Search results for: patient engagement

Authors: Inna R. Edara, Haw-Lin Wu

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Positive psychology investigates human strengths and virtues and promotes well-being. Relying on this assumption, positive interventions have been continuously designed to build pleasure and happiness, joy and contentment, engagement and meaning, hope and optimism, satisfaction and gratitude, spirituality, and various other positive measures of well-being. In line with this model of positive psychology and interventions, this study investigated certain measures of well-being in a group of 45 students enrolled in an 18-week positive psychology course and simultaneously engaged in service-oriented interventions that they chose for themselves based on the course content and individual interests. Students’ well-being was measured at the beginning and end of the course. The well-being indicators included positive automatic thoughts, optimism and hope, satisfaction with life, and spirituality. A paired-samples t-test conducted to evaluate the impact of class content and service-oriented interventions on students’ scores of well-being indicators indicated statistically significant increase from pre-class to post-class scores. There were also significant gender differences in post-course well-being scores, with females having higher levels of well-being than males. A two-way between groups analysis of variance indicated a significant interaction effect of age by gender on the post-course well-being scores, with females in the age group of 56-65 having the highest scores of well-being in comparison to the males in the same age group. Regression analyses indicated that positive automatic thought significantly predicted hope and satisfaction with life in the pre-course analysis. In the post-course regression analysis, spiritual transcendence made a significant contribution to optimism, and positive automatic thought made a significant contribution to both hope and satisfaction with life. Finally, a significant test between pre-course and post-course regression coefficients indicated that the regression coefficients at pre-course were significantly different from post-course coefficients, suggesting that the positive psychology course and the interventions were helpful in raising the levels of well-being. The overall results suggest a substantial increase in the participants’ well-being scores after engaging in the positive-oriented interventions, implying a need for designing more positive interventions in education to promote well-being.  

Keywords: hope, optimism, positive automatic thoughts, satisfaction with life, spirituality, well-being

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Authors: Ceren Akyüz, Ingo Froboese

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Health literacy has gained importance with the further spread of the coronavirus disease (COVID-19) worldwide and has been associated with health status in various chronic diseases. Many studies indicate that mental health can be improved by low- or moderate-intensity activity, and several studies have been proposed to explain the relationship between physical activity and mental health. The aim of the present study is to investigate the levels of physical activity, health literacy, and depression in first- and- second generation Turkish people in Germany. The research consists of 434 participants (255 females, 179 males; age 38.09 ± 13.73). 40.8 % of participants are married, and 59.2 % of participants are single. Education levels are mostly at university level (54.8 %), and graduate level is 18.9 %. While 24.9 % of the participants are second generation, 75.1 % of participants are first generation. All analyses were stratified on gender, marital status, education, generation and income status, and five age categories: 18–30, 31–40, 41–50, 51–60, and 61–79, which were defined to account for age-specific trends while maintaining sufficient cell size for statistical analysis. A correlation of depression with physical activity and health literacy levels between first- and- second generation Turks in Germany was evaluated in order to find out whether there are significant differences between the two populations and demographic variables (gender, marital status, education, generation, income status) with carrying out questionnaires which are European Health Literacy Survey Questionnaire (HLS-EU-Q47), International Physical Activity Questionnaire ( IPAQ) and the Patient Health Questionnaire-9 (PHQ-9).

Keywords: health literacy, turks in germany, migrants, depression, physical activity

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Authors: A. Duncan, A. Blake, A. O'Gara, J. Fitzgerald

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Introduction: Acute traumatic rib fractures have significant morbidity and mortality and are a commonly seen injury in trauma patients. Rib fracture pain can often be acute and can prove challenging to manage. We performed an audit on patients with acute traumatic rib fractures with the aim of composing a referral and treatment pathway for such patients. Methods: From January 2021 to January 2022, the pain medicine service encouraged early referral of all traumatic rib fractures to the pain service for a multi-modal management approach. A retrospective audit of analgesic management was performed on a select cohort of 24 patients, with a mean age of 67, of which 19 had unilateral rib fractures. Results: 17 of 24 patients (71%) underwent local, regional block as part of a multi-modal analgesia regime. Only one regional complication was observed, seen with hypotension occurring in one patient with a thoracic epidural. The group who did not undergo regional block had a length of stay (LOS) 17 days longer than those who did (27 vs. 10) and higher rates of pneumonia (29% vs. 18%). Conclusion: Early referral to pain specialists is an important component of the effective management of acute traumatic rib fractures. From our audit, it is evident that regional blocks can be effectively used in these cases as part of a multi-modal analgesia regime and may confer benefits in terms of respiratory complications and length of stay.

Keywords: rib fractures, regional blocks, thoracic epidural, erector spina block

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Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira

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Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.

Keywords: SCLC, NCSLC, ROS1, PDL1

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Authors: Manoj Deepak, N. Mathivanan, K. Venkatachalam

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Nerve root stenosis is one of the main cause for back pain. There are many methods both conservative and surgical to treat this disease. It is pertinent to decompress the spine to a proper extent so as to avoid the recurrence of symptoms. But too much of an aggressive approach also has its disadvantages. We present one of the methods to effectively decompress the nerve with better results. Our study was carried out in 52 patients with foramina stenosis between 2008 to 2011.We carried out the surgical procedure of shaving off the medial part of the facet joint so as to decompress the root. We selected those patients who had symptoms of claudication for more than 2 years. They had no signs of instability and they underwent conservative treatment for a period of 2 months before the procedure. Oswersty scoring was used to record the functional level of the patient before and after the procedure. All patients were followed up for a period of minimum 2.5 years. After evaluation for a minimum of 2.5 years, 34 patients had no evidence of recurrence of symptoms with improvement in the functional level.7 patients complained of minimal pain but their functional quality had improved postop. Six patients had symptoms of lumbar canal disease which reduced with conservative treatment. 5 patients required spinal fusion surgeries in the later period. Conclusion: Thus, we can effectively conclude that our procedure is safe and effective in reducing the symptoms in those patients with neurogenic claudication.

Keywords: facetectoemy, stenosis, decompression, Lumbar Foraminal Stenosis, hemi-facetectomy

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Authors: Hanaa Sameen Ameen Bajilan

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Human rights should be protected and promoted without regard to race, ethnicity, religion, political philosophy, or sexual orientation, following our firm convictions. Thus, any infringement of these rights or disdain for; any use of violence against women undermines the principles and human values of equality and endangers the entire society, including its potential to live in peace and to make growth and development. This paper represents the condition of the new Iraqi women regarding issues such as the gender wage gap, education, health, and violence against women. The study aims to determine the impact of traditions and customs on the legal position of Iraqi women. First, it seeks to assess the effects of culture as a historical agency on the legal status of Iraqi women. Second, the influence of cultural developments in the later part of the twentieth century on Iraqi women's legal standing, and third, the importance of cultural variety as a progressive cultural component in women's legal position. Finally, the study highlights the representation of women in Iraq: Gender wage Gap, Women's liberation between culture and law, and the role of women within Iraqi society based on an Iraqi novel named (Orange Light) in Arabic: برتقالو ضو. in her book, the Iraqi writer Nadia Al-Abru succeeds in portraying the post-war society's devotion to the sexual, emotional and mental marginalization of women in terms of the value of attendance. Since the study of Iraqi women's literature in Arabic-English translation is a new avenue of research that contributes to all three areas, this investigation aims to establish critical lines of engagement between contemporary Iraqi women's literature in English translation and feminist translation conceptual frameworks, and this is accomplished by first focusing on why analyzing Iraqi women writers' novels in Arabic-English translation is a timeline of inquiry that contributes to existing and emerging knowledge fields concerning Iraqi women writers' contemporary critical contexts and scholarship on Arab women's literature in Arabic-English translation.

Keywords: women in İraq, equality, violence, gender wage gap, Nadia Al-Abru, (orange light), women's liberation, İraqi women's literature,

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Authors: Farangiz Davranbekova

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Subject: The study explores the impact of Over-the-Top services in the sports rights market, focusing on football games. This impact is analysed in the big five European football markets. The research entails how the pay-TV market is combating the disruptors' entry, how the fans are adjusting to these changes and how leagues and football clubs are orienting in the transitional period of more choice. Aims and methods: The research aims to offer a general overview of the impact of OTT players in the football rights market. A theoretical framework of Jenkins’ five layers of convergence is implemented to analyse the transition the sports rights market is witnessing from various angles. The empirical analysis consists of secondary research data as and seven expert interviews from three different clusters. The findings are bound by the combination of the two methods offering general statements. Findings: The combined secondary data as well as expert interviews, conducted on five layers of convergence found: 1. Technological convergence presents that football content is accessible through various devices with innovative digital features, unlike the traditional TV set box. 2. Social convergence demonstrates that football fans multitask using various devices on social media when watching the games. These activities are complementary to traditional TV viewing. 3. Cultural convergence points that football fans have a new layer of fan engagement with leagues, clubs and other fans using social media. Additionally, production and consumption lines are blurred. 4. Economic convergence finds that content distribution is diversifying and/or eroding. Consumers now have more choices, albeit this can be harmful to them. Entry barriers are decreased, and bigger clubs feel more powerful. 5. Global convergence shows that football fans are engaging with not only local fans but with fans around the world that social media sites enable. Recommendation: A study on smaller markets such as Belgium or the Netherlands would benefit the study on the impact of OTT. Additionally, examination of other sports will shed light on this matter. Lastly, once the direct-to-consumer model is fully taken off in Europe, it will be of importance to examine the impact of such transformation in the market.

Keywords: sports rights, OTT, pay TV, football

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Authors: Julie A. Baldwin, Robert T. Trotter, Mark Remiker, C. Loren Buck, Amanda Aguirre, Trudie Milner, Emma Torres, Frank A. von Hippel

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Introduction: In the past, there have been concerns about contaminants in the water sources in Yuma, Arizona, including the Colorado River. Prolonged exposure to contaminants, such as perchlorate and heavy metals, can lead to deleterious health effects in humans. This project examined the association between the concentration of environmental contaminants and patient health outcomes in Yuma residents, using a community-engaged approach to data collection. Methods: A community-engaged design allowed community partners and researchers to establish joint research goals, recruit participants, collect data, and formulate strategies for dissemination of findings. Key informant interviews were conducted to evaluate adherence to models of community-based research. Results: The training needs, roles, and expectations of community partners varied based on available resources, prior research experience, and perceived research challenges and ways to address them. Conclusions: Leveraging community-engaged approaches for studies of environmental contamination in marginalized communities can expedite recruitment efforts and stimulate action that can lead to improved community health.

Keywords: community engaged research, environmental contaminants, underserved populations, health equity

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Authors: Zengmin Tian, Bin Lv, Rui Hui, Yupeng Liu, Chuan Wang, Qing Liu, Hongyu Li, Yan Qi, Li Song

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Objective Robot was used for replacement of the frame in recent years. The paper is to investigate the safety and effectiveness of frameless stereotactic surgery in the treatment of children with cerebral palsy. Methods Clinical data of 425 children with spastic cerebral palsy were retrospectively analyzed. The patients were treated with robot-assistant frameless stereotactic surgery of nuclear mass destruction. The motor function was evaluated by gross motor function measure-88 (GMFM-88) before the operation, 1 week and 3 months after the operation respectively. The statistical analysis was performed. Results The postoperative CT showed that the destruction area covered the predetermined target in all the patients. Minimal bleeding of puncture channel occurred in 2 patient, and mild fever in 3 cases. Otherwise, there was no severe surgical complication occurred. The GMFM-88 scores were 49.1±22.5 before the operation, 52.8±24.2 and 64.2±21.4 at the time of 1 week and 3 months after the operation, respectively. There was statistical difference between before and after the operation (P<0.01). After 3 months, the total effective rate was 98.1%, and the average improvement rate of motor function was 24.3% . Conclusion Replaced the traditional frame, the robot-assistant frameless stereotactic surgery is safe and reliable for children with spastic cerebral palsy, which has positive significance in improving patients’ motor function.

Keywords: cerebral palsy, robotics, stereotactic techniques, frameless operation

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Authors: Prachi Abhishek Dave, Abhishek Dave

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Purpose: The purpose of this study is to elucidate the role of intravitreal injection Aflibercept in managing complex cases of Wet Age Related Macular Degeneration (ARMD) and the gratifying visual recovery experienced with a minimally invasive procedure. Methods: A 73-year-old gentleman presented with a drop in vision in the left eye for 25 days. On examination, his best corrected visual acuity (BCVA) in the Right eye (OD) was 6/60, and finger counting close to face in the Left eye (OS). On multimodal imaging, he was diagnosed to have a scarred Wet ARMD in OD and an active Wet ARMD with a large subretinal bleed secondary to Wet ARMD in OS. Treatment management options included monotherapy with an Injection Aflibercept or an intravitreal gas injection with tPA followed by Injection Aflibercept. Considering his one-eyed status, the patient decided to go for Aflibercept monotherapy. Results: After 3 monthly injections of injection Aflibercept, the subretinal bleed reduced, the subretinal fluid resolved, and his vision in OS improved to 6/9. He is on a regular follow-up and has not needed any further injections in OS and he maintains 6/9 vision. Conclusions: Conventional treatment guidelines for a large subretinal bleed dictate the use of gas followed by intravitreal Injection Aflibercept. However, gas has its own limitations of causing a rise in intraocular pressure and a transient loss of vision, which is particularly troublesome in one-eyed patients. Injection Aflibercept offers a much safer, less invasive, and elegant treatment option for such patients with equally good or even better visual outcomes.

Keywords: wet ARMD, subretinal bleed, intravitreal injections, aflibercept, EYELEA, intravitreal gas

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Authors: Francesco Angelucci, Katerina Veverova, Alžbeta Katonová, Lydia Piendel, Martin Vyhnalek, Jakub Hort

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Alzheimer's disease (AD) is a central nervous system (CNS) disease characterized by loss of memory, cognitive functions and neurodegeneration. Plasmin is an enzyme degrading many plasma proteins. In the CNS, plasmin may reduce the accumulation of A, and have other actions relevant to AD pathophysiology. Brain plasmin synthesis is regulated by two enzymes: one activating, the tissue plasminogen activator (tPA), and the other inhibiting, the plasminogen activator inhibitor-1 (PAI-1). We investigated whether tPA and PAI-1 serum levels in AD and amnestic mild cognitive impairment (aMCI) patients are altered compared to cognitively healthy controls. Moreover, we examined the PAI-1/tPA ratio in these patient groups. 40 AD, 40 aMCI and 10 healthy controls were recruited. Venous blood was collected and PAI-1 and tPA serum concentrations were quantified by sandwich ELISAs. The results showed that PAI-1 levels increased in AD and aMCI patients. This increase negatively correlated with cognitive deficit measured by MMSE. Similarly, the ratio between tPA and PAI-1 gradually increases in aMCI and AD patients. This study demonstrates that AD and aMCI patients have altered PAI-1 serum levels and PAI-1/tPA ratio. Since these enzymes are CNS regulators of plasmin, PAI-1 serum levels could be a marker reflecting a cognitive decline in AD.

Keywords: Alzheimer disease, amnestic mild cognitive impairment, plasmin, tissue-type plasminogen activator

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Authors: Bayar Shahab

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The fast development of technology that has advanced neuroscience and human interaction with computers has enabled solutions to various problems, and issues of this new era have been found and are being found like no other time in history. Brain-computer interface so-called BCI has opened the door to several new research areas and have been able to provide solutions to critical and important issues such as supporting a paralyzed patient to interact with the outside world, controlling a robot arm, playing games in VR with the brain, driving a wheelchair or even a car and neurotechnology enabled the rehabilitation of the lost memory, etc. This review work presents state-of-the-art methods and improvements of canonical correlation analyses (CCA), which is an SSVEP-based BCI method. These are the methods used to extract EEG signal features or, to be said in a different way, the features of interest that we are looking for in the EEG analyses. Each of the methods from oldest to newest has been discussed while comparing their advantages and disadvantages. This would create a great context and help researchers to understand the most state-of-the-art methods available in this field with their pros and cons, along with their mathematical representations and usage. This work makes a vital contribution to the existing field of study. It differs from other similar recently published works by providing the following: (1) stating most of the prominent methods used in this field in a hierarchical way (2) explaining pros and cons of each method and their performance (3) presenting the gaps that exist at the end of each method that can open the understanding and doors to new research and/or improvements.

Keywords: BCI, CCA, SSVEP, EEG

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Authors: Soo Hong Da, Ng Zheng Yao, Burra Venkata Durga Kumar

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The Healthcare sector is a business that consists of providing medical services, manufacturing medical equipment and drugs as well as providing medical insurance to the public. Most of the time, the data stored in the healthcare database is to be related to patient’s information which is required to be accurate when it is accessed by authorized stakeholders. In distributed systems, one important issue is concurrency in the system as it ensures the shared resources to be synchronized and remains consistent through multiple read and write operations by multiple clients. The problems of concurrency in the healthcare sector are who gets the access and how the shared data is synchronized and remains consistent when there are two or more stakeholders attempting to the shared data simultaneously. In this paper, a framework that is beneficial to distributed healthcare sector concurrent environment is proposed. In the proposed framework, four different level nodes of the database, which are national center, regional center, referral center, and local center are explained. Moreover, the frame synchronization is not symmetrical. There are two synchronization techniques, which are complete and partial synchronization operation are explained. Furthermore, when there are multiple clients accessed at the same time, synchronization types are also discussed with cases at different levels and priorities to ensure data is synchronized throughout the processes.

Keywords: resources, healthcare, concurrency, synchronization, stakeholders, database

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Authors: Shweta Jha, Digambar Darekar, Krishna Kadam

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Major Depressive Disorder (MDD) is one of the most common of psychiatric disorders. It has a wide range of symptoms, aetiologies and risk factors, and these reasons make MDD affect not only the primary patient, but also their family, caregivers and associates; by negatively impacting their self dignity, economic condition and self-confidence. Thus, it is important to help individuals suffering from MDD learn adaptive mechanism and deal effectively with their environment, with that aim this study focused on a comparative therapeutic intervention using Behaviour Activation (BA), Rational Emotive Behaviour Therapy (REBT) and Waiting list control (WLC) for management of MDD. This study apart from enhancing personal skills will also help us understand which therapeutic method would be more beneficial in treating and prolonging relapse in patients with MDD in Indian population. Fifteen individuals following application of inclusion and exclusion criteria were selected as study samples. They were randomly assigned to three treatment groups. Ten sessions of therapy, forty-five minutes each according to the proposed sessions plan were conducted for each group. The individuals selected as samples were re–assessed after 2 months and 6 months post intervention. The overall result showed that individuals treated with BA and REBT showed more improvement in comparison to those in WLC.

Keywords: behaviour activation, major depressive disorder, rational emotive behaviour therapy, therapeutic intervention

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Authors: Helga Mayr

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In our ongoing effort to address urgent global challenges related to sustainability, higher education institutions play a central role in raising a generation of informed and empowered citizens committed to sustainable development. This paper presents the preliminary results of the so far realized evaluation of a compulsory module on education for sustainable development (ESD) offered to students in the bachelor's program in elementary education at the University College of Teacher Education Tyrol (PH Tirol), Austria. The module includes a lecture on sustainability and education as well as a project-based seminar that aims to foster a deep understanding of ESD and its application in pedagogical practice. The study examines various dimensions related to the module's impact on participating students, focusing on prevalent sustainability concepts, intentions, actions, general and sustainability-related self-efficacy, perceived competence related to ESD, and ESD-related self-efficacy. In addition, the research addresses assessment of the learning process. To obtain a comprehensive overview of the effectiveness of the module, a mixed methods approach was/is used in the evaluation. Quantitative data was/is collected through surveys and self-assessment instruments, while qualitative findings were/will be obtained through focus group interviews and reflective analysis. The PH Tirol is collaborating with another University College of Teacher Education (Styria) and a university of applied sciences in Switzerland (UAS of the Grisons) to broaden the scope of the analysis and allow for comparative findings. Preliminary results indicate that students have a relatively rudimentary understanding of sustainability. The extent to which completion of the module influences understanding of sustainability, awareness, intentions, and actions, as well as self-efficacy, is currently under investigation. The results will be available at the time of the conference and will be presented there. In terms of learning, the project-based seminar, which promotes hands-on engagement with ESD, was evaluated for its effectiveness in fostering key sustainability competencies as well as sustainability-related and ESD-related self-efficacy. The research not only provides insights into the effectiveness of the compulsory module ESD at the PH Tirol but also contributes to the broader discourse on integrating ESD into teacher education.

Keywords: education for sustainable development, teacher education, project-based learning, effectiveness measurements

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Authors: Fiona Lourenco, William Allen

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Dentofacial deformities are primarily surgically treated via orthognathic surgery. Health-related quality of life is concerned with aspects of quality of life that relate specifically to an individual’s health. Design and Setting: Retrospective analysis of patients who had orthognathic surgery from January 2018 - December 2022 at the trust using the previously validated Orthognathic Quality of Life questionnaire (OQoL). Materials and Methods: 32 Patient questionnaires (which included pre-operative and post-operative separate sections) were obtained via telephone survey. The data was analysed using the two-tailed paired t-test and Wilcoxon signed-rank test. Results: The change in perception post-surgery was highly significant (both tests resulted in p<0.001 for overall analysis as well as for each domain). Overall, a 74% improvement in QoL was seen following orthognathic surgery. Reports of improvement in each domain were as follows: 71% in the social aspect of the deformity domain, 76% in facial aesthetics, 60% in function, and 57% improvement in awareness of facial deformity. Conclusion: The assessment of QoL is becoming progressively imperative in clinical research. The above data shows that orthognathic surgery has a significant improvement in the QoL of patients post-operatively. The results demonstrate improvement in all domains, with perceptions in facial aesthetics seeing the highest change post-operatively.

Keywords: dentofacial, oral, facial asymmetry, orthognathic surgery, quality of life

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Authors: Christiane Dumont

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This paper proposes to revisit foreign-language learning as a tool to increase motivation through advocacy and develop effective natural communication skills, which are critical leadership qualities. To this end, collaborative initiatives undertaken by advanced university students of French with local and international community partners will be reviewed. Close attention will be paid to the acquisition of intercultural skills, the reflective process, as well as the challenges and outcomes. Two international development projects conducted in Haiti will be highlighted, i.e., collaboration with a network of providers in the Haitian cultural heritage preservation and tourism sector (2014-15) and development of investigation and teacher training tools for a primary/secondary school in the Port-au-Prince area (current). The choice of community-service learning as a framework to teach French-as-a-second-language stemmed from the need to raise awareness against stereotypes and prejudice, which hinder the development of effective intercultural skills. This type of experiential education also proved very effective in identifying and preventing miscommunication caused by the lack of face-to-face interaction in our increasingly technology-mediated world. Learners experienced first-hand, the challenges and advantages of face-to-face communication, which, in turn, enhanced their motivation for developing effective intercultural skills. Vygotsky's and Kolb's theories, current research on service learning (Dwight, Eyler), action/project-based pedagogy (Beckett), and reflective learning (TSC Farrell), will provide useful background to analyze the benefits and challenges of community-service learning. The ultimate goal of this paper is to find out what makes experiential learning truly unique and transformative for both the learners and the community they wish to serve. It will demonstrate how enhanced motivation, community engagement, and clear, concise, and respectful communication impact and empower learners. The underlying hope is to help students in high-profile, and leading-edge industries become effective global leaders.

Keywords: experiential learning, intercultural communication, reflective learning, effective leadership, learner motivation

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Authors: Hosein Alimadadi, Fatemeh Farahmand, Ali Jafarian, Nasir Fakhar, Mohammad Hassan Sohouli, Neda Raeesi

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Backgroundsː Regarding the important role of liver transplantation as the only treatment in many cases of end-stage liver disease in children, the aim of this study is to investigate the complications of liver transplantation and their management in children referred to the Children's Medical Center. Methods: This study is a cross-sectional study on pediatric patients who have undergone liver transplants in the years 2016 to 2021. The indication for liver transplantation in this population was confirmed by a pediatric gastroenterologist, and a liver transplant was performed by a transplant surgeon. Finally, information about the patient before and after the transplantation was collected and recorded. Results: A total of 53 patients participated in this study, including 25 (47.2%) boys and 28 (52.8%) girls. The most common causes of liver transplantation were cholestatic and metabolic diseases. The most common early complication of liver transplantation in children was acute cellular rejection (ACR) and anastomotic biliary stricture. The most common late complication in these patients was an infection which was observed in 56.6% of patients. Among the drug side effects, neurotoxicity (convulsions) was seen more in patients, and 15.1% of the transplanted patients died. Conclusion: In this study, the most common early complication of liver transplantation in children was ACR and biliary stricture, and the most common late complication was infection. Neurotoxicity (convulsions) was the most common side effect of drugs.

Keywords: liver transplantation, complication, infection, survival rate

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Authors: Hanifa Maryani Ahmad, Muslim Yusuf

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Background: Unilateral crossbite can be defined as an abnormal transverse relationship between the upper and lower teeth where the mandibular buccal cusp occluding to the maxillary buccal cusp and which involves only one side of the arch. This report describes the treatment of an adolescent female with Class III malocclussion unilateral crossbite resulting from a mildly constricted maxillary arch. The patient had a Class III skeletal relationship, Class III molar relationships, unilateral crossbite on the left side, and deviated midlines. Objectives: The treatment objectives were to correct the abnormal transverse relationship, achieve proper dental inclination, and correct the unilateral crossbites to improve the facial profile. Case management: The treatment protocol was using transpalatal arch with extension arm modification to expand the maxillary arch. Following the levelling and aligning stage of treatment, using a vertical loop while mandibular arch was expanded after getting an end to end relationship on the anterior side. Results: Corrections of the unilateral crossbite were achieved in 4 months. The treatment is still on process because the canines relationship were not corrected. Conclusions: This report highlights a treatment using transpalatal arch with extension arm modification that can be used to expand the transverse width of an arch to correct the discrepancy. Even though the treatment processes were still ongoing, the correction of the unilateral crossbite have been achieved in 4 months by only using the transpalatal arch.

Keywords: crossbite unilateral, late growing, non-extraction, transpalatal arch

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Authors: Hosamuddin Hamza

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The major concept of 4D printing is self-folding under thermal and humidity changes. This concept relies on understanding how the microstructures of 3D-printed models can undergo spontaneous shape transformation under thermal and moisture changes. The transformation mechanism could be achieved by mixing, in a controllable pattern, a number of materials within the printed model, each with known strain/shrinkage properties. 4D printing has a strong potential to be applied in dentistry as the technology could produce dynamic and adaptable materials to be used as functional objects in the oral environment under the continuously changing thermal and humidity conditions. The motion criteria could override the undesired dimensional changes, thermal instability, polymerization shrinkage and microleakage. 4D printing could produce restorative materials being self-adjusted spontaneously without further intervention from the dentist or patient; that is, the materials could be capable of fixing its failed portions, compensating for some lost tooth structure, while avoiding microleakage or overhangs at the margins. In prosthetic dentistry, 4D printing could provide an option to manage the influence of bone and soft tissue imbalance during mastication (and at rest) with high predictability of the type/direction of forces. It can also produce materials with better fitting and retention characteristics than conventional or 3D-printed materials. Nevertheless, it is important to highlight that 4D-printed objects, having dynamic properties, could provide some cushion as they undergo self-folding compensating for any thermal changes or mechanical forces such as traumatic forces.

Keywords: functional material, self-folding material, 3D printing, 4D printing

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Authors: Aisyah Rahmatul Laily

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Indonesia Ministry of Health is increasing their awareness on non communicable diseases. From the top ten causes of death, two of them are non communicable diseases. Diabetes Mellitus is one of the two non communicable diseases above that have the increasing number of patient from year to year. From that problem, this research is made to determine the correlation between education, food intake, exercise, and the medication obedience with the average of blood sugar. In this research, the researchers used observational and cross-sectional studies. The sample that used in this research were 50 patients in Puskesmas Gamping I Yogyakarta who have suffered from Diabetes Mellitus in long period. The researcher doing anamnesis by using questionnaire to collect the data, then analyzed it with Chi Square to determine the correlation between each variable. The dependent variable in this research is the average of blood sugar, whereas the independent variables are education, food intake, do exercise, and the obedience of medication. The result shows a relation between education and average blood sugar level (p=0.029), a relation between food intake and average blood sugar level (p=0.009), and a relation between exercise and average blood sugar level (p=0.023). There is also a relation between the medication obedience with the average of blood sugar (p=0,002). The conclusion is that the positive correlations exist between education and average blood sugar level, between food intake and average blood sugar level, and between medication obedience and average blood sugar level.

Keywords: average of blood sugar, education, exercise, food intake, medication obedience

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Authors: Raquel Vianna Duarte Cardoso, Eduarda Lobato Faria, José Jorge Boueri

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Rapid urbanization has transformed the global landscape, presenting significant challenges to public health. This article delves into the impact of urbanization on the spread of infectious diseases in cities and identifies crucial strategies to enhance urban community resilience. Massive urbanization over recent decades has created conducive environments for the rapid spread of diseases due to population density, mobility, and unequal living conditions. Urbanization has been observed to increase exposure to pathogens and foster conditions conducive to disease outbreaks, including seasonal flu, vector-borne diseases, and respiratory infections. In order to tackle these issues, a range of cross-disciplinary approaches are suggested. These encompass the enhancement of urban healthcare infrastructure, emphasizing the need for robust investments in hospitals, clinics, and healthcare systems to keep pace with the burgeoning healthcare requirements in urban environments. Moreover, the establishment of disease monitoring and surveillance mechanisms is indispensable, as it allows for the timely detection of outbreaks, enabling swift responses. Additionally, community engagement and education play a pivotal role in advocating for personal hygiene, vaccination, and preventive measures, thus playing a pivotal role in diminishing disease transmission. Lastly, the promotion of sustainable urban planning, which includes the creation of cities with green spaces, access to clean water, and proper sanitation, can significantly mitigate the risks associated with waterborne and vector-borne diseases. The article is based on a review of scientific literature, and it offers a comprehensive insight into the complexities of the relationship between urbanization and health. It places a strong emphasis on the urgent need for integrated approaches to improve urban resilience in the face of health challenges.

Keywords: infectious diseases dissemination, public health, urbanization impacts, urban resilience

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Authors: Gajendra Kumar Mourya, Dinesh Bhatia, Akash Handique, Sunita Warjri, Syed Achaab Amir

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Nowadays, Medical imaging has become an integral part of modern healthcare. Abdominal CT images are an invaluable mean for abdominal organ investigation and have been widely studied in the recent years. Diagnosis of liver pathologies is one of the major areas of current interests in the field of medical image processing and is still an open problem. To deeply study and diagnose the liver, segmentation of liver is done to identify which part of the liver is mostly affected. Manual segmentation of the liver in CT images is time-consuming and suffers from inter- and intra-observer differences. However, automatic or semi-automatic computer aided segmentation of the Liver is a challenging task due to inter-patient Liver shape and size variability. In this paper, we present a technique for automatic segmenting the liver from CT images using Random Forest Classifier. Random forests or random decision forests are an ensemble learning method for classification that operate by constructing a multitude of decision trees at training time and outputting the class that is the mode of the classes of the individual trees. After comparing with various other techniques, it was found that Random Forest Classifier provide a better segmentation results with respect to accuracy and speed. We have done the validation of our results using various techniques and it shows above 89% accuracy in all the cases.

Keywords: CT images, image validation, random forest, segmentation

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Authors: Leila Yazdanpanah, Hajieh Shahbazian, Seyed Mahmoud Latifi, Armaghan Moravej Aleali, Saeed Ghanbari

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Introduction: This study was designed to determine the prevalence of diabetes in people aged over 20 years in Ahvaz, Iran. Material and Methods: The study population selected by cluster sampling. Fasting blood sugar (FBS) assessed after minimum 8 hours night fasting. A questionnaire included: age, sex, weight, height, blood pressure, waist circumference and previous history of diabetes were completed for each patient. FBS≥126mg/dl and/or oral hypoglycemic treatment and/or insulin was defined as diabetes, FBS=100-125 mg/dl as impaired fasting glucose (IFG) and FBS<100mg/dl as normal. Results: Study population was 936 persons (47.2 % male and 52.8% female). The mean age of a population was 42.2±14 years. Diabetes was detected in 15.1 % of population. Only 57cases(6.1%) were aware of their disease and 9% had unknown diabetes. Diabetes was detected in 14.5% of male (11.3% unknown and 3.2 % known diabetes) and in 11.7% of female (7% unknown and 4.7% known diabetes). Prevalence of diabetes had no significant difference (P=0.21) in male and female but unknown diabetes was significantly higher in male (P=0.025). Prevalence of diabetes was increased with rising of age between 20-60 years old but decreasing after 60 years old. Diabetes was related to age, waist circumference and systolic and diastolic blood pressure, TG level and BMI in both sex (P=0.0001). Conclusion: More than half of female and three-fourth of male diabetic patients are unaware of their disease in South of Iran. Diabetes screening should be intensified in this population.

Keywords: diabetes, prevalence, risk factor, awareness

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Authors: Muhammad Faizan Butt, Maria Ambreen Tahir, Joshua James Pilkington, A. A. Warsi

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Background: Total parenteral nutrition (TPN) use within the NHS is crucial in the prevention of malnourishment. TPN prescriptions are tailored to an individual patient’s needs. TPN bags come in fixed sizes, and minimizing wastage has financial and sustainability implications for the health service. The aim of the study is to assess current prescribing practices, look at the volume of TPN wastage and identify reasons for it. Methodology: A retrospective cohort study on TPN prescriptions over a period of 1 year (Jan-Dec 2022) was performed. All patients prescribed TPN that had been admitted under a general surgery consultant in a small district hospital were included. Data were extracted from hospital electronic records and dietician charts. Data were described, and reasons for TPN wastage were explored. Results: 49 patients were identified. The average length of TPN prescription was 8 days (median). This totaled 608 prescriptions. Of the bags prescribed, 258, 169, and 181 were 10g (2500ml), 14g (2000ml), and 18g (2000ml), respectively. The mean volume wasted from each type of bag was 634ml, 634ml, and 648ml, respectively. Reasons for TPN wastage identified were: no loss (25%), smaller bags not available (53.6%), step-down regime (8.1%), and other (12.2%). Conclusion: This study has identified that the current stocking and prescribing of TPN within a district general hospital leads to a significant wastage of 638.2ml (average). The commonest reason for wastage is the non-availability of a more appropriate sized bag.

Keywords: general surgery, TPN, sustainability, wastage

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Authors: Hossain A., Chowdhury S. I.

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Introduction: The use of a gamma camera is a standard procedure in nuclear medicine facilities or hospitals to diagnose chronic kidney disease (CKD), but the gamma camera does not precisely stage the disease. The authors sought to determine whether they could use an artificial neural network to determine whether CKD was in normal or abnormal stages based on GFR values (ANN). Method: The 250 kidney patients (Training 188, Testing 62) who underwent an ultrasonography test to diagnose a renal test in our nuclear medical center were scanned using a gamma camera. Before the scanning procedure, the patients received an injection of ⁹⁹ᵐTc-DTPA. The gamma camera computes the pre- and post-syringe radioactive counts after the injection has been pushed into the patient's vein. The artificial neural network uses the softmax function with cross-entropy loss to determine whether CKD is normal or abnormal based on the GFR value in the output layer. Results: The proposed ANN model had a 99.20 % accuracy according to K-fold cross-validation. The sensitivity and specificity were 99.10 and 99.20 %, respectively. AUC was 0.994. Conclusion: The proposed model can distinguish between normal and abnormal stages of CKD by using an artificial neural network. The gamma camera could be upgraded to diagnose normal or abnormal stages of CKD with an appropriate GFR value following the clinical application of the proposed model.

Keywords: artificial neural network, glomerular filtration rate, stages of the kidney, gamma camera

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Authors: Ammal M. Metwally, Ghada A. Abdel-Latif, Walaa A. Fouad, Thanaa M. Rabah, Amira Mohsen, Fatma A. Shaaban, Iman I. Salama

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The study aimed at determining the impact of chronic hepatitis C virus (HCV) infection on patients’ Quality of Life (QoL) , its relation to geographical characteristics of patients, awareness of the disease, treatment regimen, co-morbid psychiatric or other diseases. 457 patients were randomly selected from ten National Treatment Reference Centers of Ministry of Health hospitals from four community locations representing Egypt. Health related QoL assessment questionnaire with the 36-item Short Form used for assessment of the enrolled patients. The study showed no significant difference between HCV patients in different governorates as regards total QoL. Females, illiterate patients and those had bilharziasis, diabetes mellitus, hypertension or were depressed had significantly the lowest QoL score. HCV patients who knew the danger of the disease had significant lower mean score of physical and mental health components. Optimal care of overall well-being of HCV patients requires adequate knowledge of their neurological and psychological status. It is important to know that any patient will need to take the time to know that his new physical limitations do not limit him as a person, as soul, no matter what other people are thinking as a positive hopeful attitude is essential for combating HCV.

Keywords: hepatitis C virus chronic infection - physical health component and mental health component of QoL– total quality of life

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Authors: Shimhanda M. N., Mogomotsi P. K., Thakadu O. T., Rutina L. P.

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Wildlife tourism (WT) in communal conservancies has the potential to contribute significantly to sustainable rural development. However, understanding local perceptions, promoting participation, and addressing stakeholder concerns are all required for sustainability. This study looks at stakeholder perceptions of WT in conservancies near protected areas in Namibia's Zambezi region, specifically the Mudumu North Complex. A mixed-methods approach was employed to collect data from 356 households using stratified sampling. Qualitative data was gathered through six focus group discussions and 22 key informant interviews. Quantitative analysis, using descriptive statistics and Spearman correlation, investigated socio-demographic influences on WT perceptions, while qualitative data were subjected to thematic analysis to identify key themes. Results revealed high awareness and generally positive perceptions of WT, particularly in Mashi Conservancy, which benefits from diverse tourism activities and joint ventures with lodges. Kwandu and Kyaramacan, which rely heavily on consumptive tourism, had lower awareness and perceived benefits. Human-wildlife conflict emerged as a persistent issue, especially in Kwandu and Mashi, where crop damage and wildlife interference undermined community support for WT. Younger, more educated, and employed individuals held more positive attitudes towards WT. The study highlights the importance of recognising community heterogeneity and tailoring WT strategies to meet diverse needs, including HWC mitigation. Policy implications include increasing community engagement, ensuring equitable benefit distribution, and implementing inclusive tourism strategies that promote long-term sustainability. These findings are critical for developing long-term WT models that address local challenges, encourage community participation, and contribute to socioeconomic development and conservation goals.

Keywords: sustainable tourism, stakeholder perceptions, community involvement, socio-economic development

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Authors: Giorgi Katamadze

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Open public service and accountability towards citizens is an important feature of democratic state based on rule of law. Effective use of electronic resources simplifies bureaucratic procedures, makes direct communications, helps exchange information, ensures government’s openness and in general helps develop electronic/digital democracy. Development of electronic democracy should be a strategic dimension of Georgian governance. Formation of electronic democracy, its functional improvement should become an important dimension of the state’s information policy. Electronic democracy is based on electronic governance and implies modern information and communication systems, their adaptation to universal standards. E-democracy needs involvement of governments, voters, political parties and social groups in an electronic form. In the last years the process of interaction between the citizen and the state becomes simpler. This process is achieved by the use of modern technological systems which gives to a citizen a possibility to use different public services online. For example, the website my.gov.ge makes interaction between the citizen, business and the state more simple, comfortable and secure. A higher standard of accountability and interaction is being established. Electronic democracy brings new forms of interactions between the state and the citizen: e-engagement – participation of society in state politics via electronic systems; e-consultation – electronic interaction among public officials, citizens and interested groups; e-controllership – electronic rule and control of public expenses and service. Public transparency is one of the milestones of electronic democracy as well as representative democracy as only on mutual trust and accountability can democracy be established. In Georgia, institutional changes concerning establishment and development of electronic democracy are not enough. Effective planning and implementation of a comprehensive and multi component e-democracy program (central, regional, local levels) requires telecommunication systems, institutional (public service, competencies, logical system) and informational (relevant conditions for public involvement) support. Therefore, a systematic project of formation of electronic governance should be developed which will include central, regional, municipal levels and certain aspects of development of instrumental basis for electronic governance.

Keywords: e-democracy, e-governance, e-services, information technology, public administration

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Authors: Paul Barasa Wanyama, Tom Wanyama

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Governments and development partners in low-income countries often prioritize building Water Sanitation and Hygiene (WaSH) infrastructure of healthcare facilities to improve maternal healthcare outcomes. However, the operation, maintenance, and utilization of this infrastructure are almost never considered. Many healthcare facilities in these countries use untreated water that is not monitored for quality or quantity. Consequently, it is common to run out of water while a patient is on their way to or in the operating theater. Further, the handwashing stations in healthcare facilities regularly run out of water or soap for months, and the latrines are typically not clean, in part due to the lack of water. In this paper, we present a system that uses Internet of Things (IoT), big data, cloud computing, and AI to initiate WaSH security in healthcare facilities, with a specific focus on maternal health. We have implemented smart sensors and actuators to monitor and control WaSH systems from afar to ensure their objectives are achieved. We have also developed a cloud-based system to analyze WaSH data in real time and communicate relevant information back to the healthcare facilities and their stakeholders (e.g., medical personnel, NGOs, ministry of health officials, facilities managers, community leaders, pregnant women, and new mothers and their families) to avert or mitigate problems before they occur.

Keywords: WaSH, internet of things, artificial intelligence, maternal health, rural communities, healthcare facilities

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