Search results for: foreign member of the board

Authors: Lauren G. Coggins

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Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are among the most common healthcare-associated infections (HAI), contributing to prolonged lengths of stay, greater costs of patient care, and increased patient mortality. Evidence-based preventative care bundles exist to establish consistent, safe patient-care practices throughout an entire organization, helping to ensure the collective application of care strategies that aim to improve patient outcomes and minimize complications. The cardiac intensive care unit at a nationally ranked teaching and research hospital in the United States exceeded its annual CAUTI and CLABSI targets in the fiscal year 2019, prompting examination into the unit’s infection prevention efforts that included preventative care bundles for both HAIs. Adherence to the CAUTI and CLABSI preventative care bundles was evaluated through frequent audits conducted over three months, using standards and resources from The Joint Commission, a globally recognized leader in quality improvement in healthcare and patient care safety. The bundle elements with the lowest scores were identified as the most commonly missed elements. Three elements from both bundles, six elements in total, served as key content areas for the educational interventions targeted to bedside nurses. The CAUTI elements included appropriate urinary catheter order, appropriate continuation criteria, and urinary catheter care. The CLABSI elements included primary tubing compliance, needleless connector compliance, and dressing change compliance. An integrated, multi-platform education campaign featured content on each CAUTI and CLABSI preventative care bundle in its entirety, with additional reinforcement focused on the lowest scoring elements. One-on-one educational materials included an informational pamphlet, badge buddy, a presentation to reinforce nursing care standards, and real-time application through case studies and electronic health record demonstrations. A digital hub was developed on the hospital’s Intranet for quick access to unit resources, and a bulletin board helped track the number of days since the last CAUTI and CLABSI incident. Audits continued to be conducted throughout the education campaign, and staff were given real-time feedback to address any gaps in adherence. Nearly every nurse in the cardiac intensive care unit received all educational materials, and adherence to all six key bundle elements increased after the implementation of educational interventions. Recommendations from this implementation include providing consistent, comprehensive education across multiple teaching tools and regular audits to track adherence. The multi-platform education campaign brought focus to the evidence-based CAUTI and CLABSI bundles, which in turn will help to reduce CAUTI and CLABSI rates in clinical practice.

Keywords: education, healthcare-associated infections, infection, nursing, prevention

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Authors: Jonathan D. Recchi

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Introduction: Workplace violence is a major concern for nurses throughout the United States and is a rising occupational health hazard that has been exacerbated by both the Covid-19 pandemic and increasing patient and family member incivility. De-escalation training has been found to be an evidence-based tool for emergency department nurses to help avoid or mitigate high-risk situations that could lead to workplace violence. Many healthcare organizations either do not provide de-escalation training to their staff or only provide it sparingly, such as during new employee orientation. There is limited research in the literature on the psychological benefits of de-escalation training. Purpose: The purpose of this study is to determine if there are psychological and organizational advantages to providing emergency department nurses with de-escalation training. Equipping emergency department nurses with skills that are essential to de-escalate violent or potentially violent patients may help prevent physical, mental, and/or psychological damage to the nurse because of violence and/or threatening acts. The hypothesis is that providing de-scalation training to emergency department nurses will lead to increased nurse confidence in dealing with aggressive patients, increased resiliency, increased professional quality of life, and increased intention to stay with their current organization. This study aims to show that organizations would benefit from providing de-escalation training to all nurses operating in high-risk areas on a regular basis. Significance: Showing psychological benefits to providing evidence-based de-escalation training can provide healthcare organizations with the ability to retain a more resilient and prepared workforce. Method: This study uses a pre-experimental cross-sectional pre-/post-test design using a convenience sample of emergency department registered nurses employed across Jefferson Health Northeast (Jefferson Torresdale, Jefferson Bucks, and Jefferson Frankford. Inclusion criteria include registered nurses who work full or part-time, with 51% or more of their clinical time spent in direct clinical care. Excluded from participation are registered nurses in orientation, per-diem nurses, temporary and/or travel nurses, nurses who spend less than 51% of their time in direct patient care, and nurses who have received de-escalation training within the past two years. This study uses the Connor-Davidson Resilience Scale 10 (CD-RISC-10), the Clinician Confidence in Coping with Patient Aggression Scale, the Press Ganey Intention To Stay question, and the Professional Quality of Life Scale. Results: A Paired t-Test will be used to analyze the mean scores of the three scales and one question pre and post-intervention to determine if there is a statistically significant difference in RN resiliency, confidence in coping with patient aggression, intention to stay, and professional quality of life. Discussion and Conclusions: Upon completion, the outcomes of this intervention will show the importance of providing evidence-based de-escalation training to all nurses operating within the emergency department.

Keywords: de-escalation, nursing, emergency department, workplace violence

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Authors: Madan Chandra Maurya, A. R. Dar

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Among the entire natural calamities earthquake is the one which is most devastating. If the losses due to all other calamities are added still it will be very less than the losses due to earthquakes. So it means we must be ready to face such a situation, which is only possible if we make our structures earthquake resistant. A review of structural damages to the braced frame systems after several major earthquakes—including recent earthquakes—has identified some anticipated and unanticipated damage. This damage has prompted many engineers and researchers around the world to consider new approaches to improve the behavior of braced frame systems. Extensive experimental studies over the last fourty years of conventional buckling brace components and several braced frame specimens have been briefly reviewed, highlighting that the number of studies on the full-scale concentric braced frames is still limited. So for this reason the study surrounds the words plastic behavior, steel structure, brace frame system. In this study, there are two different analytical approaches which have been used to predict the behavior and strength of an un-braced frame. The first is referred as incremental elasto-plastic analysis a plastic approach. This method gives a complete load-deflection history of the structure until collapse. It is based on the plastic hinge concept for fully plastic cross sections in a structure under increasing proportional loading. In this, the incremental elasto-plastic analysis- hinge by hinge method is used in this study because of its simplicity to know the complete load- deformation history of two storey un-braced scaled model. After that the experiments were conducted on two storey scaled building model with and without bracing system to know the true or experimental load deformation curve of scaled model. Only way, is to understand and analyze these techniques and adopt these techniques in our structures. The study named as Plastic Behavior of Steel Frames using Different Concentric Bracing Configurations deals with all this. This study aimed at improving the already practiced traditional systems and to check the behavior and its usefulness with respect to X-braced system as reference model i.e. is how plastically it is different from X-braced. Laboratory tests involved determination of plastic behavior of these models (with and without brace) in terms of load-deformation curve. Thus, the aim of this study is to improve the lateral displacement resistance capacity by using new configuration of brace member in concentric manner which is different from conventional concentric brace. Once the experimental and manual results (using plastic approach) compared, simultaneously the results from both approach were also compared with nonlinear static analysis (pushover analysis) approach using ETABS i.e how both the previous results closely depicts the behavior in pushover curve and upto what limit. Tests results shows that all the three approaches behaves somewhat in similar manner upto yield point and also the applicability of elasto-plastic analysis (hinge by hinge method) to know the plastic behavior. Finally the outcome from three approaches shows that the newer one configuration which is chosen for study behaves in-between the plane frame (without brace or reference frame) and the conventional X-brace frame.

Keywords: elasto-plastic analysis, concentric steel braced frame, pushover analysis, ETABS

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Authors: Kenneth A. Rostowsky, Alexander S. Maher, Nahian F. Chowdhury, Andrei Irimia

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The clinical significance of cerebral microbleeds (CMBs) due to mild traumatic brain injury (mTBI) remains unclear. Here we use magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) and connectomic analysis to investigate the statistical association between mTBI-related CMBs, post-TBI changes to the human connectome and neurological/cognitive deficits. This study was undertaken in agreement with US federal law (45 CFR 46) and was approved by the Institutional Review Board (IRB) of the University of Southern California (USC). Two groups, one consisting of 26 (13 females) mTBI victims and another comprising 26 (13 females) healthy control (HC) volunteers were recruited through IRB-approved procedures. The acute Glasgow Coma Scale (GCS) score was available for each mTBI victim (mean µ = 13.2; standard deviation σ = 0.4). Each HC volunteer was assigned a GCS of 15 to indicate the absence of head trauma at the time of enrollment in our study. Volunteers in the HC and mTBI groups were matched according to their sex and age (HC: µ = 67.2 years, σ = 5.62 years; mTBI: µ = 66.8 years, σ = 5.93 years). MRI [including T1- and T2-weighted volumes, gradient recalled echo (GRE)/susceptibility weighted imaging (SWI)] and gradient echo (GE) DWI volumes were acquired using the same MRI scanner type (Trio TIM, Siemens Corp.). Skull-stripping and eddy current correction were implemented. DWI volumes were processed in TrackVis (http://trackvis.org) and 3D Slicer (http://www.slicer.org). Tensors were fit to DWI data to perform DTI, and tractography streamlines were then reconstructed using deterministic tractography. A voxel classifier was used to identify image features as CMB candidates using Microbleed Anatomic Rating Scale (MARS) guidelines. For each peri-lesional DTI streamline bundle, the null hypothesis was formulated as the statement that there was no neurological or cognitive deficit associated with between-scan differences in the mean FA of DTI streamlines within each bundle. The statistical significance of each hypothesis test was calculated at the α = 0.05 level, subject to the family-wise error rate (FWER) correction for multiple comparisons. Results: In HC volunteers, the along-track analysis failed to identify statistically significant differences in the mean FA of DTI streamline bundles. In the mTBI group, significant differences in the mean FA of peri-lesional streamline bundles were found in 21 out of 26 volunteers. In those volunteers where significant differences had been found, these differences were associated with an average of ~47% of all identified CMBs (σ = 21%). In 12 out of the 21 volunteers exhibiting significant FA changes, cognitive functions (memory acquisition and retrieval, top-down control of attention, planning, judgment, cognitive aspects of decision-making) were found to have deteriorated over the six months following injury (r = -0.32, p < 0.001). Our preliminary results suggest that acute post-TBI CMBs may be associated with cognitive decline in some mTBI patients. Future research should attempt to identify mTBI patients at high risk for cognitive sequelae.

Keywords: traumatic brain injury, magnetic resonance imaging, diffusion tensor imaging, connectomics

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Authors: Hasan Demiroğlu, Uğur Avcıbaşı, Serhan Sakarya, Perihan Ünak

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Implanted devices are progressively practiced in innovative medicine to relieve pain or improve a compromised function. Implant-associated infections represent an emerging complication, caused by organisms which adhere to the implant surface and grow embedded in a protective extracellular polymeric matrix, known as a biofilm. In addition, the microorganisms within biofilms enter a stationary growth phase and become phenotypically resistant to most antimicrobials, frequently causing treatment failure. In such cases, surgical removal of the implant is often required, causing high morbidity and substantial healthcare costs. Staphylococcus aureus is the most common pathogen causing implant-associated infections. Successful treatment of these infections includes early surgical intervention and antimicrobial treatment with bactericidal drugs that also act on the surface-adhering microorganisms. Linezolid is a promising anti-microbial with ant-staphylococcal activity, used for the treatment of MRSA infections. Linezolid is a synthetic antimicrobial and member of oxazolidinoni group, with a bacteriostatic or bactericidal dose-dependent antimicrobial mechanism against gram-positive bacteria. Intensive use of antibiotics, have emerged multi-resistant organisms over the years and major problems have begun to be experienced in the treatment of infections occurred with them. While new drugs have been developed worldwide, on the other hand infections formed with microorganisms which gained resistance against these drugs were reported and the scale of the problem increases gradually. Scientific studies about the production of bacterial biofilm increased in recent years. For this purpose, we investigated the activity of Lin, Lin radiolabeled with 131I (131I-Lin) and cold iodinated Lin (127I-Lin) against clinical strains of Staphylococcus aureus DSM 4910 in biofilm. In the first stage, radio and cold labeling studies were performed. Quality-control studies of Lin and iodo (radio and cold) Lin derivatives were carried out by using TLC (Thin Layer Radiochromatography) and HPLC (High Pressure Liquid Chromatography). In this context, it was found that the binding yield was obtained to be about 86±2 % for 131I-Lin. The minimal inhibitory concentration (MIC) of Lin, 127I-Lin and 131I-Lin for Staphylococcus aureus DSM 4910 strain were found to be 1µg/mL. In time-kill studies of Lin, 127I-Lin and 131I-Lin were producing ≥ 3 log10 decreases in viable counts (cfu/ml) within 6 h at 2 and 4 fold of MIC respectively. No viable bacteria were observed within the 24 h of the experiments. Biofilm eradication of S. aureus started with 64 µg/mL of Lin, 127I-Lin and 131I-Lin, and OD630 was 0.507±0.0.092, 0.589±0.058 and 0.266±0.047, respectively. The media control of biofilm producing Staphylococcus was 1.675±0,01 (OD630). 131I and 127I did not have any effects on biofilms. Lin and 127I-Lin were found less effectively than 131I-Lin at killing cells in biofilm and biofilm eradication. Our results demonstrate that the 131I-Lin have potent anti-biofilm activity against S. aureus compare to Lin, 127I-Lin and media control. This is suggested that, 131I may have harmful effect on biofilm structure.

Keywords: iodine-131, linezolid, radiolabeling, slime layer, Staphylococcus

Procedia PDF Downloads 558

Authors: Maggie Hall, Haley O'Neill

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The U.S. faces a severe shortage of abortion providers, exacerbated by the June 2022 Dobbs v. Jackson Women’s Health Organization decision. Midwives, especially certified nurse midwives, are well-positioned to fill this gap in abortion care. However, a lack of clinical education and training prevents midwives from exercising their full scope of practice. National and international organizations that set obstetrics and midwifery education standards, including the International Confederation of Midwives, American College of Obstetricians and Gynecologists, and American Public Health Association, call for expansion of midwifery-managed abortion care through the first trimester. In the U.S., midwifery programs are accredited based on compliance with ACME standards and compliance is a prerequisite for the American Midwifery Certification Board exams. We conducted a literature review of studies in the last five years regarding abortion didactic and clinical education barriers via CINAHL, EBSCO and PubMed database reviews. We gave preference for primary sources within the last five years; however, due to the rapid changes in abortion education and access, we also included literature from 2012-2022. We evaluated ACME-accredited programs in relation to their geography within abortion-protected or restricted states and assessed state-specific barriers to abortion care education and provision as clinical students. There are 43 AMCB-accredited midwifery schools in 28 states across the U.S. Twenty schools (47%) are in the 15 states in which advanced practice clinicians can provide non-surgical abortion care, such as medication abortion and MVA procedures. Twenty-four schools (56%) are in the 16 states in which abortion care provision is restricted to Licensed Physicians and cannot offer in-state clinical training opportunities for midwifery students. Six schools are in the five states in which abortion is completely banned and are geographically concentrated in the southernmost region of the U.S., including Alabama, Kentucky, Louisiana, Tennessee, and Texas. Subsequently, these programs cannot offer in-state clinical training opportunities for midwifery students. Notably, there are seven ACME programs in six states that do not restrict abortion access by gestational age, including Colorado, Connecticut, Washington, D.C., New Jersey, New Mexico, and Oregon. These programs may be uniquely positioned for midwifery involvement in abortion care beyond the first trimester. While the following states don’t house ACME programs, abortion care can be provided by advanced practice clinicians in Rhode Island, Delaware, Hawaii, Maine, Maryland, Montana, New Hampshire, and Vermont, offering clinical placement and/or new ACME program development opportunities. We identify existing barriers to clinical education and training opportunities for midwifery-managed abortion care, which are both geographic and institutional in nature. We recommend expansion and standardization of clinical education and training opportunities for midwifery-managed abortion care in ACME-accredited programs to improve access to abortion care. Midwifery programs and teaching hospitals need to expand education, training, and residency opportunities for midwifery students to strengthen access to midwife-managed abortion care. ACNM and ACME should re-evaluate accreditation criteria and the implications of ACME programs in states where students are not able to learn abortion care in clinical contexts due to state-specific abortion restrictions.

Keywords: midwifery education, abortion, abortion education, abortion access

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Authors: Seungsik Yu, Minho Kang

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As the threat of terrorism to nuclear facilities is increasing globally after the attacks of September 11, we are striving to recognize the physical protection system and strengthen the emergency response system. Since 2015, Korea has implemented physical protection security exercise for nuclear facilities. The exercise should be carried out with full cooperation between the operator and response forces. Performance testing of the physical protection system should include appropriate exercises, for example, force-on-force exercises, to determine if the response forces can provide an effective and timely response to prevent sabotage. Significant deficiencies and actions taken should be reported as stipulated by the competent authority. The IAEA(International Atomic Energy Agency) is also preparing force-on-force exercise program documents to support exercise of member states. Currently, ROK(Republic of Korea) is implementing exercise on the force-on-force exercise evaluation system which is developed by itself for the nuclear power plant, and it is necessary to establish the exercise procedure considering the use of the force-on-force exercise evaluation system. The purpose of this study is to establish the work procedures of the three major organizations related to the force-on-force exercise of nuclear power plants in ROK, which conduct exercise using force-on-force exercise evaluation system. The three major organizations are composed of licensee, KINAC (Korea Institute of Nuclear Nonproliferation and Control), and the NSSC(Nuclear Safety and Security Commission). Major activities are as follows. First, the licensee establishes and conducts an exercise plan, and when recommendations are derived from the result of the exercise, it prepares and carries out a force-on-force result report including a plan for implementation of the recommendations. Other detailed tasks include consultation with surrounding units for adversary, interviews with exercise participants, support for document evaluation, and self-training to improve the familiarity of the MILES (Multiple Integrated Laser Engagement System). Second, KINAC establishes a force-on-force exercise plan review report and reviews the force-on-force exercise plan report established by licensee. KINAC evaluate force-on-force exercise using exercise evaluation system and prepare training evaluation report. Other detailed tasks include MILES training, adversary consultation, management of exercise evaluation systems, and analysis of exercise evaluation results. Finally, the NSSC decides whether or not to approve the force-on-force exercise and makes a correction request to the nuclear facility based on the exercise results. The most important part of ROK's force-on-force exercise system is the analysis through the exercise evaluation system implemented by KINAC after the exercise. The analytical method proceeds in the order of collecting data from the exercise evaluation system and analyzing the collected data. The exercise application process of the exercise evaluation system introduced in ROK in 2016 will be concretely set up, and a system will be established to provide objective and consistent conclusions between exercise sessions. Based on the conclusions drawn up, the ultimate goal is to complement the physical protection system of licensee so that the system makes licensee respond effectively and timely against sabotage or unauthorized removal of nuclear materials.

Keywords: Force-on-Force exercise, nuclear power plant, physical protection, sabotage, unauthorized removal

Procedia PDF Downloads 142

Authors: Lina Lauciene, Vaida Andruleviciute, Ingrida Sinkeviciene, Mindaugas Malakauskas, Loreta Serniene

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Dairy product manufacturers constantly are looking for new markets for their production. And in most cases, the problem of product compliance with the composition requirements of foreign products is highlighted. This is especially true of the composition of milk fat in dairy products. It is well known that there are many factors such as feeding ratio, season, cow breed, stage of lactation that affect the fatty acid composition in milk. However, there is less evidence on the impact of the technological process on the composition of fatty acids in raw milk and products made from it. In this study the influence of the technological process on fat composition in 82% fat butter, 15% fat curd, 3.6% fat yogurt and 2.5% fat UHT milk was determined. The samples were collected at each stage of production, starting with raw milk and ending with the final product in the Lithuanian milk-processing company. Fatty acids methyl esters were quantified using a GC (Clarus 680, Perkin Elmer) equipped with flame ionization detector (FID) and a capillary column SP-2560, 100 m x 0.25 mm id x 0.20 µm. Fatty acids peaks were identified using Supelco® 37 Component FAME Mix. The concentration of each fatty acid was expressed in percent of the total fatty acid amount. In the case of UHT milk production, it was compared raw milk, cream, milk mixture, and UHT milk but significant differences were not estimated between these stages. Analyzing stages of the yogurt production (raw milk, pasteurized milk, and milk with a starter culture and yogurt), no significant changes were detected between stages as well. A slight difference was observed with C4:0 - a percentage of this fatty acid was less (p=0.053) in the final stage than in milk with the starter culture. During butter production, the composition of fatty acids in raw cream, buttermilk, and butter did not change significantly. Only C14:0 decreased in the butter then compared to buttermilk. The curd fatty acid analysis showed the increase of C6:0, C8:0, C10:0, C11:0, C12:0 C14:0 and C17:0 at the final stage when compared to raw milk, cream, milk mixture, and whey. Meantime the increase of C18:1n9c (in comparison with milk mixture and curd) and C18:2n6c (in comparison with raw milk, milk mixture, and curd) was estimated in cream. The results of this study suggest that the technological process did not affect the composition of fatty acids in UHT milk, yogurt, butter, and curd but had the impact on the concentration of individual fatty acids. In general, all of the fatty acids from the raw milk were converted into the final product, only some of them slightly changed the concentration. Therefore, in order to ensure an appropriate composition of certain fatty acids in the final product, producers must carefully choose the raw milk. Acknowledgment: This research was funded by Lithuanian Ministry of Agriculture (No. MT-17-13).

Keywords: dairy products, fat composition, fatty acids, technological process

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Authors: Zeena Dcosta, Junaid Ahmed, Ceena Denny, Nandita Shenoy

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In the field of dentistry, there are many conditions which warrant the requirement of three-dimensional imaging that can aid in diagnosis and therapeutic management. Cone beam computed tomography (CBCT) is considered highly accurate in producing a three-dimensional image of an object and provides a complete insight of various findings in the captured volume. But, most of the clinicians focus primarily on the teeth and jaws and numerous unanticipated clinically significant incidental findings may be missed out. Rapid integration of CBCT into the practice of dentistry has led to the detection of various incidental findings. However, the prevalence of these incidental findings is still unknown. Thus, the study aimed to discern the reason for referral and to identify incidental findings on the referred CBCT scans. Patient’s demographic data such as age and gender was noted. CBCT scans of multiple fields of views (FOV) were considered. The referral for CBCT scans was broadly classified into two major categories: diagnostic scan and treatment planning scan. Any finding on the CBCT volumes, other than the area of concern was recorded as incidental finding which was noted under airway, developmental, pathological, endodontics, TMJ, bone, soft tissue calcifications and others. Few of the incidental findings noted under airway were deviated nasal septum, nasal turbinate hypertrophy, mucosal thickening and pneumatization of sinus. Developmental incidental findings included dilaceration, impaction, pulp stone and gubernacular canal. Resorption of teeth and periapical pathologies were noted under pathological incidental findings. Root fracture along with over and under obturation was noted under endodontics. Incidental findings under TMJ were flattening, erosion and bifid condyle. Enostosis and exostosis were noted under bone lesions. Tonsillolth, sialolith and calcified styloid ligament were noted under soft tissue calcifications. Incidental findings under others included foreign body, fused C1- C2 vertebrae, nutrient canals, and pneumatocyst. Maxillofacial radiologists should be aware of possible incidental findings and should be vigilant about comprehensively evaluating the entire captured volume, which can help in early diagnosis of any potential pathologies that may go undetected. Interpretation of CBCT is truly an art and with the experience, we can unravel the secrets hidden in the grey shades of the radiographic image.

Keywords: cone beam computed tomography, incidental findings, maxillofacial region, radiologist

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Authors: Chia-Ling Hsieh, Kankanit Potikit

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Metadiscourse refers to linguistic resources employed by writers to organize text and interact with readers. While metadiscourse has received considerable attention within the field of discourse analysis, few studies have explored the use of metadiscourse in email, one of the most popular forms of computer-mediated communication. Furthermore, the diversity of cross-linguistic research required to uncover the influence of cultural factors on metadiscourse use is lacking. The present study compares metadiscourse markers employed in Chinese and Thai-language request emails with the purpose of discovering cross-cultural similarities and differences that are meaningful and applicable to foreign language teaching. The analysis is based on a corpus of 200 request emails: 100 composed in Chinese and 100 in Thai, with half of the emails from each language data set addressed to professors and the other half addressed to classmates. Adopting Hyland’s model as an analytical framework, two primary categories of metadiscourse are identified. Textual metadiscourse helps to create text coherence, while interpersonal metadiscourse functions to convey authorial stance. Results of the study make clear that both Chinese and Thai-language emails use significantly more interpersonal markers than textual markers, indicating that email, as a unique communicative medium, is characterized by high degrees of concision and interactivity. Users of both languages further deploy similar patterns in writing emails to recipients of different social statuses. Compared with emails addressed to classmates, emails addressed to professors are notably longer and include more transition and engagement markers. Nevertheless, cultural factors do play a role. Emails composed in Thai, for example, include more textual markers than those in Chinese, as Thai favors formal expressions and detailed explanations, while in contrast, emails composed in Chinese employ more interpersonal markers than those in Thai, since Chinese tends to emphasize recipient involvement and attitudinal warmth. These findings thereby demonstrate the combined effects of email as a communicative medium, social status, and cultural values on metadiscourse usage. The study concludes by applying these findings to pedagogical suggestions for teaching email writing to Chinese and Thai language learners based on similarities and differences in metadiscourse strategy between the two languages.

Keywords: discourse analysis, email, metadiscourse, writing instruction

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Authors: Farahnaz Sadat Golestan Hashemi, Mohd Razi Ismail, Mohd Y. Rafii

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Clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated protein (Cas) system can facilitate targeted genome editing in organisms. Dual or single guide RNA (gRNA) can program the Cas9 nuclease to cut target DNA in particular areas; thus, introducing concise mutations either via error-prone non-homologous end-joining repairing or via incorporating foreign DNAs by homologous recombination between donor DNA and target area. In spite of high demand of such promising technology, developing a well-organized procedure in order for reliable mining of potential target sites for gRNAs in large genomic data is still challenging. Hence, we aimed to perform high-throughput detection of target sites by specific PAMs for not only common Streptococcus pyogenes (SpCas9) but also for Neisseria meningitides (NmCas9) CRISPR-Cas systems. Previous research confirmed the successful application of such RNA-guided Cas9 orthologs for effective gene targeting and subsequently genome manipulation. However, Cas9 orthologs need their particular PAM sequence for DNA cleavage activity. Activity levels are based on the sequence of the protospacer and specific combinations of favorable PAM bases. Therefore, based on the specific length and sequence of PAM followed by a constant length of the target site for the two orthogonals of Cas9 protein, we created a reliable procedure to explore possible gRNA sequences. To mine CRISPR target sites, four different searching modes of sgRNA binding to target DNA strand were applied. These searching modes are as follows i) coding strand searching, ii) anti-coding strand searching, iii) both strand searching, and iv) paired-gRNA searching. Finally, a complete list of all potential gRNAs along with their locations, strands, and PAMs sequence orientation can be provided for both SpCas9 as well as another potential Cas9 ortholog (NmCas9). The artificial design of potential gRNAs in a genome of interest can accelerate functional genomic studies. Consequently, the application of such novel genome editing tool (CRISPR/Cas technology) will enhance by presenting increased versatility and efficiency.

Keywords: CRISPR/Cas9 genome editing, gRNA mining, SpCas9, NmCas9

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Authors: Gebrehiwot H., Giorgis Bahita

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Firms in Africa experience less financial market in comparison to other emerging and developed countries, thus lagging behind the rest of the world in terms of innovation and growth. Though there are different factors to be considered, underdeveloped financial systems take the lion's share in hindering firm innovation and growth in Africa. Insufficient capacity to innovate is one of the problems facing African businesses. Moreover, a critical challenge faced by firms in Africa is access to finance and the inability of financially constrained firms to grow. Only little is known about how different sources of finance affect firm innovation and growth in Africa, specifically the formal and informal finance effect on firm innovation and growth. This study's aim is to address this gap by using formal and informal finance for working capital and fixed capital and its role in firm innovation and firm growth using firm-level data from the World Bank enterprise survey 2006-2019 with a total of 5661 sample firms from 14 countries based on available data on the selected variables. Additionally, this study examines factors for accessing credit from a formal financial institution. The logit model is used to examine the effect of finance on a firm’s innovation and factors to access formal finance, while the Ordinary List Square (OLS) regression mode is used to investigate the effect of finance on firm growth. 2SLS instrumental variables are used to address the possible endogeneity problem in firm growth and finance-innovation relationships. A result from the logistic regression indicates that both formal and informal finance used for working capital and investment in fixed capital was found to have a significant positive association with product and process innovation. In the case of finance and growth, finding show that positive association of both formal and informal financing to working capital and new investment in fixed capital though the informal has positive relations to firm growth as measured by sale growth but no significant association as measured by employment growth. Formal finance shows more magnitude of effect on innovation and growth when firms use formal finance to finance investment in fixed capital, while informal finance show less compared to formal finance and this confirms previous studies as informal is mainly used for working capital in underdeveloped economies like Africa. The factors that determine credit access: Age, firm size, managerial experience, exporting, gender, and foreign ownership are found to have significant determinant factors in accessing credit from formal and informal sources among the selected sample countries.

Keywords: formal finance, informal finance, innovation, growth

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Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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Authors: Nino Damenia

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The agricultural sector plays an important role in the development of Georgia's economy, it contributes to employment and food security. It faces various types of risks that may lead to heavy financial losses. Agricultural insurance is one of the means of combating agricultural risks. The paper discusses the agricultural insurance experience of those countries (European countries and the USA) that have successfully implemented the agricultural insurance program. Analysis of international cases shows that a well-designed and implemented agri-insurance system can bring significant benefits to farmers, insurance companies and the economy as a whole. In the background of all this, the Government of Georgia recognized the importance of agro-insurance and took important steps for its development. In 2014, in cooperation with insurance companies, an agro-insurance program was introduced, the purpose of which is to increase the availability of insurance for farmers and stimulate the agro-insurance market. Despite such a step forward, challenges remain such as awareness of farmers, insufficient infrastructure for data collection and risk assessment, involvement of insurance companies and other important factors. With the support of the government and stakeholders, it is possible to overcome the existing challenges and establish a strong and effective agro-insurance system. Objectives. The purpose of the research is to analyze the development trends of the agricultural insurance market, to identify the main factors affecting its growth, and to further develop recommendations for development prospects for Georgia. Methodologies. The research uses mixed methods, which combine qualitative and quantitative research techniques. The qualitative method includes the study of the literature of Georgian and foreign economists, which allows us to get acquainted with the challenges, opportunities, legislative and regulatory frameworks of agricultural insurance. Quantitative analysis involves collecting data from stakeholders and then analyzing it. The paper also uses the methods of synthesis, comparison and statistical analysis of the agricultural insurance market in Georgia, Europe and the USA. Conclusions. As the main results of the research, we can consider that the analysis of the insurance market has been made and its main functions have been identified; The essence, features and functions of agricultural insurance are analyzed; European and US agricultural insurance market is researched; The stages of formation and development of the agricultural insurance market of Georgia are studied, its importance for the agricultural sector of Georgia is determined; The role of the state for the development of agro-insurance is analyzed and development prospects are established based on the study of the current trends of the agro-insurance market of Georgia.

Keywords: agricultural insurance, agriculture, agricultural insurance program, risk

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Authors: Amelia Faotusia

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The blue economy concept was coined by Pacific nations in recognition of the importance of sustainably managing their extensive marine territories. This is especially important for major ocean-based economic sectors of Pacific economies, such as coastal tourism. There is an absence of research, however, on the key ways in which the blue economy concept has emerged in discourse and public policy in Pacific countries, as well as how it articulates with coastal tourism. This research helps to fill such a gap with a specific focus on Tonga through the application of a post-positivist research approach to conduct a desktop study of relevant national documents and qualitative interviews with relevant government staff, civil society organizations, and tourism operators. The findings of the research reflect the importance of institutional integration and partnerships for a successful blue economy transition and are presented in the form of two case studies corresponding to two sub-sectors of Tonga’s coastal tourism sector: (i) the whale-watching and swimming industry, and (ii) beach resorts and restaurants. A thematic analysis applied to the interview data of both cases then enabled the identification of key areas and issues for socio-economic policy intervention and recommendations in support of blue economy transitions in Tonga’s coastal tourism sector. Examples of the relevant areas and issues that emerged included the importance of foreign direct investment, local market access, community-based special management areas, as well as the need to address the anthropogenic impacts of tropical cyclones, whale tourism, plastic litter on coastal assets, and ecosystems. Policy and practical interventions in support of addressing such issues include a proposed restructuring of the whale-watching and swimming licensing system; integration of climate resilience, adaptation, and capacity building as priorities of local blue economy interventions; as well as strengthening of the economic sustainability dimension of blue economy policies. Finally, this research also revealed the need for further specificity and research on the influence and value of local Tongan culture and traditional knowledge, particularly within existing customary marine tenure systems, on Tonga’s national and sectoral blue economy policies and transitions.

Keywords: blue economy, coastal tourism, integrated ocean management, ecosystem resilience

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Authors: Fang Tan

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This research focuses on the appropriate use of lexical bundles in spoken discourse, particularly in English as a Foreign Language (EFL) classrooms in Northeast China. While previous studies have mainly examined lexical bundles in written discourse, there is a need to investigate their usage in spoken discourse due to the limited availability of spoken discourse corpora. English teachers’ use of lexical bundles is crucial for effective teaching and communication in the EFL classroom. The aim of this study is to investigate the functions of four-word lexical bundles in native English teachers’ EFL oral English classes in Northeast China. Specifically, the research focuses on the usage of stance bundles, which were found to be the most significant type of bundle in the analyzed corpus. By comparing the self-built university spoken English classroom discourse corpus with the other self-built university English for General Purposes (EGP) corpus, the study aims to highlight the difference in bundle usage between native and non-native teachers in EFL classrooms. The research employs a corpus-based study. The observed corpus consists of more than 300,000 tokens, in which the data has been collected in the past five years. The reference corpus is composed of over 800,000 tokens, in which the data has been collected over 12 years. All the primary data collection involved transcribing and annotating spoken English classes taught by native English teachers. The analysis procedures included identifying and categorizing four-word lexical bundles, with specific emphasis on stance bundles. Frequency counts, and comparisons with the Chinese English teachers’ corpus were conducted to identify patterns and differences in bundle usage. The research addresses the following questions: 1) What are the functions of four-word lexical bundles in native English teachers’ EFL oral English classes? 2) How do stance bundles differ in usage between native and non-native English teachers’ classes? 3) What implications can be drawn for English teachers’ professional development based on the findings? In conclusion, this study provides valuable insights into the usage of four-word lexical bundles, particularly stance bundles, in native English teachers’ EFL oral English classes in Northeast China. The research highlights the difference in bundle usage between native and non-native English teachers’ classes and provides implications for English teachers’ professional development. The findings contribute to the understanding of lexical bundle usage in EFL classroom discourse and have theoretical importance for language teaching methodologies. The self-built university English classroom discourse corpus used in this research is a valuable resource for future studies in this field.

Keywords: EFL classroom discourse, four-word lexical bundles, stance, implication

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Authors: Weili Jiang, Simon Cadavid Lopera, Klaus Drechsler

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Fuel cell vehicle has become the most competitive solution for the transportation sector in the hydrogen economy. Type IV pressure vessel is currently the most popular and widely developed technology for the on-board storage, based on their high reliability and relatively low cost. Due to the stringent requirement on mechanical performance, the pressure vessel is subject to great amount of composite material, a major cost driver for the hydrogen tanks. Evidently, the optimization of composite layup design shows great potential in reducing the overall material usage, yet requires comprehensive understanding on underlying mechanisms as well as the influence of different design parameters on mechanical performance. Given the type of materials and manufacturing processes by which the type IV pressure vessels are manufactured, the design and optimization are a nuanced subject. The manifold of stacking sequence and fiber orientation variation possibilities have an out-standing effect on vessel strength due to the anisotropic property of carbon fiber composites, which make the design space high dimensional. Each variation of design parameters requires computational resources. Using finite element analysis to evaluate different designs is the most common method, however, the model-ing, setup and simulation process can be very time consuming and result in high computational cost. For this reason, it is necessary to build a reliable automation scheme to set up and analyze the di-verse composite layups. In this research, the simulation process of different tank designs regarding various parameters is conducted and automatized in a commercial finite element analysis framework Abaqus. Worth mentioning, the modeling of the composite overwrap is automatically generated using an Abaqus-Python scripting interface. The prediction of the winding angle of each layer and corresponding thickness variation on dome region is the most crucial step of the modeling, which is calculated and implemented using analytical methods. Subsequently, these different composites layups are simulated as axisymmetric models to facilitate the computational complexity and reduce the calculation time. Finally, the results are evaluated and compared regarding the ultimate tank strength. By automatically modeling, evaluating and comparing various composites layups, this system is applicable for the optimization of the tanks structures. As mentioned above, the mechanical property of the pressure vessel is highly dependent on composites layup, which requires big amount of simulations. Consequently, to automatize the simulation process gains a rapid way to compare the various designs and provide an indication of the optimum one. Moreover, this automation process can also be operated for creating a data bank of layups and corresponding mechanical properties with few preliminary configuration steps for the further case analysis. Subsequently, using e.g. machine learning to gather the optimum by the data pool directly without the simulation process.

Keywords: type IV pressure vessels, carbon composites, finite element analy-sis, automation of simulation process

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Authors: Myriam Benraad

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On 5 July 2016, just days before the bloody terrorist attack on the Promenade des Anglais in Nice, the Al-Hayat media centre, one of the official propaganda branches of the Islamic State, broadcast a French nasheed which paid tribute to the Paris and Brussels attacks of November 2015 and March 2016. Entitled 'My Revenge', the terrorist anthem was of rare vehemence. It mentioned, sequentially, 'huddled bodies', in a reference to the civilian casualties of Western air strikes in the Iraqi-Syrian zone, 'explosive belts', 'sharp knives', 'large-calibre weapons' as well as 'localised targets'. France was accused of bearing the responsibility for the wave of attacks on its territory since the Charlie Hebdo massacre of January 2015 due to its 'ruthless war' against the Muslim world. Evoking an 'old aggression' and the 'crimes and spoliations' of which France has made itself guilty, the jihadist hymn depicted the rebirth of the caliphate as 'laudable revenge'. The notion of revenge has always been central to contemporary jihadism, understood both as a revolutionary ideology and a global militant movement. In recent years, the attacks carried out in Europe and elsewhere in the world have, for most, been claimed in its name. Whoever says jihad, says drama, yet few studies, if any, have looked at its dramatic and emotional elements, most notably its tragic vengefulness. This seems all the more astonishing that jihad is filled with drama; it could even be seen as a drama in its own right. The jihadists perform a script and take on roles inspired by their respective group’s culture (norms, values, beliefs, and symbols). The militants stage and perform such a script for a designated audience, either partisan, sympathising or hostile towards them and their cause. This research paper will examine the dramaturgy of jihadism and in particular, the genre that best characterises its violence: revenge tragedy. Theoretically, the research will rely on the tools of social movement theory and the sociology of emotions. Methodologically, it will draw from dramaturgical analysis and a combination of qualitative and quantitative tools to attain valuable observations of a number of developments, trends, and patterns. The choice has been made to focus mainly – however not exclusively – on the attacks which have taken place since 2001 in the European Union and more specific member states that have been significantly hit by jihadist terrorism. The research looks at a number of representative longitudinal samples identifying continuities and discontinuities, similarities, but also substantial differences. The preliminary findings tend to establish the relevance and validity of this approach in helping make better sense of sensitisation, mobilisation, and survival dynamics within jihadist groups, and motivations among individuals who have embraced violence. Besides, they illustrate their pertinence for counterterrorism policymakers and practitioners. Through drama, jihadist groups ensure the unceasing regeneration of their militant cause as well as their legitimation among their partisans. Without drama, and without the spectacular ideological staging of reality, they would not be able to maintain their attraction potential and power of persuasion.

Keywords: Jihadism, dramaturgy, revenge, tragedy

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Authors: Blaga Alexandra Cristina, Kloetzer Lenuta, Bompa Amalia Stela, Galaction Anca Irina, Cascaval Dan

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Vitamin B9 is an important member of vitamins B group, being a growth factor, important for making genetic material as DNA and RNA, red blood cells, for building muscle tissues, especially during periods of infancy, adolescence and pregnancy. Its production by biosynthesis is based on the high metabolic potential of mutant Bacillus subtilis, due to a superior biodisponibility compared to that obtained by chemical pathways. Pertraction, defined as the extraction and transport through liquid membranes consists in the transfer of a solute between two aqueous phases of different pH-values, phases that are separated by a solvent layer of various sizes. The pertraction efficiency and selectivity could be significantly enhanced by adding a carrier in the liquid membrane, such as organophosphoric compounds, long chain amines or crown-ethers etc., the separation process being called facilitated pertraction. The aim of the work is to determine the impact of the presence of two extractants/carriers in the bulk liquid membrane, i.e. di(2-ethylhexyl) phosphoric acid (D2EHPA) and lauryltrialkylmetilamine (Amberlite LA2) on the transport kinetics of vitamin B9. The experiments have been carried out using two pertraction equipments for a free liquid membrane or bulk liquid membrane. One pertraction cell consists on a U-shaped glass pipe (used for the dichloromethane membrane) and the second one is an H-shaped glass pipe (used for h-heptane), having 45 mm inner diameter of the total volume of 450 mL, the volume of each compartment being of 150 mL. The aqueous solutions are independently mixed by means of double blade stirrers with 6 mm diameter and 3 mm height, having the rotation speed of 500 rpm. In order to reach high diffusional rates through the solvent layer, the organic phase has been mixed with a similar stirrer, at a similar rotation speed (500 rpm). The area of mass transfer surface, both for extraction and for reextraction, was of 1.59x10-³ m2. The study on facilitated pertraction with the mixture of two carriers, namely D2EHPA and Amberlite LA-2, dissolved in two solvents with different polarities: n-heptane and dichloromethane, indicated the possibility to obtain the synergic effect. The synergism has been analyzed by considering the vitamin initial and final mass flows, as well as the permeability factors through liquid membrane. The synergic effect has been observed at low D2EHPA concentrations and high Amberlite LA-2 concentrations, being more important for the low-polar solvent (n-heptane). The results suggest that the mechanism of synergic pertraction consists on the reaction between the organophosphoric carrier and vitamin B9 at the interface between the feed and membrane phases, while the aminic carrier enhances the hydrophobicity of this compound by solvation. However, the formation of this complex reduced the reextraction rate and, consequently, affects the synergism related to the final mass flows and permeability factor. For describing the influences of carriers concentrations on the synergistic coefficients, some equations have been proposed by taking into account the vitamin mass flows or permeability factors, with an average deviations between 4.85% and 10.73%.

Keywords: pertraction, synergism, vitamin B9, Amberlite LA-2, di(2-ethylhexyl) phosphoric acid

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Authors: Norah Alosayl

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English is considered the most important foreign language in the Kingdom of Saudi Arabia (KSA) because of the usefulness of English as a global language compared to Arabic. As students’ desire to improve their English language skills has grown, English writing has been identified as the most difficult problem for Saudi students in their language learning. Although the English language in Saudi Arabia is taught beginning in the seventh grade, many students have problems at the university level, especially in writing, due to a gap between what is taught in secondary and high schools and university expectations- pupils generally study English at school, based on one book with few exercises in vocabulary and grammar exercises, and there are no specific writing lessons. Moreover, from personal teaching experience at King Saud bin Abdulaziz University, students face real problems with their writing. This paper revolves around the blackboard-based collaborative writing to help the undergraduate Saudi EFL students, in their first year enrolled in two sections of ENGL 101 in the first semester of 2021 at King Saud bin Abdulaziz University, practice the most difficult skill they found in their writing through a small group. Therefore, a sequential mixed methods design will be suited. The first phase of the study aims to highlight the most difficult skill experienced by students from an official writing exam that is evaluated by their teachers through an official rubric used in King Saud bin Abdulaziz University. In the second phase, this study will intend to investigate the benefits of social interaction on the process of learning writing. Students will be provided with five collaborative writing tasks via discussion feature on Blackboard to practice a skill that they found difficult in writing. the tasks will be formed based on social constructivist theory and pedagogic frameworks. The interaction will take place between peers and their teachers. The frequencies of students’ participation and the quality of their interaction will be observed through manual counting, screenshotting. This will help the researcher understand how students actively work on the task through the amount of their participation and will also distinguish the type of interaction (on task, about task, or off-task). Semi-structured interviews will be conducted with students to understand their perceptions about the blackboard-based collaborative writing tasks, and questionnaires will be distributed to identify students’ attitudes with the tasks.

Keywords: writing difficulties, blackboard-based collaborative writing, process of learning writing, interaction, participations

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Authors: Qurat Ul Ain Saleem, Kanwal Ameen

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The library and information science discipline is universally known as a feminist profession. It is considered a suitable field for females in Pakistan like a few other fields such as teaching and healthcare. It is also reflected through the uneven enrollment at graduate levels in library schools across the country as there are more females as compared to males. However, that uneven ratio does not really translate in the profession after passing out. There are more males in the professional as compared to females, as well as males can be seen on managerial and administrative posts majorly. A few females who joined the perception remain underrated and are hardly seen at managerial or administrative positions in the academic libraries. Therefore, this study was designed to highlight the perceptions of those females who have joined the profession to identify the issues related to equality faced by them as a professional. A qualitative research design based on a semi-structured interview was selected as an appropriate method to achieve the objectives of this study. Female librarians working in the higher education commission’s recognized public and private sector universities of Punjab, Pakistan, were selected as the population for this study. Female librarians shared that inequalities and discrimination based on face value, experience, communication, and relationship with the manager are common at their workplaces. They added that managers prefer male professionals to deal with delegation or presentations though we both can do that. Female professionals from the private sector believed that library managers make final hiring and selection decisions based on job duties and gender. However, the one with strong references will be preferred for the job. Also, private-sector employees suffered more prejudice due to the non-availability of proper patterns of promotions and increments. The government personnel said there is always a proper board/procedure for hiring and promotions; therefore, it is difficult for them to identify any inequality. Participants were dissatisfied with their managers for not allowing them to attend training and conferences. The majority of participants from the private sector said they wouldn't speak up to prejudice because they are afraid of losing their jobs and their voice is lost in a male-dominated society where males hold numerous authoritative positions and females are considered less competent. Nonetheless, the discrimination and inequalities affected the work motivation and enthusiasm of employees. Therefore, organizations should not discriminate against the staff in terms of facilities and benefits. The sample may not represent the true picture of gender equality in university libraries of Pakistan due to less number of participants and limited geographical boundaries. It is also assumed that some females may refrain from disclosing factual information or some may exaggerate the facts as a large number of participants requested to become part of the study. Equal opportunities should be offered to female library professionals to uplift and involve them to mitigate the perception of gender dominance. The organizations or immediate authorities should allow their staff to participate in training opportunities to learn modern practices to better serve the community.

Keywords: equality-workplace, libraries as workplace, female professionals, librarians-Pakistan

Procedia PDF Downloads 114

Authors: Marcelo Lopes Dias Kolling, Felipe Ferreira Laranjeira, Guilherme Augusto Hettwer, Pedro Salomão Piccinini, Marwan Masri, Carlos Oscar Uebel

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Introduction: Injectable fillers are among the most common nonsurgical cosmetic procedures, with significant growth yearly. Knowledge of rheological and mechanical characteristics of fillers, facial anatomy, and injection technique is essential for safety. Concepts such as the use of cannula versus needle, aspiration before injection, and facial danger zones have been well discussed. In case of an accidental intravascular puncture, the pressure inside the vessel may not be sufficient to push blood into the syringe due to the characteristics of the filler product; this is especially true for calcium hydroxyapatite (CaHA) or hyaluronic acid (HA) fillers with high G’. Since viscoelastic properties of normal saline are much lower than those of fillers, aspiration with saline prior to filler injection may decrease the risk of a false negative aspiration and subsequent catastrophic effects. We discuss a technique to add an additional safety step to the procedure with saline aspiration prior to injection, a ‘’reverse Seldinger’’ technique for intravascular access, which we term SANIT: Saline Aspiration Negative Intravascular Test. Objectives: To demonstrate the author’s (PSP) technique which adds an additional safety step to the process of filler injection, with both CaHA and HA, in order to decrease the risk of intravascular injection. Materials and Methods: Normal skin cleansing and topical anesthesia with prilocaine/lidocaine cream are performed; the facial subunits to be treated are marked. A 3mL Luer lock syringe is filled with 2mL of 0.9% normal saline and a 27G needle, which is turned one half rotation. When a cannula is to be used, the Luer lock syringe is attached to a 27G 4cm single hole disposable cannula. After skin puncture, the 3mL syringe is advanced with the plunger pulled back (negative pressure). Progress is made to the desired depth, all the while aspirating. Once the desired location of filler injection is reached, the syringe is exchanged for the syringe containing a filler, securely grabbing the hub of the needle and taking care to not dislodge the needle tip. Prior to this, we remove 0.1mL of filler to allow for space inside the syringe for aspiration. We again aspirate and inject retrograde. SANIT is especially useful for CaHA, since the G’ is much higher than HA, and thus reflux of blood into the syringe is less likely to occur. Results: The technique has been used safely for the past two years with no adverse events; the increase in cost is negligible (only the cost of 2mL of normal saline). Over 100 patients (over 300 syringes) have been treated with this technique. The risk of accidental intravascular puncture has been calculated to be between 1:6410 to 1:40882 syringes among expert injectors; however, the consequences of intravascular injection can be catastrophic even with board-certified physicians. Conclusions: While the risk of intravascular filler injection is low, the consequences can be disastrous. We believe that adding the SANIT technique can help further mitigate risk with no significant untoward effects and could be considered by all performing injectable fillers. Further follow-up is ongoing.

Keywords: injectable fillers, safety, saline aspiration, injectable filler complications, hyaluronic acid, calcium hydroxyapatite

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Authors: Mohsina Aktar, Bishawjit Mallick

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Bangladesh faces the multidimensional manifestations of climate change e.g. flood, cyclone, sea level rise, drainage congestion, salinity, etc. This study aimed at to find out the community’s perception of the perceived impact of climate change on their wetland resource based livelihood, to analyze their present livelihood scenario and to find out required institutional setup to strengthen present livelihood scenario. Therefore, this study required both quantitative analysis like quantification of wetland resources, occupation, etc. and also exploratory information like policy and institutional reform. For quantitative information 200 questionnaire survey and in some cases observation survey and for socially shareable qualitative and quantitative issues case study and focus group discussion were conducted. In-Depth interview was conducted for socially non-shareable qualitative issues. The overall findings of this study have been presented maintaining a sequence- perception about climate change effect, livelihood scenario and required institutional support of the wetland community. Flood has been ranked where cyclone effect is comparatively less disastrous in this area. Heavy rainfall comes after the cyclone. Female members responded almost same about the ranking and effects of frequently occurred and devastating effects of climate change. People are much more aware of the impact of climate change. Training of Care in RVCC project helps to increase their knowledge level. If the level of education can be increased, people can fight against calamity and poverty with more confidence. People seem to overcome the problems of water logging and thus besides involving in Hydroponics (33.3%) as prime occupation in monsoon; they are also engaged in other business related activities. January to May is the low-income season for the farmers. But some people don’t want to change their traditional occupation and their age is above 45. The young earning member wants to utilize their lean income period by alternative occupation. People who do not have own land and performing water transportation or other types of occupation are now interested about Hydroponics. People who give their land on rent are now thinking about renting their land in monsoon as through that they can earn a sound amount rather than get nothing. What they require is just seed, training, and capital. Present marketing system faces the problem of communication. So this sector needed to be developed. Involvement of women in income earning activity is very low (5.1%), and 100% women are housewives. They became inferior due to their educational level and dominance of their husband. Only one NGO named BCAS (Bangladesh Center for Advanced Studies) has been found engage training facilities and advocacy for this purpose. Upazilla agricultural extension office like other GO remains inactive to give support the community for extension and improvement of Hydroponics agriculture. If the community gets proper support and inspiration, they can fight against crisis of low-income and climate change, with the Hydroponics cultivation system successfully.

Keywords: wetland community, hydroponics, climate change adaptation, livelihood

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Authors: Habiba Nahzat, Karen Crow, Lisa Manuel, Maria Huijbregts

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Background and Rationale: The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. Shortly after, the Ontario provincial and Toronto municipal governments also released multiple directives that led to the mass closure of businesses both in the public and private sectors. Recent research has identified connections between Intimate Partner Violence (IPV) and COVID-19 related stressors - especially because of lockdown and social isolation measures. Psychological impacts of lengthy seclusion coupled with disconnection from extended family and diminished support services can take a toll on families at risk and may increase mental health issues and the prevalence of IPV. Research Question: Thus, the purpose of the study was to understand the perspective of the Violence Against Women (VAW) program staff on the impact of the COVID-19 pandemic; we especially wanted to understand staff views of restrictions on clients’ counseling experiences and the ability to access services in general. The study also aimed to examine VAW program staff experiences regarding remote work and explore how the pandemic restriction measures affected the ability of their program operations to support their clients and each other. Method: A cross-sectional, descriptive qualitative study was conducted with a purposive sample of 9 VAW program staff – eight VAW counselors and one VAW manager. Prior to data collection, program staff collaborated in the development of the study purpose, interview questions and methodology. Ethics approval was obtained from the sponsoring organization’s Research Ethics Board. In-depth individual interviews were conducted with study participants using a semi-structured interview questionnaire. Brief demographic information was also collected prior to the interview. Descriptive statistics were used to analyze quantitative data and qualitative data was analyzed by thematic content analysis. Results: Findings from this study indicate that the COVID-19 pandemic restrictions had an adverse impact on clients seeking VAW services based on VAW staff perspectives. Program staff reported a perceived increase in abuse among women, especially in emotional and financial abuse and experiences of isolation and trauma. Findings further highlight the challenges women experienced when trying to access services in general as well as counseling and legal services. This was perceived to be more prominent among newcomers and marginalized women. The study also revealed client and staff challenges when participating in virtual counseling, their innovations and clients’ creativity in accessing needed counseling and how staff over time adapted to providing virtual support during the pandemic. Conclusion and Next Steps: This study builds upon existing evidence on the impact of COVID-19 restrictions on VAW and may inform future research to better understand the association between the COVID-19 pandemic restrictions and VAW on a broader scale and to inform and support possible short-term and long-term changes in the client experience and counselling practice.

Keywords: COVID-19, pandemic, virtual, violence against women (VAW)

Procedia PDF Downloads 190

Authors: Dimitriu Corneliu-Ioan, Gheorghe FrațIlă

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Romania has one of the highest rates of road deaths among European Union Member States, and there is a concern that the country will not meet its goal of "zero deaths" by 2050. The European Union also aims to halve the number of people seriously injured in road accidents by 2030. Therefore, there is a need to improve road infrastructure safety management in Romania. The aim of this study is to analyze road accident data through statistical methods to assess the current state of road infrastructure safety in Bucharest. The study also aims to identify trends and make forecasts regarding serious road accidents and their consequences. The objective is to provide insights that can help prioritize measures to increase road safety, particularly in urban areas. The research utilizes statistical analysis methods, including exploratory analysis and descriptive statistics. Databases from the Traffic Police and the Romanian Road Authority are analyzed using Excel. Road risks are compared with the main causes of road accidents to identify correlations. The study emphasizes the need for better quality and more diverse collection of road accident data for effective analysis in the field of road infrastructure engineering. The research findings highlight the importance of prioritizing measures to improve road safety in urban areas, where serious accidents and their consequences are more frequent. There is a correlation between the measures ordered by road safety auditors and the main causes of serious accidents in Bucharest. The study also reveals the significant social costs of road accidents, amounting to approximately 3% of GDP, emphasizing the need for collaboration between local and central administrations in allocating resources for road safety. This research contributes to a clearer understanding of the current road infrastructure safety situation in Romania. The findings provide critical insights that can aid decision-makers in allocating resources efficiently and institutionally cooperating to achieve sustainable road safety. The data used for this study are collected from the Traffic Police and the Romanian Road Authority. The data processing involves exploratory analysis and descriptive statistics using the Excel tool. The analysis allows for a better understanding of the factors contributing to the current road safety situation and helps inform managerial decisions to eliminate or reduce road risks. The study addresses the state of road infrastructure safety in Bucharest and analyzes the trends and forecasts regarding serious road accidents and their consequences. It studies the correlation between road safety measures and the main causes of serious accidents. To improve road safety, cooperation between local and central administrations towards joint financial efforts is important. This research highlights the need for statistical data processing methods to substantiate managerial decisions in road infrastructure management. It emphasizes the importance of improving the quality and diversity of road accident data collection. The research findings provide a critical perspective on the current road safety situation in Romania and offer insights to identify appropriate solutions to reduce the number of serious road accidents in the future.

Keywords: road death rate, strategic objective, serious road accidents, road safety, statistical analysis

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Authors: Banu Baybars Hawks

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To date, academic attention in social sciences remains inadequate with regard to research and analysis of public opinion in Turkey. Most of the existing research has assessed the public opinion during political election periods. Therefore, it is of great interest to find out what the public thinks about current issues in Turkey, and how to interpret the results to be able to reveal whether they may have any reflections on social, political, and cultural structure of the country. Accordingly, the current study seeks to fill the gap in the social sciences literature in English regarding Turkey’s social and political stand which may be perceived to be very different by other nations. Without timely feedback from public surveys, various programs for improving different services and institutions functioning in the country might not achieve their expected goal, nor can decisions about which programs to implement be made rationally. Additionally, the information gathered may not only yield important insights into public’s opinion regarding current agenda in Turkey, but also into the correlates shaping public policies. Agenda-setting studies including agenda-building, agenda melding, reversed agenda-setting and information diffusion studies will be used to explain the roles of factors and actors in the formation of public opinion in Turkey. Knowing the importance of public agenda in the agenda setting and building process, this paper aims to reveal the social and political tendencies of the Turkish public. For that purpose, a survey will be carried out in December of 2014 to determine the social and political trends in Turkey for that same year. The subjects for the study, which utilize a questionairre in one-on-one interviews, will include 1,000 individuals aged 18 years and older from 26 cities representing general population. A stratified random sampling frame will be used. The topics covered by the survey include: The most important current problem in Turkey; the Economy; Terror; Approaches to the Kurdish Issue; Evaluations of the Government and Opposition Parties; Evaluations of Institutional Efficiency; Foreign Policy; the Judicial System/Constitution; Democracy and the Media; and, Social Relations/Life in Turkey. Since the beginning of the 21st century, Turkey has been undergoing a rapid transformation. The reflections of the changes can be seen in all areas from economics to politics. It is my hope that findings of this study may shed light on the important aspects of institutions, variables setting the agenda, and formation process of public opinion in Turkey.

Keywords: public opinion, media, agenda setting, information diffusion, government, freedom, Turkey

Procedia PDF Downloads 468

Authors: Lukas Reznak, Maria Reznakova

Abstract:

Recession of an economy has a profound negative effect on all involved stakeholders. It follows that timely prediction of recessions has been of utmost interest both in the theoretical research and in practical macroeconomic modelling. Current mainstream of recession prediction is based on standard OLS models of continuous GDP using macroeconomic data. This approach is not suitable for two reasons: the standard continuous models are proving to be obsolete and the macroeconomic data are unreliable, often revised many years retroactively. The aim of the paper is to explore a different branch of recession forecasting research theory and verify the findings on real data of the Czech Republic and Germany. In the paper, the authors present a family of discrete choice probit models with parameters estimated by the method of maximum likelihood. In the basic form, the probits model a univariate series of recessions and expansions in the economic cycle for a given country. The majority of the paper deals with more complex model structures, namely dynamic and bivariate extensions. The dynamic structure models the autoregressive nature of recessions, taking into consideration previous economic activity to predict the development in subsequent periods. Bivariate extensions utilize information from a foreign economy by incorporating correlation of error terms and thus modelling the dependencies of the two countries. Bivariate models predict a bivariate time series of economic states in both economies and thus enhance the predictive performance. A vital enabler of timely and successful recession forecasting are reliable and readily available data. Leading indicators, namely the yield curve and the stock market indices, represent an ideal data base, as the pieces of information is available in advance and do not undergo any retroactive revisions. As importantly, the combination of yield curve and stock market indices reflect a range of macroeconomic and financial market investors’ trends which influence the economic cycle. These theoretical approaches are applied on real data of Czech Republic and Germany. Two models for each country were identified – each for in-sample and out-of-sample predictive purposes. All four followed a bivariate structure, while three contained a dynamic component.

Keywords: bivariate probit, leading indicators, recession forecasting, Czech Republic, Germany

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Authors: B. S. Premalatha, Mereen Rose Babu, Vaishali Prabhu

Abstract:

Background: Dysphagia must be assessed, either subjectively or objectively, in order to properly address the swallowing difficulty. Providing therapeutic care to patients with dysphagia via tele mode was one approach for providing clinical services during the COVID-19 epidemic. As a result, the teleassessment of dysphagia has increased in India. Aim: This study aimed to identify challenges faced by Indian SLPs while providing teleassessment to individuals with dysphagia during the outbreak of COVID-19 from 2020 to 2021. Method: After receiving approval from the institute's institutional review board and ethics committee, the current study was carried out. The study was cross-sectional in nature and lasted from 2020 to 2021. The study enrolled participants who met the inclusion and exclusion criteria of the study. It was decided to recruit roughly 246 people based on the sample size calculations. The research was done in three stages: questionnaire development and content validation, questionnaire administration. Five speech and hearing professionals' content verified the questionnaire for faults and clarity. Participants received questionnaires via various social media platforms such as e-mail and WhatsApp, which were written in Microsoft Word and then converted to Google Forms. SPSS software was used to examine the data. Results: In light of the obstacles that Indian SLPs encounter, the study's findings were examined. Only 135 people responded. During the COVID-19 lockdowns, 38% of participants said they did not deal with dysphagia patients. After the lockout, 70.4% of SLPs kept working with dysphagia patients, while 29.6% did not. From the beginning of the oromotor examination, the main problems in completing tele evaluation of dysphagia have been highlighted. Around 37.5% of SLPs said they don't undertake the OPME online because of difficulties doing the evaluation, such as the need for repeated instructions from patients and family members and trouble visualizing structures in various positions. The majority of SLPs' online assessments were inefficient and time-consuming. A bigger percentage of SLPs stated that they will not advocate tele evaluation in dysphagia to their colleagues. SLPs' use of dysphagia assessment has decreased as a result of the epidemic. When it came to the amount of food, the majority of people proposed a small amount. Apart from placing the patient for assessment and gaining less cooperation from the family, most SLPs found that Internet speed was a source of concern and a barrier. Hearing impairment and the presence of a tracheostomy in patients with dysphagia proved to be the most difficult conditions to treat online. For patients with NPO, the majority of SLPs did not advise tele-evaluation. In the anterior region of the oral cavity, oral meal residue was more visible. The majority of SLPs reported more anterior than posterior leakage. Even while the majority of SLPs could detect aspiration by coughing, many found it difficult to discern the gurgling tone of speech after swallowing. Conclusion: The current study sheds light on the difficulties that Indian SLPs experience when assessing dysphagia via tele mode, indicating that tele-assessment of dysphagia is still to gain importance in India.

Keywords: dysphagia, teleassessment, challenges, Indian SLP

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Authors: Alaa Fezai, Anuj Sharma, Wolfgang Mueller-Hirsch, André Zimmermann

Abstract:

Viscoelastic materials have been widely used in the automotive industry over the last few decades with different functionalities. Besides their main application as a simple and efficient surface damping treatment, they may ensure optimal operating conditions for on-board electronics as thermal interface or sealing layers. The dynamic behavior of viscoelastic materials is generally dependent on many environmental factors, the most important being temperature and strain rate or frequency. Prior to the reliability analysis of systems including viscoelastic layers, it is, therefore, crucial to accurately predict the dynamic and lifetime behavior of these materials. This includes the identification of the dynamic material parameters under critical temperature and frequency conditions along with a precise damage localization and identification methodology. The goal of this work is twofold. The first part aims at applying an inverse viscoelastic material-characterization approach for a wide frequency range and under different temperature conditions. For this sake, dynamic measurements are carried on a single lap joint specimen using an electrodynamic shaker and an environmental chamber. The specimen consists of aluminum beams assembled to adapter plates through a viscoelastic adhesive layer. The experimental setup is reproduced in finite element (FE) simulations, and frequency response functions (FRF) are calculated. The parameters of both the generalized Maxwell model and the fractional derivatives model are identified through an optimization algorithm minimizing the difference between the simulated and the measured FRFs. The second goal of the current work is to guarantee an on-line detection of the damage, i.e., delamination in the viscoelastic bonding of the described specimen during frequency monitored end-of-life testing. For this purpose, an inverse technique, which determines the damage location and size based on the modal frequency shift and on the change of the mode shapes, is presented. This includes a preliminary FE model-based study correlating the delamination location and size to the change in the modal parameters and a subsequent experimental validation achieved through dynamic measurements of specimen with different, pre-generated crack scenarios and comparing it to the virgin specimen. The main advantage of the inverse characterization approach presented in the first part resides in the ability of adequately identifying the material damping and stiffness behavior of soft viscoelastic materials over a wide frequency range and under critical temperature conditions. Classic forward characterization techniques such as dynamic mechanical analysis are usually linked to limitations under critical temperature and frequency conditions due to the material behavior of soft viscoelastic materials. Furthermore, the inverse damage detection described in the second part guarantees an accurate prediction of not only the damage size but also its location using a simple test setup and outlines; therefore, the significance of inverse numerical-experimental approaches in predicting the dynamic behavior of soft bonding layers applied in automotive electronics.

Keywords: damage detection, dynamic characterization, inverse approaches, vibration testing, viscoelastic layers

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Authors: Pierobon Enrico, Missiaggia Marta, Castelluzzo Michele, Tommasino Francesco, Ricci Leonardo, Scifoni Emanuele, Vincezo Monaco, Boscardin Maurizio, La Tessa Chiara

Abstract:

Clinical outcomes collected over the past three decades have suggested that ion therapy has the potential to be a treatment modality superior to conventional radiation for several types of cancer, including recurrences, as well as for other diseases. Although the results have been encouraging, numerous treatment uncertainties remain a major obstacle to the full exploitation of particle radiotherapy. To overcome therapy uncertainties optimizing treatment outcome, the best possible radiation quality description is of paramount importance linking radiation physical dose to biological effects. Microdosimetry was developed as a tool to improve the description of radiation quality. By recording the energy deposition at the micrometric scale (the typical size of a cell nucleus), this approach takes into account the non-deterministic nature of atomic and nuclear processes and creates a direct link between the dose deposited by radiation and the biological effect induced. Microdosimeters measure the spectrum of lineal energy y, defined as the energy deposition in the detector divided by most probable track length travelled by radiation. The latter is provided by the so-called “Mean Chord Length” (MCL) approximation, and it is related to the detector geometry. To improve the characterization of the radiation field quality, we define a new quantity replacing the MCL with the actual particle track length inside the microdosimeter. In order to measure this new quantity, we propose a two-stage detector consisting of a commercial Tissue Equivalent Proportional Counter (TEPC) and 4 layers of Low Gain Avalanche Detectors (LGADs) strips. The TEPC detector records the energy deposition in a region equivalent to 2 um of tissue, while the LGADs are very suitable for particle tracking because of the thickness thinnable down to tens of micrometers and fast response to ionizing radiation. The concept of HDM has been investigated and validated with Monte Carlo simulations. Currently, a dedicated readout is under development. This two stages detector will require two different systems to join complementary information for each event: energy deposition in the TEPC and respective track length recorded by LGADs tracker. This challenge is being addressed by implementing SoC (System on Chip) technology, relying on Field Programmable Gated Arrays (FPGAs) based on the Zynq architecture. TEPC readout consists of three different signal amplification legs and is carried out thanks to 3 ADCs mounted on a FPGA board. LGADs activated strip signal is processed thanks to dedicated chips, and finally, the activated strip is stored relying again on FPGA-based solutions. In this work, we will provide a detailed description of HDM geometry and the SoC solutions that we are implementing for the readout.

Keywords: particle tracking, ion therapy, low gain avalanche diode, tissue equivalent proportional counter, microdosimetry

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