity or the resistivity of materials. Water’s electrical properties are very different from those of construction materials, which is why the water content can be deduced from these measurements. However, most moisture meters are made to measure wooden materials, and some of them can be adapted for construction materials with calibration curves. Anyway, these devices are almost never calibrated for insulation materials. The main objective of this study is to determine the reliability of moisture meters in the measurement of biobased insulation materials. The determination of which one of the capacitive or resistive methods is the most accurate and which device gives the best result is made. Several biobased insulation materials are tested. Recycled cotton, two types of wood fibers of different densities (53 and 158 kg/m3) and a mix of linen, cotton, and hemp. It seems important to assess the behavior of a mineral material, so glass wool is also measured. An experimental campaign is performed in a laboratory. A gravimetric measurement of the materials is carried out for every level of moisture content. These levels are set using a climatic chamber and by setting the relative humidity level for a constant temperature. The mass-based moisture contents measured are considered as references values, and the results given by moisture meters are compared to them. A complete analysis of the uncertainty measurement is also done. These results are used to analyze the reliability of moisture meters depending on the materials and their water content. This makes it possible to determine whether the moisture meters are reliable, and which one is the most accurate. It will then be used for future measurements on construction sites to assess the initial hygrothermal state of insulation materials, on both new-build and renovation projects.

Keywords: capacitance method, electrical resistance method, insulation materials, moisture transfer, non-destructive testing

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Authors: Stehr Melanie

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The availability of apposite information is essential for the decision-making process of organizational buyers. Due to the constraints of the Covid-19 crisis, information channels that emphasize face-to-face contact (e.g. sales visits, trade shows) have been unavailable, and usage of digitally-driven information channels (e.g. videoconferencing, platforms) has skyrocketed. This paper explores the question in which areas the pandemic induced shift in the use of information channels could be sustainable and in which areas it is a temporary phenomenon. While information and buying behavior in B2C purchases has been regularly studied in the last decade, the last fundamental model of organizational buying behavior in B2B was introduced by Johnston and Lewin (1996) in times before the advent of the internet. Subsequently, research efforts in B2B marketing shifted from organizational buyers and their decision and information behavior to the business relationships between sellers and buyers. This study builds on the extensive literature on situational factors influencing organizational buying and information behavior and uses the economics of information theory as a theoretical framework. The research focuses on the German woodworking industry, which before the Covid-19 crisis was characterized by a rather low level of digitization of information channels. By focusing on an industry with traditional communication structures, a shift in information behavior induced by an exogenous shock is considered a ripe research setting. The study is exploratory in nature. The primary data source is 40 in-depth interviews based on the repertory-grid method. Thus, 120 typical buying situations in the woodworking industry and the information and channels relevant to them are identified. The results are combined into clusters, each of which shows similar information behavior in the procurement process. In the next step, the clusters are analyzed in terms of the post and pre-Covid-19 crisis’ behavior identifying stable and dynamic information behavior aspects. Initial results show that, for example, clusters representing search goods with low risk and complexity suggest a sustainable rise in the use of digitally-driven information channels. However, in clusters containing trust goods with high significance and novelty, an increased return to face-to-face information channels can be expected after the Covid-19 crisis. The results are interesting from both a scientific and a practical point of view. This study is one of the first to apply the economics of information theory to organizational buyers and their decision and information behavior in the digital information age. Especially the focus on the dynamic aspects of information behavior after an exogenous shock might contribute new impulses to theoretical debates related to the economics of information theory. For practitioners - especially suppliers’ marketing managers and intermediaries such as publishers or trade show organizers from the woodworking industry - the study shows wide-ranging starting points for a future-oriented segmentation of their marketing program by highlighting the dynamic and stable preferences of elaborated clusters in the choice of their information channels.

Keywords: B2B buying process, crisis, economics of information theory, information channel

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Authors: Kim Bower

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Evaluating and researching motivation in language learning is a complex and multi-faceted activity. Various models for investigating learner motivation have been proposed in the literature, but no one model supplies a complex and coherent model for investigating a range of motivational characteristics. Here, such a methodological framework, which includes exemplification of sources of evidence and potential methods of investigation, is proposed. The process model for the investigation of motivation within language learning settings proposed is based on a complex dynamic systems perspective that takes account of cognition and affects. It focuses on three overarching aspects of motivation: the learning environment, learner engagement and learner identities. Within these categories subsets are defined: the learning environment incorporates teacher, course and group specific aspects of motivation; learner engagement addresses the principal characteristics of learners' perceived value of activities, their attitudes towards language learning, their perceptions of their learning and engagement in learning tasks; and within learner identities, principal characteristics of self-concept and mastery of the language are explored. Exemplifications of potential sources of evidence in the model reflect the multiple influences within and between learner and environmental factors and the possible changes in both that may emerge over time. The model was initially developed as a framework for investigating different models of Content and Language Integrated Learning (CLIL) in contrasting contexts in secondary schools in England. The study, from which examples are drawn to exemplify the model, aimed to address the following three research questions: (1) in what ways does CLIL impact on learner motivation? (2) what are the main elements of CLIL that enhance motivation? and (3) to what extent might these be transferable to other contexts? This new model has been tried and tested in three locations in England and reported as case studies. Following an initial visit to each institution to discuss the qualitative research, instruments were developed according to the proposed model. A questionnaire was drawn up and completed by one group prior to a 3-day data collection visit to each institution, during which interviews were held with academic leaders, the head of the department, the CLIL teacher(s), and two learner focus groups of six-eight learners. Interviews were recorded and transcribed verbatim. 2-4 naturalistic observations of lessons were undertaken in each setting, as appropriate to the context, to provide colour and thereby a richer picture. Findings were subjected to an interpretive analysis by the themes derived from the process model and are reported elsewhere. The model proved to be an effective and coherent framework for planning the research, instrument design, data collection and interpretive analysis of data in these three contrasting settings, in which different models of language learning were in place. It is hoped that the proposed model, reported here together with exemplification and commentary, will enable teachers and researchers in a wide range of language learning contexts to investigate learner motivation in a systematic and in-depth manner.

Keywords: investigate, language-learning, learner motivation model, dynamic systems perspective

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Authors: Aritra Majumdar

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While organizations strive to expand their new customer base, retaining existing relationships is a key aspect of improving overall profitability and also showcasing how successful an organization is in holding on to its customers. It is an experimentally proven fact that the lion’s share of profit always comes from existing customers. Hence seamless management of renewal journeys across different channels goes a long way in improving trust in the brand. From a quality assurance standpoint, time travel testing provides an approach to both business and technology teams to enhance the customer experience when they look to extend their partnership with the organization for a defined phase of time. This whitepaper will focus on key pillars of time travel testing: time travel planning, time travel data preparation, and enterprise automation. Along with that, it will call out some of the best practices and common accelerator implementation ideas which are generic across verticals like healthcare, insurance, etc. In this abstract document, a high-level snapshot of these pillars will be provided. Time Travel Planning: The first step of setting up a time travel testing roadmap is appropriate planning. Planning will include identifying the impacted systems that need to be time traveled backward or forward depending on the business requirement, aligning time travel with other releases, frequency of time travel testing, preparedness for handling renewal issues in production after time travel testing is done and most importantly planning for test automation testing during time travel testing. Time Travel Data Preparation: One of the most complex areas in time travel testing is test data coverage. Aligning test data to cover required customer segments and narrowing it down to multiple offer sequencing based on defined parameters are keys for successful time travel testing. Another aspect is the availability of sufficient data for similar combinations to support activities like defect retesting, regression testing, post-production testing (if required), etc. This section will talk about the necessary steps for suitable data coverage and sufficient data availability from a time travel testing perspective. Enterprise Automation: Time travel testing is never restricted to a single application. The workflow needs to be validated in the downstream applications to ensure consistency across the board. Along with that, the correctness of offers across different digital channels needs to be checked in order to ensure a smooth customer experience. This section will talk about the focus areas of enterprise automation and how automation testing can be leveraged to improve the overall quality without compromising on the project schedule. Along with the above-mentioned items, the white paper will elaborate on the best practices that need to be followed during time travel testing and some ideas pertaining to accelerator implementation. To sum it up, this paper will be written based on the real-time experience author had on time travel testing. While actual customer names and program-related details will not be disclosed, the paper will highlight the key learnings which will help other teams to implement time travel testing successfully.

Keywords: time travel planning, time travel data preparation, enterprise automation, best practices, accelerator implementation ideas

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Authors: Arlene Villarama, Micol Grace Guanzon, Zenaida Ramos

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This paper provides insights into teaching English as a Foreign Language in the Philippines. The authors reviewed relevant theories and literature, and provide an analysis of the issues in teaching English in the Philippine setting in the light of these theories. The authors made an investigation in Bagong Barrio National High School (BBNHS) - a public school in Caloocan City. The institution has a population of nearly 3,000 students. The performances of randomly chosen 365 respondents were scrutinised. The study regarding the success of teaching English as a foreign language to Filipino children were highlighted. This includes the respondents’ family background, surroundings, way of living, and their behavior and understanding regarding education. The results show that there is a significant relationship between demonstrative, communal, and logical areas that touch the efficacy of introducing English as a foreign Dialectal. Filipino children, by nature, are adventurous and naturally joyful even for little things. They are born with natural skills and capabilities to discover new things. They highly consider activities and work that ignite their curiosity. They love to be recognised and are inspired the most when given the assurance of acceptance and belongingness. Fun is the appealing influence to ignite and motivate learning. The magic word is excitement. The study reveals the many facets of the accumulation and transmission of erudition, in introduction and administration of English as a foreign phonological; it runs and passes through different channels of diffusion. Along the way, there are particles that act as obstructions in protocols where knowledge are to be gathered. Data gained from the respondents conceals a reality that is beyond one’s imagination. One significant factor that touches the inefficacy of understanding and using English as a foreign language is an erroneous outset gained from an old belief handed down from generation to generation. This accepted perception about the power and influence of the use of language, gives the novices either a negative or a positive notion. The investigation shows that a higher number of dislikes in the use of English can be tracked down from the belief of the story on how the English language came into existence. The belief that only the great and the influential have the right to use English as a means of communication kills the joy of acceptance. A significant notation has to be examined so as to provide a solution or if not eradicate the misconceptions that lie behind the substance of the matter. The result of the authors’ research depicts a substantial correlation between the emotional (demonstrative), social (communal), and intellectual (logical). The focus of this paper is to bring out the right notation and disclose the misconceptions with regards to teaching English as a foreign language. This will concentrate on the emotional, social, and intellectual areas of the Filipino learners and how these areas affect the transmittance and accumulation of learning. The authors’ aim is to formulate logical ways and techniques that would open up new beginnings in understanding and acceptance of the subject matter.

Keywords: accumulation, behaviour, facets, misconceptions, transmittance

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Authors: Tomohiko Utsuki, Kyoka Sato

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In emergency medicine, it is recognized that brain resuscitation is very important for the reduction of mortality rate and neurological sequelae. Especially, the control of brain temperature (BT), intracranial pressure (ICP), and cerebral blood flow (CBF) are most required for stabilizing brain’s physiological state in the treatment for such as brain injury, stroke, and encephalopathy. However, the manual control of BT, ICP, and CBF frequently requires the decision and operation of medical staff, relevant to medication and the setting of therapeutic apparatus. Thus, the integration and the automation of the control of those is very effective for not only improving therapeutic effect but also reducing staff burden and medical cost. For realizing such integration and automation, a mathematical model of brain physiological state is necessary as the controlled object in simulations, because the performance test of a prototype of the control system using patients is not ethically allowed. A model of cerebral blood circulation has already been constructed, which is the most basic part of brain physiological state. Also, a migration model of extracellular fluid in brain has been constructed, however the condition that the total volume of intracranial cavity is almost changeless due to the hardness of cranial bone has not been considered in that model. Therefore, in this research, the dynamic migration model of extracellular fluid in brain was constructed on the consideration of the changelessness of intracranial cavity’s total volume. This model is connectable to the cerebral blood circulation model. The constructed model consists of fourteen compartments, twelve of which corresponds to perfused area of bilateral anterior, middle and posterior cerebral arteries, the others corresponds to cerebral ventricles and subarachnoid space. This model enable to calculate the migration of tissue fluid from capillaries to gray matter and white matter, the flow of tissue fluid between compartments, the production and absorption of cerebrospinal fluid at choroid plexus and arachnoid granulation, and the production of metabolic water. Further, the volume, the colloid concentration, and the tissue pressure of/in each compartment are also calculable by solving 40-dimensional non-linear simultaneous differential equations. In this research, the obtained model was analyzed for its validation under the four condition of a normal adult, an adult with higher cerebral capillary pressure, an adult with lower cerebral capillary pressure, and an adult with lower colloid concentration in cerebral capillary. In the result, calculated fluid flow, tissue volume, colloid concentration, and tissue pressure were all converged to suitable value for the set condition within 60 minutes at a maximum. Also, because these results were not conflict with prior knowledge, it is certain that the model can enough represent physiological state of brain under such limited conditions at least. One of next challenges is to integrate this model and the already constructed cerebral blood circulation model. This modification enable to simulate CBF and ICP more precisely due to calculating the effect of blood pressure change to extracellular fluid migration and that of ICP change to CBF.

Keywords: dynamic model, cerebral extracellular migration, brain resuscitation, automatic control

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Authors: Charmaine B. Distor

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Collaboration has long been recognized in different fields, but there’s been little research on operationalizing it especially on a multi-sectoral setting as per the author’s best knowledge. Also, communication is one of the factors that is usually overlooked when studying it. Specifically, this study aimed to describe the organizational profile and tasks of collaborators in the visitor management program of Make It Makiling (MIM). It also identified the factors that motivated collaborators to collaborate in MIM while determining the communication dimensions in the collaborative process. It also determined the communication channels used by collaborators in MIM while identifying the outcomes of collaboration in MIM. This study also found out if a relationship exists between collaborators’ motivations for collaboration and their perceived outcomes of collaboration, and collaborators' communication dimensions and their perceived outcomes of collaboration. Lastly, it also provided recommendations to improve the communication in MIM. Data were gathered using a self-administered survey that was patterned after Mattessich and Monsey’s (1992) collaboration experience questionnaire. Interviews and secondary sources mainly provided by the Makiling Center for Mountain Ecosystems (MCME) were also used. From the seven MIM collaborating organizations that were selected through purposive sampling, 86 respondents were chosen. Then, data were analyzed through frequency counts, percentages, measures of central tendencies, and Pearson’s and Spearman rho correlations. Collaborators’ length of collaboration ranged from seven to twenty years. Furthermore, six out of seven of the collaborators were involved in the task of 'emergency, rescue, and communication'. For the other aspect of the antecedents, the history of previous collaboration efforts ranked as the highest rated motivation for collaboration. In line with this, the top communication dimension is the governance while perceived effectiveness garnered the highest overall average among the perceived outcomes of collaboration. Results also showed that the collaborators highly rely on formal communication channels. Meetings and memos were the most commonly used communication channels throughout all tasks under the four phases of MIM. Additionally, although collaborators have a high view towards their co-collaborators, they still rely on MCME to act as their manager in coordinating with one another indirectly. Based on the correlation analysis, antecedent (motivations)-outcome relationship generally had positive relationships. However, for the process (communication dimensions)-outcome relationship, both positive and negative relationships were observed. In conclusion, this study exhibited the same trend with existing literature which also used the same framework. For the antecedent-outcome relationship, it can be deduced that MCME, as the main organizer of MIM, can focus on these variables to achieve their desired outcomes because of the positive relationships. For the process-outcome relationship, MCME should also take note that there were negative relationships where an increase in the said communication dimension may result in a decrease in the desired outcome. Recommendations for further study include a methodology that contains: complete enumeration or any parametric sampling, a researcher-administered survey, and direct observations. These might require additional funding, but all may yield to richer data.

Keywords: antecedent-outcome relationship, carrying capacity, organizational communication, process-outcome relationship

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Authors: Fatma Refaat Ahmed, Sally Mohamed Farghaly

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Context: Intensive care unit (ICU) nurses often face pressure and constraints in their work, leading to the rationing of care when demands exceed available time and resources. Observations suggest that ICU nurses are frequently distracted from their core nursing roles by non-core tasks. This study aims to provide evidence on ICU nurses' multitasking activities and explore the association between nurses' personal and clinical characteristics and their time allocation. Research Aim: The aim of this study is to quantify the time spent by ICU nurses on multitasking activities and investigate the relationship between their personal and clinical characteristics and time allocation. Methodology: A self-observation form utilizing the "Diary" recording method was used to record the number of tasks performed by ICU nurses and the time allocated to each task category. Nurses also reported on the distractions encountered during their nursing activities. A convenience sample of 60 ICU nurses participated in the study, with each nurse observed for one nursing shift (6 hours), amounting to a total of 360 hours. The study was conducted in two ICUs within a university teaching hospital in Alexandria, Egypt. Findings: The results showed that ICU nurses completed 2,730 direct patient-related tasks and 1,037 indirect tasks during the 360-hour observation period. Nurses spent an average of 33.65 minutes on ventilator care-related tasks, 14.88 minutes on tube care-related tasks, and 10.77 minutes on inpatient care-related tasks. Additionally, nurses spent an average of 17.70 minutes on indirect care tasks per hour. The study identified correlations between nursing time and nurses' personal and clinical characteristics. Theoretical Importance: This study contributes to the existing research on ICU nurses' multitasking activities and their relationship with personal and clinical characteristics. The findings shed light on the significant time spent by ICU nurses on direct care for mechanically ventilated patients and the distractions that require attention from ICU managers. Data Collection: Data were collected using self-observation forms completed by participating ICU nurses. The forms recorded the number of tasks performed, the time allocated to each task category, and any distractions encountered during nursing activities. Analysis Procedures: The collected data were analyzed to quantify the time spent on different tasks by ICU nurses. Correlations were also examined between nursing time and nurses' personal and clinical characteristics. Question Addressed: This study addressed the question of how ICU nurses allocate their time across multitasking activities and whether there is an association between nurses' personal and clinical characteristics and time allocation. Conclusion: The findings of this study emphasize the need for a lean evaluation of ICU nurses' activities to identify and address potential gaps in patient care and distractions. Implementing lean techniques can improve efficiency, safety, clinical outcomes, and satisfaction for both patients and nurses, ultimately enhancing the quality of care and organizational performance in the ICU setting.

Keywords: motion study, ICU nurse, lean, nursing time, multitasking activities

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Authors: Priyanka Botny Srinath, Alessandro Suglia, Mel McKendrick

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Background: Organizational cultural studies integrate sociology and anthropology, portraying man as a creator of symbols, languages, beliefs, and ideologies -essentially, a creator and manager of meaning. In our research, we leverage analytical measures to discern whether an organization embodies a singular culture or a myriad of subcultures. Fast-forward to 2023, our research thesis focuses on digitally measuring culture, coining it as the "Work Culture Quotient." This entails conceptually mapping common experiential patterns to provide executives insights into the digital organization journey, aiding in understanding their current position and identifying future steps. Objectives: Finding the new age skills that help in defining the culture; understand the implications of post-COVID effects; derive a digital framework for measuring skillsets. Method: We conducted two comprehensive Delphi studies to distill essential insights. Delphi 1: Through a thematic analysis of interviews with 20 high-level leaders representing companies across diverse regions -India, Japan, the US, Canada, Morocco, and Uganda- we identified 20 key skills critical for cultivating a robust organizational culture. The skills are -influence, self-confidence, optimism, empathy, leadership, collaboration and cooperation, developing others, commitment, innovativeness, leveraging diversity, change management, team capabilities, self-control, digital communication, emotional awareness, team bonding, communication, problem solving, adaptability, and trustworthiness. Delphi 2: Subject matter experts were asked to complete a questionnaire derived from the thematic analysis in stage 1 to formalise themes and draw consensus amongst experts on the most important workplace skills. Results: The thematic analysis resulted in 20 workplace employee skills being identified. These skills were all included in the Delphi round 2 questionnaire. From the outputs, we analysed the data using R Studio for arriving at agreement and consensus, we also used sum of squares method to compare various agreements to extract various themes with a threshold of 80% agreements. This yielded three themes at over 80% agreement (leadership, collaboration and cooperation, communication) and three further themes at over 60% agreement (commitment, empathy, trustworthiness). From this, we selected five questionnaires to be included in the primary data collection phase, and these will be paired with the digital footprints to provide a workplace culture quotient. Implications: The findings from these studies bear profound implications for decision-makers, revolutionizing their comprehension of organizational culture. Tackling the challenge of mapping the digital organization journey involves innovative methodologies that probe not only external landscapes but also internal cultural dynamics. This holistic approach furnishes decision-makers with a nuanced understanding of their organizational culture and visualizes pivotal skills for employee growth. This clarity enables informed choices resonating with the organization's unique cultural fabric. Anticipated outcomes transcend mere individual cultural measurements, aligning with organizational goals to unveil a comprehensive view of culture, exposing artifacts and depth. Armed with this profound understanding, decision-makers gain tangible evidence for informed decision-making, strategically leveraging cultural strengths to cultivate an environment conducive to growth, innovation, and enduring success, ultimately leading to measurable outcomes.

Keywords: leadership, cooperation, collaboration, teamwork, work culture

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Authors: Stefanie M. Vanneste, Stijn Goeminne

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This paper studies the effect of political characteristics of 308 Flemish municipalities on their budget balance in the period 1995-2011. All local governments experience the same economic and financial setting, however some governments have high budget balances, while others have low budget balances. The aim of this paper is to explain the differences in municipal budget balances by a number of economic, socio-demographic and political variables. The economic and socio-demographic variables will be used as control variables, while the focus of this paper will be on the political variables. We test four hypotheses resulting from the literature, namely (i) the partisan hypothesis tests if left wing governments have lower budget balances, (ii) the fragmentation hypothesis stating that more fragmented governments have lower budget balances, (iii) the hypothesis regarding the power of the government, higher powered governments would resolve in higher budget balances, and (iv) the opportunistic budget cycle to test whether politicians manipulate the economic situation before elections in order to maximize their reelection possibilities and therefore have lower budget balances before elections. The contributions of our paper to the existing literature are multiple. First, we use the whole array of political variables and not just a selection of them. Second, we are dealing with a homogeneous database with the same budget and election rules, making it easier to focus on the political factors without having to control for the impact of differences in the political systems. Third, our research extends the existing literature on Flemish municipalities as this is the first dynamic research on local budget balances. We use a dynamic panel data model. Because of the two lagged dependent variables as explanatory variables, we employ the system GMM (Generalized Method of Moments) estimator. This is the best possible estimator as we are dealing with political panel data that is rather persistent. Our empirical results show that the effect of the ideological position and the power of the coalition are of less importance to explain the budget balance. The political fragmentation of the government on the other hand has a negative and significant effect on the budget balance. The more parties in a coalition the worse the budget balance is ceteris paribus. Our results also provide evidence of an opportunistic budget cycle, the budget balances are lower in pre-election years relative to the other years to try and increase the incumbents reelection possibilities. An additional finding is that the incremental effect of the budget balance is very important and should not be ignored like is being done in a lot of empirical research. The coefficients of the lagged dependent variables are always positive and very significant. This proves that the budget balance is subject to incrementalism. It is not possible to change the entire policy from one year to another so the actions taken in recent past years still have an impact on the current budget balance. Only a relatively small amount of research concerning the budget balance takes this considerable incremental effect into account. Our findings survive several robustness checks.

Keywords: budget balance, fragmentation, ideology, incrementalism, municipalities, opportunistic budget cycle, panel data, political characteristics, power, system GMM

Procedia PDF Downloads 299

Authors: Sharon Hovav, Ilya Levner, Oren Nahum, Istvan Szabo

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In modern large-scale logistic centers (e.g., big automated warehouses), complex logistic operations performed by human staff (pickers) need to be coordinated with the operations of automated facilities (robots, conveyors, cranes, lifts, flow racks, etc.). The efficiency of advanced logistic centers strongly depends on optimizing picking technologies in synch with the facility/product layout, as well as on optimal distribution of material flows (products) in the system. The challenge is to develop a mathematical operations research (OR) tool that will optimize system cost-effectiveness. In this work, we propose a model that describes an automatic logistic center consisting of a set of workstations located at several galleries (floors), with each station containing a known number of flow racks. The requirements of each product and the working capacity of stations served by a given set of workers (pickers) are assumed as predetermined. The goal of the model is to maximize system efficiency. The proposed model includes two echelons. The first is the setting of the (optimal) number of workstations needed to create the total processing/logistic system, subject to picker capacities. The second echelon deals with the assignment of the products to the workstations and flow racks, aimed to achieve maximal throughputs of picked products over the entire system given picker capacities and budget constraints. The solutions to the problems at the two echelons interact to balance the overall load in the flow racks and maximize overall efficiency. We have developed an operations research model within each echelon. In the first echelon, the problem of calculating the optimal number of workstations is formulated as a non-standard bin-packing problem with capacity constraints for each bin. The problem arising in the second echelon is presented as a constrained product-workstation-flow rack assignment problem with non-standard mini-max criteria in which the workload maximum is calculated across all workstations in the center and the exterior minimum is calculated across all possible product-workstation-flow rack assignments. The OR problems arising in each echelon are proved to be NP-hard. Consequently, we find and develop heuristic and approximation solution algorithms based on exploiting and improving local optimums. The LC model considered in this work is highly dynamic and is recalculated periodically based on updated demand forecasts that reflect market trends, technological changes, seasonality, and the introduction of new items. The suggested two-echelon approach and the min-max balancing scheme are shown to work effectively on illustrative examples and real-life logistic data.

Keywords: logistics center, product-workstation, assignment, maximum performance, load balancing, fast algorithm

Procedia PDF Downloads 228

Authors: Fernanda Mary R. G. Da Silva, Adriana C. F. Mozzambani, Marcelo F. Mello

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Introduction: Sexual assault against children and adolescents is a public health problem with serious consequences on their quality of life, especially for those who develop post-traumatic stress disorder (PTSD). The broad literature in this research area points to greater losses in verbal learning, explicit memory, speed of information processing, attention and executive functioning in PTSD. Objective: To compare the neuropsychological functions of adolescents from 14 to 17 years of age, victims of sexual violence with PTSD with those of healthy controls. Methodology: Application of a neuropsychological battery composed of the following subtests: WASI vocabulary and matrix reasoning; Digit subtests (WISC-IV); verbal auditory learning test RAVLT; Spatial Span subtest of the WMS - III scale; abbreviated version of the Wisconsin test; concentrated attention test - D2; prospective memory subtest of the NEUPSILIN scale; five-digit test - FDT and the Stroop test (Trenerry version) in adolescents with a history of sexual violence in the previous six months, referred to the Prove (Violence Care and Research Program of the Federal University of São Paulo), for further treatment. Results: The results showed a deficit in the word coding process in the RAVLT test, with impairment in A3 (p = 0.004) and A4 (p = 0.016) measures, which compromises the verbal learning process (p = 0.010) and the verbal recognition memory (p = 0.012), seeming to present a worse performance in the acquisition of verbal information that depends on the support of the attentional system. A worse performance was found in list B (p = 0.047), a lower priming effect p = 0.026, that is, lower evocation index of the initial words presented and less perseveration (p = 0.002), repeated words. Therefore, there seems to be a failure in the creation of strategies that help the mnemonic process of retention of the verbal information necessary for learning. Sustained attention was found to be impaired, with greater loss of setting in the Wisconsin test (p = 0.023), a lower rate of correct responses in stage C of the Stroop test (p = 0.023) and, consequently, a higher index of erroneous responses in C of the Stroop test (p = 0.023), besides more type II errors in the D2 test (p = 0.008). A higher incidence of total errors was observed in the reading stage of the FDT test p = 0.002, which suggests fatigue in the execution of the task. Performance is compromised in executive functions in the cognitive flexibility ability, suggesting a higher index of total errors in the alternating step of the FDT test (p = 0.009), as well as a greater number of persevering errors in the Wisconsin test (p = 0.004). Conclusion: The data from this study suggest that sexual violence and PTSD cause significant impairment in the neuropsychological functions of adolescents, evidencing risk to quality of life in stages that are fundamental for the development of learning and cognition.

Keywords: adolescents, neuropsychological functions, PTSD, sexual violence

Procedia PDF Downloads 135

Authors: Karishma Kashyap, Subha D. Parida

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Rapid population growth and urbanization is creating pressure throughout the world. This has a dramatic effect on a lot of elements which include water, food, transportation, energy, infrastructure etc. as few of the key services. Built environment sector is growing concurrently to meet the needs of urbanization. Due to such large scale development of buildings, there is a need for them to be monitored and managed efficiently. Along with appropriate management, climate adaptation is highly crucial as well because buildings are one of the major sources of greenhouse gas emission in their operation phase. Buildings to be adaptive need to provide a triple bottom approach to sustainability i.e., being socially, environmentally and economically sustainable. Hence, in order to deliver these sustainability outcomes, there is a growing understanding and thrive towards switching to green buildings or renovating new ones as per green standards wherever possible. Academic institutions in particular have been following this trend globally. This is highly significant as universities usually have high occupancy rates because they manage a large building portfolio. Also, as universities accommodate the future generation of architects, policy makers etc., they have the potential of setting themselves as a best industry practice model for research and innovation for the rest to follow. Hence their climate adaptation, sustainable growth and performance management becomes highly crucial in order to provide the best services to users. With the objective of evaluating appropriate management mechanisms within academic institutions, a feasibility study was carried out in a recent 5-Star Green Star rated university building (housing the School of Construction) in Victoria (south-eastern state of Australia). The key aim was to understand the behavioral and social aspect of the building users, management and the impact of their relationship on overall building sustainability. A survey was used to understand the building occupant’s response and reactions in terms of their work environment and management. A report was generated based on the survey results complemented with utility and performance data which were then used to evaluate the management structure of the university. Followed by the report, interviews were scheduled with the facility and asset managers in order to understand the approach they use to manage the different buildings in their university campuses (old, new, refurbished), respective building and parameters incorporated in maintaining the Green Star performance. The results aimed at closing the communication and feedback loop within the respective institutions and assist the facility managers to deliver appropriate stakeholder engagement. For the wider design community, analysis of the data highlights the applicability and significance of prioritizing key stakeholders, integrating desired engagement policies within an institution’s management structures and frameworks and their effect on building performance

Keywords: building optimization, green building, post occupancy evaluation, stakeholder engagement

Procedia PDF Downloads 357

Authors: Mustafa Cam, Nedim Ongun, Ufuk Kutluana

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Introduction: Restless LegsSyndrome (RLS) is a common, under-recognized disorder disrupts sleep and diminishes quality of life (1). The most common conditions highly associated with RLS include renalfailure, iron and folic acid deficiency, peripheral neuropathy, pregnancy, celiacdisease, Crohn’sdiseaseandrarelymalignancy (2).Despite a clear relation between low peripheral iron and increased prevalence and severity of RLS, the prevalence and clinical significance of RLS in iron-deficientanemic populations is unknown (2). We report here a case of RLS due to iron deficiency in the setting of neuroendocrinetumor. Report of Case: A 35 year-old man was referred to our clinic with general weakness, weight loss (10 kg in 2 months)and 2-month history of uncomfortable sensations in his legs with urge to move, partially relieved by movement. The symptoms were presented very day, worsening in the evening; the discomfort forced the patient to getup and walk around at night. RLS was severe, with a score of 22 at the International RLS ratingscale. The patient had no past medical history. The patient underwent a complete set of blood analyses and the following ab normal values were found (normal limitswithinbrackets): hemoglobin 9.9 g/dl (14-18), MCV 70 fL (80-94), ferritin 3,5 ng/mL (13-150). Brain and spinemagnetic resonance imaging was normal. The patient consultated with gastroenterology clinic and gastointestinal systemendoscopy was performed for theetiology of the iron deficiency anemia. After the gastricbiopsy, results allowed us to reach the diagnosis of neuroen docrine tumor and the patient referred to oncology clinic. Discussion: The first important consideration from this case report is that the patient was referred to our clinic because of his severe RLS symptoms dramatically reducing his quality of life. However, our clinical study clearly demonstrated that RLS was not the primary disease. Considering the information available for this patient, we believe that the most likely possibility is that RLS was secondary to iron deficiency, a very well-known and established cause of RLS in theliterature (3,4). Neuroendocrine tumors (NETs) are rare epithelial neoplasms with neuroendocrine differentiation that most commonly originate in the lungs and gastrointestinal tract (5). NETs vary widely in their clinical presentation; symptoms are often nonspecific and can be mistaken for those of other more common conditions (6). 50% of patients with reported disease stage have either regional or distant metastases at diagnosis (7). Accurate and earlier NET diagnosis is the first step in shortening the time to optimal care and improved outcomes for patients (8). The most important message from this case report is that RLS symptoms can sometimes be thesign of a life-threatening condition. Conclusion: Careful and complete collection of clinical and laboratory data should be carried out in RLS patients. Inparticular, if RLS onset coincides with weight loss and iron deficieny anemia, gastricendos copy should be performed. It is known about that malignancy is a rare etiology in RLS patients and to our knowledge; it is the first case with neuro endocrine tumor presenting with RLS.

Keywords: neurology, neuroendocrine tumor, restless legs syndrome, sleep

Procedia PDF Downloads 285

Authors: Aya Al Masri, Kamel Guerchouche, Youssef Laynaoui, Safoin Aktaou, Malorie Martin, Fouad Maaloul

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Introduction: Mobile C-arms move throughout operating rooms of the operating theater. Being designed to move between rooms, they are not equipped with relays to retrieve the exposition information and export it outside the room. Therefore, no light signaling is available outside the room to warn the X-ray emission for staff. Inadvertent exposition of staff outside the operating theater is a real problem for radiation protection. The French standard NFC 15-160 require that: (1) access to any room containing an X-ray emitting device must be controlled by a light signage so that it cannot be inadvertently crossed, and (2) setting up an emergency button to stop the X-ray emission. This study presents a system that we developed to meet these requirements and the results of its clinical test. Materials and methods: The system is composed of two communicating boxes: o The "DetectBox" is to be installed inside the operating theater. It identifies the various operation states of the C-arm by analyzing its power supply signal. The DetectBox communicates (in wireless mode) with the second box (AlertBox). o The "AlertBox" can operate in socket or battery mode and is to be installed outside the operating theater. It detects and reports the state of the C-arm by emitting a real time light signal. This latter can have three different colors: red when the C-arm is emitting X-rays, orange when it is powered on but does not emit X-rays, and green when it is powered off. The two boxes communicate on a radiofrequency link exclusively carried out in the ‘Industrial, Scientific and Medical (ISM)’ frequency bands and allows the coexistence of several on-site warning systems without communication conflicts (interference). Taking into account the complexity of performing electrical works in the operating theater (for reasons of hygiene and continuity of medical care), this system (having a size <10 cm²) works in complete safety without any intrusion in the mobile C-arm and does not require specific electrical installation work. The system is equipped with emergency button that stops X-ray emission. The system has been clinically tested. Results: The clinical test of the system shows that: it detects X-rays having both high and low energy (50 – 150 kVp), high and low photon flow (0.5 – 200 mA: even when emitted for a very short time (<1 ms)), Probability of false detection < 10-5, it operates under all acquisition modes (continuous, pulsed, fluoroscopy mode, image mode, subtraction and movie mode), it is compatible with all C-arm models and brands. We have also tested the communication between the two boxes (DetectBox and AlertBox) in several conditions: (1) Unleaded room, (2) leaded room, and (3) rooms with particular configuration (sas, great distances, concrete walls, 3 mm of lead). The result of these last tests was positive. Conclusion: This system is a reliable tool to alert the staff present outside the operating room for X-ray emission and insure their radiation protection.

Keywords: Clinical test, Inadvertent staff exposition, Light signage, Operating theater

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Authors: Sogand Barghi

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The integration of artificial intelligence (AI) in accounting practices is reshaping the landscape of financial management. This paper explores the innovative applications of AI in the realm of accounting, emphasizing its transformative impact on efficiency, accuracy, decision-making, and financial insights. By harnessing AI's capabilities in data analysis, pattern recognition, and automation, accounting professionals can redefine their roles, elevate strategic decision-making, and unlock unparalleled value for businesses. This paper delves into AI-driven solutions such as automated data entry, fraud detection, predictive analytics, and intelligent financial reporting, highlighting their potential to revolutionize the accounting profession. Artificial intelligence has swiftly emerged as a game-changer across industries, and accounting is no exception. This paper seeks to illuminate the profound ways in which AI is reshaping accounting practices, transcending conventional boundaries, and propelling the profession toward a new era of efficiency and insight-driven decision-making. One of the most impactful applications of AI in accounting is automation. Tasks that were once labor-intensive and time-consuming, such as data entry and reconciliation, can now be streamlined through AI-driven algorithms. This not only reduces the risk of errors but also allows accountants to allocate their valuable time to more strategic and analytical tasks. AI's ability to analyze vast amounts of data in real time enables it to detect irregularities and anomalies that might go unnoticed by traditional methods. Fraud detection algorithms can continuously monitor financial transactions, flagging any suspicious patterns and thereby bolstering financial security. AI-driven predictive analytics can forecast future financial trends based on historical data and market variables. This empowers organizations to make informed decisions, optimize resource allocation, and develop proactive strategies that enhance profitability and sustainability. Traditional financial reporting often involves extensive manual effort and data manipulation. With AI, reporting becomes more intelligent and intuitive. Automated report generation not only saves time but also ensures accuracy and consistency in financial statements. While the potential benefits of AI in accounting are undeniable, there are challenges to address. Data privacy and security concerns, the need for continuous learning to keep up with evolving AI technologies, and potential biases within algorithms demand careful attention. The convergence of AI and accounting marks a pivotal juncture in the evolution of financial management. By harnessing the capabilities of AI, accounting professionals can transcend routine tasks, becoming strategic advisors and data-driven decision-makers. The applications discussed in this paper underline the transformative power of AI, setting the stage for an accounting landscape that is smarter, more efficient, and more insightful than ever before. The future of accounting is here, and it's driven by artificial intelligence.

Keywords: artificial intelligence, accounting, automation, predictive analytics, financial reporting

Procedia PDF Downloads 71

Authors: Nurten Çelik

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Under the new developments in science, medicine, sociology, psychology and literary theories, body studies has gained huge importance and the body has become a debatable issue. There has emerged, among sociologists and literary theorists, an overwhelming consensus that body is socially, politically and culturally perceived and constructed and thus, the position of an individual in the society is determined in accordance with his/her body image. In this regard, the most complicated point is the theoretical views propounded upon disability studies, where the disabled body is considered to be a site upon which social and political restrictions as well as repressions are inscribed. There has been the widely-accepted view that no matter what kind of disability it is, those with physical, mental or learning impairments face varied social, political and environmental obstacles that prevent them from being an active citizen, worker, lover and even a family member. In parallel with these approaches, the matter of the sufferings of disabled individuals attains its place in cinema and literature as well as in theatre studies under the category of disability theatre. One of the prominent plays that deal with physical disability came from the contemporary British playwright Nina Raine. In her awarded play Tribes, which premiered at the Royal Court Theatre in 2010, Raine develops the social strata where her deaf protagonist, Billy, caught up between two tribes – namely his family and his lover Slyvia, a member of the deaf community– experiences personal and social hardships due to his hearing impairment. In the play, intransigent and self-opinionated family members foster no sense of empathy towards Billy, there are noisy talking and shouting, but no communication, love, compassion or mutual understanding, and language becomes just a tool for the expression of rage and oppression. In the disordered atmosphere of the family life, Billy experiences isolation and loneliness. Billy’s hopes for success and love are destroyed when Slyvia, troubled between hearing and deafness, rejects him because she does not utterly grasp what Billy is experiencing. Drawing upon the hardships, Billy undergoes in his relationships with his family and his girlfriend, Tribes problematizes the concept of deafness and explores to what extent a deaf person can find a place in the hearing world. Setting ‘the disabled’ bodies against ‘the abled’ bodies in a family, a microcosm of the society where bodies are socially shaped and constructed, Tribes dramatizes how the disabled bodies are disenfranchised, stigmatised, marginalized and othered on the grounds that they are socially misfit. Tribes, with a specific focus on the dysfunctional family, shows that the lack of communication and empathy numbs the characters to the feelings of each other and thereby, they become more disabled than Billy. In conclusion, this paper, with the reference to the embodiment of disability and social theories, aims to explore how disabled bodies are socially marked and segregated from family and society.

Keywords: body, deafness, disability, disability theatre, Nina Raine, tribes

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Authors: Mathilde Blondon, Salla Aicha Dieng, Catherine Pfister

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In a paradoxical way, teenagers nowadays seem to use suicidal attempts to elaborate on their trauma abuses and regain some kind of control in their lives. As their behavior becomes life-threatening, the hospital offers a variety of expertise to address their need, with Child Protective Services also joining in, to a point when teenagers could have a feeling of losing control of their lives, which results in them making more suicidal attempts. Our goal here is to walk with these foster teenagers long enough to step therapy up first, then as their mental health is restored enough to step the therapy down in a way that is secure and will give them their life back. This would prevent them from making suicidal attempts to get a feeling of control over their life. We’ll present a clinical case of a 14-year-old girl named Sofia, who was suffering from parental deprivation, an identity disorder, and severe depression disorder. Our intervention took place in January 2024, after Sofia had undergone four hospitalizations, including a two-month period in a specialized clinic. In a stepping-up effort, a substantial setting has been built around Sofia. She was coming three days a week to therapeutic activities at the Child Psychiatry Day Hospital, she had one psychotherapy session a week at the Medical-Psychological Center, and she was meeting with the Adolescent Psychiatrist on a regular basis. However, her suicidal attempts frequency continued to increase to the point when she couldn’t stay more than four days outside the hospital unit without harming herself and being brought back to the Emergency Unit. We were all stuck in some kind of medical deadlock, writing to clinics that had no room for her while social workers were calling foster homes that wouldn’t even accept her either. At some point, a clinical decision was made by the psychiatrist to stop what appeared to be a global movement of traumatic repetition, which involved Sofia’s family, the medical team and the social workers as one. This decision to step therapy down created a surprise and put an end to the cycle. It provided a new path, a new solution where Sofia could securely settle without being unfaithful to her family. Her suicidal attempts stopped for four weeks. She had one relapse, then didn’t make another attempt so far. There is a fine line between too little and too much, a pathway with the right amount of care and support. We believe it is not a steady line but rather a path up and down the hill. It’s about building up this moment when medication and mental processes have improved the subject’s condition enough to allow the medical team to step therapy down and give more control back to the subject. These needed variations used to come from a change of hospital or medical team. Stepped care avoids any breaking of bonds and appears to be decisive in stopping teenagers’ suicidal attempts.

Keywords: child protection, adolescent psychiatry, teenager suicidal attempt, foster teenagers, parental deprivation, stepped care

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Authors: Nicholas Anderson, Steven Petersen, Tom Bates, Val Anderson

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Under the multiple-use management regime established in the United States for federally owned lands, government agencies have come under pressure from commercial apiaries to grant permits for the summer pasturing of honeybees on government lands. Federal agencies have struggled to integrate honeybees into their management plans and have little information to make regulations that resolve how many colonies should be allowed in a single location and at what distance sets of hives should be placed. Many conservation groups have voiced their concerns regarding the introduction of honeybees to these natural lands, as they may outcompete and displace native pollinating species. Assessing the quality of an area in regard to its floral resources, pollen, and nectar can be important when attempting to create regulations for the integration of commercial honeybee operations into a native ecosystem. Areas with greater floral resources may be able to support larger numbers of honeybee colonies, while poorer resource areas may be less resilient to introduced disturbances. Attempts are made in this study to determine flower cover using high resolution drone imagery to help assess the floral resource availability to pollinators in high elevation, tall forb communities. This knowledge will help in determining the potential that different areas may have for honeybee pasturing and honey production. Roughly 700 images were captured at 23m above ground level using a drone equipped with a Sony QX1 RGB 20-megapixel camera. These images were stitched together using Pix4D, resulting in a 60m diameter high-resolution mosaic of a tall forb meadow. Using the program ENVI, a supervised maximum likelihood classification was conducted to calculate the percentage of total flower cover and flower cover by color (blue, white, and yellow). A complete vegetation inventory was taken on site, and the major flowers contributing to each color class were noted. An accuracy assessment was performed on the classification yielding an 89% overall accuracy and a Kappa Statistic of 0.855. With this level of accuracy, drones provide an affordable and time efficient method for the assessment of floral cover in large areas. The proximal step of this project will now be to determine the average pollen and nectar loads carried by each flower species. The addition of this knowledge will result in a quantifiable method of measuring pollen and nectar resources of entire landscapes. This information will not only help land managers determine stocking rates for honeybees on public lands but also has applications in the agricultural setting, aiding producers in the determination of the number of honeybee colonies necessary for proper pollination of fruit and nut crops.

Keywords: honeybee, flower, pollinator, remote sensing

Procedia PDF Downloads 141

Authors: Ana Handel, Jamal Ellerbe, Sarah Kanzaki, Natalie White, Nathan Ousey, Sean Gallagher

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A sense of belonging is the ability for individuals to feel they are a necessary part of whatever organization or community they find themselves in. In an academic setting, a sense of belonging is key to a student’s success. The collected research points to this sense of belonging in academic settings as a significant contributor of students’ levels of engagement and trust. When universities leverage the arts, students are provided with more opportunities to engage and feel confident in their surroundings. This allows for greater potential to develop within academic and social settings. The arts also call for the promotion of diversity, equity, and inclusion by showcasing works of artists from all different backgrounds, thus allowing students to gain cultural knowledge and be able to embrace differences. Equity, diversity, and inclusion are all emotional facets of belonging. Equity relates to the concept of making the conscious choice to recognize opportunities to incorporate inclusive and diverse ideals into different thought processes and collaboration. Inclusion involves providing equal access to opportunities and resources for people of all ‘ingroups. In an inclusive culture, individuals are able to maximize their potential with the confidence they have gained through an accepting environment. A variety of members in academic communities have noted it may be beneficial to make certain events surrounding the arts to be built into course requirements in order to ensure students are expanding their horizons and exposing themselves to the arts. These academics also recommend incorporating the arts into extracurricular activities, such as Greek life, in order to appeal to large groups of students. Once students have an understanding of the rich knowledge cultivated through exploring the arts, they will feel more comfortable in their surroundings and thus more confident to become involved in other areas of their university. A number of universities, including West Chester and Carnegie Mellon, have instituted programs aiming to provide students with the necessary tools and resources to feel comfortable in their educational settings. Different programs include references to hotlines for discrimination and office for diversity, equity, and inclusion. Staff members have also been provided with means of combating biases and increasing feelings of belongingness in order to properly support and communicate with students. These tools have successfully allowed universities to foster inviting environments for students of all backgrounds to feel belong as well as strengthening the community’s diversity, equity, and inclusion. Through demonstrating concepts of diversity, equity, and inclusion by introducing the arts into learning spaces, students can find a sense of belonging within their academic environments. It is essential to understand these topics and how they work together to achieve a common goal. The efforts of universities have made much progress in shedding light on different cultures and ideas to show students their full potential and opportunities. Once students feel more comfortable within their organizations, engagement will increase substantially.

Keywords: arts, belonging, engagement, inclusion

Procedia PDF Downloads 165

Authors: D. M. Koers, A. J. Groen, P. D. Englis, R. Harms

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We are witnessing the largest level of displacement of people since World War II. Refugees want to become independent as quickly as possible and build a new, safe future; however, access to the labor market is difficult and they face many problems that are not easily solved. This makes self-employment including social entrepreneurship a valuable alternative. Our research studied refugee-based entrepreneurship and examined whether prior knowledge, unmet personal needs and contextual factors influence how refugees recognize opportunities and if this influences their social orientation. In addition, we examine the barriers refugees face when starting up a company in the Netherlands. We use a case study design with a mixed-method approach, combining in-depth interviews and survey data. Data was collected from two Dutch entrepreneurial training programs in the Netherlands. We have a sample size of 27 latent refugee entrepreneurs. Our results show that refugees score high on the social entrepreneurial measures. They perceive themselves as having a strong social vision and are determined to defend a social need. They also score high on sustainability and state that their business ideas improve the quality of life on the long run. Based on these findings, we did not expect that only 5 participants had business ideas with a social orientation. In this group, 37,5% started a company before and 77.8% used their personal experience to come up with this business idea. Another 70,3% had the higher professional education or academic education. In the interviews, we found that they often copy and paste their gained experience from a previous profession on their new context and expect that it would work well. The social aspect lies in their cultural values and personal beliefs but is not reflected in their business models. One of the reasons could be that the context in which the refugee operates as a moderator suppressing the social mission and social value creation opportunities. Refugees are first and foremost focused on their survival. They do not want to be on social welfare and feel a strong need to be independent. Since they cannot access the labor market easily and face labor market discrimination they want to start a company. Another factor that explains lack of the social orientation in their business ideas is that social entrepreneurship is not a known concept in their home countries. Their idea of entrepreneurship differs substantially. We found that a huge barrier for refugees is their expectations about setting up a business, which are often not realistic because they have little knowledge about the system, institutions and corresponding red tape. In those instances, can the institutional configuration of a country, cultural differences, and perspective on entrepreneurship hinders social entrepreneurship. In conclusion, there might be latent potential for social entrepreneurship in refugees but there are many barriers to overcome. Overcoming these barriers can enhance local communities and enhance integration. In addition it has a positive financial impact on the host country because it reduces the pressure on the social system and stimulate the economy.

Keywords: immigrant entrepreneurship, refugee entrepreneurship, social entrepreneurship, prior experience, opportunity recognition

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Authors: Hansraj Bookun, Rachel Xuan, Angela Tan, Kejia Wang, Animesh Singla, David Kim, Christopher Loupos, Jim Iliopoulos

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Introduction: Complex endovascular aortic aneursymal repairs with fenestrated and branched endografts require customised devices to exclude the pathology while reducing morbidity and mortality, which was historically associated with open repair of complex aneurysms. Such endovascular procedures have predominantly been performed in a large volume dedicated tertiary centres. We present here our nine year multidisciplinary experience with this technology in an Australian tertiary centre. Method: This was a cross-sectional, single-centre observational study of 670 patients who had undergone complex endovascular aortic aneurysmal repairs with conventional endografts, fenestrated endografts, and iliac-branched devices from January 2010 to July 2019. Descriptive statistics were used to characterise our sample with regards to demographic and perioperative variables. Homogeneity of the sample was tested using multivariant regression, which did not identify any statistically significant confounding variables. Results: 670 patients of mean age 74, were included (592 males) and the comorbid burden was as follows: ischemic heart disease (55%), diabetes (18%), hypertension (90%), stage four or greater kidney impairment (8%) and current or ex-smoking (78%). The main indications for surgery were elective aneurysms (86%), symptomatic aneurysms (5%), and rupture aneurysms (5%). 106 patients (16%) underwent fenestrated or branched endograft repairs. The mean length of stay was 7.6 days. 2 patients experienced reactionary bleeds, 11 patients had access wound complications (6 lymph fistulae, 5 haematoms), 11 patients had cardiac complications (5 arrhythmias, 3 acute myocadial infarctions, 3 exacerbation of congestive cardiac failure), 10 patients had respiratory complications, 8 patients had renal impairment, 4 patients had gastrointestinal complications, 2 patients suffered from paraplegia, 1 major stroke, 1 minor stroke, and 1 acute brain syndrome. There were 4 vascular occlusions requiring further arterial surgery, 4 type I endoleaks, 4 type II endoleaks, 3 episodes of thromboembolism, and 2 patients who required further arterial operations in the setting of patient vessels. There were 9 unplanned returns to the theatre. Discussion: Our numbers of 10 years suggest that we are not a dedicated high volume centre focusing on aortic repairs. However, we have achieved significantly low complication rates. This can be attributed to our multidisciplinary approach with the intraoperative involvement of skilled interventional radiologists and vascular surgeons as well as postoperative protocols with particular attention to spinal cord protection. Additionally, we have a ratified perioperative pathway that involves multidisciplinary team discussions of patient-related factors and lesion-centered characteristics, which allows for holistic, patient-centered care.

Keywords: aneurysm, aortic, endovascular, fenestrated

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Authors: Nam Sze Cheng, P. C. Janita Chau

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Background: Eczema is a chronic inflammatory disease with high global prevalence rates in many childhood populations. It is also the most common paediatric skin problem. Although eczema education and proper skin care were effective in controlling eczema symptoms, the lack of both sufficient time for patient consultation and structured eczema education programme hindered the transferability of knowledge to patients and their parents. As a result, these young patients and their families suffer from a significant physical disability and psychological distress, which can substantially impair their quality of life. Objectives: This integrative review is to examine the effects of educational interventions for children with eczema and identify the core elements associated with an effective intervention. Methods: This integrative review targeted all articles published in 10 databases between May 2016 and February 2017 that reported the outcomes of disease interventions of any format for children and adolescents with the clinical diagnosis of eczema who were under 18 years of age. Five randomized controlled trials (RCT) and one systematic review of 10 RCTs were identified for review. All these publications had high methodological quality, except one study of web-based eczema education that was limited by selection bias and poor subject blinding. Findings: This review found that most studies adopted nurse-led or multi-disciplinary parental eczema education programme at the outpatient clinic setting. The format of these programmes included individual lectures, demonstration and group sharing, and the educational materials covered basic eczema knowledge and management as well as methods to interrupt itch-scratch cycle. The main outcome measures of these studies included severity of eczema symptoms, treatment adherence and quality of life of both patients and their families. Nine included studies reported statistically significant improvement in the primary outcome of symptom severity of these eczematous children. On the other hand, all these reviews failed to identify an effective dosage of intervention under these educational programmes that was attributed to the heterogeneity of the interventions. One study that was designed based on the social cognitive theory to guide the interventional content yielded statistically significant results. The systematic review recommended the importance of measuring parental self-efficacy. Implication: This integrative review concludes that structured educational programme can help nurses understand the theories behind different health interventions. They can then deliver eczema education to their patients in a consistent manner. These interventions also result in behavioral changes through patient education. Due to the lack of validated educational programmes in Chinese, it is imperative to conduct an RCT of eczema educational programme to investigate its effects on eczema severity, quality of life and treatment adherence in Hong Kong children as well as to promote the importance of parental self-efficacy.

Keywords: children, eczema, education, intervention

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Authors: Garima Singh

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Objectives: Behavioral Crisis Center (BCC) is a community solution to a community problem. There has been an exponential increase in the incidence and prevalence of mental health crises around the world. The effects of the crisis negatively impact our patients and their families and strain the law enforcement and emergency room. The goal of the multi-disciplinary care model is to break the crisis cycle and provide 24-7 rapid access to an acre and crisis stabilization. We initiated our first BCC care center in 2020 in the midst of the COVID pandemic and have seen a remarkable improvement in patient ‘care and positive financial outcome. Background: Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (52.9 million in 2020). This number represented 21.0% of all U.S. adults. To address some of these challenges and help our community, In May 2020, we opened our first Behavioral crisis center (BCC). Since then, we have served more than 2500 patients and is the first southwest Missouri’s first 24/7 facility for crisis–level behavioral health and substance use needs. It has been proven to be a more effective place than emergency departments, jails, or local law enforcement. Methods: BCC was started in 2020 to serve the unmet need of the community and provide access to behavioral health and substance use services identified in the community. Funding was possible with significant investment from the county and Missouri Foundation for Health, with contributions from medical partners. It is a multi-disciplinary care center consisting of Physicians, nurse practitioners, nurses, behavioral technicians, peer support specialists, clinical intake specialists, and clinical coordinators and hospitality specialists. The center provides services including psychiatry care, outpatient therapy, community support services, primary care, peer support and engagement. It is connected to a residential treatment facility for substance use treatment for continuity of care and bridging the gap, which has resulted in the completion of treatment and better outcomes. Results: BCC has proven to be a great resource to the community and the Missouri Health Coalition is providing funding to replicate the model in other regions and work on a similar model for children and adolescents. Overall, 29% of the patients seen at BCC are stabilized and discharged with outpatient care. 50% needed acute stabilization in a hospital setting and 21% required long-term admission, mostly for substance use treatment. The local emergency room had a 42% reduction in behavioral health encounters compared to the previous 3 years. Also, by a quick transfer to BCC, the average stay in ER was reduced by 10 hours and time to follow up behavioral health assessment decreased by an average of 4 hours. Uninsured patients are also provided Medicaid application assistance which has benefited 55% of individuals receiving care at BCC. Conclusions: BCC is impacting community health and improving access to quality care and substance use treatment. It is a great investment for our patients and families.

Keywords: BCC, behvaioral health, community health care, addiction treatment

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Authors: Victoria C. Valdebenito

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Located within the context of accelerating globalization in the 21^st-century knowledge society, this paper focuses on one selected university in Chile at which radical curriculum policy changes have been taking place, diverging from the traditional curriculum in Chile at the undergraduate level as a section of a larger investigation. Using a ‘policy trajectory’ framework, and guided by the interpretivist approach to research, interview transcripts and institutional documents were analyzed in relation to the meso (university administration) and the micro (academics) level. Inside the case study, participants from the university administration and academic levels were selected both via snow-ball technique and purposive selection, thus they had different levels of seniority, with some participating actively in the curriculum reform processes. Guided by an interpretivist approach to research, documents and interview transcripts were analyzed to reveal major themes emerging from the data. A further ‘bigger picture’ analysis guided by critical theory was then undertaken, involving interrogation of underlying ideologies and how political and economic interests influence the cultural production of policy. The case-study university was selected because it represents a traditional and old case of university setting in the country, undergoing curriculum changes based on international trends such as the competency model and the liberal arts. Also, it is representative of a particular socioeconomic sector of the country. Access to the university was gained through email contact. Qualitative research methods were used, namely interviews and analysis of institutional documents. In all, 18 people were interviewed. The number was defined by when the saturation criterion was met. Semi-structured interview schedules were based on the four research questions about influences, policy texts, policy enactment and longer-term outcomes. Triangulation of information was used for the analysis. While there was no intention to generalize the specific findings of the case study, the results of the research were used as a focus for engagement with broader themes, often evident in global higher education policy developments. The research results were organized around major themes in three of the four contexts of the ‘policy trajectory’. Regarding the context of influences and the context of policy text production, themes relate to hegemony exercised by first world countries’ universities in the higher education field, its associated neoliberal ideology, with accountability and the discourse of continuous improvement, the local responses to those pressures, and the value of interdisciplinarity. Finally, regarding the context of policy practices and effects (enactment), themes emerged around the impacts of the curriculum changes on university staff, students, and resistance amongst academics. The research concluded with a few recommendations that potentially provide ‘food for thought’ beyond the localized settings of this study, as well as possibilities for further research.

Keywords: curriculum, global-local dynamics, higher education, policy, sociology of education

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Authors: J. H. Boonzaaier, A. C. Brent

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South Africa, a water scarce country, experiences the phenomenon that its life supporting natural water resources is seriously threatened by the users that are totally dependent on it. South Africa is globally applauded to have of the best and most progressive water laws and policies. There are however growing concerns regarding natural water resource quality deterioration and a critical void in the management of natural resources and compliance to policies due to increasing institutional uncertainties and failures. These are in accordance with concerns of many South African researchers and practitioners that call for a change in paradigm from talk to practice and a more constructive, practical approach to governance challenges in the management of water resources. A qualitative theory-building case study through longitudinal action research was conducted from 2014 to 2017. The research assessed whether a strategic positioned institutional agent can be parlayed to facilitate and execute WRM on catchment level by engaging multiple stakeholders in a polycentric setting. Through a critical realist approach a distinction was made between ex ante self-deterministic human behaviour in the realist realm, and ex post governance-management in the constructivist realm. A congruence analysis, including Toulmin’s method of argumentation analysis, was utilised. The study evaluated the unique case of a self-steering local water management institution, the Impala Water Users Association (WUA) in the Pongola River catchment in the northern part of the KwaZulu-Natal Province of South Africa. Exploiting prevailing water resource threats, it expanded its ancillary functions from 20,000 to 300,000 ha. Embarking on WRM activities, it addressed natural water system quality assessments, social awareness, knowledge support, and threats, such as: soil erosion, waste and effluent into water systems, coal mining, and water security dimensions; through structured engagement with 21 different catchment stakeholders. By implementing a proposed polycentric governance-management model on a catchment scale, the WUA achieved to fill the void. It developed a foundation and capacity to protect the resilience of the natural environment that is critical for freshwater resources to ensure long-term water security of the Pongola River basin. Further work is recommended on appropriate statutory delegations, mechanisms of sustainable funding, sufficient penetration of knowledge to local levels to catalyse behaviour change, incentivised support from professionals, back-to-back expansion of WUAs to alleviate scale and cost burdens, and the creation of catchment data monitoring and compilation centres.

Keywords: institutional agent, water governance, polycentric water resource management, water resource management

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