Search results for: academic staff

Authors: Eyob Seife, Molla Alemayaehu, Tesfalem Teshome, Bereket Seyoum, Behailu Getachew

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Globally, immunization averts between 2 and 3 million deaths yearly, but Vaccine-Preventable Diseases still account for more in Sub-Saharan African countries and takes the majority of under-five deaths yearly, which indicates the need for consistent and on-time information to have evidence-based decision so as to save lives of these vulnerable groups. However, ensuring data of sufficient quality and promoting an information-use culture at the point of collection remains critical and challenging, especially in remote areas where the Ararso district is selected based on a hypothesis of there is a difference in reported and recounted immunization data consistency. Data quality is dependent on different factors where organizational, behavioral, technical and contextual factors are the mentioned ones. A cross-sectional quantitative study was conducted on September 2022 in the Ararso district. The study used the world health organization (WHO) recommended data quality self-assessment (DQS) tools. Immunization tally sheets, registers and reporting documents were reviewed at 4 health facilities (1 health center and 3 health posts) of primary health care units for one fiscal year (12 months) to determine the accuracy ratio, availability and timeliness of reports. The data was collected by trained DQS assessors to explore the quality of monitoring systems at health posts, health centers, and at the district health office. A quality index (QI), availability and timeliness of reports were assessed. Accuracy ratios formulated were: the first and third doses of pentavalent vaccines, fully immunized (FI), TT2+ and the first dose of measles-containing vaccines (MCV). In this study, facility-level results showed poor timeliness at all levels and both over-reporting and under-reporting were observed at all levels when computing the accuracy ratio of registration to health post reports found at health centers for almost all antigens verified. A quality index (QI) of all facilities also showed poor results. Most of the verified immunization data accuracy ratios were found to be relatively better than that of quality index and timeliness of reports. So attention should be given to improving the capacity of staff, timeliness of reports and quality of monitoring system components, namely recording, reporting, archiving, data analysis and using information for decisions at all levels, especially in remote and areas.

Keywords: accuracy ratio, ararso district, quality of monitoring system, regular immunization program, timeliness of reports, Somali region-Ethiopia

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Authors: Sandeep Vasaikar, Lary Obi

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Rapid and discriminative genotyping methods are useful for determining the clonality of the isolates in nosocomial or household outbreaks. Multilocus sequence typing (MLST) is a nucleotide sequence-based approach for characterising bacterial isolates. The genetic diversity and the clinical relevance of the drug-resistant Klebsiella isolates from Mthatha are largely unknown. For this reason, prospective, experimental study of the molecular epidemiology of Klebsiella isolates from patients being treated in Mthatha over a three-year period was analysed. Methodology: PCR amplification and sequencing of the drug-resistance-associated genes, and multilocus sequence typing (MLST) using 7 housekeeping genes mdh, pgi, infB, FusAR, phoE, gapA and rpoB were conducted. A total of 32 isolates were analysed. Results: The percentages of multidrug-resistant (MDR), extensively drug-resistance (XDR) and pandrug-resistant (PDR) isolates were; MDR 65.6 % (21) and XDR and PDR with 0 % each. In this study, K. pneumoniae was 19/32 (59.4 %). MLST results showed 22 sequence types (STs) were identified, which were further separated by Maximum Parsimony into 10 clonal complexes and 12 singletons. The most dominant group was Klebsiella pneumoniae with 23/32 (71.8 %) isolates, Klebsiella oxytoca as a second group with 2/32 (6.25 %) isolates, and a single (3.1 %) K. varricola as a third group while 6 isolates were of unknown sequences. Conclusions/significance: A phylogenetic analysis of the concatenated sequences of the 7 housekeeping genes showed that strains of K. pneumoniae form a distinct lineage within the genus Klebsiella, with K. oxytoca and K. varricola its nearest phylogenetic neighbours. With the analysis of 7 genes were determined 1 K. variicola, which was mistakenly identified as K. pneumoniae by phenotypic methods. Two misidentifications of K. oxytoca were found when phenotypic methods were used. No significant differences were observed between ESBL blaCTX-M, blaTEM and blaSHV groups in the distribution of Sequence types (STs) or Clonal complexes (CCs).

Keywords: phylogenetic analysis, phylogeny, klebsiella phylogenetic, klebsiella

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Authors: Panrapee Suttiwan, Rewadee Watakakosol Arunya Tuicomepee, Sakkaphat T. Ngamake

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Alcohol consumption ranks among the top six of health-risk behaviors that lead to disability and death among Thai teenagers. Underage drinkers have higher health risks than their non-drinking peers do. This study, therefore, aimed to explore salient beliefs of Thai teenagers with alcohol reduction and cessation based on the Theory of Planned Behaviour theoretical framework. Participants were 225 high-school and vocational school students, most of whom (60.9%) consumed alcohol almost daily (5-6 times / week), and one-third of whom (33.8%) reported habitual moderate drink. The average age was 16.5 (SD = 0.9), and the average age of the first use of alcohol was 13.7 (SD = 2.2). Instrument was an open-ended questionnaire that elicited beliefs about having alcohol reduction / cessation in the past 12 months. Findings revealed salient benefit beliefs of alcohol reduction / cessation among the teens such as improved physical and mental health, accident and violence avoidance, less sexual risks, money and time saving, better academic performance, and improved relationships. In contrast, the teens identified several disadvantage beliefs such as deteriorating health, social awkwardness, lack of little fun, excitement, and experience, physical uneasiness, stress, and lack of self-confidence. Salient normative groups for alcohol reduction / cessation included parents, elder relatives, siblings, close friends, teachers, boy / girlfriends, and seniors / juniors at school. Situations influencing alcohol reduction / cessation included quarrels with boy / girlfriends, family conflicts, peer pressure, partying and socializing, festive holidays and anniversary celebration, and visiting entertainment places, etc. This study provides empirical evidence that help to identify normative attitudes towards alcohol reduction / cessation and may thus be an important knowledge for public health campaigns seeking to reduce alcohol consumption in this population.

Keywords: alcohol consumption reduction, cessation, salient belief, Thai teenagers

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Authors: Y. Zhang, J. Perez, S. Marnier

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To date, no study on goaltending butterfly motion has been completed in real conditions, during an ice hockey game or training practice, to the author's best knowledge. This motion, performed to save score, is unnatural, intense, and repeated. The target of this research activity is to identify representative biomechanical criteria for this goaltender-specific movement pattern. Determining specific physical parameters may allow to will identify the risk of hip and groin injuries sustained by goaltenders. Four professional or academic goalies were instrumented during ice hockey training practices with five inertial measurement units. These devices were inserted in dedicated pockets located on each thigh and shank, and the fifth on the lumbar spine. A camera was also installed close to the ice to observe and record the goaltenders' activities, especially the butterfly motions, in order to synchronize the captured data and the behavior of the goaltender. Each data recorded began with a calibration of the inertial units and a calibration of the fully equipped goaltender on the ice. Three butterfly motions were recorded out of the training practice to define referential individual butterfly motions. Then, a data processing algorithm based on the Madgwick filter computed hip and knee joints joint range of motion as well as angular specific angular velocities. The developed algorithm software automatically identified and analyzed all the butterfly motions executed by the four different goaltenders. To date, it is still too early to show that the analyzed criteria are representative of the trauma generated by the butterfly motion as the research is only at its beginning. However, this descriptive research activity is promising in its ecological assessment, and once the criteria are found, the tools and protocols defined will allow the prevention of as many injuries as possible. It will thus be possible to build a specific training program for each goalie.

Keywords: biomechanics, butterfly motion, human motion analysis, ice hockey, inertial measurement unit

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Authors: Duduzile Dlamini-Boemah, Haretsebe Manwa, Lisebo Tseane-Gumbi

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The demands and expectations of twenty-first century tourists have changed, and they continue to have an impact on tour guiding in cultural and natural tourist attractions. The traditional communicative role of the tour guide as a mere presenter is not sufficient anymore; instead, there are expectations from the tourists of guides who provide effective interpretive guiding. It is always questionable if tour guides in South Africa are equipped with the skills for effective interpretation, yet limited research has been conducted to investigate the continuing professional education of tour guides in South Africa. Instead, much attention has been given to aspects of registration and certification of tour guides in South Africa. Concerns have been raised about tour guiding and have led to the development of a strategy by the Department of Tourism to professionalise tourists guiding that includes training. However, the necessity for tourism training in tour guiding in South Africa was raised as early as in the 1980s, the paper argues that there is a further need to emphasise continuing professional education in interpretive guiding in South Africa. In this study, continuing education and training are considered to involve the upgrading of the skills and knowledge of interpretation of those who are already working as tour guides at the cultural and natural attractions. The study is guided by the empowerment theory. The aim of this paper is to present issues of effective interpretive guiding and continuing professional education in interpretive guiding in South Africa. This study is based on the literature survey of secondary sources such as academic journal articles, government documents, and reports and books. The conclusions indicate that there is a need for training in interpretive delivery techniques in South Africa. The need for interpretive training in interpretive delivery techniques is attributed by the call to allow people to use indigenous knowledge, rather than formal education as a basis for becoming a field guide as well as affording the previously disadvantaged individuals to access training opportunities as tourist guides.

Keywords: continuing education, interpretive delivery skills, interpretive guiding, tour guide

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Authors: Leandi Steenkamp

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The sectional title industry has been a part of the property landscape in South Africa for almost half a century, and plays a significant role in addressing the housing problem in the country. Stakeholders such as owners and investors in sectional title property are in most cases not directly involved in the management thereof, and place reliance on the audited annual financial statements of bodies corporate for decision-making purposes. Although the industry seems to be highly regulated, the legislation regarding accounting and auditing of sectional title is vague and ambiguous. Furthermore, there are no industry-specific auditing and accounting standards to guide accounting and auditing practitioners in performing their work and industry financial benchmarks are not readily available. In addition, financial pressure on sectional title schemes is often very high due to the fact that some owners exercise unrealistic pressure to keep monthly levies as low as possible. All these factors have an impact on the business risk as well as audit risk of bodies corporate. Very little academic research has been undertaken on the sectional title industry in South Africa from an accounting and auditing perspective. The aim of this paper is threefold: Firstly, to discuss the findings of a literature review on uncertainties, ambiguity and confusing aspects in current legislation regarding the audit of a sectional title property that may cause or increase audit and business risk. Secondly, empirical findings of risk-related aspects from the results of interviews with three groups of body corporate role-players will be discussed. The role-players were body corporate trustee chairpersons, body corporate managing agents and accounting and auditing practitioners of bodies corporate. Specific reference will be made to business risk and audit risk. Thirdly, practical recommendations will be made on possibilities of closing the audit expectation gap, and further research opportunities in this regard will be discussed.

Keywords: assurance, audit, audit risk, body corporate, corporate governance, sectional title

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Authors: Jacklyn Yek, Clara Tong, Shin Yuet Chong, Yee Yian Ong

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Background: While emergency manuals and cognitive aids (CA) have been used in high-hazard industries for decades, this has been a nascent field in healthcare. CAs can potentially offset the large cognitive load involved in crisis resource management and possibly facilitate the efficient performance of key steps in treatment. A crisis manual was developed based on local guidelines and the latest evidence-based information and introduced to a tertiary hospital setting in Singapore. Hence, the objective of this study is to evaluate the effectiveness of the crisis manual in guiding response and management of critical events. Methods: 7 surgical teams were recruited to participate in a series of simulated emergencies in high-fidelity operating room simulator over the period of April to June 2018. All teams consisted of a surgical consultant and medical officer/registrar, anesthesia consultant and medical officer/registrar; as well as a circulating, scrub and anesthetic nurse. Each team performed a simulated operation in which 1 or more of the crisis events occurred. The teams were randomly assigned to a scenario of the crisis manual and all teams were deemed to be equal in experience and knowledge. Before the simulation, teams were instructed on proper checklist use but the use of the checklist was optional. Results: 7 simulation sessions were performed, consisting of the following scenarios: Airway fire, Massive Transfusion Protocol, Malignant Hyperthermia, Eclampsia, and Difficult Airway. Out of the 7 surgical teams, 2 teams made use of the crisis manual – of which both teams had encountered a ‘Malignant Hyperthermia’ scenario. These team members reflected that the crisis manual assisted allowed them to work in a team, especially being able to involve the surgical doctors who were unfamiliar with the condition and management. A run chart plotted showed a possible upward trend, suggesting that with increasing awareness and training, staff would become more likely to initiate the use of the crisis manual. Conclusion: Despite the high volume load in this tertiary hospital, certain crises remain rare and clinicians are often caught unprepared. A crisis manual is an effective tool and easy-to-use repository that can improve patient outcome and encourage teamwork. With training, familiarity would allow clinicians to be increasingly comfortable with reaching out for the crisis manual. More simulation training would need to be conducted to determine its effectiveness.

Keywords: crisis resource management, high fidelity simulation training, medical errors, visual aids

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Authors: Z. Razi, S. M. J. Mortazavi, N. Shokrpour, Z. Shayan, F. Amiri

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Long-term exposure to low doses of ionizing radiation occurs in radiation health care workplaces. Although doses in health professions are generally very low, there are still matters of concern. The radiation safety program promotes occupational radiation safety through accurate and reliable monitoring of radiation workers in order to effectively manage radiation protection. To achieve this goal, it has become mandatory to implement health examination periodically. As a result, based on the hematological alterations, working populations with a common occupational radiation history are screened. This paper calls into question the effectiveness of blood component analysis as a screening program which is mandatory for medical radiation workers in some countries. This study details the distribution and trends of changes in blood components, including white blood cells (WBCs), red blood cells (RBCs) and platelets as well as received cumulative doses from occupational radiation exposure. This study was conducted among 199 participants and 100 control subjects at the medical imaging departments at the central hospital of Shiraz University of Medical Sciences during the years 2006–2010. Descriptive and analytical statistics, considering the P-value<0.05 as statistically significance was used for data analysis. The results of this study show that there is no significant difference between the radiation workers and controls regarding WBCs and platelet count during 4 years. Also, we have found no statistically significant difference between the two groups with respect to RBCs. Besides, no statistically significant difference was observed with respect to RBCs with regards to gender, which has been analyzed separately because of the lower reference range for normal RBCs levels in women compared to men and. Moreover, the findings confirm that in a separate evaluation between WBCs count and the personnel’s working experience and their annual exposure dose, results showed no linear correlation between the three variables. Since the hematological findings were within the range of control levels, it can be concluded that the radiation dosage (which was not more than 7.58 mSv in this study) had been too small to stimulate any quantifiable change in medical radiation worker’s blood count. Thus, use of more accurate method for screening program based on the working profile of the radiation workers and their accumulated dose is suggested. In addition, complexity of radiation-induced functions and the influence of various factors on blood count alteration should be taken into account.

Keywords: blood cell count, mandatory testing, occupational exposure, radiation

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Authors: Cruz Queen Allysa Rose, Bautista Joymeeh Anne, Lantoria Kaye, Barretto Katya Louise

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The study presents the preferences of passengers on the quality of service provided by the two airline check-in methods currently present in airports-traditional counter check-in and common-use self-service kiosks. Since a study has shown that airlines perceive self-service kiosks alone are sufficient enough to ensure adequate services and customer satisfaction, and in contrast, agents and passengers stated that it alone is not enough and that human interaction is essential. In reference with former studies that established opposing ideas about the choice of the more favorable airline check-in method to employ, it is the purpose of this study to present a recommendation that shall somehow fill-in the gap between the conflicting ideas by means of comparing the perceived quality of service through the RATER model. Furthermore, this study discusses the major competencies present in each method which are supported by the theories–FIRO Theory of Needs upholding the importance of inclusion, control and affection, and the Queueing Theory which points out the discipline of passengers and the length of the queue line as important factors affecting quality service. The findings of the study were based on the data gathered by the researchers from selected Thomasian third year and fourth year college students currently enrolled in the first semester of the academic year 2014-2015, who have already experienced both airline check-in methods through the implication of a stratified probability sampling. The statistical treatments applied in order to interpret the data were mean, frequency, standard deviation, t-test, logistic regression and chi-square test. The final point of the study revealed that there is a greater effect in passenger preference concerning the satisfaction experienced in common-use self-service kiosks in comparison with the application of the traditional counter check-in.

Keywords: traditional counter check-in, common-use self-service Kiosks, airline check-in methods

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Authors: Fredrick Forster, Gareth Ward, Matthew Tubby, Pamela Lithgow, Anne Nortcliffe

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This paper presents the results from a research study of random adult participants accessing one of four different commercially available Virtual Reality (VR) Head Mounted Displays (HMDs) and completing a post user experience reflection questionnaire. The research sort to understand how inclusive commercially available VR HMDs are and identify any associated barriers that could impact the widespread adoption of the devices, specifically in Higher Education (HE). In the UK, education providers are legally required under the Equality Act 2010 to ensure all education facilities are inclusive and reasonable adjustments can be applied appropriately. The research specifically aimed to identify the considerations that academics and learning technologists need to make when adopting the use of commercial VR HMDs in HE classrooms, namely cybersickness, user comfort, Interpupillary Distance, inclusiveness, and user perceptions of VR. The research approach was designed to build upon previously published research on user reflections on presence, usability, and overall HMD comfort, using quantitative and qualitative research methods by way of a questionnaire. The quantitative data included the recording of physical characteristics such as the distance between eye pupils, known as Interpupillary Distance (IPD). VR HMDs require each user’s IPD measurement to enable the focusing of the VR HMDs virtual camera output to the right position in front of the eyes of the user. In addition, the questionnaire captured users’ qualitative reflections and evaluations of the broader accessibility characteristics of the VR HMDs. The initial research activity was accomplished by enabling a random sample of visitors, staff, and students at Canterbury Christ Church University, Kent to use a VR HMD for a set period of time and asking them to complete the post user experience questionnaire. The study identified that there is little correlation between users who experience cyber sickness and car sickness. Also, users with a smaller IPD than average (typically associated with females) were able to use the VR HMDs successfully; however, users with a larger than average IPD reported an impeded experience. This indicates that there is reduced inclusiveness for the tested VR HMDs for users with a higher-than-average IPD which is typically associated with males of certain ethnicities. As action education research, these initial findings will be used to refine the research method and conduct further investigations with the aim to provide verification and validation of the accessibility of current commercial VR HMDs. The conference presentation will report on the research results of the initial study and subsequent follow up studies with a larger variety of adult volunteers.

Keywords: virtual reality, education technology, inclusive technology, higher education

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Authors: Sara Matsuzaka

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At the center of emerging policy debates on the rights of transgender individuals in public accommodations is the collision of gender binary views with transgender perspectives that challenge conventional gender norms. The results of such socio-political debates could have significant ramifications for the policies and infrastructures of public and private institutions nationwide, including within the addiction treatment field. Despite having disproportionately high rates of substance use disorder compared to the general population, transgender individuals experience significant barriers to engaging in addiction treatment programs. Inpatient addiction treatment centers were originally designed to treat heterosexual cisgender populations and, as such, feature gender segregated housing, bathrooms, and counseling sessions. Such heteronormative structural barriers, combined with exposures to stigmatic al attitudes, may dissuade transgender populations from benefiting from the addiction treatment they so direly need. A literature review is performed to explore the mechanisms by which gender segregation alienates transgender populations within inpatient addiction treatment. The constituent parts of the current debate on the rights of transgender individuals in public accommodations are situated the context of inpatient addiction treatment facilities. Minority Stress Theory is used as a theoretical framework for understanding substance abuse issues among transgender populations as a maladaptive behavioral response for coping with chronic stressors related to gender minority status and intersecting identities. The findings include that despite having disproportionately high rates of substance use disorder compared to the general population, transgender individuals experience significant barriers to engaging in and benefiting from addiction treatment. These barriers are present in the form of anticipated or real interpersonal stigma and discrimination by service providers and structural stigma in the form of policy and programmatic components in addiction treatment that marginalize transgender populations. Transphobic manifestations within addiction treatment may dissuade transgender individuals from seeking help, if not reinforce a lifetime of stigmatic experience, potentially exacerbating their substance use issues. Conclusive recommendations for social workers and addiction treatment professionals include: (1) dismantling institutional policies around gender segregation that alienate transgender individuals, (2) developing policies that provide full protections for transgender clients against discrimination based on their gender identity, and (3) implementing trans-affirmative cultural competency training requirements for all staff. Directions for future research are provided.

Keywords: addiction treatment, gender segregation, stigma, transgender

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Authors: Ayşen Bakioğlu, Gökçen Seyra Çakır

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This study aims to explore how research assistants who work in project teams experience team member autonomy and how they reconcile team member autonomy with team collaboration. The study utilizes snowball sampling. 20 research assistants who work the faculties of education in Marmara University and Yıldız Technical University have been interviewed. The analysis of data involves a content analysis MAXQDAPlus 11 which is a qualitative data analysis software is used as the data analysis tool. According to the findings of this study, emerging themes include team norm formation, team coordination management, the role of individual tasks in team collaboration, leadership distribution. According to the findings, interviewees experience team norm formation process in terms of processes, which pertain to task fulfillment, and processes, which pertain to the regulation of team dynamics. Team norm formation process instills a sense of responsibility amongst individual team members. Apart from that, the interviewees’ responses indicate that the realization of the obligation to work in a team contributes to the team norm formation process. The participants indicate that individual expectations are taken into consideration during the coordination of the team. The supervisor of the project team also has a crucial role in maintaining team collaboration. Coordination problems arise when an individual team member does not relate his/her academic field with the research topic of the project team. The findings indicate that the leadership distribution in the project teams involves two leadership processes: leadership distribution which is based on the processes that focus on individual team members and leadership distribution which is based on the processes that focus on team interaction. Apart from that, individual tasks serve as a facilitator of collaboration amongst team members. Interviewees also indicate that individual tasks also facilitate the expression of individuality.

Keywords: project teams in higher education, research assistant teams, team collaboration, team member autonomy

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Authors: Sana Ammad

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The tradition of linguistic analysis in Islam and Christianity has developed independently of each other in lieu of the social developments specific to their historical context. However, recently increasing number of Muslim academics educated in the West have tried to apply the Western tradition of linguistic interpretation to the Qur’anic text while completely disregarding the Islamic linguistic tradition used and developed by the traditional scholars over the centuries. The aim of the paper is to outline the linguistic tools and methods used by the traditional Islamic scholars for the purpose of interpretating the Holy Qur’an and shed light on how they contribute towards a better understanding of the text compared to their Western counterparts. This paper carries out a descriptive-comparative study of the linguistic tools developed and perfected by the traditional scholars in Islam for the purpose of textual analysis of the Qur’an as they have been described in the authentic works of Usul Al Fiqh (Jurisprudence) and the principles of textual analysis employed by the Western hermeneutical tradition for the study of the Bible. First, it briefly outlines the independent historical development of the two traditions emphasizing the final normative shape that they have taken. Then it draws a comparison of the two traditions highlighting the similarities and the differences existing between them. In the end, the paper demonstrates the level of academic excellence achieved by the traditional linguistic scholars in their efforts to develop appropriate tools of textual interpretation and how these tools are more suitable for interpreting the Qur’an compared to the Western principles. Since the aim of interpreters of both the traditions is to try and attain an objective understanding of the Scriptures, the emphasis of the paper shall be to highlight how well the Islamic method of linguistic interpretation contributes to an objective understanding of the Qur’anic text. The paper concludes with the following findings: The Western hermeneutical tradition of linguistic analysis developed within the Western historical context. However, the Islamic method of linguistic analysis is much more highly developed and complex and serves better the purpose of objective understanding of the Holy text.

Keywords: Islamic jurisprudence, linguistic analysis, textual interpretation, western hermeneutics

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Authors: Andrea Giacomelli, Luciano Massetti, Elena Maggi, Antonio Raschi

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The presentation will report the activities managed during the Summer of 2017 by a team composed by staff from a University Department, a National Research Council Institute, and an outreach NGO, collecting measurements of night sky brightness and other information on artificial lighting, in order to characterize light pollution issues on portions of the Tuscan coast, in Central Italy. These activities combine measurements collected by the principal scientists, citizen science observations led by students, and outreach events targeting a broad audience. This campaign aggregates the efforts of three actors: the BuioMetria Partecipativa project, which started collecting light pollution data on a national scale in 2008 with an environmental engineering and free/open source GIS core team; the Institute of Biometeorology from the National Research Council, with ongoing studies on light and urban vegetation and a consolidated track record in environmental education and citizen science; the Department of Biology from the University of Pisa, which started experiments to assess the impact of light pollution in coastal environments in 2015. While the core of the activities concerns in situ data, the campaign will account also for remote sensing data, thus considering heterogeneous data sources. The aim of the campaign is twofold: (1) To test actions of citizen and student engagement in monitoring sky brightness (2) To collect night sky brightness data and test a protocol for applications to studies on the ecological impact of light pollution, with a special focus on marine coastal ecosystems. The collaboration of an interdisciplinary team in the study of artificial lighting issues is not a common case in Italy, and the possibility of undertaking the campaign in Tuscany has the added value of operating in one of the territories where it is possible to observe both sites with extremely high lighting levels, and areas with extremely low light pollution, especially in the Southern part of the region. Combining environmental monitoring and communication actions in the context of the campaign, this effort will contribute to the promotion of night skies with a good quality as an important asset for the sustainability of coastal ecosystems, as well as to increase citizen awareness through star gazing, night photography and actively participating in field campaign measurements.

Keywords: citizen science, light pollution, marine coastal biodiversity, environmental education

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Authors: M. Reza Roshandel, Tannaz Aghaei Badr, Batoul Khoundabi, Sara C. Lewis, Soroush Rais-Bahrami, John Sfakianos, Reza Mehrazin, Ash K. Tewari

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Introduction: Prostate biopsy is the most reliable diagnostic method for choosing the appropriate management of prostate cancer. However, discrepancies between Gleason grade groups (GG) of different biopsies remain a significant concern. This study aims to assess the association of the radiological factors with GG discrepancies in patients with index Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, using radical prostatectomy (RP) specimens as the most accurate and informative pathology. Methods: This single-institutional retrospective study was performed on a total of 2289 consecutive prostate cancer patients with combined targeted and systematic prostate biopsy followed by radical prostatectomy (RP). The database was explored for patients with the index PI-RADS 3 lesions version 2 and 2.1. Cancers with PI-RADS 4 or 5 scoring were excluded from the study. Patient characteristics and radiologic features were analyzed by multivariable logistic regression. Number-density of lesions was defined as the number of lesions per prostatic volume. Results: Of the 151 prostate cancer cases with PI-RADS 3 index lesions, 27% and 17% had upgrades and downgrades at RP, respectively. Analysis of grade changes showed no significant associations between discrepancies and the number or the number density of PI-RADS 3 lesions. Moreover, the study showed no significant association of the GG changes with race, age, location of the lesions, or prostate volume. Conclusions: This study demonstrated that in PI-RADS 3 cancerous nodules, the chance of the pathology changes in the final pathology of RP specimens was low. Furthermore, having multiple PI-RADS 3 nodules did not change the conclusion, as the possibility of grade changes in patients with multiple nodules was similar to those with solitary lesions.

Keywords: prostate, adenocarcinoma, multiparametric MRI, Gleason score, robot-assisted surgery

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Authors: Zakia Hammouni

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Healthcare professionals’ well-being is becoming a priority during this Covid-19 pandemic due to stress, fatigue, and workload. Well before this pandemic, contemporary hospitals are endowed with environmental attributes that contribute to achieving well-being within their environment with the emphasis on the patient. The patient-centered care approach has been followed by the patient-centered design approach. Studies that have focused on the physical environment in hospitals have dealt with the patient's recovery process and his well-being. Prior scientific literature has placed less emphasis on the healthcare professionals’ interactions within the physical environment and to guide hospital designers to make evidence-based design choices to meet the needs and expectations of hospital users by considering, in addition to patients, healthcare professionals. This paper examines these issues related to the daily stress of professionals who provide care in a hospital environment. In this exploratory study, the interest was to grasp the issues related to this environment and explores the current realities of newly built hospitals based on design approaches and what attributes of the physical setting support healthcare professional’s well-being. Within a constructivist approach, this study was conducted in two care units in a new hospital in a big city in Canada before the Covid-19 pandemic (august 2nd to November 2nd 2018). A spatial evaluation of these care units allowed us to understand the interaction of health professionals in their work environment, to understand the spatial behavior of these professionals, and the narratives from 44 interviews of various healthcare professionals. The mental images validated the salient components of the hospital environment as perceived by these healthcare professionals. Thematic analysis and triangulation of the data set were conducted. Among the key attributes promoting the healthcare professionals’ well-being as revealed by the healthcare professionals are the overall light-color atmosphere in the hospital and care unit, particularly in the corridors and public areas of the hospital, the maintenance and cleanliness. The presence of the art elements also brings well-being to the health professionals as well as panoramic views from the staff lounge and corridors of the care units or elevator lobbies. Despite the overall positive assessment of this environment, some attributes need to be improved to ensure the well-being of healthcare professionals and to provide them with a restructuring environment. These are the supply of natural light, softer colors, sufficient furniture, comfortable seating in the restroom, and views, which are important in allowing these healthcare professionals to recover from their work stress. Noise is another attribute that needs to be further improved in the hospital work environment, especially in the nursing workstations and consultant's room. In conclusion, this study highlights the importance of providing healthcare professionals with work and rest areas that allow them to resist the stress they face, particularly during periods of extreme stress and fatigue such as a Covid-19 pandemic.

Keywords: healthcare facilities, healthcare professionals, physical environment, well-being

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Authors: I. Ling Tsai, Shu Fen Wu, Chen-Fuh Lam, Chia Yu Chen, Shu Jiuan Chen, Yen Lin Liu

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Purpose: Following the conduction of the National Health Insurance (NHI) system in Taiwan since 1995, the demand for anesthesia services continues to increase in the operating rooms and other medical units. It has been well recognized that increased work stress not only affects the clinical performance of the medical staff, long-term work load may also result in occupational burnout. Our study aimed to determine the influence of working environment, work stress and job satisfaction on the occupational burnout in nurse anesthetists. The ultimate goal of this research project is to develop a strategy in establishing a friendly, less stressful workplace for the nurse anesthetists to enhance their job satisfaction, thereby reducing occupational burnout and increasing the career life for nurse anesthetists. Methods: This was a cross-sectional, descriptive study performed in a metropolitan teaching hospital in southern Taiwan between May 2017 to July 2017. A structured self-administered questionnaire, modified from the Practice Environment Scale of the Nursing Work Index (PES-NWI), Occupational Stress Indicator 2 (OSI-2) and Maslach Burnout Inventory (MBI) manual was collected from the nurse anesthetists. The relationships between two numeric datasets were analyzed by the Pearson correlation test (SPSS 20.0). Results: A total of 66 completed questionnaires were collected from 75 nurses (response rate 88%). The average scores for the working environment, job satisfaction, and work stress were 69.6%, 61.5%, and 63.9%, respectively. The three perspectives used to assess the occupational burnout, namely emotional exhaustion, depersonalization and sense of personal accomplishment were 26.3, 13.0 and 24.5, suggesting the presence of moderate to high degrees of burnout in our nurse anesthetists. The presence of occupational burnout was closely correlated with the unsatisfactory working environment (r=-0.385, P=0.001) and reduced job satisfaction (r=-0.430, P=0.000). Junior nurse anesthetists (<1-year clinical experience) reported having higher satisfaction in working environment than the seniors (5 to 10-year clinical experience) (P=0.02). Although the average scores for work stress, job satisfaction, and occupational burnout were lower in junior nurses, the differences were not statistically different. The linear regression model, the working environment was the independent factor that predicted occupational burnout in nurse anesthetists up to 19.8%. Conclusions: High occupational burnout is more likely to develop in senior nurse anesthetists who experienced the dissatisfied working environment, work stress and lower job satisfaction. In addition to the regulation of clinical duties, the increased workload in the supervision of the junior nurse anesthetists may result in emotional stress and burnout in senior nurse anesthetists. Therefore, appropriate adjustment of clinical and teaching loading in the senior nurse anesthetists could be helpful to improve the occupational burnout and enhance the retention rate.

Keywords: nurse anesthetists, working environment, work stress, job satisfaction, occupational burnout

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Authors: Ana Paola Echavarria, Mariuxi Medina, Haydelba D'Armas, Carmita Jaramillo, Diana San Martin

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The use of medicinal plants is one of the oldest and most extended medical therapies that goes back to prehistoric times, and nowadays, they are also used in the preparation of phytopharmaceuticals with options to cure diseases. The test for the determination of fungi was carried out in the Pharmacy Pilot Plant (treatment of the leaves of the plant species) and the Microbiology Laboratory (determination of fungi of the plant species, using growth medium called Sabouraud agar plus the vegetal sample), of the Academic Unit of Chemical Sciences and Health, of the Universidad Tecnica de Machala. Subsequently, colony counting was performed, both macroscopic, which is determined in the growth medium of the seeding, and microscopic, to identify the germinative forms using blue lactophenol. The procedure was repeated in duplicate to replicate the results data. The determination of the total fungal content of the following plant species was evaluated: Cymbopogon citratus (lemon verbena), Melissa officinalis (lemon balm), Taraxacum officinale (dandelion), Artemisia absinthium (absinthe), Piper carpunya (guaviduca), Moringa oleifera (moringa), Coriandrum sativum (coriander), Momordica charantia (achochilla), Borago officinalis (borage), Aloysia citriodora (cedron), Ambrosia artemisifolia (altamisa) and Ageratum conyzoides (mastrante). The results obtained showed that all the samples of the twelve plant species studied developed filamentous fungi, with great variability of them, within the permissible limits and contemplated by the Ecuadorian Institute of Normalization (INEN), being suitable as raw material for its use in the preparation of nutraceuticals and medicinal products or phytodrugs; with the exception of A. conyzoides (mastranto) which is the only species that exceeds the regulation in the average of dilutions.

Keywords: colonies, fungi, medicinal plants, microbiological quality, Sabouraud agar

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Authors: Beatriz Garcia-Juan, Ana B. Escrig-Tena, Vicente Roca-Puig

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The aim of this article is to conduct a theoretical and empirical study in order to examine how the goal orientation (GO) of public employees affects the relationship between the structural and psychological empowerment that they experience at their workplaces. In doing so, we follow structural empowerment (SE) and psychological empowerment (PE) conceptualizations, and relate them to the public administration framework. Moreover, we review arguments from GO theories, and previous related contributions. Empowerment has emerged as an important issue in the public sector organization setting in the wake of mainstream New Public Management (NPM), the new orientation in the public sector that aims to provide a better service for citizens. It is closely linked to the drive to improve organizational effectiveness through the wise use of human resources. Nevertheless, it is necessary to combine structural (managerial) and psychological (individual) approaches in an integrative study of empowerment. SE refers to a set of initiatives that aim the transference of power from managerial positions to the rest of employees. PE is defined as psychological state of competence, self-determination, impact, and meaning that an employee feels at work. Linking these two perspectives will lead to arrive at a broader understanding of the empowerment process. Specifically in the public sector, empirical contributions on this relationship are therefore important, particularly as empowerment is a very useful tool with which to face the challenges of the new public context. There is also a need to examine the moderating variables involved in this relationship, as well as to extend research on work motivation in public management. It is proposed the study of the effect of individual orientations, such as GO. GO concept refers to the individual disposition toward developing or confirming one’s capacity in achievement situations. Employees’ GO may be a key factor at work and in workforce selection processes, since it explains the differences in personal work interests, and in receptiveness to and interpretations of professional development activities. SE practices could affect PE feelings in different ways, depending on employees’ GO, since they perceive and respond differently to such practices, which is likely to yield distinct PE results. The model is tested on a sample of 521 Spanish local authority employees. Hierarchical regression analysis was conducted to test the research hypotheses using SPSS 22 computer software. The results do not confirm the direct link between SE and PE, but show that learning goal orientation has considerable moderating power in this relationship, and its interaction with SE affects employees’ PE levels. Therefore, the combination of SE practices and employees’ high levels of LGO are important factors for creating psychologically empowered staff in public organizations.

Keywords: goal orientation, moderating effect, psychological empowerment, structural empowerment

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Authors: Zarina Othman, Bakri Mat, Aini Fatihah Roslam

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The Burmese ethnic known as Rohingya is one of the world’s most persecuted ethnic minorities on earth. They have been massacred, discriminated, humiliated, gang-raped, trafficked, abused and neglected. More than one million Rohingyas have been displaced internally and overseas. Currently, Rohingya asylum seekers can be found in India, Bangladesh, Thailand, Malaysia, and Indonesia. This forced migration is unacceptable since the Rohingya are stateless although they have been part of Myanmar for more than one century. Why the Rohingyas crisis is important to be analyse from human security perspectives? Understanding the human security of the Rohingya is important because the crisis may have implication on the regional stability in South and South-East Asia. The objectives of the research are to provide an explanation to the current human security situation in Myanmar, to analyse the regional implication of the Rohingya’s crisis and to recommend the workable solution that may help to reduce the tension. To analyze and demonstrate the case, the research has adopted the BAGHUS or Bangi Human Security Approach, a Southeast Asian human security model, designed to protect the weakest and the vital core of human life across national borders. Based on a qualitative research, and a review of literature from secondary sources of books, reports and academic journals, the research has conducted interviews with 1) Rohingya respondents in Cox’s Baza in February 2017; 2) experts and scholars in the field in Bangladesh, Myanmar and Malaysia. Preliminary findings suggest that conflicts lead to displacement and migration across borders, human insecurity is an issue where the implementation of human rights is too slow to take place even in sovereign state like Myanmar. The political and economic interests of many extraregional powers have further contributed to the current crisis. Human security perspectives is suggested as the workable solution for stability and peace in the region.

Keywords: human security, migration, Myanmar, regional security, Rohingya

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Authors: Mukhtar Raban

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As part of Nelson Mandela University’s journey of repositioning its learning and teaching agenda, the university adopted and foregrounded a humanizing pedagogy-aligning with institutional goals of critically transforming the academic project. The university established the Humanizing Pedagogy Praxis and Research Niche (HPPRN) as a centralized hub for coordinating institutional work exploring and advancing humanizing pedagogies and tasked the unit with developing and enacting a model for humanizing pedagogy exploration. This investigation endeavored to report on the development and enactment of a model that sought to institutionalize a humanizing pedagogy at a South African university. Having followed a qualitative approach, the investigation presents the case study of Nelson Mandela University’s HPPRN and the model it subsequently established and enacted for the advancement towards a more common institutional understanding, interpretation and application of the humanizing pedagogy. The study adopted an interpretive lens for analysis, complementing the qualitative approach of the investigation. The primary challenge that confronted the HPPRN was the development of a ‘living model’ that had to complement existing institutional initiatives while accommodating a renewed spirit of critical reflection, innovation and research of continued and new humanizing pedagogical exploration and applications. The study found that the explicit consideration of tenets of humanizing and critical pedagogies in underpinning and framing the HPPRN Model contributed to the sense of ‘lived’ humanizing pedagogy experiences during enactment. The multi-leveled inclusion of critical reflection in the development and enactment stages was found to further the processes of praxis employed at the university, which is integral to the advancement of humanizing and critical pedagogies. The development and implementation of a model that seeks to institutionalize the humanizing pedagogy at a university rely not only on sound theoretical conceptualization but also on the ‘richness of becoming more human’ explicitly expressed and encountered in praxes and application.

Keywords: humanizing pedagogy, critical pedagogy, institutional implementation, praxis

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Authors: Erica Lima

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The objective of this paper is to discuss relevant points about teaching translation in Brazilian universities and the possible impacts of blogs and social networks to translator education today. It is intended to analyze the curricula of Brazilian translation courses, contrasting them to information obtained from two social networking groups of great visibility in the area concerning essential characteristics to become a successful profession. Therefore, research has, as its main corpus, a few undergraduate translation programs’ syllabuses, as well as a few postings on social networks groups that specifically share professional opinions regarding the necessity for a translator to obtain a degree in translation to practice the profession. To a certain extent, such comments and their corresponding responses lead to the propagation of discourses which influence the ideas that aspiring translators and recent graduates end up having towards themselves and their undergraduate courses. The postings also show that many professionals do not have a clear position regarding the translator education; while refuting it, they also encourage “free” courses. It is thus observed that cyberspace constitutes, on the one hand, a place of mobilization of people in defense of similar ideas. However, on the other hand, it embodies a place of tension and conflict, in view of the fact that there are many participants and, as in any other situation of interlocution, disagreements may arise. From the postings, aspects related to professionalism were analyzed (including discussions about regulation), as well as questions about the classic dichotomies: theory/practice; art/technique; self-education/academic training. As partial result, the common interest regarding the valorization of the profession could be mentioned, although there is no consensus on the essential characteristics to be a good translator. It was also possible to observe that the set of socially constructed representations in the group reflects characteristics of the world situation of the translation courses (especially in some European countries and in the United States), which, in the first instance, does not accurately reflect the Brazilian idiosyncrasies of the area.

Keywords: cyberspace, teaching translation, translator education, university

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Authors: Phillipa Denise Peart

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Black Asian and Minority Ethnic (BAME) people are more at risk of developing mental health disorders because they are more exposed to unfavorable social, economic, and environmental circumstances. These include housing, education, employment, community development, stigma, and discrimination. However, the majority of BAME mental health intervention studies focus on treatment with therapeutically effective drugs and use basic economic methods to evaluate their effectiveness; as a result, little is invested in the economic assessment of psychosocial interventions in BAME mental health. The UK government’s austerity programme and reduced funds for mental health services, has increased the need for the evaluation and assessment of initiatives to focus on value for money. The No Health without Mental Health policy (2011) provides practice guidance to practitioners, but there is little or no mention of the need to provide mental health initiatives targeted at BAME communities that are effective in terms of their impact and the cost-effectiveness. This, therefore, appears to contradict with and is at odds with the wider political discourse, which suggests there should be an increasing focus on health economic evaluation. As a consequence, it could be argued that whilst such policies provide direction to organisations to provide mental health services to the BAME community, by not requesting effective governance, assurance, and evaluation processes, they are merely paying lip service to address these problems and not helping advance knowledge and practice through evidence-based approaches. As a result, BAME communities suffer due to lack of efficient resources that can aid in the recovery process. This research study explores the mental health initiatives targeted at BAME communities, and analyses the techniques used when examining the cost effectiveness of mental health initiatives for BAME mental health communities. Using critical discourse analysis as an approach and method, mental health services will be selected as case studies, and their evaluations will be examined, alongside the political drivers that frame, shape, and direct their work. In doing so, it will analyse what the mental health policies initiatives are, how the initiatives are directed and demonstrate how economic models of evaluation are used in mental health programmes and how the value for money impacts and outcomes are articulated by mental health programme staff. It is anticipated that this study will further our understanding in order to provide adequate mental health resources and will deliver creative, supportive research to ensure evaluation is effective for the government to provide and maintain high quality and efficient mental health initiatives targeted at BAME communities.

Keywords: black, Asian and ethnic minority, economic models, mental health, health policy

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Authors: John Kosmeh

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Introduction – For years, senior health care and skilled nursing facilities have been plagued with the dilemma of not having the necessary tools and equipment to adequately care for senior residents in their communities. This has led to high transport rates to emergency departments and high 30-day readmission rates, costing billions of unnecessary dollars each year, as well as quality assurance issues. Our Senior care telemedicine program is designed to solve this issue. Methods – We conducted a 1-year pilot program using our technology coupled with our 24/7 telemedicine program with skilled nursing facilities in different parts of the United States. We then compared transports rates and 30-day readmission rates to previous years before the use of our program, as well as transport rates of other communities of similar size not using our program. This data was able to give us a clear and concise look at the success rate of reducing unnecessary transport and readmissions as well as cost savings. Results – A 94% reduction nationally of unnecessary out-of-facility transports, and to date, complete elimination of 30-day readmissions. Our virtual platform allowed us to instruct facility staff on the utilization of our tools and system as well as deliver treatment by our ER-trained providers. Delay waiting for PCP callbacks was eliminated. We were able to obtain lung, heart, and abdominal ultrasound imaging, 12 lead EKG, blood labs, auscultate lung and heart sounds, and collect other diagnostic tests at the bedside within minutes, providing immediate care and allowing us to treat residents within the SNF. Are virtual capabilities allowed for loved ones, family members, and others who had medical power of attorney to virtually connect with us at the time of visit, to speak directly with the medical provider, providing increased confidence in the decision to treat the resident in-house. The decline in transports and readmissions will greatly reduce governmental cost burdens, as well as fines imposed on SNF for high 30-day readmissions, reduce the cost of Medicare A readmissions, and significantly impact the number of patients visiting overcrowded ERs. Discussion – By utilizing our program, SNF can effectively reduce the number of unnecessary transports of residents, as well as create significant savings from loss of day rates, transportation costs, and high CMS fines. The cost saving is in the thousands monthly, but more importantly, these facilities can create a higher quality of life and medical care for residents by providing definitive care instantly with ER-trained personnel.

Keywords: senior care, long term care, telemedicine, technology, senior care communities

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Authors: Michel Foucault, Friedrich Nietzsche, Max More, Natasha Vita-More, Francesca Ferrando

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During the early part of his intellectual and academic career (1950s and 1960s), Michel Foucault developed an interest for what we can call the ‘anthropological question’, or how our modernity deals with human nature from an epistemological standpoint. The great originality of Foucault’s thought here lies in the fact that he approaches this question not from the perspective of this ‘sovereign subject’ (that has characterized the History of Western thought) he wishes to disclose and ‘denounce’, but rather at the level of discourses and the way they constitute who we are, so to speak. This led him, in turn, to formulate a series of though-provoking statements during his so-called ‘archaeological period’ of the 1960s concerning what we call ‘man’ in the West, such as that he is an ‘invention of recent date’ (as a proper object of concern and reflection), and, perhaps more importantly, that he might disappear in the near future, ‘like a face drawn in sand at the edge of the sea’. Foucault is following on the footsteps of Nietzsche in that regard, who had famously announced in the 19th ce. the ‘death of God’ and the need for the future generations to surpass (so to speak) the traditional ‘Christian-centred’ Western conception of the human. While Foucault exposed such insights more than half a century ago, they appear to be more actual than ever today with the development and rise in popularity of intellectual movements such as Transhumanism and Posthumanism, which seek to question and propose an alternative to the concepts of ‘man’ or ‘human nature’ in our culture. They rely for that on the same assumption as Foucault and Nietzsche that those concepts (and the meaning we attribute to them) have become ‘obsolete’ as it is and thus must be overcome (at a conceptual, but also a more practical level). Hence, those movements not only echo the important Foucauldian reflection of the 1950s and 1960s on the ‘anthropological question’ but seem to have been literally announced by it, so to speak. The aim of this paper will therefore be to show the relevance of Foucault (and in particular his archaeological method) in understanding the nature of Transhumanism (and Posthumanism), for instance, by analysing and assessing it as a form of discourse that is literally reshaping the way we understand ourselves as human beings in our (post)modern age, drawing for that on a number of key texts including from the early productions of Foucault.

Keywords: foucault, nietzsche, archaeology, transhumanism, posthumanism

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Authors: Hepinda Fajari Nuharini, Sugiarti A. Musabiq

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Background: Various and continuous pressures that exceed individual resources can cause first-year undergraduate college students to experience psychological distress. Psychological distress can occur when individuals use rumination as cognitive coping strategies. Rumination is one of the cognitive coping strategies that can be used by individuals to respond to psychological distress that causes individuals to think about the causes and consequences of events that have occurred. Rumination had two subtypes, such as brooding and reflective. Therefore, the purpose of this study was determining the role of brooding and reflective as subtypes of rumination toward psychological distress in University of Indonesia first-year undergraduate students. Methods: Participants of this study were 403 University of Indonesia first-year undergraduate students aged between 18 and 21 years old. Psychological distress measured using self reporting questionnaire (SRQ-20) and brooding and reflective as subtypes of rumination measured using Ruminative Response Scale - Short Version (RRS - Short Version). Results: Binary logistic regression analyses showed that 22.8% of the variation in psychological distress could be explained by the brooding and reflective as subtypes of rumination, while 77.2% of the variation in psychological distress could be explained by other factors (Nagelkerke R² = 0,228). The results of the binary logistic regression analysis also showed rumination subtype brooding is a significant predictor of psychological distress (b = 0,306; p < 0.05), whereas rumination subtype reflective is not a significant predictor of psychological distress (b = 0,073; p > 0.05). Conclusion: The findings of this study showed a positive relationship between brooding and psychological distress indicates that a higher level of brooding will predict higher psychological distress. Meanwhile, a negative relationship between reflective and psychological distress indicates a higher level of reflective will predict lower psychological distress in University of Indonesia first-year undergraduate students. Added Values: The psychological distress among first-year undergraduate students would then have an impact on student academic performance. Therefore, the results of this study can be used as a reference for making preventive action to reduce the percentage and impact of psychological distress among first-year undergraduate students.

Keywords: brooding as subtypes of rumination, first-year undergraduate students, psychological distress, reflective as subtypes of rumination

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Authors: Mareen Brosterhaus, Antje Hammer, Steffen Kalina, Stefan Grau, Anjali A. Roeth, Hany Ashmawy, Thomas Gross, Marcel Binnebosel, Wolfram T. Knoefel, Tanja Manser

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Background: The identification of critical incidents in hospitals is an essential component of improving patient safety. To date, various methods have been used to measure and characterize such critical incidents. These methods are often viewed by physicians and nurses as external quality assurance, and this creates obstacles to the reporting events and the implementation of recommendations in practice. One way to overcome this problem is to use tools that directly involve staff in measuring indicators of quality and safety of care in the department. One such instrument is the global trigger tool (GTT), which helps physicians and nurses identify adverse events by systematically reviewing randomly selected patient records. Based on so-called ‘triggers’ (warning signals), indications of adverse events can be given. While the tool is already used internationally, its implementation in German hospitals has been very limited. Objectives: This study aimed to assess the feasibility and potential of the global trigger tool for identifying adverse events in German hospitals. Methods: A total of 120 patient records were randomly selected from two surgical, and one neurosurgery, departments of three university hospitals in Germany over a period of two months per department between January and July, 2017. The records were reviewed using an adaptation of the German version of the Institute for Healthcare Improvement Global Trigger Tool to identify triggers and adverse event rates per 1000 patient days and per 100 admissions. The severity of adverse events was classified using the National Coordinating Council for Medication Error Reporting and Prevention. Results: A total of 53 adverse events were detected in the three departments. This corresponded to adverse event rates of 25.5-72.1 per 1000 patient-days and from 25.0 to 60.0 per 100 admissions across the three departments. 98.1% of identified adverse events were associated with non-permanent harm without (Category E–71.7%) or with (Category F–26.4%) the need for prolonged hospitalization. One adverse event (1.9%) was associated with potentially permanent harm to the patient. We also identified practical challenges in the implementation of the tool, such as the need for adaptation of the global trigger tool to the respective department. Conclusions: The global trigger tool is feasible and an effective instrument for quality measurement when adapted to the departmental specifics. Based on our experience, we recommend a continuous use of the tool thereby directly involving clinicians in quality improvement.

Keywords: adverse events, global trigger tool, patient safety, record review

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Authors: Yung Yau

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'Little people' are those who have extremely short stature as they suffer from rare bone diseases. They are commonly known as 'dwarves' or 'people with dwarfism'. Dwarfism is generally regarded as a type of rare disease for its extremely small odds (~1 in 15,000). On account of its rarity, dwarfism, unlike other types of disability, has attracted relatively little attention from the general public and in various academic fields (e.g. architecture, psychology and sociology) except medical science. In view of the extant research gaps, this study aims to investigate the physical barriers facing the little people in the built environment in Hong Kong. Between November 2017 and July 2018, ten little people or their family members participated in in-depth interviews. Responses of the interviewees were transcribed (i.e., speech being converted to text word for word). Interview data were then analyzed using the interpretative phenomenological analysis methodology developed by J. Smith and others in 2009. The findings of the project reveal that although Hong Kong's built environment has been designed barrier-free pursuant to the prevailing building standards, those standards do not cater to the special anthropometric characteristics of little people. As a result, little people face a lot of challenges when using built facilities. For example, most water closets, urinals, and wash hand basins are not fit for little people's use. As indicated by the project findings, we are still far away from providing a discrimination-free and barrier-free living environment for the little people in Hong Kong. To make Hong Kong society more inclusive to the little people, there is a need for further tailored building design. A set of building design principles for better inclusion of the little people in our society are highlighted. These principles include 'the building design should accommodate individuals with different heights' and 'the building design should allow individuals to use comfortably and efficiently with a minimum of fatigue'. At the end of the paper, the author also calls for an agenda for further studies. For instance, we need an anthropometric study on little people for developing practical building design guidelines.

Keywords: dwarfism, little people, inclusive buildings, people with disabilities, social sustainability

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Authors: Sophie Oakes-Rogers, Di Bailey, Karen Slade

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Female offenders are a uniquely vulnerable group, who are at high risk of suicide. Whilst the prevention of self-harm and suicide remains a key global priority, we need to better understand the relationship between these challenging behaviours that constitute a pressing problem, particularly in environments designed to prioritise safety and security. Method choice is unlikely to be random, and is instead influenced by a range of cultural, social, psychological and environmental factors, which change over time and between countries. A key aspect of self-harm and suicide in women receiving forensic care is the lack of free access to methods. At a time where self-harm and suicide rates continue to rise internationally, understanding the role of these influencing factors and the impact of current suicide prevention strategies on the use of near-lethal methods is crucial. This poster presentation will present findings from 25 interviews and 3 focus groups, which enlisted a Participatory Action Research approach to explore the differences between self-harming and suicidal behavior. A key element of this research was using the lived experiences of women receiving forensic care from one forensic pathway in the UK, and the staffs who care for them, to discuss the role of near-lethal self-harm (NLSH). The findings and suggestions from the lived accounts of the women and staff will inform a draft assessment tool, which better assesses the risk of suicide based on the lethality of methods. This tool will be the first of its kind, which specifically captures the needs of women receiving forensic services. Preliminary findings indicate women engage in NLSH for two key reasons and is determined by their history of self-harm. Women who have a history of superficial non-life threatening self-harm appear to engage in NLSH in response to a significant life event such as family bereavement or sentencing. For these women, suicide appears to be a realistic option to overcome their distress. This, however, differs from women who appear to have a lifetime history of NLSH, who engage in such behavior in a bid to overcome the grief and shame associated with historical abuse. NLSH in these women reflects a lifetime of suicidality and indicates they pose the greatest risk of completed suicide. Findings also indicate differences in method selection between forensic provisions. Restriction of means appears to play a role in method selection, and findings suggest it causes method substitution. Implications will be discussed relating to the screening of female forensic patients and improvements to the current suicide prevention strategies.

Keywords: forensic mental health, method substitution, restriction of means, suicide

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Authors: Nadeem Yousuf Khan

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This paper proposes the formation of a digital emergency response system (dERS) in the aged, long-term care, and chronic disease setups in the post-COVID healthcare ecosystem, focusing on the Asia Pacific market where the aging population is increasing significantly. It focuses on the use of digital technologies such as wearables, a global positioning system (GPS), and mobile applications to build an integrated care system for old folks with co-morbidities and other chronic diseases. The paper presents a conceptual framework of a connected digital health ecosystem that not only provides proactive care to registered patients but also prevents the damages due to sudden conditions such as strokes by alerting and treating the patients in a digitally connected and coordinated manner. A detailed review of existing digital health technologies such as wearables, GPS, and mobile apps was conducted in context with the new post-COVID healthcare paradigm, along with a detailed literature review on the digital health policies and usability. A good amount of research papers is available in the application of digital health, but very few of them discuss the formation of a new framework for a connected digital ecosystem for the aged care population, which is increasing around the globe. A connected digital emergency response system has been proposed by the author whereby all registered patients (chronic disease and aged/long term care) will be connected to the proposed digital emergency response system (dERS). In the proposed ecosystem, patients will be provided with a tracking wrist band and a mobile app through which the control room will be monitoring the mobility and vitals such as atrial fibrillation (AF), blood sugar, blood pressure, and other vital signs. In addition to that, an alert in case if the patient falls down will add value to this system. In case of any variation in the vitals, an alert is sent to the dERS 24/7, and dERS clinical staff immediately trigger that alert which goes to the connected hospital and the adulatory service providers, and the patient is escorted to the nearest connected tertiary care hospital. By the time, the patient reaches the hospital, dERS team is ready to take appropriate clinical action to save the life of the patient. Strokes or myocardial infarction patients can be prevented from disaster if they are accessible to engagement healthcare. This dERS will play an effective role in saving the lives of aged patients or patients with chronic co-morbidities.

Keywords: aged care, atrial fibrillation, digital health, digital emergency response system, digital technology

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