Search results for: perceived risk
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 7617

Search results for: perceived risk

4227 Gender Based Violence and Women’s Health

Authors: Sangita Bharati

Abstract:

Violence against women is now well recognised as a public health problem and human rights violation of worldwide significance. It is an important risk factor for women's ill health, with far reaching consequences for both their physical and mental health. Gender based violence takes many forms and results in physical, sexual and psychological harm to the women throughout their lives. Gender based violence often manifests unequal power relation between men and women in society and the secondary status of the women because of which women have to suffer a range of health problems in silence. This paper will aim at describing a few problems related to women’s health which are directly linked to their experience as victims of gender based violence.

Keywords: violence, health, women, society

Procedia PDF Downloads 480
4226 Utilizing Experiential Teaching Strategies to Reduce the Incidence of Falls in Patients in Orthopedic Wards

Authors: Yu-Shi Ye, Jia-Min Wu, Jhih-Ci Li

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Background: Most orthopedic inpatients and primary caregivers are elderly, and patients are at high risk of falls. We set up a quality control team to analyze the root cause and found the following issues: 1. The nursing staff did not conduct cognitive assessments of patients and their primary caregivers to ensure that health education content was understood. 2. Nurses prefer to use spoken language in health education but lack the skills to use diverse teaching materials. 3. Newly recruited nurses have insufficient awareness of fall prevention. Methods: The study subjects were 16 nurses in the orthopedic ward of a teaching hospital in central Taiwan. We implemented the following strategies: 1. Developed a fall simulation teaching plan and conducted teaching courses and assessments in the morning meeting; 2. Designed and used a "fall prevention awareness card" to improve the prevention awareness of elderly patients; 3. All staff (including new staff) received experiential education training. Results: In 2021, 40% of patients in the orthopedic wards were aged 60-79 years (792/1979) with a high risk of falls. According to data collection, the incidence of falls in hospitalized patients was 0.04% (5/12651), which exceeded the threshold of 0.02% in our ward. After completing the on-the-job education training in October, the nursing staff expressed that they were more aware of the special situation of fall prevention. Through practical sharing and drills, combined with experiential teaching strategies, nurses can reconstruct the safety awareness of fall prevention and deepen their cognitive memory. Participants scored between 30 and 80 on the pretest (16 students, mean: 72.6) and between 90 and 100 on the post-test (16 students, mean: 92.6), resulting in a 73.8% improvement in overall scores. We have a total of 4 new employees who have all completed the first 3 months of compulsory PGY courses. From January to April 2022, the incidence of falls in hospitalized patients was 0.025% (1/3969). We have made good improvements and will continue to track the outcome. Discussion: In addition to enhancing the awareness of falls among nursing staff, how-to guide patients and primary caregivers to prevent falls is also the focus of improvement. The proper way of health education can be better understood through practical exercises and case sharing.

Keywords: experiential teaching strategies, fall prevention, cognitive card, elderly patients, orthopedic wards

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4225 Molecular Alterations Shed Light on Alteration of Methionine Metabolism in Gastric Intestinal Metaplesia; Insight for Treatment Approach

Authors: Nigatu Tadesse, Ying Liu, Juan Li, Hong Ming Liu

Abstract:

Gastric carcinogenesis is a lengthy process of histopathological transition from normal to atrophic gastritis (AG) to intestinal metaplasia (GIM), dysplasia toward gastric cancer (GC). The stage of GIM identified as precancerous lesions with resistance to H-pylori eradication and recurrence after endoscopic surgical resection therapies. GIM divided in to two morphologically distinct phenotypes such as complete GIM bearing intestinal type morphology whereas the incomplete type has colonic type morphology. The incomplete type GIM considered to be the greatest risk factor for the development of GC. Studies indicated the expression of the caudal type homeobox 2 (CDX2) gene is responsible for the development of complete GIM but its progressive downregulation from incomplete metaplasia toward advanced GC identified as the risk for IM progression and neoplastic transformation. The downregulation of CDX2 gene have promoted cell growth and proliferation in gastric and colon cancers and ascribed in chemo-treatment inefficacies. CDX2 downregulated through promoter region hypermethylation in which the methylation frequency positively correlated with the dietary history of the patients, suggesting the role of diet as methyl carbon donor sources such as methionine. However, the metabolism of exogenous methionine is yet unclear. Targeting exogenous methionine metabolism has become a promising approach to limits tumor cell growth, proliferation and progression and increase treatment outcome. This review article discusses molecular alterations that could shed light on the potential of exogenous methionine metabolisms, such as gut microbiota alteration as sources of methionine to host cells, metabolic pathway signaling via PI3K/AKt/mTORC1-c-MYC to rewire exogenous methionine and signature of increased gene methylation index, cell growth and proliferation in GIM, with insights to new treatment avenue via targeting methionine metabolism, and the need for future integrated studies on molecular alterations and metabolomics to uncover altered methionine metabolism and characterization of CDX2 methylation in gastric intestinal metaplasia for potential therapeutic exploitation.

Keywords: altered methionine metabolism, Intestinal metaplesia, CDX2 gene, gastric cancer

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4224 Securitization of Illegal Fishing Cases in Natuna Waters by Indonesian Government: Study Case of Chinese Vessels Shootouts 2016

Authors: Ray Maximillian, Idil Syawfi

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Indonesia’s Exclusive Economic Zone and the infamous China’s nine-dash line are intersected in Natuna waters. Even though from Indonesia perspective, that line does not possess any legal basis, China treat that line as their national boundaries, therefore allowing Chinese fishermen to fish in the area. Under President Joko Widodo leadership, Indonesia which now focusing to suppress illegal fishing cases while emphasizing their maritime sovereignty is facing an imminent threat from China’s presence in Natuna. Tension between these countries spiked after three incident happened on 2016, especially after Indonesian navy shot Chinese fishermen vessel that suspected doing illegal fishing activity. This action seen as an attempt to secure Indonesia’s law enforcement in their waters after several months before such attempt was intervened by Chinese coast guard. Indonesia tries to securitize this issue to justify the shooting they done to Chinese vessels. In the process of securitization, it is imperative to identify the existential threat that leads to implementation of emergency measures which responded by units in the cases. Chinese coast guard presence in Natuna perceived as an existential threat to Indonesia, therefore, responded by shooting to Chinese vessels on the next encounter. This action then responded by Chinese government who said that there is overlapping claim between them and Indonesia in Natuna.

Keywords: China, illegal fishing, Indonesia, natuna, securitization

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4223 Transnational Higher Education: Developing a Transnational Student Success Signature for Clinical Medical Students an Action Research Project

Authors: Wendy Maddison

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This paper describes an Action Research project which was undertaken to inform professional practice in order to develop a newly created Centre for Student Success in the specific context of transnational medical and nursing education in the Middle East. The objectives were to enhance the academic performance, persistence, integration and personal and professional development of a multinational study body, in particular in relation to preclinical medical students, and to establish a comfortable, friendly and student-driven environment within an Irish medical university recently established in Bahrain. Expatriating a new part of itself into a corner of the world and within a context which could be perceived as the antithesis of itself, in particular in terms of traditional cultural and organisational values, the university has had to innovate in the range of services, programmes and other offerings which engages and supports the academic success of medical and nursing students as they “encounter the world in the classroom” in the context of an Arab Islamic culture but within a European institution of transnational education, engaging with a global learning environment locally. The outcomes of the project resulted in the development of a specific student success ‘signature’ for this particular transnational higher education context.

Keywords: transnational higher education, medical education, action research, student success, Middle Eastern context, student persistence in the global-local, student support mechanisms

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4222 Malaria Outbreak Facilitated by Appearance of Vector-Breeding Sites after Heavy Rainfall and Inadequate Preventive Measures: Nwoya District, Uganda, March–May 2018

Authors: Godfrey Nsereko, Daniel Kadobera, Denis Okethwangu, Joyce Nguna, Alex Riolexus Ario

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Background: Malaria is a leading cause of morbidity and mortality in Uganda. In April 2018, malaria cases surged in Nwoya District, northern Uganda, exceeding the action thresholds. We investigated to assess the outbreak’s magnitude, identify transmission risk factors, and recommend evidence-based control measures. Methods: We defined a malaria case as onset of fever in a resident of Nwoya District with a positive Rapid Diagnostic Test or microscopy for malaria P. falciparum from 1 February to 22 May 2018. We reviewed medical records in all health facilities of affected sub-counties to find cases. In a case-control study, we compared exposure risk factors between 107 case-persons and 107 asymptomatic controls matched by age and village. We conducted entomological assessment on vector-density and behavior. Results: We identified 3,879 case-persons (attack rate [AR]=6.5%) and 2 deaths (case-fatality rate=5.2/10,000). Females (AR=8.1%) were more affected than males (AR=4.7%). Of all age groups, the 5-18 year age group (AR=8.4%) was most affected. Heavy rain started on 4 March; a propagated outbreak began during the week of 2 April. In the case-control study, 55% (59/107) of case-patients and 18% (19/107) of controls had stagnant water around households for several days following rainfall (ORM-H=5.6, 95%CI=3.0-11); 25% (27/107) of case-patients and 51% (55/107) of controls wore long-sleeve cloths during evening hours (ORM-H=0.30, 95%CI=0.20-0.60); 29% (31/107) of case-patients and 15% (16/107) of controls did not sleep under a long-lasting insecticide-treated net (LLIN) (ORM-H=2.3, 95%CI=1.1-4.9); 37% (40/107) of case-patients and 52% (56/107) of controls had ≥1 LLIN per 2 household members (ORM-H=0.54, 95%CI=0.30-0.97). Entomological assessment indicated active breeding sites; Anopheles gambiae sensu lato species were the predominant vector. Conclusion: Increased vector breeding sites after heavy rainfall, together with inadequate malaria preventive measures caused this outbreak. We recommended increasing coverage for LLINs and larviciding breeding sites.

Keywords: malaria outbreak, Plasmodium falciparum, global health security, Uganda

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4221 Women Trainees' Perception on Non-Formal Educational Workshops in Improving Their Socio-Economic Status in Algeria and Costa Rica

Authors: Bahia Braktia, S. Anna Marcela Montenegro, Imene Abdessemed

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Adult education is still considered a crucial area of education. In a developing framework, it is regarded as a practical approach for social inclusion and poverty reduction. They are also perceived as a way to serve adults who did not have the chance to education in their early ages by providing them knowledge, skills and values. Non-formal adult education and trainings are critical means in a society to break poverty and unemployment, and to decrease the social inequality. This paper investigates the perception of women trainees about a series of workshops in natural beauty products, held in Algeria and Costa Rica and organized by a non-profit educational organization, to improve their socio-economic status. This research seeks to explore ways of empowering women by assessing their needs and providing them with skills to start their own business. A questionnaire is administered before the workshops and focus groups are held at the end. A qualitative research method is employed to analyze the data. Preliminary results show that the trainees aspire to create their businesses with the objectives of poverty reduction and social inclusion. The findings also reveal the need for small business funding programs and entrepreneurial training programs.

Keywords: adult education, non-formal education, socio-economic status, women empowerment

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4220 Field Trips inside Digital Game Environments

Authors: Amani Alsaqqaf, Frederick W. B. Li

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Field trips are essential methods of learning in different subjects, and in recent times, there has been a reduction in the number of field trips (FTs) across all learning levels around the world. Virtual field trips (VFTs) in game environments provide FT experience based on the experiential learning theory (ELT). A conceptual framework for designing virtual field trip games (VFTGs) is developed with an aim to support game designers and educators to produce an effective FT experience where technology would enhance education. The conceptual framework quantifies ELT as an internal economy to link learning elements to game mechanics such as feedback loops which leads to facilitating VFTGs design and implementation. This study assesses the conceptual framework for designing VFTGs by investigating the possibility of applying immersive VFTGs in a secondary classroom and compare them with traditional learning that uses video clips and PowerPoint slides from the viewpoint of students’ perceived motivation, presence, and learning. The assessment is achieved by evaluating the learning performance and learner experience of a prototype VFT game, Island of Volcanoes. A quasi-experiment was conducted with 60 secondary school students. The findings of this study are that the VFTG enhanced learning performance to a better level than did the traditional way of learning, and in addition, it provided motivation and a general feeling of presence in the VFTG environment.

Keywords: conceptual framework, game-based learning, game design, virtual field trip game

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4219 Evaluating Language Loss Effect on Autobiographical Memory by Examining Memory Phenomenology in Bilingual Speakers

Authors: Anastasia Sorokina

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Graduate language loss or attrition has been well documented in individuals who migrate and become emersed in a different language environment. This phenomenon of first language (L1) attrition is an example of non-pathological (not due to trauma) and can manifest itself in frequent pauses, search for words, or grammatical errors. While the widely experienced loss of one’s first language might seem harmless, there is convincing evidence from the disciplines of Developmental Psychology, Bilingual Studies, and even Psychotherapy that language plays a crucial role in the memory of self. In fact, we remember, store, and share personal memories with the help of language. Dual-Coding Theory suggests that language memory code deterioration could lead to forgetting. Yet, no one has investigated a possible connection between language loss and memory. The present study aims to address this research gap by examining a corpus of 1,495 memories of Russian-English bilinguals who are on a continuum of L1 (first language) attrition. Since phenomenological properties capture how well a memory is remembered, the following descriptors were selected - vividness, ease of recall, emotional valence, personal significance, and confidence in the event. A series of linear regression statistical analyses were run to examine the possible negative effects of L1 attrition on autobiographical memory. The results revealed that L1 attrition might compromise perceived vividness and confidence in the event, which is indicative of memory deterioration. These findings suggest the importance of heritage language maintenance in immigrant communities who might be forced to assimilate as language loss might negatively affect the memory of self.

Keywords: L1 attrition, autobiographical memory, language loss, memory phenomenology, dual coding

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4218 Locative Media Apps for Re-Building Urban Experience: Discovering Cities Through Technology

Authors: Kerem Rızvanoglu, Serhat Güney, Betül Aydoğan, Emre Kızılkaya, Ayşegül Boyalı, Onurcan Güden

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This study investigates the urban experience of international students coming to Istanbul with exchange programs and reveals how locative media applications accompany their urban experiences. The sample of the research consists of international students who lived, perceived, and conceived the city on a daily basis during the academic year of 2022. Focusing on this particular sample would demonstrate the opportunities and authentic experiences offered by the city as well as the prevalent urban problems for the foreigners. In this regard, international students' urban experience in Istanbul, the blockages they encounter as resident tourists, the hotspots that the city offers, and the role of locative media in enriching the urban experience are the main axes to be evaluated. In the first step of the multi-staged research, we conduct an online qualitative survey with a sample; then, we evaluate the data obtained from the survey using cluster analysis to identify the urban experience, consumption habits, and tastes. In the final stage, digital ethnographic fieldwork will be carried out with representative personas identified by the cluster analysis. With this field research on the urban experience accompanied by locative media applications, suggestions will be developed by evaluating the opportunities these applications offer to enrich the urban practice of foreigners.

Keywords: digital ethnography, international students, locative media applications, urban experience

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4217 Ideological and Poetological Tensions: Wu Mi’s Enterprise of Imitating and Translating George Gordon Byron

Authors: Hanjin Yan

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The English Romantic George Gordon Byron (1788-1824) was widely celebrated by men of letters in early republican China as a Satanic freedom fighter challenging classical poetics and traditional values. However, Wu Mi (1894-1978), the most persistent critic of contemporary iconoclasm, perceived Byron as a paragon of self-righteous poet-exiles who maintained moral integrity and achieved poetic excellence during times of frustration, just like canonized classical Chinese poets. Wu Mi not only composed lengthy imitations of the third canto of Byron’s Childe Harold’s Pilgrimage (1816) but also patronized a rendering of the canto. Taking André Lefevere’s rewriting theory as a framework, this paper explores the interplay of ideology and poetics by examining Wu Mi’s imitations against Byron’s original and its Chinese translation patronized by Wu Mi. Textual analysis shows that Wu Mi’s approach to Byron’s poetry was informed not only by his endeavor to invigorate classical Chinese poetics, but also by his program to preserve China’s cultural traditions and integrate Western new humanism, a theory proposed by his Harvard mentor Irving Babbitt (1865-1933). This study reveals how Byron was appropriated to serve conflicting poetic and ideological purposes in early republican China and suggests that imitation as a type of rewriting merits further attention.

Keywords: George Gordon Byron, ideology, imitation, poetics, translation

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4216 Examining the Association between Stigmatizing Attitudes in Nursing Students and Their Desire for a Career in Mental Health Nursing: A Comparative Analysis of Generic and Accelerated Programs in Israel

Authors: Merav Ben Natan, Adam Gharra, Baher Faduos, Abedallah Magadlah, Abedalrahman Biadsy

Abstract:

Introduction: Mental health nursing is often perceived as an unattractive career choice among nursing students, and it remains unclear whether the type of nursing program influences this view. Aim: This cross-sectional study aimed to explore the association between stigmatizing attitudes in nursing students and their desire for a career in mental health nursing, comparing students in generic and accelerated programs. Method: A total of 220 nursing students from generic and accelerated programs in North-Center Israel participated in this cross-sectional study, completing a questionnaire on stigmatizing attitudes and their interest in a mental health nursing career. Results: Nursing students displayed a generally low desire for mental health nursing, influenced by factors such as enrollment in the generic program, previous mental health work experience, and stigmatizing attitudes. Discussion: Students in the generic program, with lower stigmatizing attitudes and prior mental health experience, exhibited a higher inclination towards mental health nursing. Implications for Practice: Prospective mental health nursing professionals may be identified in the generic program, particularly those with prior mental health experience and lower stigmatizing attitudes. Additional studies are required to confirm and broaden their applicability to other contexts.

Keywords: nursing students, mental health nursing, stigmatizing attitudes, desire for a career in mental health nursing, generic program

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4215 Triploid Rainbow Trout (Oncorhynchus mykiss) for Better Aquaculture and Ecological Risk Management

Authors: N. N. Pandey, Raghvendra Singh, Biju S. Kamlam, Bipin K. Vishwakarma, Preetam Kala

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The rainbow trout (Oncorhynchus mykiss) is an exotic salmonid fish, well known for its fast growth, tremendous ability to thrive in diverse conditions, delicious flesh and hard fighting nature in Europe and other countries. Rainbow trout farming has a great potential for its contribution to the mainstream economy of Himalayan states in India and other temperate countries. These characteristics establish them as one of the most widely introduced and cultured fish across the globe, and its farming is also prominent in the cold water regions of India. Nevertheless, genetic fatigue, slow growth, early maturity, and low productivity are limiting the expansion of trout production. Moreover, farms adjacent to natural streams or other water sources are subject to escape of domesticated rainbow trout into the wild, which is a serious environmental concern as the escaped fish is subject to contaminate and disrupt the receiving ecosystem. A decline in production traits due to early maturity prolongs the culture duration and affects the profit margin of rainbow trout farms in India. A viable strategy that could overcome these farming constraints in large scale operation is the production of triploid fish that are sterile and more heterozygous. For better triploidy induction rate (TR), heat shock at 28°C for 10 minutes and pressure shock 9500 psi pressure for 5 minutes is applied to green eggs with 90-100% of triploidy success and 72-80% survival upto swim-up fry stage. There is 20% better growth in aquaculture with triploids rainbow trout over diploids. As compared to wild diploid fish, larger sized and fitter triploid rainbow trout in natural waters attract to trout anglers, and support the development of recreational fisheries by state fisheries departments without the risk of contaminating existing gene pools and disrupting local fish diversity. Overall, enhancement of productivity in rainbow trout farms and trout production in coldwater regions, development of lucrative trout angling and better ecological management is feasible with triploid rainbow trout.

Keywords: rainbow trout, triploids fish, heat shock, pressure shock, trout angling

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4214 The Academic-Practitioner Nexus in Countering Terrorism in New Zealand

Authors: John Battersby, Rhys Ball

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After the 15 March 2019 Mosque attacks in Christchurch, the New Zealand security sector has had to address its training and preparedness levels for dealing with contemporary terrorist threats as well as potential future manifestations of terrorism. From time to time, members of the academic community from Australia and New Zealand have been asked to assist agencies in this endeavour. In the course of 2018, New Zealand security sector professionals working in the counter-terrorism area were interviewed about how they regarded academic contributions to understanding terrorism and counter-terrorism. Responses were mixed, ranging from anti-intellectualism, a belief that the inability to access classified material rendered academic work practically useless - to some genuine interest and desire for broad based academic studies on issues practitioners did not have the time to look at. Twelve months later, researchers have revisited those spoken to prior to the Brenton Tarrant 15 March shooting to establish if there has been a change in the way academic research is perceived, viewed and valued, and what key factors have contributed to this shift in thinking. This paper takes this data, combined with a consideration of the literature on higher education within professional police and intelligence forces, and on the general perception of academics by practitioners, to present a series of findings that will contribute to a more proactive and effective set of engagements, between two distinct but important security sectors, that reflect more closely with international practice.

Keywords: academic, counter terrorism, intelligence, practitioner, research, security

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4213 Alternative Islamic Finance Channels and Instruments: An Evaluation of the Potential and Considerations in Light of Sharia Principles

Authors: Tanvir A. Uddin, Blake Goud

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Emerging trends in FinTech-enabled alternative finance, which includes channels and instruments emerging outside the traditional financial system, heralds unprecedented opportunities to improve financial intermediation and increase access to finance. With widespread criticism of the mainstream Islamic banking and finance sector as either mimicking the conventional system, failing to achieve inclusive growth or both, industry stakeholders are turning to technology to show that finance can be done differently. This paper will outline the critical elements for successful deployment of technology to maximize benefit and minimize potential for harm from introduction of Islamic FinTech and propose recommendations for Islamic financial institutions, FinTech companies, regulators and other stakeholders who are integrating or who are considering introducing FinTech solutions. The paper will present an overview of literature, present relevant case studies and summarize the lessons from interviews conducted with Islamic FinTech founders from around the world. With growing central bank concerns about leveraged loans and ballooning private credit markets globally (estimated at $1.4 trillion), current and future Islamic FinTech operators are at risk of contributing to the problems they aim to solve by operating in a 'shadow banking' system. The paper will show that by systematising a robust theory of change linked to positive outcomes, utilising objective impact frameworks (e.g., the Impact Measurement Project) and instilling a risk management culture that is proactive about potential social harm (e.g., irresponsible lending), FinTech can enable the Islamic finance industry to support positive social impact and minimize harm in support of the maqasid. The adoption of FinTech within the Islamic finance context is still at a nascent stage and the recommendations we provide based on the limited experience to date will help address some of the major cross-cutting issues related to FinTech. Further research will be needed to elucidate in more detail issues relating to individual sectors and countries within the broader global Islamic finance industry.

Keywords: alternative finance, FinTech, Islamic finance, maqasid, theory of change

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4212 Early Intervention and Teletherapy during the COVID-19 Pandemic

Authors: Stephen Hernandez, Nikita Sharma

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The Coronavirus disease (COVID-19) emerged as a worldwide pandemic at the beginning of 2020. The pandemic and its impact reached the shores of the United States by the second week of March. Once infections started to grow in numbers, early intervention programs, including those providing home-based services, recognized that to reduce the spread of the virus, many traditional in-person therapeutic interventions were going to be impossible due to social distancing and self-quarantine requirements. Initially, infants, toddlers, and their families were left without any services from their educators and therapists, but within a few weeks of the public health emergency, various states, including New York, approved the use of teletherapy/virtual visits for early intervention service provision. This paper will detail the results of a survey from over 400 E.I. service providers about their experiences utilizing teletherapy to deliver services to children in early intervention programs. The survey questions focused on how did COVID-19 stay-at-home orders impact E.I. services for young children with special needs? Sub-questions included topics such as availability of the parents, the amount of time that babies remained engaged, as well as the perceived success of teletherapy as a viable option to provide service by both parent and professional. The results of this study found that therapists found teletherapy to be a viable manner of providing services and could be very effective on a case by case basis.

Keywords: early intervention, teletheraphy, telehealth, COVID-19

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4211 Between Ralph Waldo Emerson and the Dying Infidel

Authors: Michael Keller

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Beyond the heterodoxy expressed in his now-famous 1838 address to the Harvard Divinity School, Emerson’s timing was particularly dangerous. Ideologically, New England faced a severe crisis of identity, as traditional categories of class and religion were growing increasingly unstable. Jones Very, influenced by Emerson, crossed the perceived border between acceptable religious zeal and insane enthusiasm. Abner Kneeland, on the other hand, crossed the uncomfortable border between post-Puritan Unitarian rationalism and blasphemous Enlightenment skepticism. More importantly, Kneeland oversaw a more overtly subversive brand of resistance (in the form of freethought periodicals) that not only threatened religious orthodoxy but also threatened to destabilize the class structure of New England. Very and Kneeland provide instructive case studies of how religious ideologies could run afoul of the social contract and the law itself. By looking closely at the social and religious forces that led to Kneeland’s prosecution for blasphemy, Jones Very’s forced committal to McLean Asylum, and Emerson’s escape from these fates, we gain a greater understanding of the shifting cultural landscape of 1830s New England. This paper will examine Emerson’s resistance to the traditional forces of class and ideology in Massachusetts by situating his early work in the context of the ideological battles of his time. More specifically, I will explore how Emerson was able to resist the conservative cultural forces of his time without experiencing the extremity of their wrath.

Keywords: American literature, cultural studies, emerson, religious studies

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4210 The Quality of Fishery Product on the Moldovan Market, Regulations, National Institutions, Controls and Non-Compliant Products

Authors: Mihaela Munteanu (Pila), Silvius Stanciu

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This paper presents the aspects of the official control of fishery in the Republic of Moldova. Currently, the regulations and the activity of national institutions with responsibilities in the field of food quality are in a process of harmonization with the European rules, aiming at European integration, quality improvement and providing a higher level of food safety. The National Agency for Food Safety is the main national body with responsibilities in the field of food safety. In the field of fishery products, the Agency carries out an intensive activity of informing the citizen and controlling the products marketed. The paper presents the dangers related to the consumption of fish and fishery products traded on the national market, the sanitary-veterinary inspections conducted by the profile institution and the improper situations identified. The national market of fishery products depends largely on imports, mainly focused on ocean fish. The research carried out has shown that during the period 2011-2018, following the inspections carried out on fishery products traded on the national market, a number of inconsistencies have been identified. Thus, indigenous products were frequently detected with sensory characteristics unfit for consumption, and being commercialized in inappropriate locations or contaminated with chemical pollutants. On import products controlled, the most frequent inconsistent situations have been represented by inconsistent sensory aspects and by parasite contamination. Taking into account the specific aspects of aquatic products, including the high level of alterability, special conditions of growth, marketing, culinary preparation and consumption are necessary in order to decrease the risk of disease over the population. Certificates, attestations and other documents certifying the quality of batches, completed by additional laboratory examinations, are necessary in order to increase the level of confidence on the quality of products marketed in the Republic. The implementation of various control procedures and mechanisms at national level, correlated with the focused activity of the specialized institutions, can decrease the risk of contamination and avoid cases of disease on the population due to the consumption of fishery products.

Keywords: fishery products, food safety, quality control, Republic of Moldova

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4209 Seroepidemiological Study of Toxoplasma gondii Infection in Women of Child-Bearing Age in Communities in Osun State, Nigeria

Authors: Olarinde Olaniran, Oluyomi A. Sowemimo

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Toxoplasmosis is frequently misdiagnosed or underdiagnosed, and it is the third most common cause of hospitalization due to food-borne infection. Intra-uterine infection with Toxoplasma gondii due to active parasitaemia during pregnancy can cause severe and often fatal cerebral damage, abortion, and stillbirth of a fetus. The aim of the study was to investigate the prevalence of T. gondii infection in women of childbearing age in selected communities of Osun State with a view to determining the risk factors which predispose to the T. gondii infection. Five (5) ml of blood was collected by venopuncture into a plain blood collection tube by a medical laboratory scientist. Serum samples were separated by centrifuging the blood samples at 3000 rpm for 5 mins. The sera were collected with Eppendorf tubes and stored at -20°C analysis for the presence of IgG and IgM antibodies against T. gondii by commercially available enzyme-linked immunosorbent assay (ELISA) kit (Demeditec Diagnostics GmbH, Germany) conducted according to the manufacturer’s instructions. The optical densities of wells were measured by a photometer at a wavelength of 450 nm. Data collected were analysed using appropriate computer software. The overall seroprevalence of T. gondii among the women of child-bearing age in selected seven communities in Osun state was 76.3%. Out of 76.3% positive for Toxoplasma gondii infection, 70.0% were positive for anti- T. gondii IgG, and 32.3% were positive for IgM, and 26.7% for both IgG and IgM. The prevalence of T. gondii was lowest (58.9%) among women from Ile Ife, a peri-urban community, and highest (100%) in women residing in Alajue, a rural community. The prevalence of infection was significantly higher (P= 0.000) among Islamic women (87.5%) than in Christian women (70.8%). The highest prevalence (86.3%) was recorded in women with primary education, while the lowest (61.2%) was recorded in women with tertiary education (p =0.016). The highest prevalence (79.7%) was recorded in women that reside in rural areas, and the lowest (70.1%) was recorded in women that reside in peri-urban area (p=0.025). The prevalence of T. gondii infection was highest (81.4%) in women with one miscarriage, while the prevalence was lowest in women with no miscarriages (75.9%). The age of the women (p=0.042), Islamic religion (p=0.001), the residence of the women (p=0.001), and water source were all positively associated with T. gondii infection. The study concluded that there was a high seroprevalence of T. gondii recorded among women of child-bearing age in the study area. Hence, there is a need for health education and create awareness of the disease and its transmission to women of reproductive age group in general and pregnant women in particular to reduce the risk of T. gondii in pregnant women.

Keywords: seroepidemiology, Toxoplasma gondii, women, child-bearing, age, communities, Ile -Ife, Nigeria

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4208 Teachers' Learning Community and Their Self Efficacy

Authors: Noha Desouky Aly, Maged Makram Habib

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Given the imperative role educational institutions have in the creation of a motivational learning community that develops and engages their students, the influence of evoking the same environment for their teachers needs to be examined. Teachers and their role lie at the core of the efficiency of the learning experience. One exigent aspect in the process of providing professional development to teachers is to involve them in this process, and the best manner would be through creating a learning community in which they are directly engaged and responsible for their own learning. An educational institution that thinks first of its teachers learning and growth would achieve its goals in providing an effective education for its students. The purpose of this research paper is to examine the effect of engaging teachers in a learning community in which they are responsible for their own learning through conducting and providing the material required for the training on their self efficacy, engagement, and perceived autonomy. The sample includes twenty instructors at the German University in Cairo teaching Academic skills at the Department of English and Scientific Methods. The courses taught at the department include Academic skills, writing argumentative essays, critical thinking, communication and presentation skills, and research paper writing. Procedures for the duration of eight weeks will entail pre-post measures to include The Teachers Self Efficacy Scale and an interview. During the weekly departmental meeting, teachers are to share resources and experiences or research and present a topic of their choice that contributes to their professional development. Results are yet to be found.

Keywords: learning community, self- efficacy, teachers, learning experience

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4207 Depression in Non Hospitalized Jordanian Patients with Coronary Artery Disease

Authors: Ibtisam Al-Zaru

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Background: Worldwide, depression among coronary artery disease (CAD) patients is considered a serious problem that may cause many complications and negative consequences; particularly serious being increased mortality and morbidity rate. Studying depression among CAD patients in Jordan has not been investigated thoroughly and thus a need for further studies has been a priority. Aims: To assess depression in non-hospitalized Jordanian patients with CAD; to describe the relationship between socio-demographic data, health related factors, and depression; and to examine the best predictors of depression in non-hospitalized Jordanian patients with CAD. Method: A cross-sectional-descriptive design was used to collect data from 174 non-hospitalized Jordanian patients diagnosed with CAD in outpatients’ cardiac clinics, using a self- administered questionnaires and Cardiac Depression Scale. Results: 53.4% of CAD patients reported mild/moderate, and severe depressive symptoms. Significant relationships between depressive symptoms and some demo-clinical characteristics (i.e. being female gender; having of chronic disease and surgical history; being physically inactive, and perceived their sexual activity, physical and psychological as poor). The preceding factors are also found to be statistically significant predictors for depression among this patients’ group. Conclusion: Jordanian patients with CAD had various levels of severity regarding their depressive symptoms. Therefore, health care providers need to introduce depression assessment and treatment in cardiac rehabilitation to control depression and its impact on the patient. Consequently, such control will reduce co-morbidity, mortality, complications and health costs among CAD patients and enhance the quality of their lives.

Keywords: coronary artery disease, predictors, depression, prevalence

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4206 Water Purification By Novel Nanocomposite Membrane

Authors: E. S. Johal, M. S. Saini, M. K. Jha

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Currently, 1.1 billion people are at risk due to lack of clean water and about 35 % of people in the developed world die from water related problem. To alleviate these problems water purification technology requires new approaches for effective management and conservation of water resources. Electrospun nanofibres membrane has a potential for water purification due to its high large surface area and good mechanical strength. In the present study PAMAM dendrimers composite nynlon-6 nanofibres membrane was prepared by crosslinking method using Glutaraldehyde. Further, the efficacy of the modified membrane can be renewed by mere exposure of the saturated membrane with the solution having acidic pH. The modified membrane can be used as an effective tool for water purification.

Keywords: dendrimer, nanofibers, nanocomposite membrane, water purification

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4205 A Proposed Treatment Protocol for the Management of Pars Interarticularis Pathology in Children and Adolescents

Authors: Paul Licina, Emma M. Johnston, David Lisle, Mark Young, Chris Brady

Abstract:

Background: Lumbar pars pathology is a common cause of pain in the growing spine. It can be seen in young athletes participating in at-risk sports and can affect sporting performance and long-term health due to its resistance to traditional management. There is a current lack of consensus of classification and treatment for pars injuries. Previous systems used CT to stage pars defects but could not assess early stress reactions. A modified classification is proposed that considers findings on MRI, significantly improving early treatment guidance. The treatment protocol is designed for patients aged 5 to 19 years. Method: Clinical screening identifies patients with a low, medium, or high index of suspicion for lumbar pars injury using patient age, sport participation and pain characteristics. MRI of the at-risk cohort enables augmentation of existing CT-based classification while avoiding ionising radiation. Patients are classified into five categories based on MRI findings. A type 0 lesion (stress reaction) is present when CT is normal and MRI shows high signal change (HSC) in the pars/pedicle on T2 images. A type 1 lesion represents the ‘early defect’ CT classification. The group previously referred to as a 'progressive stage' defect on CT can be split into 2A and 2B categories. 2As have HSC on MRI, whereas 2Bs do not. This distinction is important with regard to healing potential. Type 3 lesions are terminal stage defects on CT, characterised by pseudarthrosis. MRI shows no HSC. Results: Stress reactions (type 0) and acute fractures (1 and 2a) can heal and are treated in a custom-made hard brace for 12 weeks. It is initially worn 23 hours per day. At three weeks, patients commence basic core rehabilitation. At six weeks, in the absence of pain, the brace is removed for sleeping. Exercises are progressed to positions of daily living. Patients with continued pain remain braced 23 hours per day without exercise progression until becoming symptom-free. At nine weeks, patients commence supervised exercises out of the brace for 30 minutes each day. This allows them to re-learn muscular control without rigid support of the brace. At 12 weeks, bracing ceases and MRI is repeated. For patients with near or complete resolution of bony oedema and healing of any cortical defect, rehabilitation is focused on strength and conditioning and sport-specific exercise for the full return to activity. The length of this final stage is approximately nine weeks but depends on factors such as development and level of sports participation. If significant HSC remains on MRI, CT scan is considered to definitively assess cortical defect healing. For these patients, return to high-risk sports is delayed for up to three months. Chronic defects (2b and 3) cannot heal and are not braced, and rehabilitation follows traditional protocols. Conclusion: Appropriate clinical screening and imaging with MRI can identify pars pathology early. In those with potential for healing, we propose hard bracing and appropriate rehabilitation as part of a multidisciplinary management protocol. The validity of this protocol will be tested in future studies.

Keywords: adolescents, MRI classification, pars interticularis, treatment protocol

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4204 Hepatitis B, Hepatitis C and HIV Infections and Associated Risk Factors among Substance Abusers in Mekelle Substance Users Treatment and Rehabilitation Centers, Tigrai, Northern Ethiopia

Authors: Tadele Araya, Tsehaye Asmelash, Girmatsion Fiseha

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Background: Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immunodeficiency Virus (HIV) constitute serious healthcare problems worldwide. Blood-borne pathogens HBV, HCV and HIV are commonly associated with infections among substance or Injection Drug Users (IDUs). The objective of this study was to determine the prevalence of HBV, HCV, and HIV infections among substance users in Mekelle Substance users Treatment and Rehabilitation Centers. Methods: A cross-sectional study design was used from Dec 2020 to Sep / 2021 to conduct the study. A total of 600 substance users were included. Data regarding the socio-demographic, clinical and sexual behaviors of the substance users were collected using a structured questionnaire. For laboratory analysis, 5-10 ml of venous blood was taken from the substance users. The laboratory analysis was performed by Enzyme-Linked Immunosorbent Assay (ELISA) at Mekelle University, Department of Medical Microbiology and Immunology Research Laboratory. The Data was analyzed using SPSS and Epi-data. The association of variables with HBV, HCV and HIV infections was determined using multivariate analysis and a P value < 0.05 was considered statistically significant. Result: The overall prevalence rate of HBV, HCV and HIV infections were 10%, 6.6%, and 7.5%, respectively. The mean age of the study participants was 28.12 ± 6.9. A higher prevalence of HBV infection was seen in participants who were users of drug injections and in those who were infected with HIV. HCV was comparatively higher in those who had a previous history of unsafe surgical procedures than their counterparts. Homeless participants were highly exposed to HCV and HIV infections than their counterparts. The HBV/HIV Co-infection prevalence was 3.5%. Those doing unprotected sexual practices [P= 0.03], Injection Drug users [P= 0.03], those who had an HBV-infected person in their family [P=0.02], infected with HIV [P= 0.025] were statistically associated with HBV infection. HCV was significantly associated with Substance users and previous history of unsafe surgical procedures [p=0.03, p=0.04), respectively. HIV was significantly associated with unprotected sexual practices and being homeless [p=0.045, p=0.05) respectively. Conclusion-The highly prevalent viral infection was HBV compared to others. There was a High prevalence of HBV/HIV co-infection. The presence of HBV-infected persons in a family, unprotected sexual practices and sharing of needles for drug injection were the risk factors associated with HBV, HIV, and HCV. Continuous health education and screening of the viral infection coupled with medical and psychological treatment is mandatory for the prevention and control of the infections.

Keywords: hepatitis b virus, hepatitis c virus, HIV, substance users

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4203 The Influence of English Learning on Ethnic Kazakh Minority Students’ Identity (Re)Construction at Chinese Universities

Authors: Sharapat Sharapat

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English language is perceived as cultural capital in many non-native English-speaking countries, and minority groups in these social contexts seem to invest in the language to be empowered and reposition themselves from the imbalanced power relation with the dominant group. This study is devoted to explore how English learning influence minority Kazakh students’ identity (re)construction at Chinese universities from the scope of ‘imagined community, investment, and identity’ theory of Norton (2013). To this end the three research questions were designed as follows: 1) Kazakh minority students’ English learning experiences at Chinese universities; 2) Kazakh minority students’ views about benefits and opportunities of English learning; 3) the influence of English learning on Kazakh minority students’ identity (re)construction. The study employs an interview-based qualitative research method by interviewing nine Kazakh minority students in universities in Xinjiang and other inland cities in China. The findings suggest that through English learning, some students have reconstructed multiple identities as multicultural and global identities, which created ‘a third space’ to break limits of their ethnic and national identities and confused identity as someone in-between. Meanwhile, most minority students were empowered by the English language to resist inferior or marginalized positions and reconstruct imagined elite identity. However, English learning disempowered students who have little previous English education in school and placed them on unequal footing with other students, which further escalated the educational inequities.

Keywords: minority in China, identity construction, multilingual education, language empowerment

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4202 The Impact of Breast Cancer Diagnosis on Omani Women

Authors: H. Al-Awaisi, M. H. Al-Azri, S. Al-Rasbi, M. Al-Moundhri

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Breast cancer is the most common cancer among females worldwide. It is also the most common cancer among females in Oman with 100 new breast cancer cases diagnosed every year. It has been found that breast cancer have a devastating effect on women’s life. Women diagnosed with breast cancer might develop negative attitudes towards the illness and their bodies. They might also suffer from psychological ailments such as depression. Despite the evidence on the impact of breast cancer diagnosis on women, there was no study found to explore the impact of breast cancer diagnosis among women in Oman. A phenomenological qualitative study was conducted to explore the impact of breast cancer diagnosis on Omani women. Data was collected through semi-structured individual interviews with 11 Omani women diagnosed with breast cancer. Interviews were transcribed verbatim and data were analyzed thematically. From the data, there are four main themes identified in relation to the impact of cancer diagnosis on Omani women. These are 'shock and disbelieve', 'a death sentence', “uncertain future” and “social stigma”. At the time of interviews, all participants had advanced breast cancer with some participants having metastatic disease. The impact of the word “cancer” had a profound and catastrophic effect on the women and their close relatives. In conclusion, breast cancer diagnosis was shocking and mainly perceived as a death sentence by Omani women with uncertain future and social stigma. Regardless of age, maternal status and education level, it is evident that Omani women participated in this study lacked awareness about breast cancer diagnosis, treatment and prognosis.

Keywords: breast cancer, coping, diagnosis, Oman, women

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4201 The Image of Cultural Tourism in the Tourists’ Point of View

Authors: Wanida Suwunniponth

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The purposes of this research were to investigate the perceived of a cultural image and loyalty of tourists toward the attraction at Banglumphu neighborhood in Bangkok and to study the relationship of the cultural image of Banglumphu community and loyalty to visit this area of the tourists. This study employed both quantitative approach and qualitative approach. In a quantitative research, a questionnaire was used to collect data from 300 systematic sampled tourists who visited Banglumphu area and the correlation analysis were used to analyze data. The results revealed that the overall tourists’ point of view toward Banglumphu cultural image was at a good level which lifestyle had the best image, followed by value and belief, physical dimension, community identity, tradition, and local wisdom. In addition, the overall aspect of tourists’ loyalty including satisfaction, word of mouths, and revisiting were at good levels which word of mouths received the highest value, followed by revisiting, and satisfaction, respectively. In addition, the relationship between cultural image in aspect on lifestyle, tradition, local wisdom, belief, community identity and loyalty to visit Banglumphu in each aspect on satisfaction, word of mouths, and revisiting were moderately correlated at the significant level of 0.05, except physical dimension was not correlated with each aspect of tourists’ loyalty.

Keywords: cultural tourism, image, loyalty, revisit

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4200 Hydrogeochemical Investigation of Lead-Zinc Deposits in Oshiri and Ishiagu Areas, South Eastern Nigeria

Authors: Christian Ogubuchi Ede, Moses Oghenenyoreme Eyankware

Abstract:

This study assessed the concentration of heavy metals (HMs) in soil, rock, mine dump pile, and water from Oshiri and Ishiagu areas of Ebonyi State. Investigations on mobile fraction equally evaluated the geochemical condition of different HM using UV spectrophotometer for Mineralized and unmineralized rocks, dumps, and soil, while AAS was used in determining the geochemical nature of the water system. Analysis revealed very high pollution of Cd mostly in Ishiagu (Ihetutu and Amaonye) active mine zones and with subordinates enrichments of Pb, Cu, As, and Zn in Amagu and Umungbala. Oshiri recorded sparingly moderate to high contamination of Cd and Mn but out rightly high anthropogenic input. Observation showed that most of the contamination conditions were unbearable while at the control but decrease with increasing distance from the mine vicinity. The potential heavy metal risk of the environments was evaluated using the risk factors such as enrichment factor, index of Geoacumulation, Contamination Factor, and Effect Range Median. Cadmium and Zn showed moderate to extreme contamination using Geoaccumulation Index (Igeo) while Pb, Cd, and As indicated moderate to strong pollution using the Effect Range Median. Results, when compared with the allowable limits and standards, showed the concentration of the metals in the following order Cd>Zn>Pb>As>Cu>Ni (rocks), Cd>As>Pb>Zn>Cu>Ni (soil) while Cd>Zn>As>Pb> Cu (for mine dump pile. High concentrations of Zn and As were recorded more in mine pond and salt line/drain channels along active mine zones, it heightened its threat during the rainy period as it settles into river course, living behind full-scale contaminations to inhabitants depending on it for domestic uses. Pb and Cu with moderate pollution were recorded in surface/stream water source as its mobility were relatively low. Results from Ishiagu Crush rock sites and Fedeco metallurgical and auto workshop where groundwater contamination was seen infiltrating some of the wells points gave rise to values that were 4 times high than the allowable limits. Some of these metal concentrations according to WHO (2015) if left unmitigated pose adverse effects to the soil and human community.

Keywords: water, geo-accumulation, heavy metals, mine and Nigeria.

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4199 Prevalence of Hepatitis B Virus Infection and Its Determinants among Pregnant Women in East Africa: Systematic Review and Meta-Analysis

Authors: Bantie Getnet Yirsaw, Muluken Chanie Agimas, Gebrie Getu Alemu, Tigabu Kidie Tesfie, Nebiyu Mekonnen Derseh, Habtamu Wagnew Abuhay, Meron Asmamaw Alemayehu, Getaneh Awoke Yismaw

Abstract:

Introduction: Hepatitis B virus (HBV) is one of the major public health problems globally and needs an urgent response. It is one of the most responsible causes of mortality among the five hepatitis viruses, and it affects almost every class of individuals. Thus, the main objective of this study was to determine the pooled prevalence and its determinants among pregnant women in East Africa. Methods: We searched studies using PubMed, Scopus, Embase, ScienceDirect, Google Scholar, and grey literature that were published between January 01/2020 to January 30/2024. The studies were assessed using the Newcastle Ottawa Scale (NOS) quality assessment scale. The random-effect (DerSimonian) model was used to determine the pooled prevalence and associated factors of HBV among pregnant women. Heterogeneity was assessed by I² statistic, sub-group analysis, and sensitivity analysis. Publication bias was assessed by the Egger test, and the analysis was done using STATA version 17. Result: A total of 45 studies with 35639 pregnant women were included in this systematic review and meta-analysis. The overall pooled prevalence of HBV among pregnant women in East Africa was 6.0% (95% CI: 6.0%−7.0%, I² = 89.7%). The highest prevalence of 8% ((95% CI: 6%, 10%), I² = 91.08%) was seen in 2021, and the lowest prevalence of 5% ((95% CI: 4%, 6%) I² = 52.52%) was observed in 2022. A pooled meta-analysis showed that history of surgical procedure (OR = 2.14 (95% CI: 1.27, 3.61)), having multiple sexual partners (OR = 3.87 (95% CI: 2.52, 5.95), history of body tattooing (OR = 2.55 (95% CI: 1.62, 4.01)), history of tooth extraction (OR = 2.09 (95% CI: 1.29, 3.39)), abortion history(OR = 2.20(95% CI: 1.38, 3.50)), history of sharing sharp material (OR = 1.88 (95% CI: 1.07, 3.31)), blood transfusion (OR = 2.41 (95% CI: 1.62, 3.57)), family history of HBV (OR = 4.87 (95% CI: 2.95, 8.05)) and history needle injury (OR = 2.62 (95% CI: 1.20, 5.72)) were significant risk factors associated with HBV infection among pregnant women. Conclusions: The pooled prevalence of HBV infection among pregnant women in East Africa was at an intermediate level and different across countries, ranging from 1.5% to 22.2%. The result of this pooled prevalence was an indication of the need for screening, prevention, and control of HBV infection among pregnant women in the region. Therefore, early identification of risk factors, awareness creation of the mode of transmission of HBV, and implementation of preventive measures are essential in reducing the burden of HBV infection among pregnant women.

Keywords: hepatitis B virus, prevalence, determinants, pregnant women, meta-analysis, East Africa

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4198 Rethinking the Value of Pancreatic Cyst CEA Levels from Endoscopic Ultrasound Fine-Needle Aspiration (EUS-FNA): A Longitudinal Analysis

Authors: Giselle Tran, Ralitza Parina, Phuong T. Nguyen

Abstract:

Background/Aims: Pancreatic cysts (PC) have recently become an increasingly common entity, often diagnosed as incidental findings on cross-sectional imaging. Clinically, management of the lesions is difficult because of uncertainties in their potential for malignant degeneration. Prior series have reported that carcinoembryonic antigen (CEA), a biomarker collected from cyst fluid aspiration, has a high diagnostic accuracy for discriminating between mucinous and non-mucinous lesions, at the patient’s initial presentation. To the author’s best knowledge, no prior studies have reported PC CEA levels obtained from endoscopic ultrasound fine-needle aspiration (EUS-FNA) over years of serial EUS surveillance imaging. Methods: We report a consecutive retrospective series of 624 patients who underwent EUS evaluation for a PC between 11/20/2009 and 11/13/2018. Of these patients, 401 patients had CEA values obtained at the point of entry. Of these, 157 patients had two or more CEA values obtained over the course of their EUS surveillance. Of the 157 patients (96 F, 61 M; mean age 68 [range, 62-76]), the mean interval of EUS follow-up was 29.7 months [3.5-128]. The mean number of EUS procedures was 3 [2-7]. To assess CEA value fluctuations, we defined an appreciable increase in CEA as "spikes" – two-times increase in CEA on a subsequent EUS-FNA of the same cyst, with the second CEA value being greater than 1000 ng/mL. Using this definition, cysts with a spike in CEA were compared to those without a spike in a bivariate analysis to determine if a CEA spike is associated with poorer outcomes and the presence of high-risk features. Results: Of the 157 patients analyzed, 29 had a spike in CEA. Of these 29 patients, 5 had a cyst with size increase >0.5cm (p=0.93); 2 had a large cyst, >3cm (p=0.77); 1 had a cyst that developed a new solid component (p=0.03); 7 had a cyst with a solid component at any time during surveillance (p=0.08); 21 had a complex cyst (p=0.34); 4 had a cyst categorized as "Statistically Higher Risk" based on molecular analysis (p=0.11); and 0 underwent surgical resection (p=0.28). Conclusion: With serial EUS imaging in the surveillance of PC, an increase in CEA level defined as a spike did not predict poorer outcomes. Most notably, a spike in CEA did not correlate with the number of patients sent to surgery or patients with an appreciable increase in cyst size. A spike in CEA did not correlate with the development of a solid nodule within the PC nor progression on molecular analysis. Future studies should focus on the selected use of CEA analysis when patients undergo EUS surveillance evaluation for PCs.

Keywords: carcinoembryonic antigen (CEA), endoscopic ultrasound (EUS), fine-needle aspiration (FNA), pancreatic cyst, spike

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