Search results for: younger middle age
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1909

Search results for: younger middle age

1909 Multidisciplinary Approach to Diagnosis of Primary Progressive Aphasia in a Younger Middle Aged Patient

Authors: Robert Krause

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Primary progressive aphasia (PPA) is a neurodegenerative disease similar to frontotemporal and semantic dementia, while having a different clinical image and anatomic pathology topography. Nonetheless, they are often included under an umbrella term: frontotemporal lobar degeneration (FTLD). In the study, examples of diagnosing PPA are presented through the multidisciplinary lens of specialists from different fields (neurologists, psychiatrists, clinical speech therapists, clinical neuropsychologists and others) using a variety of diagnostic tools such as MR, PET/CT, genetic screening and neuropsychological and logopedic methods. Thanks to that, specialists can get a better and clearer understanding of PPA diagnosis. The study summarizes the concrete procedures and results of different specialists while diagnosing PPA in a patient of younger middle age and illustrates the importance of multidisciplinary approach to differential diagnosis of PPA.

Keywords: primary progressive aphasia, etiology, diagnosis, younger middle age

Procedia PDF Downloads 150
1908 Views of Middle-Aged Women in Malaysia towards Menopause: A Qualitative Study

Authors: Halimatus Sakdiah Minhat, Hamizah Sulaiman

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Introduction: Old age is commonly link with menopause among women. The main purpose of this study is to explore the views of middle-aged women and its association with menopause. Methods: Qualitative interviews in the form of focus group discussions (FGD) were conducted among women aged between 35 and 59 years old living in urban localities in two different states in Malaysia. Selection of respondents were conducted using the maximum variation sampling, focussing on five age categories which are between 35 to 39, 40 to 44, 45 to 49, 50 to 54 and 55 to 59 years old. Each FGD involved 5 to 7 respondents and lasted for 1 to 2 hours each. The content of the interviews were recorded, transcribed verbatim after each interview before the next focus group discussion is conducted. Field notes of reflexive observations were recorded by the rapporteur. Individual transcripts were analysed using standard methods of qualitative thematic analysis. The material was read through twice and later coded. The codes were further collapsed into several key themes related to perceptions towards menopause among the respondents. Results: A total number of 36 middle-aged women were consented for the interviews. The contents of the interviews revealed that younger women tend to associate menopause with being old, which were dominated by the younger aged categories of less than 50 years old. Majority of the respondents linked menopause with end of woman’s reproductive capacity or inability to give birth, lethargic or endless feeling of tiredness and insomnia, emotional instability or having more sensitive feelings and also the beginning of many health problems such as osteoarthritis which they perceived very synonyms with being old. Conclusion: The findings of this study indirectly reflect the negative views towards menopause among the middle-aged women in Malaysia. Being residents in the urban areas equipped with advanced technology and health information, do not exclude them from having negative views about menopause. However, this is a qualitative study which only focussing on age ranges, regardless of their socioeconomic and demographic background, which make further studies on related issues are necessaries. The fact that it was a qualitative interview, the findings could not be generalised and only specific to the targeted population.

Keywords: Menopause, Middle-aged women, old, Malaysia

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1907 “The Day I Became a Woman” by Marziyeh Meshkiny: An Analysis of the Cinematographic Image of the Middle East

Authors: Ana Carolina Domingues

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This work presents the preliminary results of the above-titled doctoral research. Based on this film and on Middle East authors who discuss films made by women, it has been concluded so far, that it is part of a larger movement, which together with other productions, show the perceptions of the world of these women, who see the world otherwise, for not holding positions of power. These modes of perception revealed from the encounter of women with the cameras, educate viewers to denaturalize the impressions constructed in relation to the Middle East.

Keywords: cinema, image, middle east, women

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1906 The Role of Middle Class in Forming of Consumption Habits of Market Institutions among Kazakh Households in Transition Period

Authors: Daurenbek Kuleimenov, Elmira Otar

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Market institutions extension within transit societies contributes to constituting the new type of middle class and households livelihood strategies. The middle class households as an example of prosperity in many cases encourage the ordinary ones to do the same economic actions. Therefore, practices of using market institutions by middle class households in transit societies, which are mostly characterized by huge influence of traditional attitudes, can carry habitual features for the whole society. Market institutions consumption habit of the middle class households makes them trendsetters of economic habits of other households while adapting to the market economy. Moreover different social-economic positions of households lead them to different consuming results such as worsening or improving household economy due to indebtedness.

Keywords: middle class, households, market institutions, transition

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1905 Ex-Post Export Data for Differentiated Products Revealing the Existence of Productcycles

Authors: Ranajoy Bhattcharyya

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We estimate international product cycles as shifting product spaces by using 1976 to 2010 UN Comtrade data on all differentiated tradable products in all countries. We use a product space approach to identify the representative product baskets of high-, middle and low-income countries and then use these baskets to identify the patterns of change in comparative advantage of countries over time. We find evidence of a product cycle in two senses: First, high-, middle- and low-income countries differ in comparative advantage, and high-income products migrate to the middle-income basket. A similar pattern is observed for middle- and low-income countries. Our estimation of the lag shows that middle-income countries tend to quickly take up the products of high-income countries, but low-income countries take a longer time absorbing these products. Thus, the gap between low- and middle-income countries is considerably higher than that between middle- and high-income nations.

Keywords: product cycle, comparative advantage, representative product basket, ex-post data

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1904 Body Mass Index and Dietary Intake Amongst Alabama Students and Georgia Campers: A Secondary Analysis

Authors: David Tran, Sina Gallo, Jenny Lin

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The present study investigated two adolescent populations between the ages of 10-14 years of age from two different studies: a dietary assessment validation study conducted at the Georgia 4-H Rock Eagle summer camp (Eatonton, Georgia) and a middle-school diet study at an Alabama middle school (Birmingham, Alabama). Energy intake and meal consumption were recorded via either direct observation of camp lunch or weighing and photography of school lunch trays. Child weight and height were measured to calculate Body Mass Index (BMI) and compared to CDC growth charts to assess percentile or Z-score. Results showed that those participants categorized with higher BMI had a statistically significant and positive correlation with energy intake (kcal). Future research should increase the sample size and include a broader subject size which includes those of a younger childhood population, to assess the effect of age.

Keywords: BMI, adolescent, direct observation, dietary intake

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1903 China's Middle East Policy and the Competition with the United States

Authors: Shabnam Dadparvar, Laijin Shen

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This paper focuses on China’s policy in the Middle East and the rivalry with the U.S. The question is that what are the main factors on China’s Middle East policy and its competition with the U.S? The hypothesis regards to three effective factors: 'China’s energy dependency' on the Middle East, 'economy' and support for 'stability' in the Middle East. What is important in China’s competition with the U.S regarding to its Middle East policy is the substantial difference in ways of treating the countries of the region; China is committed to Westphalia model based on non-interference in internal affairs of the countries and respect the sovereignty of the governments. However, after 9/11, the U.S is seeking a balance between stability and change through intervention in the international affairs and in some cases is looking for a regime change. From the other hand, China, due to its dependency on the region’s energy welcomes America’s military presence in the region for providing stability. The authors by using a descriptive analytical method try to explain the situation of rivalry between China and the United States in Middle East. China is an 'emerging power' with high economic growth and in demand of more energy supply. The problem is that a rising power in the region is often a source of concern for hegemony.

Keywords: China's foreign policy, energy, hegemony, the Middle East

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1902 Middle Management Practices and Leadership in Higher Education, Comparative Case Studies of Two Selected Post-1992 UK Universities

Authors: Thouraya Eshami

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The aim of this study is to understand, interpret and describe the dynamics of the management and leadership practices with its diverse constituents within the middle management cadre in two selected post-1992 UK universities. The information will be gleaned from interviews conducted with academics who became middle-managers (an AD, SGL and TL) in two selected case Higher Education Institutes. The term middle management is used to describe personnel occupying positions at the level of assistant deans, dean (which also referred to as associate deans), and team leaders.

Keywords: academic manager, associate dean, higher education, middle manager, post 1992 universities

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1901 Middle-Level Management Involvement in Strategy Process, and Organizational Performance

Authors: Mazyar Taghavi

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This research examines middle-level managers’ involvement in strategy process in 15 manufacturing and service companies in Iran. We considered two dominant theoretical arguments for expecting a positive association. According to the first direction involvement improves organizational performance by improving the quality of strategic decisions. According to the second track, middle managers contribute to increased levels of performance through strategic consensus among them. Results indicate that involvement in the strategy is related to organizational performance. Involvement is associated with consensus (i.e. strategic understanding and commitment) among middle-level managers. However, findings indicate that consensus is not related to the organizational performance.

Keywords: middle-level management, strategy process, organizational performance, strategy consensus

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1900 The Dietary Behavior of Eating Alone in Middle-Aged Populations by Body Mass Index (BMI)

Authors: Pil Kyoo Jo, Youngmee Lee, Jee Young Kim, Yu Jin Oh, Sohyun Park, Young Ha Joo, Hye Suk Kim, Semi Kang

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A growing number of people are living alone and eating alone. People might have different dietary behaviors between eating alone and eating with others, it can influence their weight and health. The purpose of this study was to investigate the dietary behavior of eating alone in middle-aged populations in South Korea. We used the nationally representative data from the 5th Korea National Health and Nutrition Examination Survey (KNHANES), 2010-2012 and a cross-sectional survey on the eating behaviors among adults (N=1318, 530 men, 788 women) aged from 20 to 54 years. Results showed that ‘underweight’ group ate more amount of food when eating with others compared to eating alone and ‘overweight’ and ‘obesity’ groups had opposite respondent (p<0.05). When having a meal alone, ‘underweight’ group ate food until didn’t feel hungry and ‘overweight’ and ‘obesity’ groups ate leftover food even they felt full (p<0.01). The ‘overweight’ and ‘obesity’ groups usually ate alone than ‘underweight’ group did (p<0.05). All groups had faster meal time when eating alone than eating with others and usually ate processed foods for convenience when eating alone. Younger people, aged 10-30, ate more processed food than older people did. South Koreans spend nearly 45% of their total food consumption from processed foods. This research was supported by the National Research Foundation of Korea for 2011 Korea-Japan Basic Scientific Cooperation Program (NRF-2011B00003). This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2015S1A5B6037369).

Keywords: BMI, dietary behavior, eating alone, middle-aged populations

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1899 Comparing Trastuzumab-Related Cardiotoxicity between Elderly and Younger Patients with Breast Cancer: A Prospective Cohort Study

Authors: Afrah Aladwani, Alexander Mullen, Mohammad AlRashidi, Omamah Alfarisi, Faisal Alterkit, Abdulwahab Aladwani, Asit Kumar, Emad Eldosouky

Abstract:

Introduction: Trastuzumab is a HER-2 targeted humanized monoclonal antibody that significantly improves the therapeutic outcomes of metastatic and non-metastatic breast cancer. However, it is associated with increased risk of cardiotoxicity that ranges from mild decline in the cardiac ejection fraction to permanent cardiomyopathy. Concerns have been raised in treating eligible older patients. This study compares trastuzumab outcomes between two age cohorts in the Kuwait Cancer Control Centre (KCCC). Methods: In a prospective comparative observational study, 93 HER-2 positive breast cancer patients undergoing different chemotherapy protocols + trastuzumab were included and divided into two cohorts based on their age (˂60 and ≥60 years old). The baseline left ventricular ejection fraction (LVEF) was assessed and monitored every three months during trastuzumab treatment. Event of cardiotoxicity was defined as ≥10% decline in the LVEF from the baseline. The lower accepted normal limit of the LVEF was 50%. Results: The median baseline LVEF was 65% in both age cohorts (IQR 8% and 9% for older and younger patients respectively). Whereas, the median LVEF post-trastuzumab treatment was 51% and 55% in older and younger patients respectively (IQR 8%; p-value = 0.22), despite the fact that older patients had significantly lower exposure to anthracyclines compared to younger patients (60% and 84.1% respectively; p-value ˂0.001). 86.7% and 55.6% of older and younger patients, respectively, developed ≥10% decline in their LVEF from the baseline. Among those, only 29% of older and 27% of younger patients reached a LVEF value below 50% (p-value = 0.88). Statistically, age was the only factor that significantly correlated with trastuzumab induced cardiotoxicity (OR 4; p-value ˂0.012), but it did not increase the requirement for permanent discontinuation of treatment. A baseline LVEF value below 60% contributed to developing a post-treatment value below normal ranges (50%). Conclusion: Breast cancer patients aged 60 years and above in Kuwait were at 4-fold higher risk of developing ≥10% decline in their LVEF from the baseline than younger patients during trastuzumab treatment. Surprisingly, previous exposure to anthracyclines and multiple comorbidities were not associated with significant increased risk of cardiotoxicity.

Keywords: breast cancer, elderly, Trastuzumab, cardiotoxicity

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1898 Royal Tourism: Conscious Perspicacity of Dubai

Authors: Aarti Suryawanshi

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Royal Tourism has always been a popular niche activity for many tourists around the world. The United Kingdom being at the heart of it, has been a pioneering nation for Royal tourists. Though many other countries with monarchies such as India, Thailand, Japan, Spain, Netherlands, and many more have attracted tourists with the motivation to see and experience the royalty to their nations, the Middle Eastern countries have never really been the attraction for Royal tourists. Royalty in the middle east is fast emerging as a tourist product and also paving way to marketing opportunity that may lead to the increased popularity of the Royal Houses of the region. Dubai has been garnering the centre stage for futuristic developments, economic growth initiatives, and continuous efforts towards urbanisation which has brought the lime light on the Royal house of the Al Maktoum globally, along with the younger royal members being extensively recognised and appreciated for their public and private adventures which are shared through various social media platforms. The objective of this paper is to analyse the popularity of His Highness Sheikh Hamdan Bin Mohammed Bin Rashid Al Maktoum through social media platforms and the possibility of inducing Royal Tourism in Dubai. An empirical study has been performed to describe the automated repositioning of the city of Dubai as a royal tourism hub.

Keywords: royalty, royal tourism, monarchy, marketing strategy, repositioning

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1897 Stories of Digital Technology and Online Safety: Storytelling as a Tool to Find out Young Children’s Views on Digital Technology and Online Safety

Authors: Lindsey Watson

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This research is aimed at facilitating and listening to the voices of younger children, recognising their contributions to research about the things that matter to them. Digital technology increasingly impacts on the lives of young children, therefore this study aimed at increasing children’s agency through recognising and involving their perspectives to help contribute to a wider understanding of younger children’s perceptions of online safety. Using a phenomenological approach, the paper discusses how storytelling as a creative methodological approach enabled an agentic space for children to express their views, knowledge, and perceptions of their engagement with the digital world. Setting and parental informed consent were gained in addition to an adapted approach to child assent through the use of child-friendly language and emoji stickers, which was also recorded verbally. Findings demonstrate that younger children are thinking about many aspects of digital technology and how this impacts on their lives and that storytelling as a research method is a useful tool to facilitate conversations with young children. The paper thus seeks to recognise and evaluate how creative methodologies can provide insights into children’s understanding of online safety and how this can influence practitioners and parents in supporting younger children in a digital world.

Keywords: early childhood, family, online safety, phenomenology, storytelling

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1896 Mythological Influences on the Works of J. R. R. Tolkien: A Scrutiny of Middle-Earth Stories

Authors: Ali Mohammadi

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The present study is an attempt to investigate the influence of mythology on J.R.R. Tolkien's literary works in general and on Middle-Earth in particular. Moreover, despite the fact that mythology is usually regarded as a thing of the past predominantly found in the early works of literature, this inquiry reveals that how modern literary works can artistically benefit from mythological elements of Old English Era so as to enrich their content and stand out as innovative masterpieces. Indeed, having been a philologist and well-acquainted with mythological literature, Tolkien paved the way for a novel understanding of literature by bridging the gap between the old and the new. In the end, it was concluded that had mythology not been utilised by Tolkien, his works, and on top of all, Middle-Earth, would not have turned into a modern literary showpiece.

Keywords: literature, Middle-Earth, mythology, Tolkien

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1895 The Language Use of Middle Eastern Freedom Activists' Speeches: A Gender Perspective

Authors: Sulistyaningtyas

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Examining the role of Middle Eastern freedom activists’ speech based on gender perspective is considered noteworthy because the society in the Middle East is patriarchal. This research aims to examine the language use of the Middle Eastern freedom activists’ speeches through gender perspective. The data sources are from male and female Middle Eastern freedom activists’ speech videos. In analyzing the data, the theories employed are about Language Style from Gender Perspective and The Language for Speech. The result reveals that there are sets of spoken language differences between male and female speakers. In using the language for speech, both male and female speakers produce metaphor, euphemism, the ‘rule of three’, parallelism, and pronouns in random frequency of production, which cannot be separated by genders. Moreover, it cannot be concluded that one gender is more potential than the other to influence the audience in delivering speech. There are other factors, particularly non-verbal factors, existing to give impacts on how a speech can influence the audience.

Keywords: gender perspective, language use, Middle Eastern freedom activists, speech

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1894 China and the Middle East in the 21st Century: From Political Mediation to Economic Expansionism

Authors: Ali Asghar Sotoudeh

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Mediation Diplomacy has emerged as one of the main pillars of China's foreign policy goals and practices, and Beijing has established itself as a peacekeeping force in regional conflicts and crises such as Afghanistan, Syria, Sudan, Yemen, and the Arab-Israeli peace process. China is deepening and intensifying its diplomatic interventions in the Middle East and trying to shape the security and political developments in the Middle East. On the other hand, economically, China has become one of the most important trading partners with Middle Eastern governments. China is also seeking to expand its foreign policy and economic interests in the Middle East through the New Silk Road initiative and has signed cooperation agreements with 17 Arab countries. In this regard, due to the importance of the subject, this research focuses on answering this question; what is the basis of China's political mediation and economic expansionism in the Middle East? In parallel with this question, this study follows the hypothesis that the mediating role of peace is a legitimate way for China to intervene in Middle East political crises, Without causing China to deviate from its traditional guiding principles based on non-interference in the internal affairs of other actors in the international system. This policy also promotes the security of economic interests and increases the country's political influence in the Middle East. The research method is descriptive-analytical based on the qualitative method, and the data collection method is library and internet resources.

Keywords: China, middle east, political mediation, economic expansionism

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1893 Introduction to Political Psychoanalysis of a Group in the Middle East

Authors: Seyedfateh Moradi, Abas Ali Rahbar

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The present study focuses on investigating group psychoanalysis in the Middle East. The study uses a descriptive-analytic method and library resources have been used to collect the data. Additionally, the researcher’s observations of people’s everyday behavior have played an important role in the production and analysis of the study. Group psychoanalysis in the Middle East can be conducted through people’s daily behaviors, proverbs, poetry, mythology, etc., and some of the general characteristics of people in the Middle East include: xenophobia, revivalism, fatalism, nostalgic, wills and so on. Members of the group have often failed to achieve Libido wills and it is very important in unifying and reproduction violence. Therefore, if libidinal wills are irrationally fixed, it will be important in forming fundamentalist and racist groups, a situation that is dominant among many groups in the Middle East. Adversities, from early childhood and afterwards, in the subjects have always been influential in the political behavior of group members, and it manifests itself as counter-projections. Consequently, it affects the foreign policy of the governments. On the other hand, two kinds of subjects are identifiable in the Middle East, one; classical subject that is related to nostalgia and mythology and, two; modern subjects which is self-alienated. As a result, both subjects are seeking identity and self-expression in public in relation to forming groups. Therefore, collective unconscious in the Middle East shows itself as extreme boundaries and leads to forming groups characterized with violence. Psychoanalysis shows important aspects to identify many developments in the Middle East; totally analysis of Freud, Carl Jung and Reich about groups can be applied in the present Middle East.

Keywords: political, psychoanalysis, group, Middle East

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1892 Minorities and Soccer in the Middle East: Yelling From the Touchline

Authors: Saeb Farhan Al Ganideh

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We draw on insights from theories of group threat and identity to explore how soccer rivalries can decode the relationship between ethnic minorities and local societies. How ethnic minorities used soccer, in the Arab countries of the Middle East, to express their racial-ethnic heritage is the main question that this paper grapples with at its most general level. The rhetoric around soccer and minorities in the Middle East show that ethnic minorities’ soccer clubs have faced varying degrees of discrimination. The paper relies on an analysis of 4 ethnic minorities’ soccer clubs, namely, Circassians in Jordan, Kurds in Syria, Sahrawis in Morocco, and Amazighs in Algeria, focusing on previous and current performance of these clubs. Ethnic minorities’ soccer clubs were the pinnacle in the Middle East region a few decades ago. Nonetheless, these soccer clubs, currently, fighting for not only their place in their countries’ local competitions but also for their existence as soccer clubs. Minorities’ soccer clubs have been plagued with challenges related to the change in political and social contexts in these countries.

Keywords: minorities, rivalries, soccer, middle east

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1891 Alternative Futures for the Middle East

Authors: Dorsa Bakhshandehgeyazdi

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This paper examines elective future of security in the Middle East trying to find a way that could take the district from a shaky past to a more secure future. Taking a gander at five situations about the eventual future of world legislative issues, in particular, globalization, fragmentation, conflict of civilizations, majority rule peace and the development of a security group, the paper contends that albeit every situation has its qualities (and in addition shortcomings), it is the situation that predicts the foundation of a security group that joins a more express thought for forming a more secure future for the Middle East.

Keywords: Middle East, Globalization, Fragmentation, Conflict of civilizations, Majority rule peace, Development of a security group

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1890 The Current Status of Middle Class Internet Use in China: An Analysis Based on the Chinese General Social Survey 2015 Data and Semi-Structured Investigation

Authors: Abigail Qian Zhou

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In today's China, the well-educated middle class, with stable jobs and above-average income, are the driving force behind its Internet society. Through the analysis of data from the 2015 Chinese General Social Survey and 50 interviewees, this study investigates the current situation of this group’s specific internet usage. The findings of this study demonstrate that daily life among the members of this socioeconomic group is closely tied to the Internet. For Chinese middle class, the Internet is used to socialize and entertain self and others. It is also used to search for and share information as well as to build their identities. The empirical results of this study will provide a reference, supported by factual data, for enterprises seeking to target the Chinese middle class through online marketing efforts.

Keywords: middle class, Internet use, network behaviour, online marketing, China

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1889 Factors Associated with Recurrence and Long-Term Survival in Younger and Postmenopausal Women with Breast Cancer

Authors: Sopit Tubtimhin, Chaliya Wamaloon, Anchalee Supattagorn

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Background and Significance: Breast cancer is the most frequently diagnosed and leading cause of cancer death among women. This study aims to determine factors potentially predicting recurrence and long-term survival after the first recurrence in surgically treated patients between postmenopausal and younger women. Methods and Analysis: A retrospective cohort study was performed on 498 Thai women with invasive breast cancer, who had undergone mastectomy and been followed-up at Ubon Ratchathani Cancer Hospital, Thailand. We collected based on a systematic chart audit from medical records and pathology reports between January 1, 2002, and December 31, 2011. The last follow-up time point for surviving patients was December 31, 2016. A Cox regression model was used to calculate hazard ratios of recurrence and death. Findings: The median age was 49 (SD ± 9.66) at the time of diagnosis, 47% was post-menopausal women ( ≥ 51years and not experienced any menstrual flow for a minimum of 12 months), and 53 % was younger women ( ˂ 51 years and have menstrual period). Median time from the diagnosis to the last follow-up or death was 10.81 [95% CI = 9.53-12.07] years in younger cases and 8.20 [95% CI = 6.57-9.82] years in postmenopausal cases. The recurrence-free survival (RFS) for younger estimates at 1, 5 and 10 years of 95.0 %, 64.0% and 58.93% respectively, appeared slightly better than the 92.7%, 58.1% and 53.1% for postmenopausal women [HRadj = 1.25, 95% CI = 0.95-1.64]. Regarding overall survival (OS) for younger at 1, 5 and 10 years were 97.7%, 72.7 % and 52.7% respectively, for postmenopausal patients, OS at 1, 5 and 10 years were 95.7%, 70.0% and 44.5 respectively, there were no significant differences in survival [HRadj = 1.23, 95% CI = 0.94 -1.64]. Multivariate analysis identified five risk factors for negatively impacting on survival were triple negative [HR= 2.76, 95% CI = 1.47-5.19], Her2-enriched [HR = 2.59, 95% CI = 1.37-4.91], luminal B [HR = 2.29, 95 % CI=1.35-3.89], not free margin [HR = 1.98, 95%CI=1.00-3.96] and patients who received only adjuvant chemotherapy [HR= 3.75, 95% CI = 2.00-7.04]. Statistically significant risks of overall cancer recurrence were Her2-enriched [HR = 5.20, 95% CI = 2.75-9.80], triple negative [HR = 3.87, 95% CI = 1.98-7.59], luminal B [HR= 2.59, 95% CI = 1.48-4.54,] and patients who received only adjuvant chemotherapy [HR= 2.59, 95% CI = 1.48-5.66]. Discussion and Implications: Outcomes from this studies have shown that postmenopausal women have been associated with increased risk of recurrence and mortality. As the results, it provides useful information for planning the screening and treatment of early-stage breast cancer in the future.

Keywords: breast cancer, menopause status, recurrence-free survival, overall survival

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1888 Factors Influencing the Roles and Responsibilities of Middle Leaders in Saudi and English Primary Schools: A Comparative Critical Study

Authors: Saeed Musaid H. Alzahrani

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The role of middle leaders, especially in primary schools, is a multi-faced role that has been subject to changes in nature over recent decades, with claims for more distributed leadership practices. This research examines the way 18 middle leaders in Saudi and English primary schools conceptualise their roles and responsibilities, and different factors influencing those roles and responsibilities. It begins from the premise that both the power of the role and the values of middle leaders are grounded in cultural and political bases, a belief held by the researcher as an 'insider' within the Saudi educational leadership context. The study consisted of a comparative analysis of the role and the responsibilities of middle leaders in Saudi primary schools and their equivalents in English primary schools. A purely qualitative methodological stance was adopted, using in-depth face-to-face semi-structured interviews, observations and document analysis. Middle leaders were asked to reflect deeply on their perceptions and understanding of their roles and explain what they thought influenced their daily practices and responsibilities. The findings suggest that the concept of middle leadership has been influenced by power imposed from above by political authority, via internal and external hierarchical structures, which shapes the nature of the role of the middle leaders and forces them to comply. Middle leaders seem to believe they have the power to make decisions and promote change, but these findings suggest that this is illusory. The power that keeps middle leaders performing is the power of their cultural and religious values. Those values are the resource to which they turn in their search for more energy when they lack support and are short of time taken. Middle leaders in Saudi, just like their equivalents in English schools must comply with the requirements of their role. However, Saudi middle leaders are given no leeway to make decisions or implement change, neither do they have the culture of collegiality that seems to give middle leaders in England more power over their resources and decisions. However, in neither educational setting have middle leaders been given the power to lead, so they remain managers rather than leaders. The findings of this research suggest that there are more similarities between the educational settings of Saudi and England than differences; and in the light of different factors identified in the study, suggest the establishment of a framework for middle leadership, in the hope of enhancing the way the role is practiced.

Keywords: middle leader, primary school, power, educational leadership, value, culture, model, Saudi Arabia, England

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1887 Autonomy in Healthcare Organisations: A Comparative Case Study of Middle Managers in England and Iran

Authors: Maryam Zahmatkesh

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Middle managers form a significant occupational category in organisations. They undertake a vital role, as they sit between the operational and strategic roles. Traditionally they were acting as diplomat administrators, and were only in power to meet the demands of professionals. Following the introduction of internal market, in line with the principles of New Public Management, middle managers have been considered as change agents. More recently, in the debates of middle managers, there is emphasis on entrepreneurialism and enacting strategic role. It was assumed that granting autonomy to the local organisations and the inception of semi-autonomous hospitals (Foundation Trusts in England and Board of Trustees in Iran) would give managers more autonomy to act proactively and innovatively. This thesis explores the hospital middle managers’ perception of and responses to public management reforms (in particular, hospital autonomy) in England and Iran. In order to meet the aims of the thesis, research was undertaken within the interpretative paradigm, in line with social constructivism. Data were collected from interviews with forty-five middle managers, observational fieldwork and documentary analysis across four teaching university hospitals in England and Iran. The findings show the different ways middle managers’ autonomy is constrained in the two countries. In England, middle managers have financial and human recourses, but their autonomy is constrained by government policy and targets. In Iran, middle managers are less constrained by government policy and targets, but they do not have financial and human resources to exercise autonomy. Unbalanced autonomy causes tension and frustration for middle managers. According to neo-institutional theory, organisations are deeply embedded within social, political, economic and normative settings that exert isomorphic and internal population-level pressures to conform to existing and established modes of operation. Health systems which are seeking to devolve autonomy to middle managers must appreciate the multidimensional nature of the autonomy, as well as the wider environment that organisations are embedded, if they are about to improve the performance of managers and their organisations.

Keywords: autonomy, healthcare organisations, middle managers, new public management

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1886 Analyzing Middle Actors' Influence on Land Use Policy: A Case Study in Central Kalimantan, Indonesia

Authors: Kevin Soubly, Kaysara Khatun

Abstract:

This study applies the existing Middle-Out Perspective (MOP) as a complementing analytical alternative to the customary dichotomous options of top-down vs. bottom-up strategies of international development and commons governance. It expands the framework by applying it to a new context of land management and environmental change, enabling fresh understandings of decision making around land use. Using a case study approach in Central Kalimantan, Indonesia among a village of indigenous Dayak, this study explores influences from both internal and external middle actors, utilizing qualitative empirical evidence and incorporating responses across 25 village households and 11 key stakeholders. Applying the factors of 'agency' and 'capacity' specific to the MOP, this study demonstrates middle actors’ unique capabilities and criticality to change due to their influence across various levels of decision-making. Study results indicate that middle actors play a large role, both passively and actively, both directly and indirectly, across various levels of decision-making, perception-shaping, and commons governance. In addition, the prominence of novel 'passive' middle actors, such as the internet, can provide communities themselves with a level of agency beyond that provided by other middle actors such as NGOs and palm oil industry entities – which often operate at the behest of the 'top' or out of self-interest. Further, the study posits that existing development and decision-making frameworks may misidentify the 'bottom' as the 'middle,' raising questions about traditional development and livelihood discourse, strategies, and support, from agricultural production to forest management. In conclusion, this study provides recommendations including that current policy preconceptions be reevaluated to engage middle actors in locally-adapted, integrative manners in order to improve governance and rural development efforts more broadly.

Keywords: environmental management, governance, Indonesia, land use, middle actors, middle-out perspective

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1885 The Development of a School-Based Wellbeing Programme to Enhance the Social Functioning of Learners in Middle Childhood

Authors: Soretha Beets, Izanette Van Schalkwyk, Doret K. Kirsten

Abstract:

Children in middle childhood are exposed to various risks, for example, risks associated with poverty and/or dysfunctional families, that may threaten their social functioning. The aim of this study was to develop and design a programme that can be presented to children in middle childhood in order to enhance their social functioning towards better wellbeing. The skills and competencies needed to be included in the programme were identified by means of a literature review and 4 focus groups with educators from 4 sub-areas in a certain district in the North-West Province of South Africa. The programme consists of 8 sessions, presented in a certain order. The sessions cover the following aspects: self-esteem and gratitude, self-regulation and goal-setting, values and relationships, communication and listening, conflict management, emotional competence, and resilient coping. These aspects may benefit children in the middle child’s wellbeing and live on the short-term and may also hold long-term benefits.

Keywords: middle childhood, programme development, social functioning, wellbeing

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1884 Civil-Military Relations in Turkey, Europe, and Middle East

Authors: Dorsa Bakhshandehgeyazdi

Abstract:

This article tries to comprehend the change of Turkish common military relations in an analogical viewpoint. The investigation is taking into account two criteria: institutional / legitimate systems and political oversight of the military's self-sufficiency. Examination of European furthermore, Middle Eastern common military relations models to the Turkish ideal model discloses grave contrasts in the middle of Turkish and Middle Eastern common military relations. The Turkish model in change for not less than 10 years is closer to the European show in both lawful and political perspectives. However, the article underscores that Turkish common military relations are still in change and despite the fact that the EU increase procedure has continuously democratized the legitimate arrangement of the nation, law based combining obliges further advances in the political area. A the result, stabilization in Turkey depends not just on withdrawing of the military from the political domain, additionally on the best possible civilization of the administration in hypothesis and practice.

Keywords: Turkish common military, institutional, legitimate systems, political oversight, middle Eastern common military

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1883 Personal Perception of the Acoustic Properties of Three Different Rooms for Music Lessons

Authors: Natalia Ivanova, Konstantin Adamov

Abstract:

The importance of acoustics in music classes made us analyse three music rooms in a Bulgarian school. The same music piece was performed in every one of the classrooms. The recording was played to 2 groups of students. A survey was then taken among those students in order to determine their personal preferences and impressions of the acoustic. The results show differences in the preferences of older students compared to younger ones. Results of the survey show a correlation between older students’ preferences and the standard requirements. However, we discover that younger students’ classrooms should be further analysed and adapted to their needs and preferences.

Keywords: acousic, building acoustic, sound quality, scool acoustic

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1882 Roles Currently Played by Educational Middle Leaders

Authors: Elaine Marta Pereira Aaltonen

Abstract:

Effective school leadership materialised in educational settings through the high standard professional performance of senior and middle leaders, has increasingly become an education policy priority around the world due to a wide recognition that schools need knowledgeable, skilled, and committed leaders, along with great teachers, in order to ensure outstanding education at all levels of schooling. The scope of this paper is the work of middle leaders, whose direct influence on teachers and classroom teaching, thus, on student learning outcomes, is a key component for successful school systems. It particularly aims at sharing some of the findings obtained through an academic study recently carried out by the same researcher, which was focused on enhancing understanding about aspects related to the professional performance of educational middle leaders, applied to the context of the lower elementary school division of a private mainstream school located in Brazil. The master´s dissertation findings included identifying the roles performed by a team of educational middle leaders throughout the year of 2021, as well as gaining insights on their perceptions about the roles performed, both through an electronic questionnaire and individual face-to-face interviews. Not only the roles of the middle leaders who participated in the research have been identified through the qualitative case study undertaken, but additional research finding lying within the sphere of the categorisation of such roles, based upon coherent domains of practice, has possibly been made. Hence, the main purpose of this paper is to outline the findings concerning the current roles played by educational middle leaders.

Keywords: roles, middle leaders, educational leadership, school leadership, and management

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1881 A Systematic Review on Assistive Technology Robotics in Lower and Middle-Income Settings

Authors: Sumudu Sameera Perera Kimmantudawage, Chapal Khasnabis

Abstract:

Technology is changing at a rapid rate, with innovations in robotics being hailed and tested in countries such as Japan, the United States and Australia, however the conversation in a public health context is stagnant. While obvious barriers to robotics use in low and middle-income countries and regions exist, the avoidance of attempting to address these regions of the world may potentially lead to an ever-increasing divide between those of high income countries and those of less. A systematic review was undertaken to determine the number of projects involving research, development and testing of robotics considered low and middle-income regions. Major findings indicate that an overwhelmingly significant number of projects failed to consider low and middle-income countries or regions. These results are unsurprising however alarming, as bridging the divide is an important step forward in achieving the UN Sustainable Development Goals by 2030. It is hoped that this research would spawn future robotics research that focusses on lower and middle-income regions.

Keywords: assistive technology, health equality, robotics, socioeconomic

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1880 Mediation of the Middle Eastern Crises and Economic Growth: An Application of Times Series Analysis

Authors: Gokhan Erkal, Gulsen Aydin, Muge Yuce, Lokman Sahin

Abstract:

This study aims to analyze the impacts of involving in mediation of conflicts in the Middle East from the perspective of the economic growth of the mediators. The Middle East is a highly volatile region of the world with rampant crises whose affects spill beyond its borders. Therefore, management and resolution of the conflicts in the region are of great significance. Mediation is an instrument used for abating violence and settling dispute. The recourse to mediation has grown to an important degree in recent years. However, for mediators, it is a daunting task to involve in the mediation of the deadlocks in the Middle East. This study tries to shed light on the positive correlation between economic growth of the mediator and the successful outcome of the mediation process to provide motivation for mediators. To this end, first, it briefly introduces the conflicts ongoing in the region and their negative impacts. Second, the methodology, time series analysis, and the data to be used, International Crisis Behavior Project Data, are presented. Third, the empirical test is carried out and the findings are evaluated. The conclusion highlights the benefits of successful mediation for the economic growth of the mediators of Middle Eastern crises.

Keywords: international crises, mediation, Middle East, times series analysis

Procedia PDF Downloads 152