Search results for: educational assessment

Authors: Harley Bray, Helen Pymar, Michelle Liu, Chau Pham, Tomislav Jelic, Fran Mulhall

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Background: Our study assesses the impact of the COVID-19 pandemic on early pregnancy assessment clinic (EPAC) referrals and the use of virtual consultation in Winnipeg, Manitoba. Our clinic expanded to accept referrals from all Winnipeg Emergency Department (ED)/Urgent Care (UC) sites beginning November 2019 to April 2020. By May 2020, the COVID-19 pandemic reached Manitoba and EPAC virtual care was expanded by performing hCG remotely and reviewing blood and ED/UC ultrasound results by phone. Methods: Emergency Department Information Systems (EDIS) and EPAC data reviewed ED/UC visits for pregnancy <20 weeks and vaginal bleeding 1-year pre-COVID (March 12, 2019, to March 11, 2020) and during COVID (March 12, 2020 (first case in Manitoba) to March 11, 2021). Results: There were fewer patient visits for vaginal bleeding or pregnancy of <20 weeks (4264 vs. 5180), diagnoses of threatened abortion (1895 vs. 2283), and ectopic pregnancy (78 vs. 97) during COVID compared with pre-COVID, respectively. ICD 10 codes were missing in 849 (20%) and 1183 (23%) of patients during COVID and pre-COVID, respectively. Wait times for all patient visits improved during COVID-19 compared to pre-COVID (5.1 ± 4.4 hours vs. 5.5 ± 3.8 hours), more patients received obstetrical ultrasounds, 761 (18%) vs. 787 (15%), and fewer patients returned within 30 days (1360 (32%) vs. 1848 (36%); p<0.01). EPAC saw 708 patients (218; 31% new ED/UC) during COVID-19 compared to 552 (37; 7% new ED/UC) pre-COVID. Fewer operative interventions for pregnancy loss (346 vs. 456) and retained products (236 vs. 272) were noted. Surgeries to treat ectopic pregnancy (106 vs 113) remained stable during the study time interval. Conclusion: Accurate identification of pregnancy complications was difficult, with over 20% missing ICD-10 diagnostic codes. There were fewer ED/UC visits and surgical management for threatened abortion during COVID-19, but ectopic pregnancy operative management remained unchanged.

Keywords: early pregnancy, ultrasound, COVID-19, obstetrics

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Authors: Nesrin Demir, Betül Demirbağ

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In recent years, the type and content of bullying in schools changes together with technological development. Many studies attribute bullying movement to virtual platform to the widespread use of social media and internet. The main goal of this research is to determine if there is a correlation between subjective well-being as a popular conception of Positive Psychology and being cyber bully/victim. For this purpose, 287 students from various public high schools in Malatya have reached. As assessment tool, Cyber Bully/Victim Scale and Self Well Being Scale for Adolescents were used. Results were discussed in the relevant literature.

Keywords: cyber bully, cyber victim, school counseling, subjective well-being

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Authors: Abdou Elhendy

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Numerous study have shown the efficacy of the percutaneous intervention (PCI) and coronary stenting in improving left ventricular function and relieving exertional angina. Furthermore, PCI remains the main line of therapy in acute myocardial infarction. Improvement of procedural techniques and new devices have resulted in an increased number of PCI in those with difficult and extensive lesions, multivessel disease as well as total occlusion. Immediate and late outcome may be compromised by acute thrombosis or the development of fibro-intimal hyperplasia. In addition, progression of coronary artery disease proximal or distal to the stent as well as in non-stented arteries is not uncommon. As a result, complications can occur, such as acute myocardial infarction, worsened heart failure or recurrence of angina. In a stent, restenosis can occur without symptoms or with atypical complaints rendering the clinical diagnosis difficult. Routine invasive angiography is not appropriate as a follow up tool due to associated risk and cost and the limited functional assessment. Exercise and pharmacologic stress testing are increasingly used to evaluate the myocardial function, perfusion and adequacy of revascularization. Information obtained by these techniques provide important clues regarding presence and severity of compromise in myocardial blood flow. Stress echocardiography can be performed in conjunction with exercise or dobutamine infusion. The diagnostic accuracy has been moderate, but the results provide excellent prognostic stratification. Adding myocardial contrast agents can improve imaging quality and allows assessment of both function and perfusion. Stress radionuclide myocardial perfusion imaging is an alternative to evaluate these patients. The extent and severity of wall motion and perfusion abnormalities observed during exercise or pharmacologic stress are predictors of survival and risk of cardiac events. According to current guidelines, stress echocardiography and radionuclide imaging are considered to have appropriate indication among patients after PCI who have cardiac symptoms and those who underwent incomplete revascularization. Stress testing is not recommended in asymptomatic patients, particularly early after revascularization, Coronary CT angiography is increasingly used and provides high sensitive for the diagnosis of coronary artery stenosis. Average sensitivity and specificity for the diagnosis of in stent stenosis in pooled data are 79% and 81%, respectively. Limitations include blooming artifacts and low feasibility in patients with small stents or thick struts. Anatomical and functional cardiac imaging modalities are corner stone for the assessment of patients after PCI and provide salient diagnostic and prognostic information. Current imaging techniques cans serve as gate keeper for coronary angiography, thus limiting the risk of invasive procedures to those who are likely to benefit from subsequent revascularization. The determination of which modality to apply requires careful identification of merits and limitation of each technique as well as the unique characteristic of each individual patient.

Keywords: coronary artery disease, stress testing, cardiac imaging, restenosis

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Authors: C. Bejrananda, Y. Lee, T. Khamkaew

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With the rise of the importance of air transportation in the 21st century, the role of economics in airport planning and decision-making has become more important to the urban structure and land value around it. Therefore, this research aims to examine the relationship between an airport and its impacts on the distribution of urban land uses and land values by applying the Alonso’s bid rent model. The New Bangkok International Airport (Suvarnabhumi International Airport) was taken as a case study. The analysis was made over three different time periods of airport development (after the airport site was proposed, during airport construction, and after the opening of the airport). The statistical results confirm that Alonso’s model can be used to explain the impacts of the new airport only for the northeast quadrant of the airport, while proximity to the airport showed the inverse relationship with the land value of all six types of land use activities through three periods of time. It indicates that the land value for commercial land use is the most sensitive to the location of the airport or has the strongest requirement for accessibility to the airport compared to the residential and manufacturing land use. Also, the bid-rent gradients of the six types of land use activities have declined dramatically through the three time periods because of the Asian Financial Crisis in 1997. Therefore, the lesson learned from this research concerns about the reliability of the data used. The major concern involves the use of different areal units for assessing land value for different time periods between zone block (1995) and grid block (2002, 2009). As a result, this affect the investigation of the overall trends of land value assessment, which are not readily apparent. In addition, the next concern is the availability of the historical data. With the lack of collecting historical data for land value assessment by the government, some of data of land values and aerial photos are not available to cover the entire study area. Finally, the different formats of using aerial photos between hard-copy (1995) and digital photo (2002, 2009) made difficult for measuring distances. Therefore, these problems also affect the accuracy of the results of the statistical analyses.

Keywords: airport development area, economic rents, spatial pattern, suvarnabhumi international airport

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Authors: Daria Karasalihovic Sedlar, Lucija Jukic, Ivan Smajla, Marija Macenic

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This paper analyses possible geothermal energy production from a mature oil reservoir based on exploitation of underlying aquifer thermal energy for the purpose of heating public buildings. Research was conducted based on the case study of the City of Ivanic-Grad public buildings energy demand and Ivanic oil filed that is situated in the same area. Since the City of Ivanic is one of the few cities in the EU where hydrocarbon exploitation has been taking place for decades almost entirely in urban area, decommissioning of oil wells is inevitable; therefore, the research goal was to investigate how to extend the life-time of the reservoir by exploiting geothermal brine beneath the oil reservoir in an environmental friendly manner. This kind of a project is extremely complex in all segments, from documentation preparation, implementation of technological solutions, and providing ecological measures for environmentally acceptable geothermal energy production and utilization. New mining activities that will be needed for the development of geothermal project at the observed Hydrocarbon Exploitation Field Ivanic will be carried out in order to prepare wells for increasing geothermal brine production. These operations involve the conversion of existing wells (well completion for conversion of the observation wells to production ones) along with workover activities, installation of new heat exchangers, and pipelines. Since the wells are in the urban area of the City of Ivanic-Grad in high density populated area, the inhabitants will be exposed to the different environmental impacts during preparation phase of the project. For the purpose of performing workovers, it will be necessary to secure access to wellheads of existing wells. This paper gives guidelines for describing potential impacts on environment components that could occur during geothermal production preparation on existing mature oil filed, recommends possible protection measures to mitigate these impacts, and gives recommendations for environmental monitoring.

Keywords: geothermal energy production, mature oil filed, environmental impact assessment, underlying aquifer thermal energy

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Authors: Vijaya Subramaniam, Loh Soh Kheang, Astimar Abdul Aziz

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Water footprint (WFP) has gained importance due to the increase in water scarcity in the world. This study analyses the WFP for an agriculture sector, i.e., the oil palm supply chain, which produces oil palm fresh fruit bunch (FFB), crude palm oil, palm kernel, and crude palm kernel oil. The water accounting and vulnerability evaluation (WAVE) method was used. This method analyses the water depletion index (WDI) based on the local blue water scarcity. The main contribution towards the WFP at the plantation was the production of FFB from the crop itself at 0.23m³/tonne FFB. At the mill, the burden shifts to the water added during the process, which consists of the boiler and process water, which accounted for 6.91m³/tonne crude palm oil. There was a 33% reduction in the WFP when there was no dilution or water addition after the screw press at the mill. When allocation was performed, the WFP reduced by 42% as the burden was shared with the palm kernel and palm kernel shell. At the kernel crushing plant (KCP), the main contributor towards the WFP 4.96 m³/tonne crude palm kernel oil which came from the palm kernel which carried the burden from upstream followed by electricity, 0.33 m³/tonne crude palm kernel oil used for the process and 0.08 m³/tonne crude palm kernel oil for transportation of the palm kernel. A comparison was carried out for mills with biogas capture versus no biogas capture, and the WFP had no difference for both scenarios. The comparison when the KCPs operate in the proximity of mills as compared to those operating in the proximity of ports only gave a reduction of 6% for the WFP. Both these scenarios showed no difference and insignificant difference, which differed from previous life cycle assessment studies on the carbon footprint, which showed significant differences. This shows that findings change when only certain impact categories are focused on. It can be concluded that the impact from the water used by the oil palm tree is low due to the practice of no irrigation at the plantations and the high availability of water from rainfall in Malaysia. This reiterates the importance of planting oil palm trees in regions with high rainfall all year long, like the tropics. The milling stage had the most significant impact on the WFP. Mills should avoid dilution to reduce this impact.

Keywords: life cycle assessment, water footprint, crude palm oil, crude palm kernel oil, WAVE method

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Authors: Gokul Pathak, Dilip Kumar Yadav

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Background: Unsafe/unprotected and early sexual relations are highly responsible for the problems of unwanted pregnancy, child birth and other adverse consequences. Emergency contraception (EC) refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure or incorrect use. Aim and Objective: The objective of this research study was to assess the level of knowledge, attitude and behavior on emergency contraception among youth students of Lekhnath Municipality. Methodology: This institution based descriptive study was carried out in August-October 2012 on Lekhnath Municipality, Nepal. Multistage simple random sampling procedure with pretested semi structured questionnaire following self administered technique was used to collect information. Collected data was coded and entered in the EpiData 3.1 ® and exported to Statistical Package for Social Science (SPSS®) version 20.0 for analysis. Chi-square test and Spearman correlation was applied wherever required. Results: A total of 641 students (87.6 %), youth students participated in this study which incorporates 354 male and 287 female youth students, of them 54.3% were from Higher Secondary level and 45.7% were from Undergraduate level. The awareness of EC among respondents was found only 64.7%. 25.8% respondents were found to have fair knowledge level where as 74.2% had poor knowledge level. Level of knowledge was significantly associated with age, educational level, faculty and educational status of mother. The study showed 82.4% respondent’s favorable attitude towards use of EC. 21.1% respondents were found to be sexually active (29.7% male and 10.5% female) and only 28.1% of sexually active respondents had ever used any method of EC. Conclusion: Knowledge about EC was found quiet low among youth. There was significant lack of knowledge about exact time limit of using devices of EC. Similarly several misconceptions regarding EC were found very high among youth. Health education initiatives should target students as they are more likely to be sexually active.

Keywords: emergency contraception, youth, unsafe/unprotected sexual intercourse, knowledge, attitude and behavior

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Authors: Xiping Wang，Shuran Yao, Liqin Dai

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Many studies report the winter is getting warmer and the minimum air temperature is obviously rising as the important climate warming evidences. The exacerbated air temperature fluctuation tending to bring more severe weather variation is another important consequence of recent climate change which induced more disasters to crop growth in quite a certain regions. Hebei Province is an important winter wheat growing province in North of China that recently endures more winter freezing injury influencing the local winter wheat crop management. A winter wheat freezing injury assessment Bayesian Network framework was established for the objectives of estimating, assessing and predicting winter wheat freezing disasters in Hebei Province. In this framework, the freezing disasters was classified as three severity degrees (SI) among all the three types of freezing, i.e., freezing caused by severe cold in anytime in the winter, long extremely cold duration in the winter and freeze-after-thaw in early season after winter. The factors influencing winter wheat freezing SI include time of freezing occurrence, growth status of seedlings, soil moisture, winter wheat variety, the longitude of target region and, the most variable climate factors. The climate factors included in this framework are daily mean and range of air temperature, extreme minimum temperature and number of days during a severe cold weather process, the number of days with the temperature lower than the critical temperature values, accumulated negative temperature in a potential freezing event. The Bayesian Network model was evaluated using actual weather data and crop records at selected sites in Hebei Province using real data. With the multi-stage influences from the various factors, the forecast and assessment of the event-based target variables, freezing injury occurrence and its damage to winter wheat production, were shown better scoped by Bayesian Network model.

Keywords: bayesian networks, climatic change, freezing Injury, winter wheat

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Authors: Kinda AlSamara

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The nineteenth century was characterized by major educational reforms in the Arab World. One of the unintended outcomes of colonization in Arab countries was the initiation of women liberation as well as the introduction of modern education and its application in sensitizing people on the rights of women and their liberation. The reforms were often attributed to various undercurrents that took place at different levels within the Ottoman Empire, and particularly the arrival and influence of the Christian missionaries were supported by the American and European governments. These trends were also significantly attributed to the increase in the presence of Europeans in the region, as well as the introduction of secular ideas and approaches related to the meaning of modernity. Using literary analysis as a method, this paper examines the role of an important male figure like the political activist and writer Qāsim Amīn and the religious reformer Muḥammad ʻAbduh in starting this discourse and shows their impact on the emancipation of women movement (Taḥrīr), and how later women led the movement with their published work. This paper explores Arab Salons and the initiation of women’s literary circles. Women from wealthy families in Egypt and Syria who had studied in Europe or interacted with European counterparts began these circles. These salons acted as central locations where people could meet and hold discussions on political, social, and literary trends as they happened each day. The paper concludes with a discussion of current debates between the Islamist and the secularist branches of the movement today. While the Islamists believe that adhering to the core of Islam with some of its contested position on women is a modern ideology of liberation that fits the current culture of modern time Egypt; the secularists argue that the influence that Islam has on the women’s liberation movement in Egypt has been a threat to the natural success and progress of the movement, which was initiated in the early nineteenth century independent of the more recent trends towards religiosity in the country.

Keywords: educational model, crisis of terminologies, Arab awakening, nineteenth century

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Authors: Gulmira Umarova

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The data on the assessment of the influence of environmental risk to the health of the population of Uralsk in the West region of Kazakhstan were presented. Calculation of non-carcinogenic risks was performed for such air pollutants as sulfur dioxide, nitrogen oxides, hydrogen sulfide, carbon monoxide. Here with the critical organs and systems, which are affected by the above-mentioned substances were taken into account. As well as indicators of primary and general morbidity by classes of diseases among the population were considered. The quantitative risk of the influence of substances on organs and systems is established by results of the calculation.

Keywords: environment, health, morbidity, non-carcinogenic risk

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Authors: Martina Dickson, Hanadi Kadbey, Melissa Mcminn

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Research has shown that anxiety and trepidation towards learning about science is prevalent among elementary school teachers in Western countries. It has also been shown repeatedly that pre-service and in-service teachers who show signs of anxiety towards science are; a) less likely to teach it at all, where they have some autonomy over this, b) less likely to teach it effectively c) ultimately that their students have lower attainment scores in science. It is therefore critically important to gauge pre-service teachers’ science anxiety levels early on whilst there are still possibilities to overturn some of the reasons behind these fears and avert these serious issues occurring later on. This study takes place in the capital of the United Arab Emirates (U.A.E.) in the context of training local elementary school teachers. In the U.A.E., where Emirati teachers are already in the vast minority and attrition rates are high, it is important to offer as much support to pre-service teachers as possible. If pre-service teachers are graduating with high levels of science anxiety unabated, according to the research there is a very real concern that as generalist primary school teachers, their science teaching will be far from optimal. The aims of this research study were to ascertain the science anxiety levels of pre-service elementary teachers and to identify particular areas of their science anxiety, if appropriate. We surveyed 200 Emirati pre-service teachers and found that levels of science anxiety were directly related to their perceptions of performance in science exams, laboratory experiments and inquiry approaches to science learning. Whilst some studies have shown that science anxiety can decrease as students gain confidence in science knowledge by studying courses, we did not see this effect in our study. This is based upon a theoretical framework which holds that in some cases, science anxiety is related to lack of exposure to, or insecurity with science content itself which in some cases is alleviated by the students’ covering of material and greater confidence in the subject. Exploring this variable allowed us to explore whether students educated in schools influenced by the educational reform in Abu Dhabi have differing science anxiety levels from those who were educated prior to the reforms. We discuss the possible implications of these findings to the future teaching of science in Abu Dhabi public schools.

Keywords: pre-service teachers, science anxiety, United Arab Emirates, educational reform

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Authors: Hsin-Chieh Lee, Fen-Ling Kuo, Jui-Chi Lin

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Background: Upper extremity functional impairment that occurs after stroke includes hemiplegia, synergy movement, muscle hypertonicity, and somatosensory impairment, which result in inefficient and inaccurate movement. Robot-assisted rehabilitation is an intensive training approach that is effective in sensorimotor and hand function recovery. However, these systems mostly focused on the proximal part of the upper limb rather than the distal part. The device used in our study was Gloreha Sinfonia, which focuses on the distal part of the upper limb and uses a dynamic support system to facilitate the whole limb function. The objective of this study was to investigate the effects of robot-assisted therapy (RT) with Gloreha device on sensorimotor, and ADLs in patients with stroke. Method: Patients with stroke (N=25) participated AB or BA (A = 12 RT sessions and B = 12 conventional therapy (CT) sessions) for 6 weeks (60 min at each session, twice a week), with 1-month break for washout period. The performance of the patients was assessed by a blinded assessor at 4 time points (pretest 1, posttest 1, pretest 2, posttest 2) which including the Fugl–Meyer Assessment-upper extremity (FMA-UE), box and block test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, a grip dynamometer for motor evaluation; Semmes–Weinstein hand monofilament and Revision of the Nottingham Sensory Assessment for sensory evaluation; and the Modified Barthel Index (MBI) for assessing the ADL ability. Result: RT group significantly improved FMA-UE proximal scores (p = 0.038), FMA-UE total scores (p = 0.046), and MBI (p = 0.030). The EDC exhibited higher efficiency during the small block grasping task in the RT group than in the CT group (p = 0.050). Conclusions: RT with the Gloreha device might lead to beneficial effects on arm motor function, ADL ability, and EDC muscle recruitment efficacy in patients with subacute to chronic stroke.

Keywords: activities of daily living, hand function, robotic rehabilitation, stroke

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Authors: David N. Prihoda

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This paper charts the history of the English word Tempest from its origins in Proto-Indo European to its modern usage as a term for storms, both literal and metaphorical. It does so by way of considering the word’s morphology, semiotics, and phonetics. It references numerous language studies and dictionaries to chronicle the word’s many steps along that path, from demarcation of measurement to assessment of time, all the way to an observation about the weather or the human psyche. The conclusive findings show that tempest has undergone numerous changes throughout its history, and these changes interestingly parallel its connotations as a symbol for both chaotic weather and the chaos of the human spirit

Keywords: Tempest, etymology, language origins, English

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Authors: Carolina S. Monteiro, Eugénia Pinto, Miguel A. Faria, Sara C. Cunha

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About half of the world's population eats rice daily, making it the primary food source for billions of people. Besides its nutrition potential, rice can be a significant route of exposure to many contaminants. Mycotoxins are an example of such contaminants that can be present in rice. Among them, ochratoxin (OTA), citrinin (CIT), and zearalenone (ZEN) are frequently reported in rice. During digestion, only a fraction of mycotoxins from food can be absorbed (bioaccessible fraction), influencing their ability to cause toxic effects. Insufficient knowledge of the bioavailability of mycotoxins, alone and in combination, may hinder an accurate risk assessment of contaminants ingested by humans. In this context, two different rice (Oryza sativa) varieties, Carolino white and Carolino brown, both with and without turmeric, were boiled and individually spiked with OTA, CIT, and ZEN plus with its combination. Subsequently, samples were submitted to the INFOGEST harmonized in vitro digestion protocol to evaluate the bioaccessibility of mycotoxins. Afterward, the in vitro intestinal transport of the mycotoxins, both alone and in combination, was evaluated in digests of Carolino white rice with and without turmeric. Assays were performed with a monolayers of of Caco-2 and HT-29 cells. Bioaccessibility of OTA and ZEN, alone and in combination, were similar in Carolino white and brown rice with or without turmeric. For CIT, when Carolino white rice was used, the bioaccessibility was higher alone than in combination (62.00% vs. 25.00%, without turmeric; 87.56% vs. 53.87%, with turmeric); however, with Carolino brown rice was the opposite (66.38% vs. 75.20%, without turmeric; 43.89% vs. 59.44%, with turmeric). All the mycotoxins, isolated, reached the higher bioaccessibility in the Carolino white rice with turmeric (CIT: 87.56%; OTA: 59.24%; ZEN: 58.05%). When mycotoxins are co-present, the higher bioaccessibility of each one varies with the type of rice. In general, when turmeric is present, bioaccessibility increases, except for CIT, using Carolino brown rice. Concerning the intestinal absorption in vitro, after 3 hours of transport, all mycotoxins were detected in the basolateral compartment being thus transported through the cells monolayer. ZEN presented the highest fraction absorbed isolated and combined, followed by CIT and OTA. These findings highlight that the presence of other components in the complex dietary matrix, like turmeric, and the co-presence of mycotoxins can affect its final bioavailability with obvious implications for health risk. This work provides new insights to qualitatively and quantitatively describe mycotoxin in rice fate during human digestion and intestinal absorption and further contribute to better risk assessment.

Keywords: bioaccessibility, digestion, intestinal absorption, mycotoxins

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Authors: Esther Friedlander, Philip Friedlander

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The use of immunotherapy that inhibits programmed death-1 (PD-1) or its ligand PD-L1 confers survival benefits in patients with non-small cell lung cancer (NSCLC). However, approximately 45% of patients experience primary treatment resistance, necessitating the development of strategies to improve efficacy. While the renin-angiotensin system (RAS) has systemic hemodynamic effects, tissue-specific regulation exists along with modulation of immune activity in part through regulation of myeloid cell activity, leading to the hypothesis that RAS inhibition may improve anti-PD-1/L-1 efficacy. A retrospective analysis was conducted that included 173 advanced solid tumor cancer patients treated at Valley Hospital, a community Hospital in New Jersey, USA, who were treated with a PD-1/L-1 inhibitor in a defined time period showing a statistically significant relationship between RAS pathway inhibition (RASi through concomitant treatment with an ACE inhibitor or angiotensin receptor blocker) and positive efficacy to the immunotherapy that was independent of age, gender and cancer type. Subset analysis revealed strong numerical benefit for efficacy in both patients with squamous and nonsquamous NSCLC as determined by documented clinician assessment of efficacy and by duration of therapy. A PUBMED literature search was now conducted to identify studies assessing the effect of RAS pathway inhibition on anti-PD-1/L1 efficacy in advanced solid tumor patients and compare these findings to those seen in the Valley Hospital retrospective study with a focus on NSCLC specifically. A total of 11 articles were identified assessing the effects of RAS pathway inhibition on the efficacy of checkpoint inhibitor immunotherapy in advanced cancer patients. Of the 11 studies, 10 assessed the effect on survival of RASi in the context of treatment with anti-PD-1/PD-L1, while one assessed the effect on CTLA-4 inhibition. Eight of the studies included patients with NSCLC, while the remaining 2 were specific to genitourinary malignancies. Of the 8 studies, two were specific to NSCLC patients, with the remaining 6 studies including a range of cancer types, of which NSCLC was one. Of these 6 studies, only 2 reported specific survival data for the NSCLC subpopulation. Patient characteristics, multivariate analysis data and efficacy data seen in the 2 NSLCLC specific studies and in the 2 basket studies, which provided data on the NSCLC subpopulation, were compared to that seen in the Valley Hospital retrospective study supporting a broader effect of RASi on anti-PD-1/L1 efficacy in advanced NSLCLC with the majority of studies showing statistically significant benefit or strong statistical trends but with one study demonstrating worsened outcomes. This comparison of studies extends published findings to the community hospital setting and supports prospective assessment through randomized clinical trials of efficacy in NSCLC patients with pharmacodynamic components to determine the effect on immune cell activity in tumors and on the composition of the tumor microenvironment.

Keywords: immunotherapy, cancer, angiotensin, efficacy, PD-1, lung cancer, NSCLC

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Authors: Jolanta Uszko, Tomasz Wloch, Aneta Pirowska, Roman Nowobilski

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Introduction: Phantom phenomena are often reported by subjects who have undergone limb amputation. Mostly, patients feel the amputated part of the limb as if it was still attached to the body. Two types of phantom phenomena: painless (phantom sensation) and painful (phantom pain) were described. Triggers of phantom sensations and phantom pain, as well as fully effective treatment, have not been clearly described yet. Purpose: To assess the influence of psychosocial factors and some clinical conditions on the occurrence of phantom phenomena in amputee athletes. Subjects: 21 men (age: 31 years, SD = 7.5 years) after lower or upper extremity amputation, who regularly performed high-intensity sports (Amp Football Team Players) were included to the study. Method and equipment: In the research, the following method and tools were used: Questionnaire [Pirowska] adapted for athletes with disabilities, Numerical Rating Scale (NRS) - for phantom pain assessment, McGill Pain Assessment Questionnaire (short version), Beck's Depression Inventory (BDI), State Trait Anxiety Inventory (STAI): X-1 and X-2, shortened version of The World Health Organization Quality of Life (WHOQOLBREFF). Results: In the study group, the lower leg amputations with traumatic etiology were predominant. Phantom sensations were present in all subjects. Half of the respondents claimed to experience phantom sensations at least once a day, paroxysmally. There was a prevalence of phantom sensations characterized as incomplete, immobile limb. Phantom pain was reported by over 85% of respondents. The nature of phantom pain was frequently described as stabbing, squeezing, shooting, pulsing, tiring. There was a significant correlation between phantom pain intensity and anxiety, quality of life, depressive tendencies, perception of phantom pain as the obstacle in daily functioning and intensity of the limb pain before amputation. Conclusions: The etiology of phantom phenomena is complex. Psychological factors seem to have a significant influence on the intensity of the phantom pain. Particular attention should be paid to patients who complain about persistent limb pain before the amputation. These are patients with an increased risk of the phantom pain of relatively high intensity.

Keywords: amputation, phantom pain, phantom sensations, adaptive sports

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Authors: Kottaridi Klimentia, Demopoulos Vasilis, Sidiropoulos Anastasios, Ihara Diego, Nikolaidis Vasileios, Antonopoulos Dimitrios

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Aflatoxins are highly poisonous and carcinogenic compounds produced by species of the genus Aspergillus spp. that can infect a variety of agricultural foods, including dried figs. Biological and environmental factors, such as population, pathogenicity, and aflatoxinogenic capacity of the strains, topography, soil, and climate parameters of the fig orchards, are believed to have a strong effect on aflatoxin levels. Existing methods for aflatoxin detection and measurement, such as high performance liquid chromatography (HPLC), and enzyme-linked immunosorbent assay (ELISA), can provide accurate results, but the procedures are usually time-consuming, sample-destructive, and expensive. Predicting aflatoxin levels prior to crop harvest is useful for minimizing the health and financial impact of a contaminated crop. Consequently, there is interest in developing a tool that predicts aflatoxin levels based on topography and soil analysis data of fig orchards. This paper describes the development of a risk assessment tool for the contamination of aflatoxin on dried figs, based on the location and altitude of the fig orchards, the population of the fungus Aspergillus spp. in the soil, and soil parameters such as pH, saturation percentage (SP), electrical conductivity (EC), organic matter, particle size analysis (sand, silt, clay), the concentration of the exchangeable cations (Ca, Mg, K, Na), extractable P, and trace of elements (B, Fe, Mn, Zn and Cu), by employing machine learning methods. In particular, our proposed method integrates three machine learning techniques, i.e., dimensionality reduction on the original dataset (principal component analysis), metric learning (Mahalanobis metric for clustering), and k-nearest neighbors learning algorithm (KNN), into an enhanced model, with mean performance equal to 85% by terms of the Pearson correlation coefficient (PCC) between observed and predicted values.

Keywords: aflatoxins, Aspergillus spp., dried figs, k-nearest neighbors, machine learning, prediction

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Authors: Gadah Alkeniah

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Leadership is acknowledged internationally as fundamental to school efficiency and school enhancement nevertheless there are various understandings of what leadership is and how it is realised in practice. There are a number of educational leadership models that are considered important. However, the present study uses a systematic review method to examine and compare five models of the most well-known contemporary models of leadership as well as introduces the dimension of each model. Our results reveal that recently the distributed leadership has grown in popularity within the field of education. The study concludes by suggesting future directions in leadership development and education research.

Keywords: distributed leadership, instructional leadership, leadership models, moral leadership, strategic leadership, transformational leadership

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Authors: Priscilla Echeverria

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For us grown up in neoliberal societies, it is not always clear that we have not only incorporated an economic logic into our subjectivities, but a technical reason, an instrumental way of relationship with the environment inspired in a control interest that constantly dehumanizes us as takes away our capacity of action, becoming mere objects or bureaucrats, stripped of our citizen dimension to participate in social and political issues responsibly and creatively. To restore the capacity of action -agency- is urgent in our societies to strengthen better democracies. On this, the formal educational system plays a crucial role, which in turn needs teachers prepared to understand their role as integral educators instead of mere curriculum managers. For this reason, initial teacher formation (ITF) programs must assume the responsibility of helping them to develop an ethical/political/epistemic pedagogical agency to deal with a technical school culture and, in turn, able to relate to their students in democratic ways to help them to develop their agency capacities. By highlighting a perspective of education as the opposite of technocracy and bureaucracy, this talk precisely addresses ITF as a crucial and formative space to restore a perspective of what a critical education can look like, enabling pedagogy students with pedagogical agency capacities to, in turn, allow their future students to develop it. This discussion is part of my doctoral research, "The importance of developing the capacity for ethical-political-epistemic agency in novice teachers during initial teacher formation to contribute to social justice", which I currently develop in the Educational Research program of the University of Lancaster, United Kingdom, as a Conicyt fellow for the 2019 cohort. This presentation specifically offers preliminary results of the analysis of critical incidents as a research methodological tool to analyse the capacity of pedagogical agency deployed by novice teachers in their first pedagogical experiences in the Chilean context.

Keywords: initial teacher formation, pedagogical agency, pedagogical interaction, hidden curriculum, critical pedagogy, social justice

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Authors: Jeffrey R. Mueller

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This paper expands on the role of the professor by detailing the origins of the profession, adding some of the unique contributions of North American Universities, as well as some of the best practice recommendations, to the unique tripartite role of the professor. It describes current challenges to the profession including the ever-controversial student rating of professors. It continues with the significance of empowerment to the role of the professor. It concludes with a predictive prescription for the future of the professoriate and the role of the university-level educational administrator toward that end.

Keywords: professoriate history, tripartite role, challenges, empowerment, shared governance, administratization

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Authors: Thomas Ruppert, Shana Jones, J. Scott Pippin

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State and federal government agencies within the United States have recently invested substantial resources into studies of future flood risk conditions associated with climate change and sea-level rise. A review of numerous case studies has uncovered several key themes that speak to an overall incoherence within current flood risk assessment procedures in the U.S. context. First, there are substantial local differences in the quality of available information about basic infrastructure, particularly with regard to local stormwater features and essential facilities that are fundamental components of effective flood hazard planning and mitigation. Second, there can be substantial mismatch between regulatory Flood Insurance Rate Maps (FIRMs) as produced by the National Flood Insurance Program (NFIP) and other 'current condition' flood assessment approaches. This is of particular concern in areas where FIRMs already seem to underestimate extant flood risk, which can only be expected to become a greater concern if future FIRMs do not appropriately account for changing climate conditions. Moreover, while there are incentives within the NFIP’s Community Rating System (CRS) to develop enhanced assessments that include future flood risk projections from climate change, the incentive structures seem to have counterintuitive implications that would tend to promote moral hazard. In particular, a technical finding of higher future risk seems to make it easier for a community to qualify for flood insurance savings, with much of these prospective savings applied to individual properties that have the most physical risk of flooding. However, there is at least some case study evidence to indicate that recognition of these issues is prompting broader discussion about the need to move beyond FIRMs as a standalone local flood planning standard. The paper concludes with approaches for developing climate adaptation and flood resilience strategies in the U.S. that move away from the social welfare model being applied through NFIP and toward more of an informed risk approach that transfers much of the investment responsibility over to individual private property owners.

Keywords: climate change adaptation, flood risk, moral hazard, sea-level rise

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Authors: Larissa Bolliger, Junoš Lukan, Mitja Lustrek, Dirk De Bacquer, Els Clays

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Introduction and Aim: Chronic workplace stress and its health-related consequences like mental and cardiovascular diseases have been widely investigated. This project focuses on the sources and context of psychosocial daily workplace stress in a real-world setting. The main objective is to analyze and model real-time relationships between (1) psychosocial stress experiences within the natural work environment, (2) micro-level work activities and events, and (3) physiological signals and behaviors in office workers. Methods: An Ecological Momentary Assessment (EMA) protocol has been developed, partly building on machine learning techniques. Empatica® wristbands will be used for real-life detection of stress from physiological signals; micro-level activities and events at work will be based on smartphone registrations, further processed according to an automated computer algorithm. A field study including 100 office-based workers with high-level problem-solving tasks like managers and researchers will be implemented in Slovenia and Belgium (50 in each country). Data mining and state-of-the-art statistical methods – mainly multilevel statistical modelling for repeated data – will be used. Expected Results and Impact: The project findings will provide novel contributions to the field of occupational health research. While traditional assessments provide information about global perceived state of chronic stress exposure, the EMA approach is expected to bring new insights about daily fluctuating work stress experiences, especially micro-level events and activities at work that induce acute physiological stress responses. The project is therefore likely to generate further evidence on relevant stressors in a real-time working environment and hence make it possible to advise on workplace procedures and policies for reducing stress.

Keywords: ecological momentary assessment, real-time, stress, work

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Authors: Majda Ibrahim Aljaroudi, Jwaher Alburake

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The study aimed to identify the active role of the teacher in the management of the effective classroom environment for high school students from the viewpoint of the teachers, and to identify whether there were statistically significant differences between the averages of the respondents regarding the active role of the high school teachers in managing effective classroom environment in Riyadh, and also the total score depending on the variables of the study (qualifications, years of experience, training and development programs). This study used the descriptive survey approach where a questionnaire has been built and consisted of (35) items about five areas as a tool to measure the teacher's role in the management of effective classroom environment for high school students. The study population consisted of (1313) high school teachers in the government schools in south of Riyadh. It consisted of (70) teachers who were selected randomly. It used the appropriate statistical methods to analyze data by using statistical packages (SPSS). The study found the following results: • Most of the study sample members agreed on their role in the effective classroom environment management for high school students in government schools in Riyadh with an average (3.91 out of 5), which falls in the fifth category of Quintet scale (from 3.41 to 4.20) that refers to the option "often". • There are statistically significant differences between the mean responses of the study sample about the active role of the teacher in the effective classroom environment management for high school students regarding the concept of order in the classroom depending on the variable of years of experience for the benefit of teachers who have over 10 years of experience. There are statistically significant differences between the mean responses of the study sample about the teacher's active role in the effective classroom environment management for high school students regarding the educational process for maintaining the order in the classroom depending on the variable of training and development programs for the benefit of the teachers who have more than (5) courses. Due to the results of the study the researcher recommended a number of recommendations to improve the teacher's role in the effective classroom environment management for high school students.

Keywords: effective management, active learning, educational sciences, pedagogical sciences

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Authors: M. Zareh, H. Mohammadi, B. Naser

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Atherosclerotic plaque rupture is the main trigger of heart attack and brain stroke which are the leading cause of death in developed countries. Better understanding of rupture-prone plaque can help clinicians detect vulnerable plaques- rupture prone or instable plaques- and apply immediate medical treatment to prevent these life-threatening cardiovascular events. Therefore, there are plenty of studies addressing disclosure of vulnerable plaques properties. Necrotic core and fibrous tissue are two major tissues constituting atherosclerotic plaque; using histopathological and numerical approaches, many studies have demonstrated that plaque rupture is strongly associated with a large necrotic core and a thin fibrous cap, two morphological characteristic which can be acquired by two-dimensional imaging of atherosclerotic plaque present in coronary and carotid arteries. Plaque rupture is widely considered as a mechanical failure inside plaque tissue; this failure occurs when the stress within plaque excesses the strength of tissue material; hence, finite element method, a strong numerical approach, has been extensively applied to estimate stress distribution within plaques with different compositions which is then used for assessment of various vulnerability characteristics including plaque morphology, material properties and blood pressure. This study aims to evaluate significance of three-dimensional morphology on vulnerability degree of atherosclerotic plaque. To reach this end, different two-dimensional geometrical models of atherosclerotic plaques are considered based on available data and named Main 2D Models (M2M). Then, for each of these M2Ms, two three-dimensional idealistic models are created. These two 3D models represent two possible three-dimensional morphologies which might exist for a plaque with similar 2D morphology to one of M2Ms. Finite element method is employed to estimate stress, von-Mises stress, within each 3D models. Results indicate that for each M2Ms stress can significantly varies due to possible 3D morphological changes in that plaque. Also, our results show that an atherosclerotic plaque with thick cap may experience rupture if it has a critical 3D morphology. This study highlights the effect of 3D geometry of plaque on its instability degree and suggests that 3D morphology of plaque might be necessary to more effectively and accurately assess atherosclerotic plaque vulnerability.

Keywords: atherosclerotic plaque, plaque rupture, finite element method, 3D model

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Authors: Selim M. Khan

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Indoor air quality is strongly influenced by the presence of radioactive radon (222Rn) gas. Indeed, exposure to high 222Rn concentrations is unequivocally linked to DNA damage and lung cancer and is a worsening issue in North American and European built environments, having increased over time within newer housing stocks as a function of as yet unclear variables. Indoor air radon concentration can be influenced by a wide range of environmental, structural, and behavioral factors. As some of these factors are quantitative while others are qualitative, no single statistical model can determine indoor radon level precisely while simultaneously considering all these variables across a complex and highly diverse dataset. The ability of AI- machine (deep) learning to simultaneously analyze multiple quantitative and qualitative features makes it suitable to predict radon with a high degree of precision. Using Canadian and Swedish long-term indoor air radon exposure data, we are using artificial deep neural network models with random weights and polynomial statistical models in MATLAB to assess and predict radon health risk to human as a function of geospatial, human behavioral, and built environmental metrics. Our initial artificial neural network with random weights model run by sigmoid activation tested different combinations of variables and showed the highest prediction accuracy (>96%) within the reasonable iterations. Here, we present details of these emerging methods and discuss strengths and weaknesses compared to the traditional artificial neural network and statistical methods commonly used to predict indoor air quality in different countries. We propose an artificial deep neural network with random weights as a highly effective method for assessing and predicting indoor radon.

Keywords: radon, radiation protection, lung cancer, aI-machine deep learnng, risk assessment, risk prediction, Europe, North America

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Authors: Cláudia Alcoforado, Anabela Ribeiro

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This paper is part of an ongoing PhD thesis. It seeks to develop a model to identify the spatial failures of the public transportation supply. In the construction of the model, it also seeks to detect the social needs arising from the disadvantage in transport. The case study is carried out for the Brazilian city of Recife. Currently, Recife has a population density of 7,039.64 inhabitants per km². Unfortunately, only 46.9% of urban households on public roads have adequate urbanization. Allied to this reality, the trend of the occupation of the poorest population is that of the peripheries, a fact that has been consolidated in Brazil and Latin America, thus burdening the families' income, since the greater the distances covered for the basic activities and consequently also the transport costs. In this way, there have been great impacts caused by the supply of public transportation to locations with low demand or lack of urban infrastructure. The model under construction uses methods such as Currie’s Gap Assessment associated with the London’s Public Transport Access Level, and the Public Transport Accessibility Index developed by Saghapour. It is intended to present the stage of the thesis with the spatial/need gaps of the neighborhoods of Recife already detected. The benefits of the geographic information system are used in this paper. It should be noted that gaps are determined from the transport supply indices. In this case, considering the presence of walking catchment areas. Still in relation to the detection of gaps, the relevant demand index is also determined. This, in turn, is calculated through indicators that reflect social needs. With the use of the smaller Brazilian geographical unit, the census sector, the model with the inclusion of population density in the study areas should present more consolidated results. Based on the results achieved, an analysis of transportation disadvantage will be carried out as a factor of social exclusion in the study area. It is anticipated that the results obtained up to the present moment, already indicate a strong trend of public transportation in areas of higher income classes, leading to the understanding that the most disadvantaged population migrates to those neighborhoods in search of employment.

Keywords: gap assessment, public transport supply, social exclusion, spatial gaps

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Authors: Shelley Y. Hawkins

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Introduction/Background: As technology has grown exponentially in healthcare, nurse educators must prepare Advanced Practice Registered Nurse (APRN) graduates with the knowledge and skills in information systems/technology to support and improve patient care and health care systems. APRN’s are expected to lead in caring for populations who lack accessibility and availability through the use of technology, specifically telehealth. The capacity to effectively and efficiently use technology in patient care delivery is clearly delineated in the American Association of Colleges of Nursing (AACN) Doctor of Nursing Practice (DNP) and Master of Science in Nursing (MSN) Essentials. However, APRN’s have minimal, or no, exposure to formalized telehealth education and lack necessary technical skills needed to incorporate telehealth into their patient care. APRN’s must successfully master the technology using telehealth/telemedicine, electronic health records, health information technology, and clinical decision support systems to advance health. Furthermore, APRN’s must be prepared to lead the coordination and collaboration with other healthcare providers in their use and application. Aim/Goal/Purpose: The purpose of this presentation is to establish and operationalize telehealth-focused educational partnerships between one University School of Nursing and two health care systems in order to enhance the preparation of APRN NP students for practice, teaching, and/or scholarly endeavors. Methods: The proposed project was initially presented by the project director to selected multidisciplinary stakeholders including leadership, home telehealth personnel, primary care providers, and decision support systems within two major health care systems to garner their support for acceptance and implementation. Concurrently, backing was obtained from key university-affiliated colleagues including the Director of Simulation and Innovative Learning Lab and Coordinator of the Health Care Informatics Program. Technology experts skilled in design and production in web applications and electronic modules were secured from two local based technology companies. Results: Two telehealth-focused APRN Program academic/practice partnerships have been established. Students have opportunities to engage in clinically based telehealth experiences focused on: (1) providing patient care while incorporating various technology with a specific emphasis on telehealth; (2) conducting research and/or evidence-based practice projects in order to further develop the scientific foundation regarding incorporation of telehealth with patient care; and (3) participating in the production of patient-level educational materials related to specific topical areas. Conclusions: Evidence-based APRN student telehealth clinical experiences will assist in preparing graduates who can effectively incorporate telehealth into their clinical practice. Greater access for diverse populations will be available as a result of the telehealth service model as well as better care and better outcomes at lower costs. Furthermore, APRN’s will provide the necessary leadership and coordination through interprofessional practice by transforming health care through new innovative care models using information systems and technology.

Keywords: academic/practice partnerships, advanced practice nursing, nursing education, telehealth

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Authors: Mustafa Gulsen, Nihan Pekyavas, Emine Atıcı

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Purpose: The aim of this study is to investigate the effects of Kinesio taping on postural stability and in young soccer players. Subjects and Methods: 62 volunteered soccer players from Cayyolu Sports Club were included in our study. Permissions were also taken from the club directors about the inclusion of their players to our study. Soccer players between the age of 12 and 16 were included in our study. Players that had previous injury on lower extremities were excluded from the study. Players were randomly divided into two groups: Kinesio taping (KT) (n=31), and control group (n = 31). KT application including gastrocnemius and quadriceps femoris muscle facilitation techniques were applied to the first group. A rest time for 45 minutes was given in order to see the best effectiveness of the tape. The second group was set as the control group and no application was made. All participants were assessed before the application and 45 minutes later. In order to provide the double-blind design of the study, an experienced physiotherapist has done the assessments and another experienced physiotherapist has done the taping. The patients were randomly assigned to one of the two groups using an online random allocation software program. Postural stability was assessed by using Tetrax Interactive Balance System. Thermographic assessment was done by using FLIR E5 (FLIR Systems AB, Sweden) thermal camera in order to see which muscles have the most thermal activity while maintaining postural stability. Results: Statistically significant differences were found in all assessment parameters in both Kinesio Taping and control groups (all p<0.05) except thermal imaging of dominant gastrocnemius muscle results (p=0.668) (Table 1). In comparison of the two groups, statistically significant differences were found in all parameters (all p<0.05). Conclusion: In this study, we investigated the effects of Kinesio taping on postural stability in young soccer players and found that KT application on Quadriceps and Gastrocnemius muscles may have decreased the risk of falling more than the control group. According to thermal imaging assessments, both Quadriceps and Gastrocnemius muscles may be active in maintaining postural stability but in KT group, the temperature of these muscles are higher which leads us to think that they are more activated.

Keywords: Kinesio taping, fall risk, muscle temperature, postural stability

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Authors: Helga Mayr

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In our ongoing effort to address urgent global challenges related to sustainability, higher education institutions play a central role in raising a generation of informed and empowered citizens committed to sustainable development. This paper presents the preliminary results of the so far realized evaluation of a compulsory module on education for sustainable development (ESD) offered to students in the bachelor's program in elementary education at the University College of Teacher Education Tyrol (PH Tirol), Austria. The module includes a lecture on sustainability and education as well as a project-based seminar that aims to foster a deep understanding of ESD and its application in pedagogical practice. The study examines various dimensions related to the module's impact on participating students, focusing on prevalent sustainability concepts, intentions, actions, general and sustainability-related self-efficacy, perceived competence related to ESD, and ESD-related self-efficacy. In addition, the research addresses assessment of the learning process. To obtain a comprehensive overview of the effectiveness of the module, a mixed methods approach was/is used in the evaluation. Quantitative data was/is collected through surveys and self-assessment instruments, while qualitative findings were/will be obtained through focus group interviews and reflective analysis. The PH Tirol is collaborating with another University College of Teacher Education (Styria) and a university of applied sciences in Switzerland (UAS of the Grisons) to broaden the scope of the analysis and allow for comparative findings. Preliminary results indicate that students have a relatively rudimentary understanding of sustainability. The extent to which completion of the module influences understanding of sustainability, awareness, intentions, and actions, as well as self-efficacy, is currently under investigation. The results will be available at the time of the conference and will be presented there. In terms of learning, the project-based seminar, which promotes hands-on engagement with ESD, was evaluated for its effectiveness in fostering key sustainability competencies as well as sustainability-related and ESD-related self-efficacy. The research not only provides insights into the effectiveness of the compulsory module ESD at the PH Tirol but also contributes to the broader discourse on integrating ESD into teacher education.

Keywords: education for sustainable development, teacher education, project-based learning, effectiveness measurements

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Authors: Sylvie Studente

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Despite the increase in international students migrating to the UK, the transition from home environment to a host institution abroad can be overwhelming for many students due to acculturative stressors. These stressors are reported to peak within the first six months of transitioning into study abroad which has determinantal impacts for Higher Education Institutions. These impacts include; increased drop-out rates and overall decreases in academic performance. Research suggests that belongingness can negate acculturative stressors through providing opportunities for students to form necessary social connections. In response to this universities have focussed on utilising technology to create learning communities with the most commonly deployed being social media, blogs, and discussion forums. Despite these attempts, the application of technology in supporting international students is still ambiguous. With the reported growing popularity of mobile devices among students and accelerations in learning technology owing to the COVID-19 pandemic, the potential is recognised to address this challenge via the use of chatbot technology. Whilst traditionally, chatbots were deployed as conversational agents in business domains, they have since been applied to the field of education. Within this emerging area of research, a gap exists in addressing the educational value of chatbots over and above the traditional service orientation categorisation. The proposed study seeks to extend upon current understandings by investigating the challenges faced by international students in studying abroad and exploring the potential of chatbots as a solution to assist students’ acculturation. There has been growing interest in the application of chatbot technology to education accelerated by the shift to online learning during the COVID-19 pandemic. Although interest in educational chatbots has surged, there is a lack of consistency in the research area in terms of guidance on the design to support international students in HE. This gap is widened when considering the additional challenge of supporting multicultural international students with diverse. Diversification in education is rising due to increases in migration trends for international study. As global opportunities for education increase, so does the need for multiculturally inclusive learning support.

Keywords: chatbots, education, international students, acculturation

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