Search results for: classification of primary care

Authors: Santos Maza, Enzo Aldoradin, Carlos Pariona, Eliud Arpi, Maria Rosales

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The objective of this study was to investigate the effect of flaying then bleeding anchovy (Engraulis ringens) immersed within a sodium citrate solution. Anchovy is a pelagic fish that readily deteriorates due to its high content of polyunsaturated fatty acids. As such, within the Peruvian food industry, the shelf life of frozen anchovy is explicitly 6 months, this short duration imparts a barrier to use for direct consumption human. Thus, almost all capture of anchovy by the fishing industry is eventually used in the production of fishmeal. We offer this an alternative to its typical production process in order to increase shelf life. In the present study, 100 kg of anchovies were captured and immediately mixed with ice on ship, maintaining a high quality sensory metric (e.g., with color blue in back) while still arriving for processing less than 2 h after capture. Anchovies with fat content of 3% were immediately flayed (i.e., reducing subcutaneous fat), beheaded, gutted and bled (i.e., removing hemoglobin) by immersion in water (Control) or in a solution of 2.5% sodium citrate (treatment), then subsequently frozen at -30 °C for 8 h in 2 kg batches. Subsequent glazing and storage at -25 °C for 14 months completed the experiments parameters. The peroxide value (PV), acidity (A), fatty acid profile (FAP), thiobarbituric acid reactive substances (TBARS), heme iron (HI), pH and sensory attributes of the samples were evaluated monthly. The results of the PV, TBARS, A, pH and sensory analyses displayed significant differences (p<0.05) between treatment and control sample; where the sodium citrate treated samples showed increased preservation features. Specifically, at the beginning of the study, flayed, beheaded, gutted and bled anchovies displayed low content of fat (1.5%) with moderate amount of PV, A and TBARS, and were not rejected by sensory analysis. HI values and FAP displayed varying behavior, however, results of HI did not reveal a decreasing trend. This result is indicative of the fact that levels of iron were maintained as HI and did not convert into no heme iron, which is known to be the primary catalyst of lipid oxidation in fish. According to the FAP results, the major quantity of fatty acid was of polyunsaturated fatty acid (PFA) followed by saturated fatty acid (SFA) and then monounsaturated fatty acid (MFA). According to sensory analysis, the shelf life of flayed, beheaded and gutted anchovy (control and treatment) was 14 months. This shelf life was reached at laboratory level because high quality anchovies were used and immediately flayed, beheaded, gutted, bled and frozen. Therefore, it is possible to maintain the shelf life of anchovies for a long time. Overall, this method displayed a large increase in shelf life relative to that commonly seen for anchovies in this industry. However, these results should be extrapolated at industrial scales to propose better processing conditions and improve the quality of anchovy for direct human consumption.

Keywords: citrate sodium solution, heme iron, polyunsaturated fatty acids, shelf life of frozen anchovy

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Authors: Shailendra Kumar, Lokesh Kashyap, Puneet Khanna, Nishant Patel, Rakesh Kumar, Arshad Ayub, Kelika Prakash, Yudhyavir Singh, Krithikabrindha V.

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Introduction: Spinal anesthesia is considered a standard anesthesia technique for caesarean delivery. The incidence of spinal hypotension during caesarean delivery is 70 -80%. Spinal hypotension may cause cerebral hypoperfusion in the mother, but physiologically cerebral autoregulatory mechanisms accordingly prevent cerebral hypoxia. Cerebral blood flow remains constant in the 50-150 mmHg of Cerebral Perfusion Pressure (CPP) range. Near-infrared spectroscopy (NIRS) is a non-invasive technology that is used to detect Cerebral Desaturation Events (CDEs) immediately compared to other conventional intraoperative monitoring techniques. Objective: The primary aim of the study is to correlate the change in cerebral oxygen saturation using NIRS with respect to a fall in mean blood pressure after spinal anaesthesia and to find out the effects of spinal hypotension on neonatal APGAR score, neonatal acid-base variations, and presence of Postoperative Delirium (POD). Methodology: NIRS sensors were attached to the forehead of all the patients, and their baseline readings of cerebral oxygenation on the right and left frontal regions and mean blood pressure were noted. Subarachnoid block was given with hyperbaric 0.5% bupivacaine plus fentanyl, the dose being determined by the individual anaesthesiologist. Co-loading of IV crystalloid solutions was given to the patient. Blood pressure reading and cerebral saturation were recorded every 1 minute till 30min. Hypotension was a fall in MAP less than 20% of the baseline values. Patients going for hypotension were treated with an IV Bolus of phenylephrine/ephedrine. Umbilical cord blood samples were taken for blood gas analysis, and neonatal APGAR was noted by a neonatologist. Study design: A prospective observational study conducted in a population of Thirty ASA 2 and 3 parturients scheduled for lower segment caesarean section (LSCS). Results: Mean fall in regional cerebral saturation is 28.48 ± 14.7% with respect to the mean fall in blood pressure 38.92 ± 8.44 mm Hg. The correlation coefficient between fall in saturation and fall in mean blood pressure is 0.057, and p-value {0.7} after subarachnoid block. A fall in regional cerebral saturation occurred 2±1 min before a fall in mean blood pressure. Twenty-nine out of thirty patients required vasopressors during hypotension. The first dose of vasopressor requirement is needed at 6.02±2 min after the block. The mean APGAR score was 7.86 and 9.74 at 1 and 5 min of birth, respectively, and the mean umbilical arterial pH of 7.3±0.1. According to DRS-98 (Delirium Rating Scale), the mean delirium rating score on postoperative day 1 and day 2 were 0.1 and 0.7, respectively. Discussion: There was a fall in regional cerebral oxygen saturation, which started before with respect to a significant fall in mean blood pressure readings but was statistically not significant. Maximal fall in blood pressure requiring vasopressors occurs within 10 min of SAB. Neonatal APGAR scores and acid-base variations were in the normal range with maternal hypotension, and there was no incidence of postoperative delirium in patients with post-spinal hypotension.

Keywords: cerebral oxygenation, LSCS, NIRS, spinal hypotension

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Authors: Aleksandra Rajewska-Rager, Maria Skibinska, Monika Dmitrzak-Weglarz, Natalia Lepczynska, Pawel Kapelski, Joanna Pawlak, Joanna Hauser

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Introduction: Inflammation and cytokines have emerged as a promising target in mood disorders research; however there are still very limited numbers of study regarding inflammatory alterations among adolescents and young adults with mood disorders. The Macrophage Migration Inhibitory Factor (MIF) and Stem Cell Factor (SCF) are the pleiotropic cytokines which may play an important role in mood disorders pathophysiology. The aim of this study was to investigate levels of these factors in serum of adolescent and young adults with mood disorders compared to healthy controls. Subjects: We involved 79 patients aged 12-24 years in 2-year follow-up study with a primary diagnosis of mood disorders: bipolar disorder (BP) and unipolar disorder with BP spectrum. Study group includes 23 males (mean age 19.08, SD 3.3) and 56 females (18.39, SD 3.28). Control group consisted 35 persons: 7 males (20.43, SD 4.23) and 28 females (21.25, SD 2.11). Clinical diagnoses according to DSM-IV-TR criteria were assessed using Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL) and Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID) in young adults respectively. Clinical assessment includes evaluation of clinical factors and symptoms severity (rated using the Hamilton Depression Rating Scale and Young Mania Rating Scale). Clinical and biological evaluations were made at control visits respectively at baseline (week 0), euthymia (at month 3 or 6) and after 12 and 24 months. Methods: Serum protein concentration was determined by Enzyme-Linked Immunosorbent Assays (ELISA) method. Human MIF and SCF DuoSet ELISA kits were used. In the analyses non-parametric tests were used: Mann-Whitney U test, Kruskal-Wallis ANOVA, Friedman’s ANOVA, Wilcoxon signed rank test, Spearman correlation. We defined statistical significance as p < 0.05. Results: Comparing MIF and SCF levels between acute episode of depression/hypo/mania at baseline and euthymia (at month 3 or 6) we did not find any statistical differences. At baseline patients with age above 18 years old had decreased MIF level compared to patients younger than 18 years. MIF level at baseline positively correlated with age (p=0.004). Positive correlations of SCF level at month 3 and 6 with depression or mania occurrence at month 24 (p=0.03 and p=0.04, respectively) was detected. Strong correlations between MIF and SCF levels at baseline (p=0.0005) and month 3 (p=0.03) were observed. Discussion: Our results did not show any differences in MIF and SCF levels between acute episode of depression/hypo/mania and euthymia in young patients. Further studies on larger groups are recommended. Grant was founded by National Science Center in Poland no 2011/03/D/NZ5/06146.

Keywords: cytokines, MIF, mood disorders, SCF

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Authors: Ayush Aditya

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In today's digitised world, the extent of an individual’s social involvement is largely determined by their interaction over the internet. The Internet has emerged as a primary source of information consumption and a reliable medium for receiving updates on everyday activities. Owing to this change in the information consumption pattern, the internet has also emerged as a hotbed of misinformation. Experts are of the view that media literacy has emerged as one of the most effective strategies for addressing the issue of misinformation. This paper aims to study the evolution of the Kerala government's media literacy policy, its implementation strategy, challenges and opportunities. The objective of this paper is to create a conceptual framework containing details of the implementation strategy based on the Kerala model. Extensive secondary research of literature, newspaper articles, and other online sources was carried out to locate the timeline of this policy. This was followed by semi-structured interview discussions with government officials from Kerala to trace the origin and evolution of this policy. Preliminary findings based on the collected data suggest that this policy is a case of policy by chance, as the officer who headed this policy during the state level implementation was the one who has already piloted a media literacy program in a district called Kannur as the district collector. Through this paper, an attempt is made to trace the history of the media literacy policy starting from the Kannur intervention in 2018, which was started to address the issue of vaccine hesitancy around measles rubella(MR) vaccination. If not for the vaccine hesitancy, this program would not have been rolled out in Kannur. Interviews with government officials suggest that when authorities decided to take up this initiative in 2020, a huge amount of misinformation emerging during the COVID-19 pandemic was the trigger. There was misinformation regarding government orders, healthcare facilities, vaccination, and lockdown regulations, which affected everyone, unlike the case of Kannur, where it was only a certain age group of kids. As a solution to this problem, the state government decided to create a media literacy curriculum to be taught in all government schools of the state starting from standard 8 till graduation. This was a tricky task, as a new course had to be immediately introduced in the school curriculum amid all the disruptions in the education system caused by the pandemic. It was revealed during the interview that in the case of the state-wide implementation, every step involved multiple checks and balances, unlike the earlier program where stakeholders were roped-in as and when the need emerged. On the pedagogy, while the training during the pilot could be managed through PowerPoint presentation, designing a state-wide curriculum involved multiple iterations and expert approvals. The reason for this is COVID-19 related misinformation has lost its significance. In the next phase of the research, an attempt will be made to compare other aspects of the pilot implementation with the state-wide implementation.

Keywords: media literacy, digital media literacy, curriculum based media literacy intervention, misinformation

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Authors: Margarita Ivanova, Julia Dao, Andrew Friedman, Neil Kasaci, Rekha Gopal, Ozlem Goker-Alpan

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In Fabry disease (FD), α-galactosidase A (α-Gal A) deficiency leads to the accumulation of globotriaosylceramide (Lyso-Gb3 and Gb3), triggering a pathologic cascade that causes the severity of organs damage. The heart is one of the several organs with high sensitivity to the α-Gal A deficiency. A subgroup of patients with significant residual of α-Gal A activity with primary cardiac involvement is occasionally referred to as “cardiac variant.” The cardiovascular complications are most frequently encountered, contributing substantially to morbidity, and are the leading cause of premature death in male and female patients with FD. The deposition of Lyso-Gb-3 and Gb-3 within the myocardium affects cardiac function with resultant progressive cardiovascular pathology. Gb-3 and Lyso-Gb-3 accumulation at the cellular level trigger a cascade of events leading to end-stage fibrosis. In the cardiac tissue, Lyso-Gb-3 deposition is associated with the increased release of inflammatory factors and transforming growth factors. Infiltration of lymphocytes and macrophages into endomyocardial tissue indicates that inflammation plays a significant role in cardiac damage. Moreover, accumulated data suggest that chronic inflammation leads to multisystemic FD pathology even under enzyme replacement therapy (ERT). NF-κB activation plays a subsequent role in the inflammatory response to cardiac dysfunction and advanced heart failure in the general population. TNFalpha/NF-κB signaling protects the myocardial evoking by ischemic preconditioning; however, this protective effect depends on the concentration of TNF-α. Thus, we hypothesize that TNF-α is a critical factor in determining the grade of cardio-pathology. Cardiac hypertrophy corresponds to the expansion of the coronary vasculature to maintain a sufficient supply of nutrients and oxygen. Coronary activation of angiogenesis and fibrosis plays a vital role in cardiac vascularization, hypertrophy, and tissue remodeling. We suggest that the interaction between the inflammatory pathways and cardiac vascularization is a bi-directional process controlled by secreted cytokines and growth factors. The co-coordination of these two processes has never been explored in FD. In a cohort of 40 patients with FD, biomarkers associated with inflammation and cardio hypertrophic remodeling were studied. FD patients were categorized into three groups based on LVmass/DSA, LVEF, and ECG abnormalities: FD with no cardio complication, FD with moderate cardio complication, and severe cardio complication. Serum levels of NF-kB, TNFalpha, Il-6, Il-2, MCP1, ING-gamma, VEGF, IGF-1, TGFβ, and FGF2 were quantified by enzyme-linked immunosorbent assays (ELISA). Among the biomarkers, MCP-1, INF-gamma, VEGF, TNF-alpha, and TGF-beta were elevated in FD patients. Some of these biomarkers also have the potential to correlate with cardio pathology in FD. Conclusion: The study provides information about the role of inflammatory pathways and biomarkers of cardio hypertrophic remodeling in FD patients. This study will also reveal the mechanisms that link intracellular accumulation of Lyso-GB-3 and Gb3 to the development of cardiomyopathy with myocardial thickening and resultant fibrosis.

Keywords: biomarkers, Fabry disease, inflammation, growth factors

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Authors: Sam Bartlett, Thomas Bacquart, Arul Murugan, Abigail Morris

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Fuel cell electric vehicles provide the potential to decarbonise road transport, create new economic opportunities, diversify national energy supply, and significantly reduce the environmental impacts of road transport. A potential issue, however, is that the catalyst used at the fuel cell cathode is susceptible to degradation by impurities, especially sulphur-containing compounds. A recent European Directive (2014/94/EU) stipulates that, from November 2017, all hydrogen provided to fuel cell vehicles in Europe must comply with the hydrogen purity specifications listed in ISO 14687-2; this includes reactive and toxic chemicals such as ammonia and total sulphur-containing compounds. This requirement poses great analytical challenges due to the instability of some of these compounds in calibration gas standards at relatively low amount fractions and the difficulty associated with undertaking measurements of groups of compounds rather than individual compounds. Without the available reference materials and analytical infrastructure, hydrogen refuelling stations will not be able to demonstrate compliance to the ISO 14687 specifications. The hydrogen purity laboratory at NPL provides world leading, accredited purity measurements to allow hydrogen refuelling stations to evidence compliance to ISO 14687. Utilising state-of-the-art methods that have been developed by NPL’s hydrogen purity laboratory, including a novel method for measuring total sulphur compounds at 4 nmol/mol and a hydrogen impurity enrichment device, we provide the capabilities necessary to achieve these goals. An overview of these capabilities will be given in this paper. As part of the EMPIR Hydrogen co-normative project ‘Metrology for sustainable hydrogen energy applications’, NPL are developing a validated analytical methodology for the measurement of speciated sulphur-containing compounds in hydrogen at low amount fractions pmol/mol to nmol/mol) to allow identification and measurement of individual sulphur-containing impurities in real samples of hydrogen (opposed to a ‘total sulphur’ measurement). This is achieved by producing a suite of stable gravimetrically-prepared primary reference gas standards containing low amount fractions of sulphur-containing compounds (hydrogen sulphide, carbonyl sulphide, carbon disulphide, 2-methyl-2-propanethiol and tetrahydrothiophene have been selected for use in this study) to be used in conjunction with novel dynamic dilution facilities to enable generation of pmol/mol to nmol/mol level gas mixtures (a dynamic method is required as compounds at these levels would be unstable in gas cylinder mixtures). Method development and optimisation are performed using gas chromatographic techniques assisted by cryo-trapping technologies and coupled with sulphur chemiluminescence detection to allow improved qualitative and quantitative analyses of sulphur-containing impurities in hydrogen. The paper will review the state-of-the art gas standard preparation techniques, including the use and testing of dynamic dilution technologies for reactive chemical components in hydrogen. Method development will also be presented highlighting the advances in the measurement of speciated sulphur compounds in hydrogen at low amount fractions.

Keywords: gas chromatography, hydrogen purity, ISO 14687, sulphur chemiluminescence detector

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Authors: Hirseland Andreas, Kerschbaumer Lukas

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In the case of Germany, there are about one million long-term unemployed – a figure that did not vary much during the past years. These long-term unemployed did not benefit from the prospering labor market while most short-term unemployed did. Instead, they are continuously dependent on welfare and sometimes precarious short-term employment, experiencing work poverty. Long-term unemployment thus turns into a main obstacle to become employed again, especially if it is accompanied by other impediments such as low-level education (school/vocational), poor health (especially chronical illness), advanced age (older than fifty), immigrant status, motherhood or engagement in care for other relatives. As can be shown by this current research project, in these cases the chance to regain employment decreases to near nil. Almost two-thirds of all welfare recipients have multiple impediments which hinder a successful transition from welfare back to sustainable and sufficient employment. Prospective employers are unlikely to hire long-term unemployed with additional impediments because they evaluate potential employees on their negative signaling (e.g. low-level education) and the implicit assumption of unproductiveness (e.g. poor health, age). Some findings of the panel survey “Labor market and social security” (PASS) carried out by the Institute of Employment Research (the research institute of the German Federal Labor Agency) spread a ray of hope, showing that unlikely does not necessarily mean impossible. The presentation reports on current research on these very scarce “success stories” of unlikely transitions from long-term unemployment to work and how these cases were able to perform this switch against all odds. The study is based on a mixed-method design. Within the panel survey (~15,000 respondents in ~10,000 households), only 66 cases of such unlikely transitions were observed. These cases have been explored by qualitative inquiry – in depth-interviews and qualitative network techniques. There is strong evidence that sustainable transitions are influenced by certain biographical resources like habits of network use, a set of informal skills and particularly a resilient way of dealing with obstacles, combined with contextual factors rather than by job-placement procedures promoted by Job-Centers according to activation rules or by following formal paths of application. On the employer’s side small and medium-sized enterprises are often found to give job opportunities to a wider variety of applicants, often based on a slow but steadily increasing relationship leading to employment. According to these results it is possible to show and discuss some limitations of (German) activation policies targeting the labor market and their impact on welfare dependency and long-term unemployment. Based on these findings, indications for more supportive small-scale measures in the field of labor-market policies are suggested to help long-term unemployed with multiple impediments to overcome their situation (e.g. organizing small-scale-structures and low-threshold services to encounter possible employers on a more informal basis like “meet and greet”).

Keywords: against-all-odds, mixed-methods, Welfare State, long-term unemployment

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Authors: Christine Hough, Eddie Abbott-Halpin, Tariq Mahmood, Jessica Giles

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This paper draws together the findings from two research studies, each undertaken with cohorts of South Asian Muslim respondents located in the North of England between 2017 and 2019. The first study, entitled Faith Family and Crime (FFC), investigated the extent to which a Muslim family’s social and health well-being is affected by a family member’s involvement in the Criminal Justice System (CJS). This study captured a range of data through a detailed questionnaire and structured interviews. The data from the interview transcripts were analysed using open coding and an application of aspects of the grounded theory approach. The findings provide clear evidence that the respondents were neither well-informed nor supported throughout the processes of the CJS, from arrest to post-sentencing. These experiences gave rise to mental and physical stress, potentially unfair sentencing, and a significant breakdown in communication within the respondents’ families. They serve to highlight a particular aspect of complexity in the current needs of those South Asian Muslim families who find themselves involved in the CJS and is closely connected to family structure, culture, and faith. The second study, referred to throughout this paper as #ImamsBritain (that provides the majority of content for this paper), explores how Imams, in their role as community faith leaders, can best address the complex – and changing - needs of South Asian Muslims families, such as those that emerged in the findings from FFC. The changing socio-economic and political climates of the last thirty or so years have brought about significant changes to the lives of Muslim families, and these have created more complex levels of social, cultural, and faith-based needs for families and individuals. As a consequence, Imams now have much greater demands made of them, and so their role has undergone far-reaching changes in response to this. The #ImamsBritain respondents identified a pressing need to develop a wider range of pastoral and counseling skills, which they saw as extending far beyond the traditional role of the Imam as a religious teacher and spiritual guide. The #ImamsBritain project was conducted with a cohort of British Imams in the North of England. Data was collected firstly through a questionnaire that related to the respondents’ training and development needs and then analysed in depth using the Delphi approach. Through Delphi, the data were scrutinized in depth using interpretative content analysis. The findings from this project reflect the respondents’ individual perceptions of the kind of training and development they need to fulfill their role in 21st Century Britain. They also provide a unique framework for constructing a professional guide for Imams in Great Britain. The discussions and critical analyses in this paper draw on the discourses of professionalization and pastoral care and relevant reports and reviews on Imam training in Europe and Canada.

Keywords: criminal justice system, faith and culture, Imams, Muslim community leadership, professionalization, South Asian family structure

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Authors: Marina Gold, Yves Jackson, David Parrat

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The high predominance of Latin American migrants in Geneva from countries where Chagas disease is endemic (Bolivia, Brazil, Argentina, Colombia) is increasing the incidence of chronic Chagas-related problems, especially cardiovascular complications. The precarious migratory status of what are mostly undocumented migrants complicates access to health and affects patients’ and doctors’ health perceptions regarding screening, treatment and monitoring of Chagas-related health concerns. This project results from a 3 year collaboration between the Geneva University Hospital and the NGO Mundo Sano to understand the following questions: 1) how do Latin American migrants perceive their health? 2) What do they understand from Chagas disease? 3) Are patients’ and doctors’ health perceptions similar or do they have competing agendas? This paper aims to present the results of a long-term study that interrogates health perceptions among Latin American migrants in Geneva. The first phase consisted in completing surveys at three community screening events (2016, 2017. 2018), and the results of these surveys reveal the subordination of the importance of health to that of having met economic family obligation. That is, health is important only when it becomes an impediment to economic gain. The contradictory result emerged that people are aware of the importance of health prevention in order to ensure long-term health, but they do not always have agency over their life-style habits (healthy food, regular exercise, emotional stability). The second phase of the research collected open-ended interviews with selected participants, in order to explore in more detail how Latin American migrants deal with Chagas in a different socio-political and economic context to that of endemic countries. These interviews (5 in total) reveal mixed methods of managing health: social networks, access to health care transnationally (in Geneva, Spain and back in their home country), and different valuations of health problems in each situation. The third phase consisted in observations of doctor-patient consultations and further extended interviews with patients to determine doctor/patient health perceptions around Chagas disease. This phase is ongoing, but it has yielded preliminarily observations regarding the expectations that patients’ have of doctors, and the understanding of doctors’ to patients’ complex situations. Positive and complementary health perceptions include patients’ feeling that doctors in Geneva are more understanding, more knowledgeable and less racist than those in their home country, who do not provide detailed information about Chagas or its treatment and discriminate against them for being indigenous or from poor rural areas, enabling a better communication between doctors and patients. Possible conflicting health perceptions include patients addressing their health concerns more holistically and encountering the specialist’s limitations to only treating one health concern, given time limitations and lack of competition with their colleagues (the general practitioner that referred the patient, for example). The implications of this study extend the case of Chagas disease in Geneva and is relevant for all chronic concerns and migratory contexts of precarity.

Keywords: chagas disease, health perceptions, Latin American Migrants, non-endemic countries

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Authors: Manasi Mahanty

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In the current phase of globalization, the mobility of capital facilitates outsourcing and subcontracting of production processes to the developing economies for cheap and flexible labour force. In such process, the globalization of production networks operates at multi-locational points within the nation. Under the new quota regime in the globalization period, the Indian manufacturing exporters came under the influence of corporate buyers and large retailers from the importing countries. As part of such process, the garment manufacturing sector is expected to create huge employment opportunities and to expand the export market in the country. While following these, expectations, the apparel and garment industries mostly target to hire female migrant workers with a purpose of establishing more flexible industrial relations through the casual nature of employment contract. It leads to an increasing women’s participation in the labour market as well as the rise in precarious forms of female paid employment. In the context, the main objective of the paper is to understand the wider dynamics of globalization of production and its link with informalization, feminization of labour force and internal migration process of the country. For this purpose, the study examines the changing labour relations in the KINFRA Apparel Park at Kerala’s Special Economic Zone which operates under the scheme ‘Apparel Parks for Export’ (APE) of the Government of India. The present study was based on both quantitative and qualitative analysis. In the first, the secondary sources of data were collected from the source location (SEAM centre) and destination (KINFRA Park). The official figures and data were discussed and analyzed in order to find out the various dimensions of labour relations under globalization of production. In the second, the primary survey was conducted to make a comparative analysis of local and migrant female workers. The study is executed by taking 100 workers in total. The local workers comprised of 53% of the sample whereas the outside state workers were 47%. Even personal interviews with management staff, and workers were also made for collecting the information regarding the organisational structure, nature, and mode of recruitment, work environment, etc. The study shows the enormous presence of rural women migrant workers in KINFRA Apparel Park. A Public Private Partnership (PPP) arranged migration system is found as Skills for Employment in Apparel Manufacturing (SEAM) from where young women and girls are being sent to work in garment factories of Kerala’s KINFRA International Apparel Park under the guise of an apprenticeship based recruitment. The study concludes that such arrangements try to avoid standard employment relationships and strengthen informalization, casualization and contractualization of work. In this process, the recruitment of women migrant workers is to be considered as best option for the employers of private industries which could be more easily hired and fired.

Keywords: female migration, globalization, informalization, KINFRA apparel park

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Authors: Vasundhara Arora, Anupam Jhobta, Suresh Thakur, Sanjiv Sharma

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Aims and Objectives: Intracranial tuberculosis (TB) is one of the most devastating manifestations of TB and a challenging public health issue of considerable importance and magnitude world over. This study elaborates on the imaging spectrum of neurotuberculosis on magnetic resonance imaging (MRI) in 29 clinically suspected cases from a tertiary care hospital. Materials and Methods: The prospective hospital based evaluation of MR imaging features of neuro-tuberculosis in 29 clinically suspected cases was carried out in Department of Radio-diagnosis, Indira Gandhi Medical Hospital from July 2017 to August 2018. MR Images were obtained on a 1.5 T Magnetom Avanto machine and were analyzed to identify any abnormal meningeal enhancement or parenchymal lesions. Microbiological and Biochemical CSF analysis was performed in radio-logically suspected cases and the results were compared with the imaging data. Clinical follow up of the patients started on anti-tuberculous treatment was done to evaluate the response to treatment and clinical outcome. Results: Age range of patients in the study was between 1 year to 73 years. The mean age of presentation was 11.5 years. No significant difference in the distribution of cerebral tuberculosis was noted among the two genders. Imaging findings of neuro-tuberculosis obtained were varied and non specific ranging from lepto-meningeal enhancement, cerebritis to space occupying lesions such as tuberculomas and tubercular abscesses. Complications presenting as hydrocephalus (n= 7) and infarcts (n=9) was noted in few of these patients. 29 patients showed radiological suspicion of CNS tuberculosis with meningitis alone observed in 11 cases, tuberculomas alone were observed in 4 cases, meningitis with parenchymal tuberculomas in 11 cases. Tubercular abscess and cerebritis were observed in one case each. Tuberculous arachnoiditis was noted in one patient. Gene expert positivity was obtained in 11 out of 29 radiologically suspected patients; none of the patients showed culture positivity. Meningeal form of the disease alone showed higher positivity rate of gene Xpert (n=5) followed by combination of meningeal and parenchymal forms of disease (n=4). The parenchymal manifestation of disease alone showed least positivity rates (n= 3) with gene xpert testing. All 29 patients were started on anti tubercular treatment based on radiological suspicion of the disease with clinical improvement observed in 27 treated patients. Conclusions: In our study, higher incidence of neuro- tuberculosis was noted in paediatric population with predominance of the meningeal form of the disease. Gene Xpert positivity obtained was low due to paucibacillary nature of cerebrospinal fluid (CSF) with even lower positivity of CSF samples in parenchymal form of the manifestation. MRI showed high accuracy in detecting CNS lesions in neuro-tuberculosis. Hence, it can be concluded that MRI plays a crucial role in the diagnosis because of its inherent sensitivity and specificity and is an indispensible imaging modality. It caters to the need of early diagnosis owing to poor sensitivity of microbiological tests more so in the parenchymal manifestation of the disease.

Keywords: neurotuberculosis, tubercular abscess, tuberculoma, tuberculous meningitis

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Authors: Susmita Ghosh

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Catchment area of Damodar River, India experiences seasonal rains due to the south-west monsoon every year and depending upon the intensity of the storms, floods occur. During the monsoon season, the rainfall in the area is mainly due to active monsoon conditions. The upstream reach of Damodar river system has five dams store the water for utilization for various purposes viz, irrigation, hydro-power generation, municipal supplies and last but not the least flood moderation. But, in the downstream reach of Damodar River, known as Lower Damodar region, is severely and frequently suffering from flood due to heavy monsoon rainfall and also release from upstream reservoirs. Therefore, an effective flood management study is required to know in depth the nature and extent of flood, water logging, and erosion related problems, affected area, and damages in the Lower Damodar region, by conducting mathematical model study. The design flood or discharge is needed to decide to assign the respective model for getting several scenarios from the simulation runs. The ultimate aim is to achieve a sustainable flood management scheme from the several alternatives. there are various methods for estimating flood discharges to be carried through the rivers and their tributaries for quick drainage from inundated areas due to drainage congestion and excess rainfall. In the present study, the flood frequency analysis is performed to decide the design flood discharge of the study area. This, on the other hand, has limitations in respect of availability of long peak flood data record for determining long type of probability density function correctly. If sufficient past records are available, the maximum flood on a river with a given frequency can safely be determined. The floods of different frequency for the Damodar has been calculated by five candidate distributions i.e., generalized extreme value, extreme value-I, Pearson type III, Log Pearson and normal. Annual peak discharge series are available at Durgapur barrage for the period of 1979 to 2013 (35 years). The available series are subjected to frequency analysis. The primary objective of the flood frequency analysis is to relate the magnitude of extreme events to their frequencies of occurrence through the use of probability distributions. The design flood for return periods of 10, 15 and 25 years return period at Durgapur barrage are estimated by flood frequency method. It is necessary to develop flood hydrographs for the above floods to facilitate the mathematical model studies to find the depth and extent of inundation etc. Null hypothesis that the distributions fit the data at 95% confidence is checked with goodness of fit test, i.e., Chi Square Test. It is revealed from the goodness of fit test that the all five distributions do show a good fit on the sample population and is therefore accepted. However, it is seen that there is considerable variation in the estimation of frequency flood. It is therefore considered prudent to average out the results of these five distributions for required frequencies. The inundated area from past data is well matched using this flood.

Keywords: design discharge, flood frequency, goodness of fit, sustainable flood management

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Authors: Ifeyinwa Victor-Uadiale, Georgina Pearson, Sophie Witter, D. Reidpath

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Introduction: Smoking, alcohol misuse, unhealthy diet, and physical inactivity are the primary drivers of noncommunicable diseases (NCD), including cardiovascular diseases, cancers, respiratory diseases, and diabetes, worldwide. Collectively, these diseases are the leading cause of all global deaths, most of which are premature, affecting people between 30 and 70 years. Empirical evidence suggests that these risk behaviors can be modified by community-based interventions (CBI). However, there is little insight into the mechanisms and contextual factors of successful community interventions that impact risk behaviours for chronic diseases. This study examined “Under what circumstances, for whom, and how, do community-based interventions modify smoking, alcohol use, unhealthy diet, and physical inactivity among adults”. Adopting the Capability (C), Opportunity (O), Motivation (M), Behavior (B) (COM-B) framework for behaviour change, it sought to: (1) identify the mechanisms through which CBIs could reduce tobacco use and alcohol consumption and increase physical activity and the consumption of healthy diets and (2) examine the contextual factors that trigger the impact of these mechanisms on these risk behaviours among adults. Methods: Pawson’s realist review method was used to examine the literature. Empirical evidence and theoretical understanding were combined to develop a realist program theory that explains how CBIs influence NCD risk behaviours. Documents published between 2002 and 2020 were systematically searched in five electronic databases (CINAHL, Cochrane Library, Medline, ProQuest Central, and PsycINFO). They were included if they reported on community-based interventions aimed at cardiovascular diseases, cancers, respiratory diseases, and diabetes in a global context; and had an outcome targeted at smoking, alcohol, physical activity, and diet. Findings: Twenty-nine scientific documents were retrieved and included in the review. Over half of them (n = 18; 62%) focused on three of the four risk behaviours investigated in this review. The review identified four mechanisms: capability, opportunity, motivation, and social support that are likely to change the dietary and physical activity behaviours in adults given certain contexts. There were weak explanations of how the identified mechanisms could likely change smoking and alcohol consumption habits. In addition, eight contextual factors that may affect how these mechanisms impact physical activity and dietary behaviours were identified: suitability to work and family obligations, risk status awareness, socioeconomic status, literacy level, perceived need, availability and access to resources, culture, and group format. Conclusion: The findings suggest that CBIs are likely to improve the physical activity and dietary habits of adults if the intervention function seeks to educate, incentivize, change the environment, and model the right behaviours. The review applies and advances theory, realist research, and the design and implementation of community-based interventions for NCD prevention.

Keywords: community-based interventions, noncommunicable disease, realist program theory, risk behaviors

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Authors: Radhika Ralhan

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With the formalization of 2030, Global Agenda for Sustainable Development nations have instantaneously geared up their efforts towards the implementation of a comprehensive list of global goals. The criticality of Sustainable Development Goals (SDGs) is imperative, as it will define the course and pace of development for the next 15 years. This development will entail transformational shifts towards a green and inclusive growth. Leadership, investments and technology will constitute as key ingredients of this transformational shift and governance will emerge as a one of the most significant driver of the global 2030 agenda. Corporate Governance is viewed as one of the key force to accelerate the momentum of SDGs and initiate these transformational shifts. Many senior level leaders have reinstated their conviction that adopting a triple bottom line approach will play an imperative role in transforming the entire industrial sector. In the Indian context, the above occurrence bears an intriguing facet, as the framing of SDGs in the global scenario coincided with the emergence of mandatory Corporate Social Responsibility (CSR) Rules in India at national level. As one of the leading democracies in the world, India is among few countries to formally mandate companies to spend 2% from their CSR funds under Section 135 of The New Companies Act 2013. The overarching framework of SDGs correlates to the areas of CSR interventions as mentioned in the Schedule VII of Section 135. As one of the legitimate stakeholders, business leaders have expressed their commitments to their respective governments, to reorient the entire fabric of their companies to scale up global priorities. This is explicitly seen in the case of India where leading business entities have converged national government priorities of Clean India, Make in India and Skill India by actively participating in the campaigns and incorporating these programmes within the ambit of their CSR policies. However, the CSR Act has received mixed responses with associated concerns such as the onus of doing what the government has to do, mandatory reporting mechanisms, policy disclosures, personnel handling CSR portfolios etc. The overall objective of the paper, therefore, rests in analyzing the discourse of CSR and the perspectives of Indian Inc. in imbibing the principles of SDGs within their business polices and operations. Through primary and secondary research analysis, the paper attempts to outline the diverse challenges that are being faced by Indian businesses while establishing the business case of sustainable responsibility. Some of the principal questions that paper addresses are: What are the SDG priorities for India Inc. as per their respective industry sectors? How can corporate policies imbibe the SDGs principles? How can the global concerns in form of SDGs align with the national CSR mandate and development issues? What initiatives have been undertaken by the companies to integrate their long term business strategy and sustainability? The paper will also reinstate an approach or a way forward that will enable businesses to proceed beyond compliance and accentuate the principles of responsibility and transparency within their operational framework.

Keywords: corporate social responsibility, CSR, India Inc., section 135, new companies act 2013, sustainable development goals, SDGs, sustainability, corporate governance

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Authors: Fernando Martinez Soto, Gaetano Di Mino

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The application of rubber into bituminous mixtures requires attention and care during mixing and compaction. Rubber modifies the properties because it reacts in the internal structure of bitumen at high temperatures changing the performance of the mixture (interaction process of solvents with binder-rubber aggregate). The main change is the increasing of the viscosity and elasticity of the binder due to the larger sizes of the rubber particles by dry process but, this positive effect is counteracted by short mixing times, compared to wet technology, and due to the transport processes, curing time and post-compaction of the mixtures. Therefore, negative effects as swelling of rubber particles, rebounding effect of the specimens and thermal changes by different expansion of the structure inside the mixtures, can change the mechanical properties of the rubberized blends. Based on the dry technology, different asphalt-rubber binders using devulcanized or natural rubber (truck and bus tread rubber), have served to demonstrate these effects and how to solve them into two dense-gap graded rubber modified asphalt concrete mixes (RUMAC) to enhance the stability, workability and durability of the compacted samples by Superpave gyratory compactor method. This paper specifies the procedures developed in the Department of Civil Engineering of the University of Palermo during September 2016 to March 2017, for characterizing the post-compaction and mix-stability of the one conventional mixture (hot mix asphalt without rubber) and two gap-graded rubberized asphalt mixes according granulometry for rail sub-ballast layers with nominal size of Ø22.4mm of aggregates according European standard. Thus, the main purpose of this laboratory research is the application of ambient ground rubber from scrap tires processed at conventional temperature (20ºC) inside hot bituminous mixtures (160-220ºC) as a substitute for 1.5%, 2% and 3% by weight of the total aggregates (3.2%, 4.2% and, 6.2% respectively by volumetric part of the limestone aggregates of bulk density equal to 2.81g/cm³) considered, not as a part of the asphalt binder. The reference bituminous mixture was designed with 4% of binder and ± 3% of air voids, manufactured for a conventional bitumen B50/70 at 160ºC-145ºC mix-compaction temperatures to guarantee the workability of the mixes. The proportions of rubber proposed are #60-40% for mixtures with 1.5 to 2% of rubber and, #20-80% for mixture with 3% of rubber (as example, a 60% of Ø0.4-2mm and 40% of Ø2-4mm). The temperature of the asphalt cement is between 160-180 ºC for mixing and 145-160 ºC for compaction, according to the optimal values for viscosity using Brookfield viscometer and 'ring and ball' - penetration tests. These crumb rubber particles act as a rubber-aggregate into the mixture, varying sizes between 0.4mm to 2mm in a first fraction, and 2-4mm as second proportion. Ambient ground rubber with a specific gravity of 1.154g/cm³ is used. The rubber is free of loose fabric, wire, and other contaminants. It was found optimal results in real beams and cylindrical specimens with each HMA mixture reducing the swelling effect. Different factors as temperature, particle sizes of rubber, number of cycles and pressures of compaction that affect the interaction process are explained.

Keywords: crumb-rubber, gyratory compactor, rebounding effect, superpave mix-design, swelling, sub-ballast railway

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

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

Keywords: dysphagia, teleassessment, challenges, Indian SLP

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Authors: Cristina Opris, Bogdan Cojocaru, Madalina Tudorache, Simona M. Coman, Vasile I. Parvulescu, Camelia Bala, Bahir Duraki, Jeroen A. Van Bokhoven

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The tremendous achievements in the development of the society concretized by more sophisticated materials and systems are merely based on non-renewable resources. Consequently, after more than two centuries of intensive development, among others, we are faced with the decrease of the fossil fuel reserves, an increased impact of the greenhouse gases on the environment, and economic effects caused by the fluctuations in oil and mineral resource prices. The use of biomass may solve part of these problems, and recent analyses demonstrated that from the perspective of the reduction of the emissions of carbon dioxide, its valorization may bring important advantages conditioned by the usage of genetic modified fast growing trees or wastes, as primary sources. In this context, the abundance and complex structure of lignin may offer various possibilities of exploitation. However, its transformation in fuels or chemicals supposes a complex chemistry involving the cleavage of C-O and C-C bonds and altering of the functional groups. Chemistry offered various solutions in this sense. However, despite the intense work, there are still many drawbacks limiting the industrial application. Thus, the proposed technologies considered mainly homogeneous catalysts meaning expensive noble metals based systems that are hard to be recovered at the end of the reaction. Also, the reactions were carried out in organic solvents that are not acceptable today from the environmental point of view. To avoid these problems, the concept of this work was to investigate the synthesis of superparamagnetic core shell catalysts for the fragmentation of lignin directly in the aqueous phase. The magnetic nanoparticles were covered with a nanoshell of an oxide (niobia) with a double role: to protect the magnetic nanoparticles and to generate a proper (acidic) catalytic function and, on this composite, cobalt nanoparticles were deposed in order to catalyze the C-C bond splitting. With this purpose, we developed a protocol to prepare multifunctional and magnetic separable nano-composite Co@Nb2O5@Fe3O4 catalysts. We have also established an analytic protocol for the identification and quantification of the fragments resulted from lignin depolymerization in both liquid and solid phase. The fragmentation of various lignins occurred on the prepared materials in high yields and with very good selectivity in the desired fragments. The optimization of the catalyst composition indicated a cobalt loading of 4wt% as optimal. Working at 180 oC and 10 atm H2 this catalyst allowed a conversion of lignin up to 60% leading to a mixture containing over 96% in C20-C28 and C29-C37 fragments that were then completely fragmented to C12-C16 in a second stage. The investigated catalysts were completely recyclable, and no leaching of the elements included in the composition was determined by inductively coupled plasma optical emission spectrometry (ICP-OES).

Keywords: superparamagnetic core-shell catalysts, environmental production of fuels, renewable lignin, recyclable catalysts

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Authors: Angela Oktavia Suryani, Bernadeth Gloria, Edwin Sutamto, Jessica Kristianty, Ni Made Rai Sapitri, Patricia Catherine Agla, Sitti Arlinda Rochiadi

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It was found that some blogs or personal websites in Indonesia sell standardized intelligence tests (for example, Progressive Matrices (PM), Intelligence Structure Test (IST), and Culture Fair Intelligence Test (CFIT)) and other psychological tests, together with the manual and the key answers for public. Individuals can buy and prepare themselves for selection or recruitment with the real test. This action drives people to lie to the institution (education or company) and also to themselves. It was also found that those tests are old. Some items are not relevant with the current context, for example a question about a diameter of a certain coin that does not exist anymore. These problems motivate us to develop a new intelligence battery test, namely of Multiple Aptitude Battery (MAB). The battery test was built by using Thurstone’s Primary Mental Abilities theory and intended to be used by high schools students, university students, and worker applicants. The battery tests consist of 9 subtests. In the current study we examine six subtests, namely Reading Comprehension, Verbal Analogies, Numerical Inductive Reasoning, Numerical Deductive Reasoning, Mechanical Ability, and Two Dimensional Spatial Reasoning for university students. The study included 1424 data from students recruited by convenience sampling from eight faculties at Atma Jaya Catholic University of Indonesia. Classical and modern test approaches (Item Response Theory) were carried out to identify the item difficulties of the items and confirmatory factor analysis was applied to examine their internal validities. The validity of each subtest was inspected by using convergent–discriminant method, whereas the reliability was examined by implementing Kuder–Richardson formula. The result showed that the majority of the subtests were difficult in medium level, and there was only one subtest categorized as easy, namely Verbal Analogies. The items were found homogenous and valid measuring their constructs; however at the level of subtests, the construct validity examined by convergent-discriminant method indicated that the subtests were not unidimensional. It means they were not only measuring their own constructs but also other construct. Three of the subtests were able to predict academic performance with small effect size, namely Reading Comprehension, Numerical Inductive Reasoning, and Two Dimensional Spatial Reasoning. GPAs in intermediate level (GPAs at third semester and above) were considered as a factor for predictive invalidity. The Kuder-Richardson formula showed that the reliability coefficients for both numerical reasoning subtests and spatial reasoning were superior, in the range 0.84 – 0.87, whereas the reliability coefficient for the other three subtests were relatively below standard for ability test, in the range of 0.65 – 0.71. It can be concluded that some of the subtests are ready to be used, whereas some others are still need some revisions. This study also demonstrated that the convergent-discrimination method is useful to identify the general intelligence of human.

Keywords: intelligence, psychometric examination, multiple aptitude battery, university students

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Authors: Khlood F. Salman, Richard Zoucha, Hani Nawafleh

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Introduction: Jordan ranks the fourth highest breast cancer prevalence after Lebanon, Bahrain, and Kuwait. Considerable evidence showed that cultural, ethnic, and economic differences influence a woman’s practice to early detection and prevention of breast cancer. Objectives: To understand women’s health beliefs and values in relation to early detection of breast cancer; and to explore the impact of these beliefs on their decisions regarding reluctance or acceptance of early detection measures such as mammogram screening. Design: A qualitative focused ethnography was used to collect data for this study. Settings: The study was conducted in the second largest city surrounded by a large rural area in Ma’an- Jordan. Participants: A total of twenty seven women, with no history of breast cancer, between the ages of 18 and older, who had prior health experience with health providers, and were willing to share elements of personal health beliefs related to breast health within the larger cultural context. The participants were recruited using the snowball method and words of mouth. Data collection and analysis: A short questionnaire was designed to collect data related to socio demographic status (SDQ) from all participants. A Semi-structured interviews guide was used to elicit data through interviews with the informants. Nvivo10 a data manager was utilized to assist with data analysis. Leininger’s four phases of qualitative data analysis was used as a guide for the data analysis. The phases used to analyze the data included: 1) Collecting and documenting raw data, 2) Identifying of descriptors and categories according to the domains of inquiry and research questions. Emic and etic data is coded for similarities and differences, 3) Identifying patterns and contextual analysis, discover saturation of ideas and recurrent patterns, and 4) Identifying themes and theoretical formulations and recommendations. Findings: Three major themes were emerged within the cultural and religious context; 1. Fear, denial, embarrassment and lack of knowledge were common perceptions of Ma’anis’ women regarding breast health and screening mammography, 2. Health care professionals in Jordan were not quick to offer information and education about breast cancer and screening, and 3. Willingness to learn about breast health and cancer prevention. Conclusion: The study indicated the disparities between the infrastructure and resourcing in rural and urban areas of Jordan, knowledge deficit related to breast cancer, and lack of education about breast health may impact women’s decision to go for a mammogram screening. Cultural beliefs, fear, embarrassments as well as providers lack of focus on breast health were significant contributors against practicing breast health. Health providers and policy makers should provide resources for the establishment health education programs regarding breast cancer early detection and mammography screening. Nurses should play a major role in delivering health education about breast health in general and breast cancer in particular. A culturally appropriate health awareness messages can be used in creating educational programs which can be employed at the national levels.

Keywords: breast health, beliefs, cultural context, ethnography, mammogram screening

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Authors: Isaac Martin, Abigail Lark, Sandra Morales, Eric W. Alton, Jane C. Davies

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Objectives: The cystic fibrosis (CF) lung is a unique microbiological niche, wherein harmful bacteria persist for many years despite antibiotic therapy. Pseudomonas aeruginosa (Pa), the major culprit leading to lung decline and increased mortality, thrives in the lungs of patients with CF due to several factors that have been linked with poor antibiotic performance. Our group is investigating alternative therapies including bacteriophage cocktails with which we have previously demonstrated efficacy against planktonic organisms. In this study, we explored the effects of a 4-phage cocktail on Pa grown in two different conditions, intended to mirror the CF lung: a) alongside standard antibiotic treatment in pre-formed biofilms (structures formed by Pa-secreted exopolysaccharides which provide both physical and cell division barriers to antimicrobials and host defenses and b) in an acidic environment postulated to be present in the CF airway due both to the primary defect in bicarbonate secretion and secondary effects of inflammation. Methods: 16 Pa strains from CF patients at the Royal Brompton Hospital were selected based on sensitivity to a) ceftazidime/ tobramycin and b) the phage cocktail in a conventional plaque assay. To assess efficacy of phage in biofilms, 96 well plates with Pa (5x10⁷ CFU/ ml) were incubated in static conditions, allowing adherent bacterial colonies to form for 24 hr. Ceftazidime and tobramycin (both at 2 × MIC) were added, +/- bacteriophage (4x10⁸ PFU/mL) for a further 24 hr. Cell viability and biomass were estimated using fluorescent resazurin and crystal violet assays, respectively. To evaluate the effect of pH, strains were grown planktonically in shaking 96 well plates at pH 6.0, 6.6, 7.0 and 7.5 with tobramycin or phage, at varying concentrations. Cell viability was quantified by fluorescent resazurin assay. Results: For the biofilm assay, treatment groups were compared with untreated controls and expressed as percent reduction in cell viability and biomass. Addition of the 4-phage cocktail resulted in a 1.3-fold reduction in cell viability and 1.7-fold reduction in biomass (p < 0.001) when compared to standard antibiotic treatment alone. Notably, there was a 50 ± 15% reduction in cell viability and 60 ± 12% reduction in biomass (95% CI) for the 4 biofilms demonstrating the most resistance to antibiotic treatment. 83% of strains tested (n=6) showed decreased bacterial killing by tobramycin at acidic pHs (p < 0.01). However, 25% of strains (n=12) showed improved phage killing at acidic pHs (p < 0.05), with none showing the pattern of reduced efficacy at acidic pH demonstrated by tobramycin. Conclusion: The 4-phage anti-Pa cocktail tested against Pa performs well in pre-formed biofilms and in acidic environments; two conditions intended to mimic the CF lung. To our knowledge, these are the first data looking at the effects of subtle pH changes on phage-mediated bacterial killing in the context of Pa infection. These findings contribute to a growing body of evidence supporting the use of nebulised lytic bacteriophage as a treatment in the context of lung infection.

Keywords: biofilm, cystic fibrosis, pH, Pseudomonas aeruginosa, lytic bacteriophage

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Authors: Ayesha Akbar

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Public service delivery has witnessed a significant improvement with the integration of information communication technology (ICT). It not only improves management structure with advanced technology for surveillance of service delivery but also provides evidence for informed decisions and policy. Pakistan’s public sector organizations have not been able to produce some good results to ensure service delivery. Notwithstanding, some of the public sector organizations in Pakistan has diffused modern technology and proved their credence by providing better service delivery standards. These good indicators provide sound basis to integrate technology in public sector organizations and shift of policy towards evidence based policy making. Rescue-1122 is a public sector organization which provides emergency services and proved to be a successful model for the provision of service delivery to save human lives and to ensure human development in Pakistan. The information about the organization has been received by employing qualitative research methodology. The information is broadly based on primary and secondary sources which includes Rescue-1122 website, official reports of organizations; UNDP (United Nation Development Program), WHO (World Health Organization) and by conducting 10 in-depth interviews with the high administrative staff of organizations who work in the Lahore offices. The information received has been incorporated with the study for the better understanding of the organization and their management procedures. Rescue-1122 represents a successful model in delivering the services in an efficient way to deal with the disaster management. The management of Rescue has strategized the policies and procedures in such a way to develop a comprehensive model with the integration of technology. This model provides efficient service delivery as well as maintains the standards of the organization. The service delivery model of rescue-1122 works on two fronts; front-office interface and the back-office interface. Back-office defines the procedures of operations and assures the compliance of the staff whereas, front-office equipped with the latest technology and good infrastructure handles the emergency calls. Both ends are integrated with satellite based vehicle tracking, wireless system, fleet monitoring system and IP camera which monitors every move of the staff to provide better services and to pinpoint the distortions in the services. The standard time of reaching to the emergency spot is 7 minutes, and during entertaining the case; driver‘s behavior, traffic volume and the technical assistance being provided to the emergency case is being monitored by front-office. Then the whole information get uploaded to the main dashboard of Lahore headquarter from the provincial offices. The latest technology is being materialized by Rescue-1122 for delivering the efficient services, investigating the flaws; if found, and to develop data to make informed decision making. The other public sector organizations of Pakistan can also develop such models to integrate technology for improving service delivery and to develop evidence for informed decisions and policy making.

Keywords: data, e-governance, evidence, policy

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Authors: Mengjiao Fan, Thomson W. L. Wong

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It is unavoidable that older adults may have to deal with aging-related motor problems. Aging is highly likely to affect motor learning and control as well. For example, older adults may suffer from poor motor function and quality of life due to age-related eye changes. These adverse changes in vision results in impairment of movement automaticity. Reaching is a fundamental component of various complex movements, which is therefore beneficial to explore the changes and adaptation in visuomotor behaviors. The current study aims to explore how aging affects visuomotor behaviors by comparing motor performance and gaze behaviors between two age groups (i.e., young and older adults). Visuomotor behaviors in reaching under providing or blocking online visual feedback (simulated visual deficiency) conditions were investigated in 60 healthy young adults (Mean age=24.49 years, SD=2.12) and 37 older adults (Mean age=70.07 years, SD=2.37) with normal or corrected-to-normal vision. Participants in each group were randomly allocated into two subgroups. Subgroup 1 was provided with online visual feedback of the hand-controlled mouse cursor. However, in subgroup 2, visual feedback was blocked to simulate visual deficiency. The experimental task required participants to complete 20 times of reaching to a target by controlling the mouse cursor on the computer screen. Among all the 20 trials, start position was upright in the center of the screen and target appeared at a randomly selected position by the tailor-made computer program. Primary outcomes of motor performance and gaze behaviours data were recorded by the EyeLink II (SR Research, Canada). The results suggested that aging seems to affect the performance of reaching tasks significantly in both visual feedback conditions. In both age groups, blocking online visual feedback of the cursor in reaching resulted in longer hand movement time (p < .001), longer reaching distance away from the target center (p<.001) and poorer reaching motor accuracy (p < .001). Concerning gaze behaviors, blocking online visual feedback increased the first fixation duration time in young adults (p<.001) but decreased it in older adults (p < .001). Besides, under the condition of providing online visual feedback of the cursor, older adults conducted a longer fixation dwell time on target throughout reaching than the young adults (p < .001) although the effect was not significant under blocking online visual feedback condition (p=.215). Therefore, the results suggested that different levels of visual feedback during movement execution can affect gaze behaviors differently in older and young adults. Differential effects by aging on visuomotor behaviors appear on two visual feedback patterns (i.e., blocking or providing online visual feedback of hand-controlled cursor in reaching). Several specific gaze behaviors among the older adults were found, which imply that blocking of visual feedback may act as a stimulus to seduce extra perceptive load in movement execution and age-related visual degeneration might further deteriorate the situation. It indeed provides us with insight for the future development of potential rehabilitative training method (e.g., well-designed errorless training) in enhancing visuomotor adaptation for our aging population in the context of improving their movement automaticity by facilitating their compensation of visual degeneration.

Keywords: aging effect, movement automaticity, reaching, visuomotor behaviors, visual degeneration

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Authors: Tomaz Oliveira, Rui Medeiros, André Lacerda

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Introduction: Cleft lip and/or palate are the most frequent forms of congenital craniofacial anomalies, affecting mainly the middle third of the face and manifesting by functional and aesthetic changes. Bilateral cleft lip represents a reconstructive surgical challenge, not only for the labial component but also for the associated nasal deformation. Recently, the paradigm of the approach to this pathology has changed, placing the focus on muscle reconstruction and anatomical repositioning of the nasal cartilages in order to obtain the best aesthetic and functional results. The aim of this study is to carry out a systematic review of the surgical approach to bilateral cleft lip, retrospectively analyzing the case series of Plastic Surgery Service at Hospital Santa Maria (Lisbon, Portugal) regarding this pathology, the global assessment of the characteristics of the operated patients and the study of the different surgical approaches and their complications in the last 20 years. Methods: The present work demonstrates a retrospective and descriptive study of patients who underwent at least one reconstructive surgery for cleft lip and/or palate, in the CPRE service of the HSM, in the period between January 1 of 1997 and December 31 of 2017, in which the data relating to 361 individuals were analyzed who, after applying the exclusion criteria, constituted a sample of 212 participants. The variables analyzed were the year of the first surgery, gender, age, type of orofacial cleft, surgical approach, and its complications. Results: There was a higher overall prevalence in males, with cleft lip and cleft palate occurring in greater proportion in males, with the cleft palate being more common in females. The most frequently recorded malformation was cleft lip and palate, which is complete in most cases. Regarding laterality, alterations with a unilateral labial component were the most commonly observed, with the left lip being described as the most affected. It was found that the vast majority of patients underwent primary intervention up to 12 months of age. The surgical techniques used in the approach to this pathology showed an important chronological variation over the years. Discussion: Cleft lip and/or palate is a medical condition associated with high aesthetic and functional morbidity, which requires early treatment in order to optimize the long-term outcome. The existence of a nasolabial component and its respective surgical correction plays a central role in the treatment of this pathology. The high rates of post-surgical complications and unconvincing aesthetic results have motivated an evolution of the surgical technique, increasingly evident in recent years, allowing today to achieve satisfactory aesthetic results, even in bilateral cleft lip with high deformation complexity. The introduction of techniques that favor nasolabial reconstruction based on anatomical principles has been producing increasingly convincing results. The analyzed sample shows that most of the results obtained in this study are, in general, compatible with the results published in the literature. Conclusion: This work showed that the existence of small variations in the surgical technique can bring significant improvements in the functional and aesthetic results in the treatment of bilateral cleft lip.

Keywords: cleft lip, palate lip, congenital abnormalities, cranofacial malformations

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Authors: Fathonah Siti, Ardiana Irma

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Indonesia is currently on its track to achieve Universal Health Coverage (UHC) by 2019. The program aims to address issues on disintegration in the implementation and coverage of various health insurance schemes and fragmented fund pooling. Family planning service is covered as one of benefit packages under preventive care. However, little has been done to examine how family planning program are appropriately managed across levels of governments and how family planning services are delivered to the end user. The study is performed through focus group discussion to related policy makers and selected programmers at central and district levels. The study is also benefited from relevant studies on family planning in the UHC scheme and other supporting data. The study carefully investigates some programmatic implications when family planning is integrated in the UHC program encompassing the need to recalculate contraceptive logistics for beneficiaries (eligible couple); policy reformulation for contraceptive service provision including supply chain management; establishment of family planning standard of procedure; and a call to update Management Information System. The study confirms that there is a significant increase in the numbers of contraceptive commodities needs to be procured by the government. Holding an assumption that contraceptive prevalence rate and commodities cost will be as expected increasing at 0.5% annually, the government need to allocate almost IDR 5 billion by 2019, excluded fee for service. The government shifts its focus to maintain eligible health facilities under National Population and Family Planning Board networks. By 2019, the government has set strategies to anticipate the provision of family planning services to 45.340 health facilities distributed in 514 districts and 7 thousand sub districts. Clear division of authorities has been established among levels of governments. Three models of contraceptive supply planning have been developed and currently in the process of being institutionalized. Pre service training for family planning services has been piloted in 10 prominent universities. The position of private midwives has been appreciated as part of the system. To ensure the implementation of quality and health expenditure control, family planning standard has been established as a reference to determine set of services required to deliver to the clients properly and types of health facilities to conduct particular family planning services. Recognition to individual status of program participation has been acknowledged in the Family Enumeration since 2015. The data is precisely recorded by name by address for each family and its members. It supplies valuable information to 15.131 Family Planning Field Workers (FPFWs) to provide information and education related to family planning in an attempt to generate demand and maintain the participation of family planning acceptors who are program beneficiaries. Despite overwhelming efforts described above, some obstacles remain. The program experiences poor socialization and yet removes geographical barriers for those living in remote areas. Family planning services provided for this sub population conducted outside the scheme as a complement strategy. However, UHC program has brought remarkable improvement in access and quality of family planning services.

Keywords: beneficiary, family planning services, national population and family planning board, universal health coverage

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Authors: Xu Qian

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This abstract examines the concept of resilience in adolescents from both adolescent medicine and child psychology perspectives. It discusses the role of healthcare providers in fostering resilience among adolescents, encompassing physical, psychological, and social aspects. The paper highlights evidence-based interventions and practical strategies for promoting resilience in this population. Introduction: Resilience plays a crucial role in the healthy development of adolescents, enabling them to navigate through the challenges of this transitional period. This abstract explores the concept of resilience from the perspectives of adolescent medicine and child psychology, shedding light on the collective efforts of healthcare providers in fostering resilience. By integrating the principles and practices of these two disciplines, this abstract emphasizes the multidimensional nature of resilience and its significance in the overall well-being of adolescents. Methods: A comprehensive literature review was conducted, encompassing research articles, empirical studies, and expert opinions from both adolescent medicine and child psychology fields. The search included databases such as PubMed, PsycINFO, and Google Scholar, focusing on publications from the past decade. The review aimed to identify evidence-based interventions and practical strategies employed by healthcare providers to promote resilience among adolescents. Results: The review revealed several key findings regarding the promotion of resilience in adolescents. Firstly, resilience is a dynamic process influenced by individual characteristics, environmental factors, and the interaction between the two. Secondly, healthcare providers play a critical role in fostering resilience by addressing the physical, psychological, and social needs of adolescents. This entails comprehensive healthcare services that integrate medical care, mental health support, and social interventions. Thirdly, evidence-based interventions such as cognitive-behavioral therapy, social skills training, and positive youth development programs have shown promising outcomes in enhancing resilience. Discussion: The integration of adolescent medicine and child psychology perspectives provides a comprehensive framework for promoting resilience in adolescents. By acknowledging the interplay between physical health, psychological well-being, and social functioning, healthcare providers can tailor interventions to address the specific needs and challenges faced by adolescents. Collaborative efforts between medical professionals, psychologists, educators, and families are vital in creating a supportive environment that fosters resilience. Additionally, the findings highlight the importance of early identification and intervention, emphasizing the need for routine screening and assessment to identify adolescents at risk and provide timely support. Conclusion: Promoting resilience in adolescents requires a holistic approach that integrates adolescent medicine and child psychology perspectives. By recognizing the multifaceted nature of resilience, healthcare providers can implement evidence-based interventions and practical strategies to enhance the well-being of adolescents. The collaboration between healthcare professionals from different disciplines, alongside the involvement of families and communities, is crucial for creating a resilient support system. By investing in the promotion of resilience during adolescence, we can empower young individuals to overcome adversity and thrive in their journey toward adulthood.

Keywords: psychology, clinical psychology, child psychology, adolescent psychology, adolescent

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Authors: Chitresh Prasad, Arvind Ramesh, Aditya Virkar, Karan Dholkaria, Vinayak Malhotra

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Solid Propellant Rocket is a rocket that utilises a combination of a solid Oxidizer and a solid Fuel. Success in Solid Rocket Motor design and development depends significantly on knowledge of burning rate behaviour of the selected solid propellant under all motor operating conditions and design limit conditions. Most Solid Motor Rockets consist of the Main Engine, along with multiple Boosters that provide an additional thrust to the space-bound vehicle. Though widely used, they have been eclipsed by Liquid Propellant Rockets, because of their better performance characteristics. The addition of a catalyst such as Iron Oxide, on the other hand, can drastically enhance the performance of a Solid Rocket. This scientific investigation tries to emulate the working of a Solid Rocket using Sparklers and Energized Candles, with a central Energized Candle acting as the Main Engine and surrounding Sparklers acting as the Booster. The Energized Candle is made of Paraffin Wax, with Magnesium filings embedded in it’s wick. The Sparkler is made up of 45% Barium Nitrate, 35% Iron, 9% Aluminium, 10% Dextrin and the remaining composition consists of Boric Acid. The Magnesium in the Energized Candle, and the combination of Iron and Aluminium in the Sparkler, act as catalysts and enhance the burn rates of both materials. This combustion of Metallized Propellants has an influence over the regression rate of the subject candle. The experimental parameters explored here are Separation Distance, Systematically varying Configuration and Layout Symmetry. The major performance parameter under observation is the Regression Rate of the Energized Candle. The rate of regression is significantly affected by the orientation and configuration of the sparklers, which usually act as heat sources for the energized candle. The Overall Efficiency of any engine is factorised by the thermal and propulsive efficiencies. Numerous efforts have been made to improve one or the other. This investigation focuses on the Orientation of Rocket Motor Design to maximize their Overall Efficiency. The primary objective is to analyse the Flame Spread Rate variations of the energized candle, which resembles the solid rocket propellant used in the first stage of rocket operation thereby affecting the Specific Impulse values in a Rocket, which in turn have a deciding impact on their Time of Flight. Another objective of this research venture is to determine the effectiveness of the key controlling parameters explored. This investigation also emulates the exhaust gas interactions of the Solid Rocket through concurrent ignition of the Energized Candle and Sparklers, and their behaviour is analysed. Modern space programmes intend to explore the universe outside our solar system. To accomplish these goals, it is necessary to design a launch vehicle which is capable of providing incessant propulsion along with better efficiency for vast durations. The main motivation of this study is to enhance Rocket performance and their Overall Efficiency through better designing and optimization techniques, which will play a crucial role in this human conquest for knowledge.

Keywords: design modifications, improving overall efficiency, metallized combustion, regression rate variations

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Authors: Salma Akter, Md. Kamal Uddin

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This study aims to demonstrate how top-down shelter policy and its resultant dwelling environment leads to ‘everyday compromise’ by the grassroots according to subjective (satisfaction) and objective (physical design elements and physical environmental elements) indicators, which are measured across three levels of the settlement; macro (Community), meso (Neighborhood or shelter/built environment) and micro (family). Ashrayan Prakalpa is a resettlement /housing project of Government of Bangladesh for providing shelters and human resources development activities like education, microcredit, and training programme to landless, homeless and rootless people. Despite the integrated nature of the shelter policies (comprises poverty alleviation, employment opportunity, secured tenure, and livelihood training), the ‘quality of life’ issue at the different levels of settlements becomes questionable. As dwellers of shelter units (although formally termed as ‘barracks’ rather shelter or housing) remain on the receiving end of government’s resettlement policies, they often involve with spatial-physical and socio-economic negotiation and assume curious forms of spatial practice, which often upholds contradiction with policy planning. Thus, policy based shelter force dwellers to persistently compromise with their provided built environments both in overtly and covertly. Compromising with prescribed designed space and facilities across living places articulated their negotiation with the quality of allocated space, built form and infrastructures, which in turn exert as less quality of life. The top-down shelter project, Dakshin Chandani Mahal Ashrayan Prakalpa at Dighalia Upazila, the study area located at the Eastern fringe area of Khulna, Bangladesh, is still in progress to resettle internally displaced and homeless people. In terms of methodology, this research is primarily exploratory and adopts a case study method, and an analytical framework is developed through the deductive approach for evaluating the quality of life. Secondary data have been obtained from housing policy analysis and relevant literature review, while key informant interview, focus group discussion, necessary drawings and photographs and participant observation across dwelling, neighborhood, and community level have also been administered as primary data collection methodology. Findings have revealed that various shortages, inadequacies, and negligence of policymakers force to compromise with allocated designed space, physical infrastructure and economic opportunities across dwelling, neighborhood and mostly community level. Thus, the outcome of this study can be beneficial for a global-level understating of the compromising the ‘quality of life’ under top-down shelter policy. Locally, for instance, in the context of Bangladesh, it can help policymakers and concerned authorities to formulate the shelter policies and take initiatives to improve the well-being of marginalized.

Keywords: Ashrayan Prakalpa, compromise, displaced people, quality of life

Procedia PDF Downloads 124

Authors: Jonathan Kissi, Baozhen Dai, Wisdom W. K. Pomegbe, Abdul-Basit Kassim

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Protecting patient’s digital information is a growing concern for healthcare institutions as people nowadays perpetually live their lives through telemedicine services. These telemedicine services have been confronted with several determinants that hinder their successful implementations, especially in developing countries. Identifying such determinants that influence the acceptance of telemedicine services is also a problem for healthcare professionals. Despite the tremendous increase in telemedicine services, its adoption, and use has been quite slow in some healthcare settings. Generally, it is accepted in today’s globalizing world that the success of telemedicine services relies on users’ satisfaction. Satisfying health professionals and patients are one of the crucial objectives of telemedicine success. This study seeks to investigate the determinants that influence health professionals’ intention to utilize telemedicine services in clinical activities in a sub-Saharan African country in West Africa (Ghana). A hybridized model comprising of health adoption models, including technology acceptance theory, diffusion of innovation theory, and protection of motivation theory, were used to investigate these quandaries. The study was carried out in four government health institutions that apply and regulate telemedicine services in their clinical activities. A structured questionnaire was developed and used for data collection. Purposive and convenience sampling methods were used in the selection of healthcare professionals from different medical fields for the study. The collected data were analyzed based on structural equation modeling (SEM) approach. All selected constructs showed a significant relationship with health professional’s behavioral intention in the direction expected from prior literature including perceived usefulness, perceived ease of use, management strategies, financial sustainability, communication channels, patients security threat, patients privacy risk, self efficacy, actual service use, user satisfaction, and telemedicine services systems securities threat. Surprisingly, user characteristics and response efficacy of health professionals were not significant in the hybridized model. The findings and insights from this research show that health professionals are pragmatic when making choices for technology applications and also their willingness to use telemedicine services. They are, however, anxious about its threats and coping appraisals. The identified significant constructs in the study may help to increase efficiency, quality of services, quality patient care delivery, and satisfactory user satisfaction among healthcare professionals. The implantation and effective utilization of telemedicine services in the selected hospitals will aid as a strategy to eradicate hardships in healthcare services delivery. The service will help attain universal health access coverage to all populace. This study contributes to empirical knowledge by identifying the vital factors influencing health professionals’ behavioral intentions to adopt telemedicine services. The study will also help stakeholders of healthcare to formulate better policies towards telemedicine service usage.

Keywords: telemedicine service, perceived usefulness, perceived ease of use, management strategies, security threats

Procedia PDF Downloads 111

Authors: Joy Chadwick

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There is no doubt that classrooms of today are more complex and diverse than ever before. Preparing teacher candidates to meet these challenges is essential to ensure the retention of teachers within the profession and to ensure that graduates begin their teaching careers with the knowledge and understanding of how to effectively meet the diversity of students they will encounter. Creating inclusive classrooms requires teachers to have a repertoire of effective instructional skills and strategies. Teachers must also have the mindset to embrace diversity and value the uniqueness of individual students in their care. This qualitative study analyzed teacher candidates' experiences as they completed a fourteen-week teaching practicum while simultaneously completing a university course focused on inclusive pedagogy. The research investigated the challenges and successes teacher candidates had in navigating the translation of theory related to inclusive pedagogy into their teaching practice. Applying threshold concept theory as a framework, the research explored the troublesome concepts, liminal spaces, and transformative experiences as connected to inclusive practices. Threshold concept theory suggests that within all disciplinary fields, there exists particular threshold concepts that serve as gateways or portals into previously inaccessible ways of thinking and practicing. It is in these liminal spaces that conceptual shifts in thinking and understanding and deep learning can occur. The threshold concept framework provided a lens to examine teacher candidate struggles and successes with the inclusive education course content and the application of this content to their practicum experiences. A qualitative research approach was used, which included analyzing twenty-nine course reflective journals and six follow up one-to-one semi structured interviews. The journals and interview transcripts were coded and themed using NVivo software. Threshold concept theory was then applied to the data to uncover the liminal or stuck spaces of learning and the ways in which the teacher candidates navigated those challenging places of teaching. The research also sought to uncover potential transformative shifts in teacher candidate understanding as connected to teaching in an inclusive classroom. The findings suggested that teacher candidates experienced difficulties when they did not feel they had the knowledge, skill, or time to meet the needs of the students in the way they envisioned they should. To navigate the frustration of this thwarted vision, they relied on present and previous course content and experiences, collaborative work with other teacher candidates and their mentor teachers, and a proactive approach to planning for students. Transformational shifts were most evident in their ability to reframe their perceptions of children from a deficit or disability lens to a strength-based belief in the potential of students. It was evident that through their course work and practicum experiences, their beliefs regarding struggling students shifted as they saw the value of embracing neurodiversity, the importance of relationships, and planning for and teaching through a strength-based approach. Research findings have implications for teacher education programs and for understanding threshold concepts theory as connected to practice-based learning experiences.

Keywords: inclusion, inclusive education, liminal space, teacher education, threshold concepts, troublesome knowledge

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Authors: Netalie Shloim, Brian Brown, Siobhan Hugh-Jones, Jane Plastow, Diana Setiyawati, Anna Madill

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In June 2021, the World Health Organization launched its guidance and technical packages on community mental health services, stressing a human rights-based approach to care. This initiative stems from an increasing acknowledgment of the role mental health plays in achieving the Sustainable Development Goals. Nevertheless, mental health remains a relatively neglected research area and the estimates for untreated mental disorders in low-and-middle-income countries (LMICs) are as high as 78% for adults. Moreover, the development sector and research programs too often side-line mental health as a privilege in the face of often immediate threats to life and livelihood. As a way of addressing this problem, this study aimed to examine past or ongoing GCRF projects to see if there were opportunities where mental health impact could have been achieved without compromising a study's main aim and without overburdening a project. Projects funded by the UKRI Global Challenges Research Fund (GCRF) were analyzed. This program was initiated in 2015 to support cutting-edge research that addresses the challenges faced by developing countries. By the end of May 2020, a total of 15,279 projects were funded of which only 3% had an explicit mental health focus. A sample of 36 non-mental-health-focused projects was then sampled for diversity across research council, challenge portfolio and world region. Each of these 36 projects was coded by two coders for opportunities to embed mental health impact. To facilitate coding, the literature was inspected for dimensions relevant to LMIC settings. Three main psychological and three main social dimensions were identified: promote a positive sense of self; promote positive emotions, safe expression and regulation of challenging emotions, coping strategies, and help-seeking; facilitate skills development; and facilitate community-building; preserve sociocultural identity; support community mobilization. Coding agreement was strong on missed opportunities for mental health impact on the three social dimensions: support community mobilization (92%), facilitate community building (83%), preserve socio-cultural identity (70%). Coding agreement was reasonably strong on missed opportunities for mental health impact on the three psychological dimensions: promote positive emotions (67%), facilitate skills development (61%), positive sense of self (58%). In order of frequency, the agreed perceived opportunities from the highest to lowest are: support community mobilization, facilitate community building, facilitate skills development, promote a positive sense of self, promote positive emotions, preserve sociocultural identity. All projects were considered to have an opportunity to support community mobilization and to facilitate skills development by at least one coder. Findings provided support that there were opportunities to embed mental health impact in research across the range of development sectors and identifies what kind of missed opportunities are most frequent. Hence, mainstreaming mental health has huge potential to tackle the lack of priority and funding it has attracted traditionally. The next steps are to understand the barriers to mainstreaming mental health and to work together to overcome them.

Keywords: GCRF, mental health, psychosocial wellbeing, LMIC

Procedia PDF Downloads 149