Dynamic Admission Control Based on Effective Demand for Next Generation Wireless Networks

In next generation wireless networks (i.e., 4G and beyond), one of the main objectives is to ensure highest level of customer satisfaction in terms of data transfer speed, decrease in cost and delay, non-rejection and no drop of calls, availability of ‘always-on’ connectivity and services, continuity of connected services, hastle-free roaming in addition to the convenience of use of network services from anywhere and anytime. To take care of these requirements effectively, internet service providers (ISPs) and network planners have to go for major capacity enhancement of network resources and at the same time these resources are to be used effectively and efficiently to reduce cost and to increase revenue. In this work, the effective bandwidth available in a Mobile Switching Center (MSC) of a wireless network providing multi-class multimedia services is analyzed. Bandwidth requirement of the users for a customized Quality of Service (QoS) is estimated. The findings of the QoS estimation are applied for the capacity planning and admission control of the multi-class traffic flows coming into the MSC.

A Comparative Study of Insurance Policies Worldwide in Public Private Partnerships

The frequent occurrence of failures in PPP projects which caused great loss has raised attention from the government as well as the concessionaire. PPPs are complex arrangements for its long operation period and multiple players. Many types of risks in PPP projects may cause the project fail. The insurance is an important tool to transfer the risks. Through a comparison and analysis of international government PPP guidelines and contracts as well as the case studies worldwide, we have identified eight main insurance principles, discussed thirteen insurance types in different stages. An overall procedure would be established to improve the practices in PPP projects.

Three-Stage Mining Metals Supply Chain Coordination and Product Quality Improvement with Revenue Sharing Contract

One of the main concerns of miners is to increase the quality level of their products because the mining metals price depends on their quality level; however, increasing the quality level of these products has different costs at different levels of the supply chain. These costs usually increase after extractor level. This paper studies the coordination issue of a decentralized three-level supply chain with one supplier (extractor), one mineral processor and one manufacturer in which the increasing product quality level cost at the processor level is higher than the supplier and at the level of the manufacturer is more than the processor. We identify the optimal product quality level for each supply chain member by designing a revenue sharing contract. Finally, numerical examples show that the designed contract not only increases the final product quality level but also provides a win-win condition for all supply chain members and increases the whole supply chain profit.

Development of Mechanisms of Value Creation and Risk Management Organization in the Conditions of Transformation of the Economy of Russia

In modern conditions, scientific judgment of problems in developing mechanisms of value creation and risk management acquires special relevance. Formation of economic knowledge has resulted in the constant analysis of consumer behavior for all players from national and world markets. Effective mechanisms development of the demand analysis, crucial for consumer's characteristics of future production, and the risks connected with the development of this production are the main objectives of control systems in modern conditions. The modern period of economic development is characterized by a high level of globalization of business and rigidity of competition. At the same time, the considerable share of new products and services costs has a non-material intellectual nature. The most successful in Russia is the contemporary development of small innovative firms. Such firms, through their unique technologies and new approaches to process management, which form the basis of their intellectual capital, can show flexibility and succeed in the market. As a rule, such enterprises should have very variable structure excluding the tough scheme of submission and demanding essentially new incentives for inclusion of personnel in innovative activity. Realization of similar structures, as well as a new approach to management, can be constructed based on value-oriented management which is directed to gradual change of consciousness of personnel and formation from groups of adherents included in the solution of the general innovative tasks. At the same time, valuable changes can gradually capture not only innovative firm staff, but also the structure of its corporate partners. Introduction of new technologies is the significant factor contributing to the development of new valuable imperatives and acceleration of the changing values systems of the organization. It relates to the fact that new technologies change the internal environment of the organization in a way that the old system of values becomes inefficient in new conditions. Introduction of new technologies often demands change in the structure of employee’s interaction and training in their new principles of work. During the introduction of new technologies and the accompanying change in the value system, the structure of the management of the values of the organization is changing. This is due to the need to attract more staff to justify and consolidate the new value system and bring their view into the motivational potential of the new value system of the organization.

Position of the Constitutional Court of the Russian Federation on the Matter of Restricting Constitutional Rights of Citizens Concerning Banking Secrecy

The aim of the present article is to analyze the position of the Constitutional Court of the Russian Federation on the matter of restricting the constitutional rights of citizens to inviolability of professional and banking secrecy in effecting controlling activities. The methodological ground of the present Article represents the dialectic scientific method of the socio-political, legal and organizational processes with the principles of development, integrity, and consistency, etc. The consistency analysis method is used while researching the object of the analysis. Some public-private research methods are also used: the formally-logical method or the comparative legal method, are used to compare the understanding of the ‘secrecy’ concept. The aim of the present article is to find the root of the problem and to give recommendations for the solution of the problem. The result of the present research is the author’s conclusion on the necessity of the political will to improve Russian legislation with the aim of compliance with the provisions of the Constitution. It is also necessary to establish a clear balance between the constitutional rights of the individual and the limit of these rights when carrying out various control activities by public authorities. Attempts by the banks to "overdo" an anti-money laundering law under threat of severe sanctions by the regulators actually led to failures in the execution of normal economic activity. Therefore, individuals face huge problems with payments on the basis of clearing, in addition to problems with cash withdrawals. The Bank of Russia sets requirements for banks to execute Federal Law No. 115-FZ too high. It is high place to attract political will here. As well, recent changes in Russian legislation, e.g. allowing banks to refuse opening of accounts unilaterally, simplified banking activities in the country. The article focuses on different theoretical approaches towards the concept of “secrecy”. The author gives an overview of the practices of Spain, Switzerland and the United States of America on the matter of restricting the constitutional rights of citizens to inviolability of professional and banking secrecy in effecting controlling activities. The Constitutional Court of the Russian Federation basing on the Constitution of the Russian Federation has its special understanding of the issue, which should be supported by further legislative development in the Russian Federation.

Growth Performance and Yield of the Edible White Rot Fungus (Pleurotus ostreatus) on Different Agro Waste Materials

A study was carried out to evaluate the growth and yield performance of Pleurotus ostreatus spawn on different organic substrates in Lafia, Nasarawa State, Nigeria. 50 g each of four different substrates namely; corncobs, rice straw, sugarcane bagasse and sawdust sourced locally from farmlands and processing sites, were amended with 2% calcium carbonate and calcium sulphide and sterilized using three sterilization methods namely; hot water, steam, and lime. Five grams of P. ostreatus spawn were inoculated unto treated substrates, incubated in the dark for 16 days and in light for 19 days at 25 0C for the commencement of pinhead and fruit body formations respectively. Growth and yield parameters such as days to full colonization, days to pinhead formation and days to fruit body formation were recorded. Cap diameter and fresh weight of mature mushrooms were also measured for a total count of four flushes. P. ostreatus spawn grown on sugarcane bagasse recorded the highest mean cap diameter (4.69 cm), highest mean fresh weight (34.68 g), highest biological efficiency (69.37%) and highest production rate (2.83 g per day). Spawn grown on rice straw recorded the least number of days to full substrate colonization (11.00). Spawn grown on corn cobs recorded the least mean number of days to pin head (18.75) and fruiting body formations (20.25). There were no significant differences (P ≤ 0.05) among the evaluated substrates with respect to growth and yield performance of P. ostreatus. Substrates sterilized with hot water supported the highest mean cap diameter (5.64 cm), highest biological efficiency (87.04%) and highest production rate (3.43 g per day) of P. ostreatus. Significant differences (P ≤ 0.05) were observed in cap diameter, fresh weight, biological efficiency and production rates among the evaluated sterilization methods. Hot water sterilization of sugarcane bagasse could be adopted for enhanced yield of oyster mushrooms, especially among indigent farming communities in Nigeria and beyond.

Islamic Education System: Implementation of Curriculum Kuttab Al-Fatih Semarang

The picture and pattern of Islamic education in the Prophet's period in Mecca and Medina is the history of the past that we need to bring back. The Basic Education Institute called Kuttab. Kuttab or Maktab comes from the word kataba which means to write. The popular Kuttab in the Prophet’s period aims to resolve the illiteracy in the Arab community. In Indonesia, this Institution has 25 branches; one of them is located in Semarang (i.e. Kuttab Al-Fatih). Kuttab Al-Fatih as a non-formal institution of Islamic education is reserved for children aged 5-12 years. The independently designed curriculum is a distinctive feature that distinguishes between Kuttab Al-Fatih curriculum and the formal institutional curriculum in Indonesia. The curriculum includes the faith and the Qur’an. Kuttab Al-Fatih has been licensed as a Community Activity Learning Center under the direct supervision and guidance of the National Education Department. Here, we focus to describe the implementation of curriculum Kuttab Al-Fatih Semarang (i.e. faith and al-Qur’an). After that, we determine the relevance between the implementation of the Kuttab Al-Fatih education system with the formal education system in Indonesia. This research uses literature review and field research qualitative methods. We obtained the data from the head of Kuttab Al-Fatih Semarang, vice curriculum, faith coordinator, al-Qur’an coordinator, as well as the guardians of learners and the learners. The result of this research is the relevance of education system in Kuttab Al-Fatih Semarang about education system in Indonesia. Kuttab Al-Fatih Semarang emphasizes character building through a curriculum designed in such a way and combines thematic learning models in modules.

FPGA Implementation of Adaptive Clock Recovery for TDMoIP Systems

Circuit switched networks widely used until the end of the 20th century have been transformed into packages switched networks. Time Division Multiplexing over Internet Protocol (TDMoIP) is a system that enables Time Division Multiplexing (TDM) traffic to be carried over packet switched networks (PSN). In TDMoIP systems, devices that send TDM data to the PSN and receive it from the network must operate with the same clock frequency. In this study, it was aimed to implement clock synchronization process in Field Programmable Gate Array (FPGA) chips using time information attached to the packages received from PSN. The designed hardware is verified using the datasets obtained for the different carrier types and comparing the results with the software model. Field tests are also performed by using the real time TDMoIP system.

ZnS and Graphene Quantum Dots Nanocomposite as Potential Electron Acceptor for Photovoltaics

Zinc sulphide (ZnS) quantum dots (QDs) were synthesized successfully via simple sonochemical method. X-ray diffraction (XRD), scanning electron microscopy (SEM) and high resolution transmission electron microscopy (HRTEM) analysis revealed the average size of QDs of the order of 3.7 nm. The band gap of the QDs was tuned to 5.2 eV by optimizing the synthesis parameters. UV-Vis absorption spectra of ZnS QD confirm the quantum confinement effect. Fourier transform infrared (FTIR) analysis confirmed the formation of single phase ZnS QDs. To fabricate the diode, blend of ZnS QDs and P3HT was prepared and the heterojunction of PEDOT:PSS and the blend was formed by spin coating on indium tin oxide (ITO) coated glass substrate. The diode behaviour of the heterojunction was analysed, wherein the ideality factor was found to be 2.53 with turn on voltage 0.75 V and the barrier height was found to be 1.429 eV. ZnS-Graphene QDs nanocomposite was characterised for the surface morphological study. It was found that the synthesized ZnS QDs appear as quasi spherical particles on the graphene sheets. The average particle size of ZnS-graphene nanocomposite QDs was found to be 8.4 nm. From voltage-current characteristics of ZnS-graphene nanocomposites, it is observed that the conductivity of the composite increases by 104 times the conductivity of ZnS QDs. Thus the addition of graphene QDs in ZnS QDs enhances the mobility of the charge carriers in the composite material. Thus, the graphene QDs, with high specific area for a large interface, high mobility and tunable band gap, show a great potential as an electron-acceptors in photovoltaic devices.

Improved Small-Signal Characteristics of Infrared 850 nm Top-Emitting Vertical-Cavity Lasers

High-speed infrared vertical-cavity surface-emitting laser diodes (VCSELs) with Cu-plated heat sinks were fabricated and tested. VCSELs with 10 mm aperture diameter and 4 mm of electroplated copper demonstrated a -3dB modulation bandwidth (f-3dB) of 14 GHz and a resonance frequency (fR) of 9.5 GHz at a bias current density (Jbias) of only 4.3 kA/cm2, which corresponds to an improved f-3dB2/Jbias ratio of 44 GHz2/kA/cm2. At higher and lower bias current densities, the f-3dB2/ Jbias ratio decreased to about 30 GHz2/kA/cm2 and 18 GHz2/kA/cm2, respectively. Examination of the analogue modulation response demonstrated that the presented VCSELs displayed a steady f-3dB/ fR ratio of 1.41±10% over the whole range of the bias current (1.3Ith to 6.2Ith). The devices also demonstrated a maximum modulation bandwidth (f-3dB max) of more than 16 GHz at a bias current less than the industrial bias current standard for reliability by 25%.

Gamification of eHealth Business Cases to Enhance Rich Learning Experience

Introduction of games has expanded the application area of computer-aided learning tools to wide variety of age groups of learners. Serious games engage the learners into a real-world -type of simulation and potentially enrich the learning experience. Institutional background of a Bachelor’s level engineering program in Information and Communication Technology is introduced, with detailed focus on one of its majors, Health Technology. As part of a Customer Oriented Software Application thematic semester, one particular course of “eHealth Business and Solutions” is described and reflected in a gamified framework. Learning a consistent view into vast literature of business management, strategies, marketing and finance in a very limited time enforces selection of topics relevant to the industry. Health Technology is a novel and growing industry with a growing sector in consumer wearable devices and homecare applications. The business sector is attracting new entrepreneurs and impatient investor funds. From engineering education point of view the sector is driven by miniaturizing electronics, sensors and wireless applications. However, the market is highly consumer-driven and usability, safety and data integrity requirements are extremely high. When the same technology is used in analysis or treatment of patients, very strict regulatory measures are enforced. The paper introduces a course structure using gamification as a tool to learn the most essential in a new market: customer value proposition design, followed by a market entry game. Students analyze the existing market size and pricing structure of eHealth web-service market and enter the market as a steering group of their company, competing against the legacy players and with each other. The market is growing but has its rules of demand and supply balance. New products can be developed with an R&D-investment, and targeted to market with unique quality- and price-combinations. Product cost structure can be improved by investing to enhanced production capacity. Investments can be funded optionally by foreign capital. Students make management decisions and face the dynamics of the market competition in form of income statement and balance sheet after each decision cycle. The focus of the learning outcome is to understand customer value creation to be the source of cash flow. The benefit of gamification is to enrich the learning experience on structure and meaning of financial statements. The paper describes the gamification approach and discusses outcomes after two course implementations. Along the case description of learning challenges, some unexpected misconceptions are noted. Improvements of the game or the semi-gamified teaching pedagogy are discussed. The case description serves as an additional support to new game coordinator, as well as helps to improve the method. Overall, the gamified approach has helped to engage engineering student to business studies in an energizing way.

Heavy Metal Contamination of a Dumpsite Environment as Assessed with Pollution Indices

Indiscriminate refuse dumping in and around Ado-Ekiti combined with improper management of few available dumpsites, such as Ilokun dumpsite, posed the threat of heavy metals pollution in the surrounding soils and underground water that needs assessment using pollution indices. Surface soils (0-15 cm) were taken from the centre of Ilokun dumpsite (0 m) and environs at different directions and distances during the dry and wet seasons, as well as a background sample at 1000 m away, adjacent to the dumpsite at Ilokun, Ado-Ekiti, Nigeria. The concentration of heavy metals used to calculate the pollution indices for the soils were determined using Atomic Adsorption Spectrophotometer. The soils recorded high concentrations of all the heavy metals above the background concentrations irrespective of the season with highest concentrations at the 0 m except Ni and Fe at 50 m during the dry and wet season, respectively. The heavy metals concentration were in the order of Ni > Mn > Pb > Cr > Cu > Cd > Fe during the dry season, and Fe > Cr > Cu > Pb > Ni > Cd > Mn during the wet season. Using the Contamination Factor (CF), the soils were classified to be moderately contaminated with Cd and Fe to very high contamination with other metals during the dry season and low Cd contamination (0.87), moderate contamination with Fe, Pb, Mn and Ni and very high contamination with Cr and Cu during the wet season. At both seasons, the Pollution Load Index (PLI) indicates the soils to be generally polluted with heavy metals and the Geoaccumulation Index (Igeo) calculated shown the soils to be in unpolluted to moderately polluted levels. Enrichment Factor (EF) implied the soils to be deficiently enriched with all the heavy metals except Cr (7.90) and Cu (6.42) that were at significantly enrichment levels during the wet season. Modified Degree of Contamination (mCd) recorded, indicated the soils to be of very high to extremely high degree of contamination during the dry season and moderate degree of contamination during the wet season except 0 m with high degree of contamination. The concentration of heavy metals in the soils combined with some of the pollution indices indicated the soils in and around the Ilokun Dumpsite are being polluted with heavy metals from anthropogenic sources constituted by the indiscriminate refuse dumping.

The Impact of Leadership Style and Sense of Competence on the Performance of Post-Primary School Teachers in Oyo State, Nigeria

The not so pleasing state of the nation's quality of education has been a major area of research. Many researchers have looked into various aspects of the educational system and organizational structure in relation to the quality of service delivery of the staff members. However, there is paucity of research in areas relating to the sense of competence and commitment in relation to leadership styles. Against this backdrop, this study investigated the impact of leadership style and sense of competence on the performance of post-primary school teachers in Oyo state Nigeria. Data were generated across public secondary schools in the city using survey design method. Ibadan as a metropolis has eleven local government areas contained in it. A systematic random sampling technique of the eleven local government areas in Ibadan was done and five local government areas were selected. The selected local government areas are Akinyele, Ibadan North, Ibadan North-East, Ibadan South and Ibadan South-West. Data were obtained from a range of two – three public secondary schools selected in each of the local government areas mentioned above. Also, these secondary schools are a representation of the variations in the constructs under consideration across the Ibadan metropolis. Categorically, all secondary school teachers in Ibadan were clustered into selected schools in those found across the five local government areas. In all, a total of 272 questionnaires were administered to public secondary school teachers, while 241 were returned. Findings revealed that transformational leadership style makes room for job commitment when compared with transactional and laissez-faire leadership styles. Teachers with a high sense of competence are more likely to demonstrate more commitment to their job than others with low sense of competence. We recommend that, it is important an assessment is made of the leadership styles employed by principals and school administrators. This guides administrators and principals in to having a clear, comprehensive knowledge of the style they currently adopt in the management of the staff and the school as a whole; and know where to begin the adjustment process from. Also to make an impact on student achievement, being attentive to teachers’ levels of commitment may be an important aspect of leadership for school principals.

Studying the Behavior of Asphalt Mix and Their Properties in the Presence of Nano Materials

Due to rapid development, increase in the traffic load, higher traffic volume and seasonal variation in temperature, asphalt pavement shows distresses like rutting, fatigue and thermal cracking etc. because of this pavement fails during service life so that bitumen needs to be modified with some additive. In this study VG30 grade bitumen modify with addition of nanosilica with 1% to 5% (increment of 1%) by weight of bitumen. Hot mix asphalt (HMA) have higher mixing, laying and rolling temperatures which leads to higher consumption of fuel. To address this issue, a nano material named ZycoTherm which is chemical warm mix asphalt (WMA) additive is added to bitumen. Nanosilica modification (NSMB) results in the increase in stability compared to unmodified bitumen (UMB). WMA modified mix shows slightly higher stability than UMB and NSMB in a lower bitumen content. The Retained stability and tensile strength ratio (TSR) is more than 75% and 80% respectively for both mixes. Nanosilica with WMA has more resistant to temperature susceptibility, moisture susceptibility and short term aging than NSMB.

Nonstationarity Modeling of Economic and Financial Time Series

Traditional techniques for analyzing time series are based on the notion of stationarity of phenomena under study, but in reality most economic and financial series do not verify this hypothesis, which implies the implementation of specific tools for the detection of such behavior. In this paper, we study nonstationary non-seasonal time series tests in a non-exhaustive manner. We formalize the problem of nonstationary processes with numerical simulations and take stock of their statistical characteristics. The theoretical aspects of some of the most common unit root tests will be discussed. We detail the specification of the tests, showing the advantages and disadvantages of each. The empirical study focuses on the application of these tests to the exchange rate (USD/TND) and the Consumer Price Index (CPI) in Tunisia, in order to compare the Power of these tests with the characteristics of the series.

Optimization the Conditions of Electrophoretic Deposition Fabrication of Graphene-Based Electrode to Consider Applications in Electro-Optical Sensors

Graphene has gained much attention owing to its unique optical and electrical properties. Charge carriers in graphene sheets (GS) carry out a linear dispersion relation near the Fermi energy and behave as massless Dirac fermions resulting in unusual attributes such as the quantum Hall effect and ambipolar electric field effect. It also exhibits nondispersive transport characteristics with an extremely high electron mobility (15000 cm2/(Vs)) at room temperature. Recently, several progresses have been achieved in the fabrication of single- or multilayer GS for functional device applications in the fields of optoelectronic such as field-effect transistors ultrasensitive sensors and organic photovoltaic cells. In addition to device applications, graphene also can serve as reinforcement to enhance mechanical, thermal, or electrical properties of composite materials. Electrophoretic deposition (EPD) is an attractive method for development of various coatings and films. It readily applied to any powdered solid that forms a stable suspension. The deposition parameters were controlled in various thicknesses. In this study, the graphene electrodeposition conditions were optimized. The results were obtained from SEM, Ohm resistance measuring technique and AFM characteristic tests. The minimum sheet resistance of electrodeposited reduced graphene oxide layers is achieved at conditions of 2 V in 10 s and it is annealed at 200 °C for 1 minute.

The Effects of Mountain Biking as Psychomotor Instrument in Physical Education: Balance’s Evaluation

The school physical education is going through several changes over the years, and diversification of its content from specific interests is one of the reasons for these changes, soon, the formality in education do not have to stay out, but needs to open up the possibilities offered by the world, so the Mountain Bike, an adventure sport, offers several opportunities for intervention Its application in the school allows diverse interventions in front of the psychomotor development, besides opening possibilities for other contents, respecting the previous experiences of the students in their common environment. The choice of theme was due to affinity with the practice and experience of the Mountain Bike at different levels. Both competitive as recreational, professional standard and amateur, focus as principle the bases of the Cycling, coupled with the inclusion in the Centre for Studies in Management of Sport and Leisure and of the Southwest Bahia State University and the preview of the modality's potential to help the children’s psychomotor development. The goal of this research was to demonstrate like a pilot project the effects of the Mountain Bike as psychomotor instrument in physical education at one of the psychomotor valences, Balance, evaluating Immobility, Static Balance and Dynamic Balance. The methodology used Fonseca’s Psychomotor Battery in 10 students (n=10) of a brazilian public primary’s school, with ages between 9 and 11 years old to use the Mountain Biking contents. The balance’s skills dichotomized in Regular and Good. Regarding the variable Immobility, in the initial test, regardless of gender, 70% (n = 7) were considered Regular. After four months of activity, the Good profile, which had only 30% (n = 3) of the sample, evolved to 60% (n = 6). As in Static and Dynamic Balance there was an increase of 30% (n = 3) and 50% (n = 5) respectively for Good. Between genders, female evolution was better for Good in Immobility and in Static Equilibrium. Already the male evolution was better observed in the Dynamic Equilibrium, with 66.7% (n = 4) for Good. Respecting the particularities of the motor development, an indication of the positive effects of the MTB for the evolution in the balance perceived, necessitating studies with greater sampling.

The Experiences of Hong Kong Chinese Divorced Wives in Facing the Cancer Death of Their Ex-Husbands

With the surge of divorce rate and male cancer onset/death rates, the phenomenon of divorced wives in the facing cancer death of their ex-husbands is not uncommon in Hong Kong. Yet, there is a dearth of study on the experiences of bereaved-divorced wives in the Hong Kong cultural context. This project fills the knowledge gap by conducting a qualitative study for having interviewed four bereaved ex-wives, who returned to ex-husbands’ end-of-life caregiving and eventually grieved for the ex-spousal’s death. From the perspectives of attachment theory and disenfranchised grief in the Hong Kong cultural context, a ‘double-loss’ experience is found in which interviewees suffer from the first loss of divorce and the second loss of ex-husbands’ death. Traumatic childhood experiences, attachment needs, role ambiguity, unresolved emotions and unrecognized grief are found significant in their lived experiences which alert the ‘double-loss’ is worthy of attention. Extending a family-centered end-of-life and bereavement care services to divorced couples is called for, in which validation on the attachment needs, ex-couple reconciliation, and acknowledgement on the disenfranchised grief are essential for social work practice on this group of clienteles specifically in Hong Kong cultural context.

Hypersonic Flow of CO2-N2 Mixture around a Spacecraft during the Atmospheric Reentry

The aim of this work is to analyze a flow around the axisymmetric blunt body taken into account the chemical and vibrational nonequilibrium flow. This work concerns the entry of spacecraft in the atmosphere of the planet Mars. Since the equations involved are non-linear partial derivatives, the volume method is the only way to solve this problem. The choice of the mesh and the CFL is a condition for the convergence to have the stationary solution.

A Study of Applying the Use of Breathing Training to Palliative Care Patients, Based on the Bio-Psycho-Social Model

In clinical practices, it is common that while facing the unknown progress of their disease, palliative care patients may easily feel anxious and depressed. These types of reactions are a cause of psychosomatic diseases and may also influence treatment results. However, the purpose of palliative care is to provide relief from all kinds of pains. Therefore, how to make patients more comfortable is an issue worth studying. This study adopted the “bio-psycho-social model” proposed by Engel and applied spontaneous breathing training, in the hope of seeing patients’ psychological state changes caused by their physiological state changes, improvements in their anxious conditions, corresponding adjustments of their cognitive functions, and further enhancement of their social functions and the social support system. This study will be a one-year study. Palliative care outpatients will be recruited and assigned to the experimental group or the control group for six outpatient visits (once a month), with 80 patients in each group. The patients of both groups agreed that this study can collect their physiological quantitative data using an HRV device before the first outpatient visit. They also agreed to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” before the first outpatient visit, to fill a self-report questionnaire after each outpatient visit, and to answer the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire” after the last outpatient visit. The patients of the experimental group agreed to receive the breathing training under HRV monitoring during the first outpatient visit of this study. Before each of the following three outpatient visits, they were required to fill a self-report questionnaire regarding their breathing practices after going home. After the outpatient visits, they were taught how to practice breathing through an HRV device and asked to practice it after going home. Later, based on the results from the HRV data analyses and the pre-tests and post-tests of the “Beck Anxiety Inventory (BAI)”, the “Taiwanese version of the WHOQOL-BREF questionnaire”, the influence of the breathing training in the bio, psycho, and social aspects were evaluated. The data collected through the self-report questionnaires of the patients of both groups were used to explore the possible interfering factors among the bio, psycho, and social changes. It is expected that this study will support the “bio-psycho-social model” proposed by Engel, meaning that bio, psycho, and social supports are closely related, and that breathing training helps to transform palliative care patients’ psychological feelings of anxiety and depression, to facilitate their positive interactions with others, and to improve the quality medical care for them.