Search results for: blind disability

Authors: Rao Singh Priyanka, Jayangondaperumal R.

Abstract:

The Himalayan active fault has the potential to generate great earthquakes in the future, posing a biggest existential threat to humans in the Himalayan and adjacent region. Quantitative evaluation of accumulated and released interseismic strain is crucial to assess the magnitude and spatio-temporal variability of future great earthquakes along the Himalayan arc. To mitigate the destruction and hazards associated with such earthquakes, it is important to understand their recurrence cycle. The eastern Himalayan and Indo-Burman plate boundary systems offers an oblique convergence across two orthogonal plate boundaries, resulting in a zone of distributed deformation both within and away from the plate boundary and clockwise rotation of fault-bounded blocks. This seismically active region has poorly documented historical archive of the past large earthquakes. Thus, paleoseismologicalstudies confirm the surface rupture evidences of the great continental earthquakes (Mw ≥ 8) along the Himalayan Frontal Thrust (HFT), which along with the Geodetic studies, collectively provide the crucial information to understand and assess the seismic potential. These investigations reveal the rupture of 3/4th of the HFT during great events since medieval time but with debatable opinions for the timing of events due to unclear evidences, ignorance of transverse segment boundaries, and lack of detail studies. Recent paleoseismological investigations in the eastern Himalaya and Mishmi ranges confirms the primary surface ruptures of the 1950 C.E. great earthquake (M>8). However, a seismic gap exists between the 1714 C.E. and 1950 C.E. Assam earthquakes that did not slip since 1697 C.E. event. Unlike the latest large blind 2015 Gorkha earthquake (Mw 7.8), the 1950 C.E. event is not triggered by a large event of 1947 C.E. that occurred near the western edge of the great upper Assam event. Moreover, the western segment of the eastern Himalayadid not witness any surface breaking earthquake along the HFT for over the past 300 yr. The frontal fault excavations reveal that during the 1950 earthquake, ~3.1-m-high scarp along the HFT was formed due to the co-seismic slip of 5.5 ± 0.7 m at Pasighat in the Eastern Himalaya and a 10-m-high-scarp at a Kamlang Nagar along the Mishmi Thrust in the Eastern Himalayan Syntaxis is an outcome of a dip-slip displacement of 24.6 ± 4.6 m along a 25 ± 5°E dipping fault. This event has ruptured along the two orthogonal fault systems in the form of oblique thrust fault mechanism. Approx. 130 km west of Pasighat site, the Himebasti village has witnessed two earthquakes, the historical 1697 Sadiya earthquake, and the 1950 event, with a cumulative dip-slip displacement of 15.32 ± 4.69 m. At Niglok site, Arunachal Pradesh, a cumulative slip of ~12.82 m during at least three events since pre 19585 B.P. has produced ~6.2-m high scarp while the youngest scarp of ~2.4-m height has been produced during 1697 C.E. The site preserves two deformational events along the eastern HFT, providing an idea of last serial ruptures at an interval of ~850 yearswhile the successive surface rupturing earthquakes lacks in the Mishmi Range to estimate the recurrence cycle.

Keywords: paleoseismology, surface rupture, recurrence interval, Eastern Himalaya

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Authors: Kinnsley Travis, Camerron M. Crowder

Abstract:

Mapk8ip3 (Mitogen-Activated Protein Kinase 8 Interacting Protein 3) is a gene that codes for the JIP3 protein, which is a part of the JIP scaffolding protein family. This protein is involved in axonal vesicle transport, elongation and regeneration. Variants in the Mapk8ip3 gene are associated with a rare-genetic condition that results in a neurodevelopmental disorder that can cause a range of phenotypes including global developmental delay and intellectual disability. Currently, there are 18 known individuals diagnosed to have sequenced confirmed Mapk8ip3 genetic disorders. This project focuses on examining the impact of a subset of missense patient variants on the Jip3 protein function by overexpressing the mRNA of these variants in a zebrafish knockout model for Jip3. Plasmids containing cDNA with individual missense variants were reverse transcribed, purified, and injected into single-cell zebrafish embryos (Wild Type, Jip3 -/+, and Jip3 -/-). At 6-days post mRNA microinjection, morphological, behavioral, and microscopic phenotypes were examined in zebrafish larvae. Morphologically, we compared the size and shape of the zebrafish during their development over a 5-day period. Total locomotive activity was assessed using the Microtracker assay and patterns of movement over time were examined using the DanioVision assay. Lastly, we used confocal microscopy to examine sensory axons for swelling and shortened length, which are phenotypes observed in the loss-of-function knockout Jip3 zebrafish model. Using these assays during embryonic development, we determined the impact of various missense variants on Jip3 protein function, compared to knockout and wild-type zebrafish embryo models. Variants in the gene Mapk8ip3 cause rare-neurodevelopmental disorders due to an essential role in axonal vesicle transport, elongation and regeneration. A subset of missense variants was examined by overexpressing the mRNA of these variants in a Jip3 knock-out zebrafish. Morphological, behavioral, and microscopic phenotypes were examined in zebrafish larvae. Using these assays, the spectrum of disorders can be phenotypically determined and the impact of variant location can be compared to knockout and wild-type zebrafish embryo models.

Keywords: rare disease, neurodevelopmental disorders, mrna overexpression, zebrafish research

Procedia PDF Downloads 88

Authors: Jee-Young Lee, Joaquim J. Ferreira, Hyeo-il Ma, José-Francisco Rocha, Beomseok Jeon

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The effective management of wearing-off is a key driver of medication changes for patients with Parkinson’s disease (PD) treated with levodopa (L-DOPA). While L-DOPA is well tolerated and efficacious, its clinical utility over time is often limited by the development of complications such as dyskinesia. Still, common first-line option includes adjusting the daily L-DOPA dose followed by adjunctive therapies usually counting for the L-DOPA equivalent daily dose (LEDD). The LEDD conversion formulae are a tool used to compare the equivalence of anti-PD medications. The aim of this work is to compare the effects of opicapone (OPC) 50 mg, a catechol-O-methyltransferase (COMT) inhibitor, and an additional 100 mg dose of L-DOPA in reducing the off time in PD patients with early motor fluctuations receiving different daily L-DOPA doses. OPC was found to be well tolerated and efficacious in advanced PD population. This work utilized patients' home diary data from a 4-week Phase 2 pharmacokinetics clinical study. The Korean ADOPTION study randomized (1:1) patients with PD and early motor fluctuations treated with up to 600 mg of L-DOPA given 3–4 times daily. The main endpoint was change from baseline in off time in the subgroup of patients receiving 300–400 mg/day L-DOPA at baseline plus OPC 50 mg and in the subgroup receiving >300 mg/day L-DOPA at baseline plus an additional dose of L-DOPA 100 mg. Of the 86 patients included in this subgroup analysis, 39 received OPC 50 mg and 47 L-DOPA 100 mg. At baseline, both L-DOPA total daily dose and LEDD were lower in the L-DOPA 300–400 mg/day plus OPC 50 mg group than in the L-DOPA >300 mg/day plus L-DOPA 100 mg. However, at Week 4, LEDD was similar between the two groups. The mean (±standard error) reduction in off time was approximately three-fold greater for the OPC 50 mg than for the L-DOPA 100 mg group, being -63.0 (14.6) minutes for patients treated with L-DOPA 300–400 mg/day plus OPC 50 mg, and -22.1 (9.3) minutes for those receiving L-DOPA >300 mg/day plus L-DOPA 100 mg. In conclusion, despite similar LEDD, OPC demonstrated a significantly greater reduction in off time when compared to an additional 100 mg L-DOPA dose. The effect of OPC appears to be LEDD independent, suggesting that caution should be exercised when employing LEDD to guide treatment decisions as this does not take into account the timing of each dose, onset, duration of therapeutic effect and individual responsiveness. Additionally, OPC could be used for keeping the L-DOPA dose as low as possible for as long as possible to avoid the development of motor complications which are a significant source of disability.

Keywords: opicapone, levodopa, pharmacokinetics, off-time

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Authors: Naziema Jappie

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There is a wealth of knowledge about JEDI (Justice Equity Diversity Inclusion), but unfortunately this remains at a discrete initiative level at universities. South African universities are committed to social justice by promoting inclusive teaching, learning and research environments, diversity and equity in access and participation of students and staff regardless of age; disability; gender; sexual orientation; nationality, ethnic or national origin; religion; and socioeconomic background in all aspects of higher education at a national level. Universities strive to promote and protect equal rights and equity of access is safeguarded for international students by recognizing the foreign policies and practices. Nevertheless, many international students remain underrepresented, alienated and often without employment. Universities see internationalisation as a commercial venture, but where does JEDI fit into this plan? Given the focus on diversity in higher education institutions, one would assume that JEDI should have a broader compass rather than a narrow scope. Over the past decades, national trends have emerged in the commitment to international diversification by admitting students and recruiting staff, mainly from the African continent. Most importantly, emergence of statements of broader diversity and equity plans across the campuses, included in the strategic plans of institutions are counterproductive to the statements of the Employment Equity plans and targets when aligned to the recruitment processes. These trends are certainly significant and relevant given the increasing diverse populations in higher education. What is missing in JEDI initiatives is the lack of global perspective and situating JEDI within a larger and inclusive context to embrace institutional internationalization. It is not a separate construct but internationalization framework takes the JEDI vision from local to global. Embracing JEDI and internationalization are fundamental for future economic growth. JEDI creates diverse perspectives and builds a team of top diverse and international talent that will gives a competitive edge. Increasing internationalization efforts and creating a knowledge platform will affect the innovation performance of the economy. Transforming South African policies require a comprehensive educational strategy on justice, equity, diversity, and inclusion (JEDI).

Keywords: equity, diversity, inclusion, internationalization, justice, higher education

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Authors: Lindsay Foreman

Abstract:

Introduction: Goals have become synonymous with the quest for the good life and the pursuit of happiness, with coaching and positive psychology gaining popularity as an approach in recent decades. And yet mental health is on the rise and the leading cause of disability, wellbeing is on the decline, stress is leading to 50-60% of workday absences and the need for action is indisputable and urgent. Purpose: The purpose of this study is to better understand two things we cannot see, but that play the most significant role in these outcomes - what we think and how we feel. With many working on the assumption that positive thinking and an optimistic outlook are necessary or valuable components of goal pursuit, this study uncovers the reality of the ‘inner-game’ from the coachees perspective. Method: With a mixed methods design using a Q Method study of subjectivity to ‘make the unseen seen’. First, a wide-ranging universe of subjective thoughts and feelings experienced during goal pursuit are explored.. These are generated from literature and a Qualtrics survey to create a Q-Set of 40 statements. Then 19 participants in professional and organisational settings offer their perspectives on these 40 Q-Set statements. Each rank them in a semi-forced distribution from ‘most like me’ to ‘least like me’ using Q-Sort software. From these individual perspectives, clusters of perspectives are identified using factor analysis and four distinct viewpoints, have emerged. Findings: These Goal Pursuit Viewpoints offer insight into the states and self-talk experienced by coachees and may not reflect the assumption of positive thinking associated with achieving goals. The four Viewpoints are 1) the Positive View, 2) the Realistic View 3) The Dreamer View and 4) The Conflicted View. With only a quarter of the Dreamer View, and a third of the Positive view going on to achieve their goals, these assumptions need review. And with all the Realistic View going on to achieve their goals, the role of self-doubt, overwhelm and anxiousness in goal achievement cannot be overlooked. Contribution: This study offers greater insight and understanding of people's inner experiences as they pursue goals and highlights the necessary and normal negative states associated with goal achievement. It also offers a practical tool of 40 ‘Clarity Card’ Q-set statements to help coaches and coachees explore the current state and help navigate the journey towards goal achievement. It calls into question whether goals should always be part of coaching, and if values, identity, and purpose may play a greater role than goals

Keywords: self-talk, mental health, inner critic, inner coach

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Authors: Michelle Jennett, Jana Dengler, Maytal Perlman

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Background: Cervical spinal cord injury (SCI) is a devastating event that results in upper limb paralysis, loss of independence, and disability. People living with cervical SCI have identified improvement of upper limb function as a top priority. Nerve and tendon transfer surgery has successfully restored upper limb function in cervical SCI but is not universally used or available to all eligible individuals. This exploratory mixed-methods study used an implementation science approach to better understand these factors that influence access to upper limb reconstruction in the Canadian context and design an intervention to increase access to care. Methods: Data from the Canadian Institute for Health Information’s Discharge Abstracts Database (CIHI-DAD) and the National Ambulatory Care Reporting System (NACRS) were used to determine the annual rate of nerve transfer and tendon transfer surgeries performed in cervical SCI in Canada over the last 15 years. Semi-structured interviews informed by the consolidated framework for implementation research (CFIR) were used to explore Ontario healthcare provider knowledge and practices around upper limb reconstruction. An inductive, iterative constant comparative process involving descriptive and interpretive analyses was used to identify themes that emerged from the data. Results: Healthcare providers (n = 10 upper extremity surgeons, n = 10 SCI physiatrists, n = 12 physical and occupational therapists working with individuals with SCI) were interviewed about their knowledge and perceptions of upper limb reconstruction and their current practices and discussions around upper limb reconstruction. Data analysis is currently underway and will be presented. Regional variation in rates of upper limb reconstruction and trends over time are also currently being analyzed. Conclusions: Utilization of nerve and tendon transfer surgery to improve upper limb reconstruction in Canada remains low. There are a complex array of interrelated individual-, provider- and system-level barriers that prevent individuals with cervical SCI from accessing upper limb reconstruction. In order to offer equitable access to care, a multi-modal approach addressing current barriers is required.

Keywords: cervical spinal cord injury, nerve and tendon transfer surgery, spinal cord injury, upper extremity reconstruction

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Authors: Carlos V. Gonzalez

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Background: Providers of in-home and community based services strive for the elimination of preventable harm to the people under their care as well as to the employees who support them. Traditional models of safety and protection from harm have assumed that the absence of incidents of harm is a good indicator of safe practices. However, this model creates an illusion of safety that is easily shaken by sudden and inadvertent harmful events. As an alternative, we have developed and implemented an evidence-based resilient model of safety known as C.O.P.E. (Caring, Observing, Predicting and Evaluating). Within this model, safety is not defined by the absence of harmful incidents, but by the presence of continuous monitoring, anticipation, learning, and rapid response to events that may lead to harm. Objective: The objective was to evaluate the effectiveness of the C.O.P.E. model for the reduction of harm to individuals with mental disabilities who receive home and community based services. Methods: Over the course of 2 years we counted the number of incidents of harm and near misses. We trained employees on strategies to eliminate incidents before they fully escalated. We trained employees to track different levels of patient status within a scale from 0 to 10. Additionally, we provided direct support professionals and supervisors with customized smart phone applications to track and notify the team of changes in that status every 30 minutes. Finally, the information that we collected was saved in a private computer network that analyzes and graphs the outcome of each incident. Result and conclusions: The use of the COPE model resulted in: A reduction in incidents of harm. A reduction the use of restraints and other physical interventions. An increase in Direct Support Professional’s ability to detect and respond to health problems. Improvement in employee alertness by decreasing sleeping on duty. Improvement in caring and positive interaction between Direct Support Professionals and the person who is supported. Developing a method to globally measure and assess the effectiveness of prevention from harm plans. Future applications of the COPE model for the reduction of harm to people who receive home and community based services are discussed.

Keywords: harm, patients, resilience, safety, mental illness, disability

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Authors: Linghua Kong, Xinxia Chen, Mika Gissler, Catharina Lavebratt

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Background: Prenatal exposure to preeclampsia has been associated with an increased risk of offspring attention-deficit/hyperactivity disorders (ADHD), autism spectrum disorder (ASD), and intellectual disability. However, little is known about the association between prenatal exposure to severe preeclampsia and neurodevelopmental and psychiatric disorders in offspring. Objective: This study aimed to assess the risk of maternal preeclampsia combined with perinatal problems, specifically low birth weight and prematurity, on offspring neuropsychiatric disorders. Methods: All singleton live births in Finland between 1996 and 2014 (n=1 012 723) were followed up in nation-wide registries until 2018. Main exposures included pre-eclampsia, small for gestational age, and delivery before 34 gestational weeks. Offspring neurodevelopmental and psychiatric disorders (ICD-10 codes) were examined as outcomes variables. Offspring birth year, sex, maternal age at delivery, parity, marital status at birth, mother's country of birth, maternal smoking, maternal gestational diabetes, maternal use of psychotropic medication during pregnancy, and maternal systemic inflammatory diseases were used as covariates. Risks for neurodevelopmental and psychiatric disorders were estimated using Cox proportional hazards modeling. Results: Of the 1 012 723 offspring, 25 901 (2.6%) were exposed to preeclampsia, and 93 281 (9.2%) were diagnosed with a neuropsychiatric disorder. Compared to births unexposed to preeclampsia, small for gestational age or delivery before 34 gestational weeks, those exposed to preeclampsia only had a 21% increase in the likelihood of any neuropsychiatric disorders after adjusting for potential confounding (adjusted HR=1.21, 95% CI: 1.15-1.26), while exposure to preeclampsia combined with small for gestational age or delivery before 34 gestational weeks had a more than twofold increased risk of having a child with neuropsychiatric disorders (adjusted HR=2.16, 95% CI: 2.02-2.32). The adjusted HR for neuropsychiatric disorders in offspring with small for gestational age or delivery before 34 gestational weeks only was 1.79 (95% CI: 1.73-1.83). In addition, the risk estimate in offspring exposed to both preeclampsia and perinatal problems was greater than those only exposed to preeclampsia for having personality disorders (adjusted HR=1.66; 95% CI: 1.07-2.57), intellectual disabilities (adjusted HR=3.47; 95% CI: 2.86-4.22), specific developmental disorders (adjusted HR=2.91; 95% CI: 2.69-3.15), ASD (adjusted HR=1.75; 95% CI: 1.42-2.17), ADHD and conduct disorders (adjusted HR=2.00; 95%CI: 1.76-2.27), and other behavioral and emotional disorders (adjusted HR=2.09; 95% CI: 1.84-2.37). Conclusion: In utero exposure to severe preeclampsia increased the risk of several neurodevelopmental and psychiatric disorders in offspring. Our findings are relevant to women with hypertensive disorders with regard to pregnancy consultation and management and may yield effective clues for the prevention of neurodevelopmental and psychiatric disorders in childhood.

Keywords: low birth weight, neurodevelopmental disorders, preeclampsia, prematurity, psychiatric disorders

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Authors: Jennifer Gallup, Joel Bocanegra, Greg Callan, Abigail Vaughn

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Students with disabilities (SWD) engaged in a distance summer program delivered over multiple virtual mediums that used gaming principles to teach and practice self-regulated learning (SRL) through the process of exploring possible jobs. Gaming quests were developed to explore jobs and teach transition skills. Students completed specially designed quests that taught and reinforced SRL and problem-solving through individual, group, and teacher-led experiences. SRL skills learned were reinforced through guided job explorations over the context of MinecraftEDU, zoom with experts in the career, collaborations with a team over Marco Polo, and Zoom. The quests were developed and laid out on an accessible web page, with active learning opportunities and feedback conducted within multiple virtual mediums including MinecraftEDU. Gaming mediums actively engage players in role-playing, problem-solving, critical thinking, and collaboration. Gaming has been used as a medium for education since the inception of formal education. Games, and specifically board games, are pre-historic, meaning we had board games before we had written language. Today, games are widely used in education, often as a reinforcer for behavior or for rewards for work completion. Games are not often used as a direct method of instruction and assessment; however, the inclusion of games as an assessment tool and as a form of instruction increases student engagement and participation. Games naturally include collaboration, problem-solving, and communication. Therefore, our summer program was developed using gaming principles and MinecraftEDU. This manuscript describes a virtual learning summer program called Virtual Academy New and Exciting Transitions (VAN) that was redesigned from a face-to-face setting to a completely online setting with a focus on SWD aged 14-21. The focus of VAN was to address transition planning needs such as problem-solving skills, self-regulation, interviewing, job exploration, and communication for transition-aged youth diagnosed with various disabilities (e.g., learning disabilities, attention-deficit hyperactivity disorder, intellectual disability, down syndrome, autism spectrum disorder).

Keywords: autism, disabilities, transition, summer program, gaming, simulations

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Authors: Valeria Tatano, Francesca Guidolin, Francesca Peltrera

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The preservation of historical Italian heritage, at the urban and architectural scale, has to consider restrictions and requirements connected with conservation issues and usability needs, which are often at odds with historical heritage preservation. Recent decades have been marked by the search for increased accessibility not only of public and private buildings, but to the whole historical city, also for people with disability. Moreover, in the last years the concepts of Smart City and Healthy City seek to improve accessibility both in terms of mobility (independent or assisted) and fruition of goods and services, also for historical cities. The principles of Inclusive Design have introduced new criteria for the improvement of public urban space, between current regulations and best practices. Moreover, they have contributed to transforming “special needs” into an opportunity of social innovation. These considerations find a field of research and analysis in the historical city of Venice, which is at the same time a site of UNESCO world heritage, a mass tourism destination bringing in visitors from all over the world and a city inhabited by an aging population. Due to its conformation, Venetian urban fabric is only partially accessible: about four thousand bridges divide thousands of islands, making it almost impossible to move independently. These urban characteristics and difficulties were the base, in the last 20 years, for several researches, experimentations and solutions with the aim of eliminating architectural barriers, in particular for the usability of bridges. The Venetian Municipality with the EBA Office and some external consultants realized several devices (e.g. the “stepped ramp” and the new accessible ramps for the Venice Marathon) that should determine an innovation for the city, passing from the use of mechanical replicable devices to specific architectural projects in order to guarantee autonomy in use. This paper intends to present the state-of-the-art in bridges accessibility, through an analysis based on Inclusive Design principles and on the current national and regional regulation. The purpose is to evaluate some possible strategies that could improve performances, between limits and possibilities of interventions. The aim of the research is to lay the foundations for the development of a strategic program for the City of Venice that could successfully bring together both conservation and improvement requirements.

Keywords: accessibility of historical cities, historical heritage preservation, inclusive design, technological and social innovation

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Authors: Dana El-Mughayyar, Neil Manson, Erin Bigney, Eden Richardson, Dean Tripp, Edward Abraham

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Use of narcotics to treat pain has increased over the past two decades and is a contributing factor to the current public health crisis. Understanding the pre-operative risks of chronic narcotic use may be aided through investigation of psychological measures. The objective of the reported study is to determine predictors of narcotic use two years post-surgery in a thoracolumbar spine surgery population, including an array of psychological factors. A prospective observational study of 191 consecutively enrolled adult patients having undergone thoracolumbar spine surgery is presented. Baseline measures of interest included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, Multidimensional Scale for Perceived Social Support (MSPSS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Oswestry Disability Index (ODI), Numeric Rating Scales for back and leg pain (NRS-B/L), SF-12’s Mental Component Summary (MCS), narcotic use and demographic variables. The post-operative measure of interest is narcotic use at 2-year follow-up. Narcotic use is collapsed into binary categories of use and no use. Descriptive statistics are run. Chi Square analysis is used for categorical variables and an ANOVA for continuous variables. Significant variables are built into a hierarchical logistic regression to determine predictors of post-operative narcotic use. Significance is set at α < 0.05. Results: A total of 27.23% of the sample were using narcotics two years after surgery. The regression model included ODI, NRS-Leg, time with condition, chief complaint, pre-operative drug use, gender, MCS, PCS subscale helplessness, and CPAQ subscale pain willingness and was significant χ² (13, N=191)= 54.99; p = .000. The model accounted for 39.6% of the variance in narcotic use and correctly predicted in 79.7% of cases. Psychological variables accounted for 9.6% of the variance over and above the other predictors. Conclusions: Managing chronic narcotic usage is central to the patient’s overall health and quality of life. Psychological factors in the preoperative period are significant predictors of narcotic use 2 years post-operatively. The psychological variables are malleable, potentially allowing surgeons to direct their patients to preventative resources prior to surgery.

Keywords: narcotics, psychological factors, quality of life, spine surgery

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Authors: Samantha R. Dutra

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There are many issues that students face in college, such as academic-based struggles, financial issues, family responsibilities, and vocational problems. Students with dyslexia struggle even more with these problems compared to other students. This qualitative study examines faculty perceptions of instructing students with dyslexia. This study is important to the human services and post-secondary educational fields due to the increase in disabled students enrolled in college. This study is also substantial because of the reported bias faced by students with dyslexia and their academic failure. When students with LDs such as dyslexia experience bias, discrimination, and isolation, they are more apt to not seek accommodations, lack communication with faculty, and are more likely to drop out or fail. College students with dyslexia often take longer to complete their post-secondary education and are more likely to withdraw or drop out without earning a degree. Faculty attitudes and academic cultures are major barriers to the success and use of accommodations as well as modified instruction for students with disabilities, which leads to student success. Faculty members are often uneducated or misinformed regarding students with dyslexia. More importantly, many faculty members are unaware of the many ethical and legal implications that they face regarding accommodating students with dyslexia. Instructor expectations can generally be defined as the understanding and perceptions of students regarding their academic success. Skewed instructor expectations can affect how instructors interact with their students and can also affect student success. This is true for students with dyslexia in that instructors may have lower and biased expectations of these students and, therefore, directly impact students’ academic successes and failures. It is vital to understand how instructor attitudes affect the academic achievement of dyslexic students. This study will examine faculty perceptions of instructing students with dyslexia and faculty attitudes towards accommodations and institutional support. The literature concludes that students with dyslexia have many deficits and several learning needs. Furthermore, these are the students with the highest dropout and failure rates, as well as the lowest retention rates. Disabled students generally have many reasons why accommodations and supports just do not help. Some research suggests that accommodations do help students and show positive outcomes. Many improvements need to be made between student support service personnel, faculty, and administrators regarding providing access and adequate supports for students with dyslexia. As the research also suggests, providing more efficient and effective accommodations may increase positive student as well as faculty attitudes in college, and may improve student outcomes overall.

Keywords: dyslexia, faculty perception, higher education, learning disability

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Authors: Laura M. Hovsepyan, Gayane S. Ghazaryan, Hasmik V. Zanginyan

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Hypertension (HD) is the most common cardiovascular pathology that causes disability and mortality in the working population. Most often, heart failure (HF), which is based on myocardial remodeling, leads to death in hypertension. Recently, endothelial dysfunction (EDF) or a violation of the functional state of the vascular endothelium has been assigned a significant role in the structural changes in the myocardium and the occurrence of heart failure in patients with hypertension. It has now been established that tissues affected by inflammation form increased amounts of superoxide radical and NO, which play a significant role in the development and pathogenesis of various pathologies. They mediate inflammation, modify proteins and damage nucleic acids. The aim of this work was to study the processes of oxidative modification of proteins (OMP) and the production of nitric oxide in hypertension. In the experimental work, the blood of 30 donors and 33 patients with hypertension was used. For the quantitative determination of OMP products, the based on the reaction of the interaction of oxidized amino acid residues of proteins and 2,4-dinitrophenylhydrazine (DNPH) with the formation of 2,4-dinitrophenylhydrazones, the amount of which was determined spectrophotometrically. The optical density of the formed carbonyl derivatives of dinitrophenylhydrazones was recorded at different wavelengths: 356 nm - aliphatic ketone dinitrophenylhydrazones (KDNPH) of neutral character; 370 nm - aliphatic aldehyde dinirophenylhydrazones (ADNPH) of neutral character; 430 nm - aliphatic KDNFG of the main character; 530 nm - basic aliphatic ADNPH. Nitric oxide was determined by photometry using Grace's solution. Adsorption was measured on a Thermo Scientific Evolution 201 SF at a wavelength of 546 nm. Thus, the results of the studies showed that in patients with arterial hypertension, an increased level of nitric oxide in the blood serum is observed, and there is also a tendency to an increase in the intensity of oxidative modification of proteins at a wavelength of 270 nm and 363 nm, which indicates a statistically significant increase in aliphatic aldehyde and ketone dinitrophenylhydrazones. The increase in the intensity of oxidative modification of blood plasma proteins in the studied patients, revealed by us, actually reflects the general direction of free radical processes and, in particular, the oxidation of proteins throughout the body. A decrease in the activity of the antioxidant system also leads to a violation of protein metabolism. The most important consequence of the oxidative modification of proteins is the inactivation of enzymes.

Keywords: hypertension (HD), oxidative modification of proteins (OMP), nitric oxide (NO), oxidative stress

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Authors: Lindsay Foreman

Abstract:

Introduction: Goals have become synonymous with the quest for the good life and the pursuit of happiness, with coaching and positive psychology gaining popularity as an approach in recent decades. And yet mental health is on the rise and the leading cause of disability, wellbeing is on the decline, stress is leading to 50-60% of workday absences and the need for action is indisputable and urgent. Purpose: The purpose of this study is to better understand two things we cannot see, but that play the most significant role in these outcomes - what we think and how we feel. With many working on the assumption that positive thinking and an optimistic outlook are necessary or valuable components of goal pursuit, this study uncovers the reality of the ‘inner-game’ from the coachee's perspective. Method: With a mixed methods design using a Q Method study of subjectivity to ‘make the unseen seen’. First, a wide-ranging universe of subjective thoughts and feelings experienced during goal pursuit are explored. These are generated from literature and a Qualtrics survey to create a Q-Set of 40 statements. Then 19 participants in professional and organisational settings offer their perspectives on these 40 Q-Set statements. Each rank them in a semi-forced distribution from ‘most like me’ to ‘least like me’ using Q-Sort software. From these individual perspectives, clusters of perspectives are identified using factor analysis and four distinct viewpoints have emerged. Findings: These Goal Pursuit Viewpoints offer insight into the states and self-talk experienced by coachees and may not reflect the assumption of positive thinking associated with achieving goals. The four Viewpoints are 1) the Optimistic View, 2) the Realistic View 3) The Dreamer View and 4) The Conflicted View. With only a quarter of the Dreamer View, and a third of the Optimistic view going on to achieve their goals, these assumptions need review. And with all the Realistic Views going on to achieve their goals, the role of self-doubt, overwhelm and anxiousness in goal achievement cannot be overlooked. Contribution: This study offers greater insight and understanding of people's inner experiences as they pursue goals and highlights the necessary and normal negative states associated with goal achievement. It also offers a practical tool of the Q-set statements to help coaches and coachees explore the current state and help navigate the journey towards goal achievement. It calls into question whether goals should always be part of coaching and if values, identity, and purpose may play a greater role than goals.

Keywords: coaching, goals, positive psychology, mindset, leadership, mental health, beliefs, cognition, emotional intelligence

Procedia PDF Downloads 83

Authors: Matthew Conner, Leah Plocharczyk

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This study examines the role of academic libraries in support of the intellectually disabled (ID) in post-secondary education. With the growing public awareness of the ID, there has been recognition of their need for post-secondary educational opportunities. This was an unforeseen result for a population that has been associated with elementary levels of education, yet the reasons are compelling. After aging out of the school system, the ID need and deserve educational and social support as much as anyone. Moreover, the commitment to diversity in higher education rings hollow if this group is excluded. Yet, challenges remain to integrating the ID into a college curriculum. This presentation focuses on the role of academic libraries. Neglecting this vital resource for the support of the ID is not to be thought of, yet the library’s contribution is not clear. Library collections presume reading ability and libraries already struggle to meet their traditional goals with the resources available. This presentation examines how academic libraries can support post-secondary ID. For context, the presentation first examines the state of post-secondary education for the ID with an analysis of data on the United States compiled by the ThinkCollege! Project. Geographic Information Systems (GIS) and statistical analysis will show regional and methodological trends in post-secondary support of the ID which currently lack any significant involvement by college libraries. Then, the presentation analyzes a case study of a book club at the Florida Atlantic University (FAU) libraries which has run for several years. Issues such as the selection of books, effective pedagogies, and evaluation procedures will be examined. The study has found that the instruction pedagogies used by libraries can be extended through concepts of Universal Learning Design (ULD) to effectively engage the ID. In particular, student-centered, participatory methodologies that accommodate different learning styles have proven to be especially useful. The choice of text is complex and determined not only by reading ability but familiarity of subject and features of the ID’s developmental trajectory. The selection of text is not only a necessity but also promises to give insight into the ID. Assessment remains a complex and unresolved subject, but the voluntary, sustained, and enthusiastic attendance of the ID is an undeniable indicator. The study finds that, through the traditional library vehicle of the book club, academic libraries can support ID students through training in both reading and socialization, two major goals of their post-secondary education.

Keywords: academic libraries, intellectual disability, literacy, post-secondary education

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Authors: Tuna Şahsuvaroğlu

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The concept of disability is a concept that has been the subject of many studies in national and international literature with its social, sociological, political, anthropological, economic and social dimensions as well as with individual and social consequences. A disabled person is defined as a person who has difficulties in adapting to social life and meeting daily needs due to loss of physical, mental, spiritual, sensory and social abilities to various degrees, either from birth or for any reason later, and they are in need of protection, care, rehabilitation, counseling and support services. The industrial revolution and the rapid industrialization it brought with it led to an increase in the rate of disabilities resulting from work accidents, in addition to congenital disabilities. This increase has resulted in disabled people included in the employment policies of nations as a disadvantaged group. Although the participation of disabled individuals in the workforce is of great importance in terms of both increasing their quality of life and their integration with society and although disabled individuals are willing to participate in the workforce, they encounter with many problems. One of these problems is the negative attitudes and prejudices that develop in society towards the employment of disabled individuals. One of the most powerful ways to turn these negative attitudes and prejudices into positive ones is education. Education is a way of guiding societies and transferring existing social characteristics to future generations. This can be maintained thanks to teachers, who are one of the most dynamic parts of society and act as the locomotive of education driven by the need to give direction and transfer and basically to help and teach. For this reason, there is a strong relationship between the teaching profession and the attitudes formed in society towards the employment of disabled individuals, as they can influence each other. Therefore, the purpose of this study is to examine teacher candidates' attitudes towards the employment of disabled individuals in terms of various variables. The participants of the study consist of 665 teacher candidates studying at various departments at Marmara University Faculty of Education in the 2022-2023 academic year. The descriptive survey model of the general survey model was used in this study as it intends to determine the attitudes of teacher candidates towards the employment of disabled individuals in terms of different variables. The Attitude Scale Towards Employment of Disabled People was used to collect data. The data were analyzed according to the variables of age, gender, marital status, the department, and whether there is a disabled relative in the family, and the findings were discussed in the context of further research.

Keywords: teacher candidates, disabled, attitudes towards the employment of disabled people, attitude scale towards the employment of disabled people

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Authors: Abdreheman Seid Abdella

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This study examined instructors willingness, self-efficacy beliefs, attitudes and knowledge about provisions of instructional accommodations for students with disabilities in universities. Major concepts used in this study operationally defined and some models of disability were reviewed. Questionnaires were distributed to a total of 181 instructors from four universities and quantitative data was generated. Then to analyze the data, appropriate methods of data analysis were employed. The result indicated that on average instructors had positive willingness, strong self-efficacy beliefs and positive attitudes towards providing instructional accommodations. In addition, the result showed that the majority of participants had moderate level of knowledge about provision of instructional accommodations. Concerning the relationship between instructors background variables and dependent variables, the result revealed that location of university and awareness raising training about Inclusive Education showed statistically significant relationship with all dependent variables (willingness, self-efficacy beliefs, attitudes and knowledge). On the other hand, gender and college/faculty did not show a statistically significant relationship. In addition, it was found that among the inter-correlation of dependent variables, the correlation between attitudes and willingness to provide accommodations was the strongest. Furthermore, using multiple linear regression analysis, this study also indicated that predictor variables like self-efficacy beliefs, attitudes, knowledge and teaching methodology training made statistically significant contribution to predicting the criterion willingness. Predictor variables like willingness and attitudes made statistically significant contribution to predicting self-efficacy beliefs. Predictor variables like willingness, Special Needs Education course and self-efficacy beliefs made statistically significant contribution to predict attitudes. Predictor variables like Special Needs Education courses, the location of university and willingness made statistically significant contribution to predicting knowledge. Finally, using exploratory factor analysis, this study showed that there were four components or factors each that represent the underlying constructs of willingness and self-efficacy beliefs to provide instructional accommodations items, five components for attitudes towards providing accommodations items and three components represent the underlying constructs for knowledge about provisions of instructional accommodations items. Based on the findings, recommendations were made for improving the situation of instructional accommodations in Ethiopian universities.

Keywords: willingness, self-efficacy belief, attitude, knowledge

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Authors: Sharon Milberger, Jane Turner, Denise White-Perkins

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Michigan shares the overall U.S. national need for more highly qualified professionals who have knowledge and experience in the use of evidence-based practices to meet the special health care needs of children, adolescents, and adults with neurodevelopmental disabilities including autism spectrum disorder (DD/ASD). The Michigan Leadership Education in Neurodevelopmental Disabilities (MI-LEND) program is a consortium of six universities that spans the state of Michigan and serves more than 181,800 undergraduate, graduate, and professional students. The purpose of the MI LEND program is to improve the health of infants, children and adolescents with disabilities in Michigan by training individuals from different disciplines to assume leadership roles in their respective fields and work across disciplines. The MI-LEND program integrates “L.I.F.E.” perspectives into all training components. L.I.F.E. is an acronym for Leadership, Interdisciplinary, Family-Centered and Equity perspectives. This paper will describe how L.I.F.E. perspectives are embedded into all aspects of the MI-LEND training program including the application process, didactic training, community and clinical experiences, discussions, journaling and projects. Specific curriculum components will be described including content from a training module dedicated to Equity. Upon completion of the Equity module, trainees are expected to be able to: 1) Use a population health framework to identify key social determinants impacting families and children; 2) Explain how addressing bias and providing culturally appropriate linguistic care/services can influence patient/client health and wellbeing; and 3) Describe the impact of policy and structural/institutional factors influencing care and services for children with DD/ASD and their families. Each trainee completes two self-assessments: the Cultural and Linguistic Competence Health Practitioner Assessment and the other assessing social attitudes/implicit bias. Trainees also conduct interviews with a family with a child with DD/ASD. In addition, interdisciplinary Equity-related group activities are incorporated into face-to-face training sessions. Each MI-LEND trainee has multiple ongoing opportunities for self-reflection through discussion and journaling and completion of a L.I.F.E. project as a culminating component of the program. The poster will also discuss the challenges related to teaching and measuring successful outcomes related to diversity/equity perspectives.

Keywords: disability, diversity, equity, training

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Authors: P. W. G. D. P. Samarasekara, S. M. K. S. Seneviratne, D. Munidasa, S. S. Williams

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Sustaining a spinal cord injury (SCI) causes severe disruption of all aspects of a person’s life, resulting in the difficult process of coping with the distressing effects of paralysis affecting their ability to lead a meaningful life. These persons are hospitalized in the acute stage of injury and subsequently for rehabilitation and the treatment of complications. The purpose of this study was to explore coping strategies used by persons with SCI during their rehabilitation period. A qualitative study was conducted among persons with SCI, undergoing rehabilitation at the Rheumatology and Rehabilitation Hospitals, Ragama and Digana Sri Lanka. Twelve participants were selected purposively to represent both males and females, with cervical, thoracic or lumbar levels of injuries due to traumatic and non-traumatic causes as well as from different socioeconomic backgrounds. Informed consent was taken from the participants. In-depth interviews were conducted using an interview guide to collect data. Probes were used to get more information and to encourage participants. Interviews were audio taped and transcribed verbatim. Qualitative content analysis was conducted. Ethical approval for this study was obtained from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya. Five themes were identified in the content analysis: social support, religious beliefs, determination, acceptance and making comparisons. Participants indicated that the support from their family members had been an essential factor in coping, after sustaining an SCI and they expressed the importance of emotional support from family members during their rehabilitation. Many participants had a strong belief towards the God, who had a personal interest in their lives, played an important role in their ability to cope with the injury. They believed that what happens to them in this life results from their actions in previous lives. They expressed that determination was essential as a factor that helps them cope with their injury. They indicated their focus on the positive aspects of the life and accepted the disability. They made comparisons to other persons who were worse off than them to help lift them out of unpleasant experience. Even some of the most severely injured and disabled participants presented evidence of using this coping strategy. Identification of coping strategies used by persons with SCI will help nurses and other health-care professionals in reinforcing the most effective coping strategies among persons with SCI. The findings recommend that engagement coping positively influences psychosocial adaptation.

Keywords: content analysis, coping strategies, rehabilitation, spinal cord injury

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Authors: M. Walmsley, S. Elmatarri, S. Mannion

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Introduction: Self-inflicted injury is a recognised cause of major trauma in adults and is an independent indicator of a reduced functional outcome compared to non-intentional major trauma. There is little literature available on the inpatient mental health (MH) management of this vulnerable group. A retrospective review was conducted of inpatient MH management of major trauma patients admitted to a UK regional Major Trauma Centre (MTC). Their outcomes were compared to all major trauma patients. This group of patients required multiple MH interventions whilst on the Major Trauma Ward (MTW) and a had worse functional outcome compared to non-intentional trauma. Method: The national TARN (Trauma Audit and Research Network) database was used to identify patients admitted to a regional MTC over a 2-year period from June 2018 to July 2020. Patients with an ISS (Injury Severity Score) of greater than 15 with a mechanism of either self-harm or high-risk behavior were included for further analysis. Inpatient medical notes were reviewed for MH interventions on the MTW. Further outcomes, including mortality, length of stay (LOS) and Glasgow Outcome Score (GOS) were compared with all major trauma patients for the same time period. Results: A total of 60 patients were identified in the time period and of those, 27 spent time on the MTW. A total of 23 (85%) had a prior MH diagnosis, with 11 (41%) under the care of secondary MH services. Adequate inpatient records for review were available for 24 patients. During their inpatient stay, 8 (33%) were reviewed on the ward by the inpatient MH team. There were 10 interventions required for 6 (25%) patients on the MTW including, sections under the Mental Health Act, transfer to specialist MH facility, pharmacological sedation and security being called to the MTW. When compared to all major trauma patients, those admitted due to self-harm or high-risk behavior had a statistically significantly higher ISS (31.43 vs 24.22, p=0.0001) and LOS (23.51d vs 16.06d, p=0.002). Functional outcomes using the GOS were reduced in this group of patients, GOS 5 (low disability) (51.66% vs. 61.01%) and they additionally had a higher level of mortality, GOS 1 (15.00% vs 11.67%). Discussion: Intentional self-harm is a recognised cause of major trauma in adults and this patient group sustains more severe injuries, requiring a longer hospital stay with worse outcomes compared to all major trauma patients. Inpatient MH interventions are required for a significant proportion of these patients and therefore, there needs to be a close relationship with MH services. There is limited available evidence for how this patient group is best managed as an inpatient to aid their recovery and further work is needed on how outcomes in this vulnerable group can be improved.

Keywords: adult major trauma, attempted suicide, self-inflicted major trauma, inpatient management

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Authors: Chia-Wen Wang, Patou Masika Musumari, Teeranee Techasrivichien, S. Pilar Suguimoto, Chang-Chuan Chan, Masako Ono-Kihara, Masahiro Kihara

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Background: In recent years, a particular form of bullying, referred to as 'cyberbullying' has emerged along with the rapid expansion of the Internet, social network services (SNSs) and smart phones. Many Asian countries, including Taiwan, are faced with both the cyberbullying and the traditional form of bullying. This study aims to explore Taiwanese adolescents’ experiences, perceptions and opinions regarding cyberbullying and traditional bullying through the perspective of victim, perpetrator, or witness. Method: This is a qualitative study using face-to-face in-depth interviews guided by a semi-structured questionnaire among high school students -aged 16 to 18 years- in Taipei, Taiwan. The participants were recruited through convenience sampling from five high schools between June and November 2016. Interviews were digitally recorded, transcribed, and analyzed using the thematic analysis approach. Results: Forty-eight participants were recruited, of which, 14 (29.2%) reported had ever experienced bullying. Specifically, 7 participants (14.6%) reported had ever been victims of cyberbullying, 1 (2%) had been victims of traditional bullying, and 6 (12.5%) had been victims of both cyber and traditional bullying. The majority (70.8%) reported had ever witnessed acts of bullying; however, none of the participants recognized had ever been a perpetrator of bullying. Cyberbullying mostly happens on social media (Facebook and Instagram) or LINE instant messaging application, and included upload and sharing of degrading pictures and videos of victims, as well as gossip and mean messages by the perpetrators. The anonymous and public nature of social media groups in schools made it easier to perpetrate bullying. The victim of traditional bullying reported being the target of verbal attack because of his physical appearance. Regardless of the type of bullying, victims reported feeling bad, angry, or depressed as a result of being bullied. Witnesses of both cyber- and traditional bullying cited physical appearance (e.g. having the big/flat bust or big butt, or overweight or obese) and disability as the most reasons of being a bullying victim. Conclusion: Both cyberbullying and traditional bullying had negative emotional and psychological impacts on victims. This study warrants further research to assess the extent of this phenomenon and understand the characteristics of perpetrators, victims, and witnesses to inform the design of tailored interventions using appropriate channels of dissemination.

Keywords: cyberbullying, traditional bullying, social media, adolescents

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Authors: Melissa K. Hord, Stephen P. Whiteside

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Impairment in functioning is a requirement for diagnosing psychopathology, identifying individuals in need of treatment, and documenting improvement with treatment. Further, identifying different types of functional impairment can guide educators and treatment providers. However, most assessment tools focus on symptom severity and few measures assess impairment associated with childhood anxiety disorders. The child- and parent-report versions of the Child Sheehan Disability Scale (CSDS) are measures that may provide useful information regarding impairment. The purpose of the present study is to examine whether children diagnosed with different anxiety disorders have greater impairment in school or home functioning based on self or parent report. The sample consisted of 844 children ages 5 to 19 years of age (mean 13.43, 61% female, 90.9% Caucasian), including 281 children diagnosed with obsessive compulsive disorder (OCD), 200 with generalized anxiety disorder (GAD), 176 with social phobia, 83 with separation anxiety, 61 with anxiety not otherwise specified (NOS), 30 with panic disorder, and 13 with panic with agoraphobia. To assess whether children and parents reported greater impairment in school or home functioning, a multivariate analysis of variance was conducted. (The assumptions of independence and homogeneity of variance were checked and met). A significant difference was found, Pillai's trace = .143, F (4, 28) = 4.19, p < .001, partial eta squared = .04. Post hoc comparisons using the Tukey HSD test indicated that children report significantly greater impairment in school with panic disorder (M=5.18, SD=3.28), social phobia (M=4.95, SD=3.20), and OCD (M=4.62, SD=3.32) compared to other diagnoses; whereas parents endorse significantly greater school impairment when their child has a social phobia (M=5.70, SD=3.39) diagnosis. Interestingly, both children and parents reported greater impairment in family functioning for an OCD (child report M=5.37, SD=3.20; parent report M=5.59, SD=3.38) diagnosis compared to other anxiety diagnoses. (Additional findings for the anxiety disorders associated with less impairment will also be presented). The results of the current study have important implications for educators and treatment providers who are working with anxious children. First, understanding that differences exist in how children and parents view impairment related to childhood anxiety can help those working with these families to be more sensitive during interactions. Second, evidence suggests that difficulties in one environment do not necessarily translate to another environment, thus caregivers may benefit from careful explanation of observations obtained by educators. Third, results support the use of the CSDS measure by treatment providers to identify impairment across environments in order to more effectively target interventions.

Keywords: anxiety, childhood, impairment, school functioning

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Authors: S. Somerset, D. J. Hoare

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Participation in sport is linked to better mental and physical health in children and adults. Studies have shown children who participate in sports benefit from improved social skills, self-confidence, communication skills and a better quality of life. Children who participate in sports from a young age are also more likely to continue to have active lifestyles during adulthood. This is an important consideration with a nation where physical activity levels are declining and the incidences of obesity are rising. Getting children active and keeping them active can provide long term health benefits to the individual but also a potential reduction in health costs in the future. This systematic review aims to identify the barriers to participation in sport for children aged up to 18 years and encompasses both qualitative and quantitative studies. The bibliographic databases, EMBASE, Medline, CINAHL and SportDiscus were searched. Additional hand searches were carried out on review articles found in the searches to identify any studies that may have been missed. Studies involving children up to 18 years without additional needs focusing on barriers to participation in sport were included. Randomised control trials, policy guidelines, studies with sport as an intervention, studies focusing on the female athlete triad, tobacco abuse, alcohol abuse, drug abuse, pre exercise testing, and cardiovascular disease were excluded. Abstract review, full paper review and quality appraisal were conducted by two researchers. A consensus meeting took place to resolve any differences at the abstract, full text and data extraction / quality appraisal stages. The CASP qualitative studies appraisal tool and the CASP cohort studies tool (excluding question 3 and 4 which refer to interventions) were used for quality appraisal in this review. The review identified several salient barriers to participation in sport for children. These barriers ranged from the uniform worn during school physical education lessons to the weather during participation in sport. The most commonly identified barriers in the review include parental support, time allocation, location of the activity and the cost of the activity. Therefore, it would be beneficial for a greater provision to be made within the school environment for children to participate sport. This can reduce the cost and time commitment required from parents to encourage participation. This would help to increase activity levels of children, which ultimately can only be a good thing.

Keywords: barrier, children, participation, sport

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Authors: Carolina Beltran, Carlos De Los Reyes

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Acquired brain injury (ABI) is any physical and functional injury secondary to events that affect the brain tissue. It is one of the biggest causes of disability in the world and it has a high annual incidence in the pediatric population. There are several causes of ABI such as traumatic brain injury, central nervous system infection, stroke, hypoxia, tumors and others. The consequences can be cognitive, behavioral, emotional and functional. The cognitive rehabilitation is necessary to achieve the best outcomes for pediatric people with ABI. Cognitive orientation to daily occupational performance (CO-OP) is an individualized client-centered, performance-based, problem-solving approach that focuses on the strategy used to support the acquisition of three client-chosen goals. It has demonstrated improvements in the pediatric population with other neurological disorder but not in Spanish speakers with ABI. Aim: The main objective of this study was to determine the efficacy of cognitive orientation to daily occupational performances (CO-OP) adapted to Spanish speakers, in the level of independence and behavior in a pediatric population with ABI. Methods: Case studies with measure pre/post-treatment were used in three children with ABI, sustained at least before 6 months assessment, in school, aged 8 to 16 years, age ABI after 6 years old and above average intellectual ability. Twelve sessions of CO-OP adapted to Spanish speakers were used and videotaped. The outcomes were based on cognitive, behavior and functional independence measurements such as Child Behavior Checklist (CBCL), Behavior Rating Inventory of Executive Function (BRIEF), The Vineland Adaptive Behavior Scales (VINELAND, Social Support Scale (MOS-SSS) and others neuropsychological measures. This study was approved by the ethics committee of Universidad del Norte in Colombia. Informed parental written consent was obtained for all participants. Results: children were able to identify three goals and use the global strategy ‘goal-plan-do-check’ during each session. Verbal self-instruction was used by all children. CO-OP showed a clinically significant improvement in goals regarding with independence level and behavior according to parents and teachers. Conclusion: The results indicated that CO-OP and the use of a global strategy such as ‘goal-plan-do-check’ can be used in children with ABI in order to improve their specific goals. This is a preliminary version of a big study carrying in Colombia as part of the experimental design.

Keywords: cognitive rehabilitation, acquired brain injury, pediatric population, cognitive orientation to daily occupational performance

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Authors: Shivani Dhande, Sanjiv Choudhary, Adarshlata Singh

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Introduction: Chemical peeling is a popular, relatively inexpensive day procedure and generally safe method for treatment of pigmentary skin disorders and for skin rejuvenation. Chemical peels are classified by the depth of action into superficial, medium, and deep peels.Various facial pigmentary conditions have significant impact on quality of life causing psychological stress, necessitating its safe and effective treatment.Aim & Objectives:To compare the efficacy of Salicylic acid, Trichloroaceticacid & Glycolic Acid in facial melanosis(melasma,photomelanosis& post acne pigmentation).To study the side effects of above mentioned peeling agents. Method and Materials:It was a randomized parallel control single blind study consisting of total of 36 cases, 12 cases each of melasma, photo melanosis and post acne pigmentation within age group 20-50 years having fitzpatrick’s skin type4. Woods lamp examination was done to confirm the type of melasma.Patients with keloidal tendency, active herpes infection or past history of hypersensitivity to salicylic acid, trichloroaceticand glycolic acid as well aspatients on systemic isotretinoin were excluded.Clinical photographs at the beginning of therapy and then serially, were taken to assess the clinical response. Prior to application a written informed consent was obtained. A post auricular test peel was performed. Patients were divided into 3 groups, containing 12 patients each of melasma, photomelanosis and post acnepigmentation.All the three peels SA peel 20% (done once in 2 weeks), GA peel 50% (done once in 3 weeks) and TCA 15% (done once in 3 weeks) were used with total six settings for each patient. Before application of peel patients were counseled to wash the face with soap and water. Then face was dried and cleaned with spirit and acetone to remove all cutaneous oils. GA, TCA, SA were applied with cotton buds/gauze withmild strokes. After a contact period off 5-10mins neutralization was done with cold water. Post peel topical sunscreen application was mandatory. MASI was used pre and post treatment to assess melasma. Investigator’s global improvement scale- overall hyperpigmentation (4-significant, 3-moderate, 2-mild, 1-minimal, 0-no change ) and Patient’s satisfaction grading scale (>70%- excellent response, 50-70%- good response, <50%- average response) was used to assess improvement in all the three facial melanosis.Results:In our study of 12 patients of melasma, 4 (33.33%)patients showed excellent results;3 (25%) with GAand 1(8.33%) of TCA.Good response was seen in 4 (33.33%) patients;1(8.33%) each for GA & SA and 2(16.66%) for TCA.Poor response was seen in 4(33.33%) patients;1(8.33%) for TCA and 3 (25%) for SA.Of 12 patients of photomelanosis, excellent resultswas seen in 3(25%)patients of TCA. Good response was seen in 4 (33.33%) patients, 1(8.33%) each of TCA &SA and 2(16.66%) of GA.Poor responsewas seen in 5(41.66%) patients;3 (25%) for SA and 2(16.66%) of GA.Of 12 patients of post acne pigmentation, excellent responsein 3 (25%) patients;2(16.66%) of SA and 1(8.33%) of TCA.Good responsewas seen in 5(41.66%) patients;2(16.66%) of SA and GA and1(8.33%) of TCA.Poor response was seen in 4 (33.33%) patients; 2 (16.66%) for SA and TCA both. No major side effects in the form of scarring or persistant pigmentation was seen. Transient blackening of skin with burning sensation was seen in cases treated with TCA and SA. Post procedural itching and redness was noted with GA peel. Conclusion- In our study GA(50%),TCA(15%) & SA(20%) peels showed excellent response in melasma, photomelanosis and post-acne pigmentation respectively.All the 3 peeling agents were well tolerated without any significant side-effects in the above specified concentrations.

Keywords: facial melanosis, gycolic acid, salicylic acid, trichloroacetic acid

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Authors: Neil Singla, Derek Muse, Karen DiDonato, Pamela Palmer

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Introduction: Pain is the most common reason people visit emergency rooms. Studies indicate however, that Emergency Department (ED) physicians often do not provide adequate analgesia to their patients as a result of gender and age bias, opiophobia and insufficient knowledge of and formal training in acute pain management. Novel classes of analgesics have recently been introduced, but many patients suffer from acute pain in settings where the availability of intravenous (IV) access may be limited, so there remains a clinical need for rapid-acting, potent analgesics that do not require an invasive route of delivery. A sublingual sufentanil tablet (SST), dispensed using a single-dose applicator, is in development for treatment of moderate-to-severe acute pain in a medically-supervised setting. Objective: The primary objective of this study was to demonstrate the repeat-dose efficacy, safety and tolerability of sufentanil 20 mcg and 30 mcg sublingual tablets compared to placebo for the management of acute pain as determined by the time-weighted sum of pain intensity differences (SPID) to baseline over the 12-hour study period (SPID12). Key secondary efficacy variables included SPID over the first hour (SPID1), Total pain relief over the 12-hour study period (TOTPAR12), time to perceived pain relief (PR) and time to meaningful PR. Safety variables consisted of adverse events (AE), vital signs, oxygen saturation and early termination. Methods: In this Phase 2, double-blind, dose-finding study, an equal number of male and female patients were randomly assigned in a 2:2:1 ratio to SST 20 mcg, SS 30 mcg or placebo, respectively, following bunionectomy. Study drug was dosed as needed, but not more frequently than hourly. Rescue medication was available as needed. The primary endpoint was the Summed Pain Intensity Difference to baseline over 12h (SPIDI2). Safety was assessed by continuous oxygen saturation monitoring and adverse event reporting. Results: 101 patients (51 Male/50 Female) were randomized, 100 received study treatment (intent-to-treat [ITT] population), and 91 completed the study. Reasons for early discontinuation were lack of efficacy (6), adverse events (2) and drug-dosing error (1). Mean age was 42.5 years. For the ITT population, SST 30 mcg was superior to placebo (p=0.003) for the SPID12. SPID12 scores in the active groups were superior for both male (ANOVA overall p-value =0.038) and female (ANOVA overall p-value=0.005) patients. Statistically significant differences in favour of sublingual sufentanil were also observed between the SST 30mcg and placebo group for SPID1(p<0.001), TOTPAR12(p=0.002), time to perceived PR (p=0.023) and time to meaningful PR (p=0.010). Nausea, vomiting and somnolence were more frequent in the sufentanil groups but there were no significant differences between treatment arms for the proportion of patients who prematurely terminated due to AE or inadequate analgesia. Conclusions: Sufentanil tablets dispensed sublingually using a single-dose applicator is in development for treatment of patients with moderate-to-severe acute pain in a medically-supervised setting where immediate IV access is limited. When administered sublingually, sufentanil’s pharmacokinetic profile and non-invasive delivery makes it a useful alternative to IM or IV dosing.

Keywords: acute pain, pain management, sublingual, sufentanil

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Authors: A. Ham, A. Kuckert-Wostheinrich

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Demographic changes, like the ageing population in European countries and shortage of nursing staff, the increasing number of people with severe cognitive impairment, and elderly socially isolated people raise important questions about who will provide long-term care for ageing citizens. Due to the so-called refugee crisis in 2015, some health care institutions for ageing citizens in Europe invited first generation immigrants to start a nursing career and providing them language skills, nursing training, and internships. The aim of this ethnographic research was to explore the social processes affecting workforce integration and how newcomers enact good care in ageing citizens in a German nursing home. By ethnographic fieldwork, 200 hours of participant observations, 25 in-depth interviews with immigrants and established staff, 2 focus groups with 6 immigrants, and 6 established staff members, data were analysed. The health care institution provided the newcomers a nursing program on psychogeriatric theory and nursing skills in the psychogeriatric field and professional oriented language skills. Courses of health prevention and theater plays accompanied the training. The knowledge learned in education could be applied in internships on the wards. Additionally, diversity and inclusivity courses were given to established personal for cultural awareness and sensitivity. They learned to develop a collegial attitude of respect and appreciation, regardless of gender, nationality, ethnicity, religion or belief, age sexual orientation, or disability and identity. The qualitative data has shown that social processes affected workforce integration, like organizational constraints, staff shortages, and a demanding workload. However, zooming in on the interactions between newcomers and residents, we noticed how they tinkered to enact good care by embodied caring, playing games, singing and dancing. By situational acting and practical wisdom in nursing care, the newcomers could meet the needs of ageing residents. Thus, when health care institutions open up nursing programs for newcomers with refugees’ backgrounds and focus on talent instead of shortcomings, we might as well stimulate the unknown competencies, attitudes, skills, and expertise of newcomers and create excellent nurses for excellent care.

Keywords: established staff, Germany, nursing, refugees

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Authors: Ingrid van der Heijden, Kristen Dunkle, Rachel Jewkes

Abstract:

Background: Emerging literature on prevalence shows that men with disabilities are four more times likely than men without disabilities to experience sexual violence during their lifetime. However, compared to women with disabilities, men with disabilities still have lesser experiences of violence. While empirical evidence on the prevalence of victimization of men with disabilities is emerging, there is scarcer evidence highlighting disabled men’s perpetration of different forms of violence, particularly intimate partner violence. We can assume that men are likely to be both perpetrators and victims of violence, making more complex the causes and risks of violence. Gender norms and disability stigma play important roles in men’s experiences of violence. Men may be stigmatized because of their inability to attain hegemonic masculine ideals of strength, control over women and sexual conquest, which makes them more susceptible to emotional, physical and sexual abuse. Little to no evidence exists of men with disabilities’ experiences of perpetration of intimate partner violence, family violence or community violence. So far studies on male victimization do not succeed to offer contextual evidence that would highlight why and how men with disabilities perpetrate and/or are victims of sexual or other forms of violence. Objective: The overall aim to highlight men with disabilities’ experiences of both victimization and perpetration, and how living up to normative and hegemonic ideals of masculinity and ‘ability’ shape their experiences. It will include: identifying how gender and impairments intersect and shape their experiences of violence; identifying the contexts of and risks for violence; identifying the impacts and consequences of violence on their lives (including mental health impacts), and identifying obstacles and enablers to support and interventions to prevent violence. Methodology: In-depth qualitative interviews with 20 men with disabilities participating in interventions conducted by the What Works Global Programme for violence prevention (DIFD) in Africa and Asia. Men with a range of disabilities will be invited to share their lifetime experiences of violence. Implications for Practice: The data from this study will be used to start thinking about strategies to include men with disabilities in violence prevention strategies for both men and women. Limitations: Because men will be participating in interventions, it is assumed that they will not have severe impairments that hamper their cognitive or physical ability to participate in the intervention activities - and therefore will be able to participate in the in-depth interviews. Of course, this is a limitation of the study as it does not include those men with severe disabilities – measured by the World Health Organization’s International Classification of Functioning - who may be more vulnerable and at higher risk of experiencing violence, and who are less likely to be able to access services and interventions.

Keywords: gender, men with disabilities, perpetration of violence, victimization

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Authors: Germans Natuhwera, Peter Ellis, Acuda Wilson, Anne Merriman, Martha Rabwoni

Abstract:

Objective: The aim of the study was to diagnose the socio-economic burden and impact of a diagnosis of cervical cancer (CC) in rural women in the context of low-resourced country Uganda, using a phenomenological enquiry. Methods: This was a multi-site phenomenological inquiry, conducted at three hospice settings; Mobile Hospice Mbarara in southwestern, Little Hospice Hoima in Western, and Hospice Africa Uganda Kampala in central Uganda. A purposive sample of women with a histologically confirmed diagnosis of CC was recruited. Data was collected using open-ended audio-recorded interviews conducted in the native languages of participants. Interviews were transcribed verbatim in English, and Braun and Clarke’s (2019) framework of thematic analysis was used. Results: 13 women with a mean age of 49.2 and age range 29-71 participated in the study. All participants were of low socioeconomic status. The majority (84.6%) had advanced disease at diagnosis. A fuller reading of transcripts produced four major themes clustered under; (1) socioeconomic characteristics of women, (2) impact of CC on women’s relationships, (3) disrupted and impaired activities of daily living (ADLs), and (4) economic disruptions. Conclusions: A diagnosis of CC introduces significant socio-economic disruptions in a woman’s and her family’s life. CC causes disability, impairs the woman and her family’s productivity hence exacerbating levels of poverty in the home. High and expensive out-of-pocket expenditure on treatment, investigations, and transport costs further compound the socio-economic burden. Decentralizing cancer care services to regional centers, scaling up screening services, subsidizing costs of cancer care services, or making cervical cancer care treatment free of charge, strengthening monitoring mechanisms in public facilities to curb the vice of healthcare workers soliciting bribes from patients, increased mass awareness campaigns about cancer, training more healthcare professionals in cancer investigation and management, and palliative care, and introducing an introductory course on gynecologic cancers into all health training institutions are recommended.

Keywords: activities of daily living, cervical cancer, out-of-pocket, expenditure, phenomenology, socioeconomic

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Authors: Maryam Hazrati, Tengku Aizan Hamid, Rahimah Ibrahim, Siti Aishah Hassan, Farkhondeh Sharif, Zahra Bagheri

Abstract:

Background: Emotional abuse is the most common type of spousal abuse. In a long-term marriage which lasts several decades, the couple will be faced with greater vulnerability due to illness, disability, and dependence. Emotional abuse can have a devastating impact on victims, leading to low self-esteem, depression, anxiety, and post-traumatic stress disorder. Research Aim: The aim of this study was to investigate the effects of an emotional-focused psychoeducational intervention (EFPEI) on emotional abuse and marital satisfaction among older adults couples and also to examine the dyadic effects of each partner’s emotional abuse behaviors (EAB) on his/her marital satisfaction (MS) in Shiraz-Iran. Methodology: The study was a randomized controlled trial (RCT). A total of 57 eligible couples were randomly assigned to either the experimental group or the control group. The experimental group received EFPEI, which consisted of 12 sessions, each lasting 90 minutes. The control group did not receive any intervention. Data were collected using demographic questionnaire, Multidimensional Measure of Emotional Abuse (MMEAQ), and Marital Satisfaction Questionnaire for Older People (MSQFOP). The data was analyzed using a variety of statistical methods, including repeated measures ANOVA, path analysis, and correlational analyses. Findings: The results of the study showed that the EFPEI was effective in reducing emotional abuse and increasing marital satisfaction among older adults couples. Specifically, the mean scores for emotional abuse and marital satisfaction were significantly lower in the experimental group than in the control group at the end of the intervention. These effects were maintained at a 3-month follow-up. Moreover, the dyadic analysis revealed that husbands’ EAB had no significant effects on his own marital satisfaction but a significant negative partner effect, while wives’ EAB had significant negative actor and partner effects. Conclusion: The findings of this study provide support for the use of EFPEI as an effective intervention for decreasing emotional abuse and improving marital dissatisfaction among older adults. EFPEI is a short-term, evidence-based intervention that can be delivered by trained professionals. The intervention focuses on helping couples to improve their communication skills, resolve conflict, and build a stronger emotional connection.

Keywords: spouse abuse, emotion, aged, satisfaction, dyadic effect

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