Search results for: combined modality therapy

Authors: Valeria Aman

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The presented study examines the impact of international mobility on knowledge production among mobile scientists and within the sending and receiving research groups. Scientists are relevant to the dynamics of knowledge production because scientific knowledge is mainly characterized by embeddedness and tacitness. International mobility enables the dissemination of scientific knowledge to other places and encourages new combinations of knowledge. It can also increase the interdisciplinarity of research by forming synergetic combinations of knowledge. Particularly innovative ideas can have their roots in related research domains and are sometimes transferred only through the physical mobility of scientists. Diversity among scientists with respect to their knowledge base can act as an engine for the creation of knowledge. It is therefore relevant to study how knowledge acquired through international mobility affects the knowledge production process. In certain research domains, international mobility may be essential to contextualize knowledge and to gain access to knowledge located at distant places. The knowledge production process contingent on the type of international mobility and the epistemic culture of a research field is examined. The production of scientific knowledge is a multi-faceted process, the output of which is mainly published in scholarly journals. Therefore, the study builds upon publication and citation data covered in Elsevier’s Scopus database for the period of 1996 to 2015. To analyse these data, bibliometric and social network analysis techniques are used. A basic analysis of scientific output using publication data, citation data and data on co-authored publications is combined with a content map analysis. Abstracts of publications indicate whether a research stay abroad makes an original contribution methodologically, theoretically or empirically. Moreover, co-citations are analysed to map linkages among scientists and emerging research domains. Finally, acknowledgements are studied that can function as channels of formal and informal communication between the actors involved in the process of knowledge production. The results provide better understanding of how the international mobility of scientists contributes to the production of knowledge, by contrasting the knowledge production dynamics of internationally mobile scientists with those being nationally mobile or immobile. Findings also allow indicating whether international mobility accelerates the production of knowledge and the emergence of new research fields.

Keywords: bibliometrics, diversity, interdisciplinarity, international mobility, knowledge production

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Authors: Liz van Acker, Linda Colley

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Political processes are shaped by the gendered culture of parliaments. This paper examines how the institution of parliament has been affected by the changing number of women in politics. In order to understand how and why gender change occurs, the paper employs a feminist historical institutionalism approach. It argues that while it is difficult to change the gendered nature of political institutions, it is possible, from a gender perspective, to understand the processes of change both formally and informally. Increasing women’s representation has been a slow process which has not occurred without political struggles. A broadly defined ‘feminist historical institutionalism’ has critiqued existing approaches to institutions and combined historical institutional analysis with tools of gender to enhance our understanding of institutional processes and change. The paper examines the gendered rules, norms, and practices that influence institutional design choices and processes. Institutions such as Parliament often are able to adjust to women’s entry and absorb them without too much interruption. Exploring the hidden aspects to informal institutions involves identifying unspoken and accepted norms that may guide decision-making – exposing and questioning the gender status quo. This paper examines the representation of women in the Queensland Parliament, Australia. It places the Queensland experience in historical context, as well as in the national and international context. The study is interesting, given that its gender representation has rocketed from one of the worst performing states in 2012 to one of the best performing in 2015 with further improvements in 2017. The state currently has a re-elected female Premier, a female Deputy Premier and a female-dominated cabinet – in fact, Queensland was the first ministry in Australia to have a majority of women in its Cabinet. However, it is unnecessary to dig far below these headlines to see that this is uncharacteristic of its history: progress towards this current position has been slow and patchy. The paper finds that matters such as the glass ceiling and the use of quotas explain women’s recent success in Queensland politics.

Keywords: feminist historical institutional approach, glass ceiling, quotas, women’s participation in politics

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Authors: Naim Izet Kajtazi

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Context: Increased intracranial pressure and associated symptoms such as headache, papilledema, motor or sensory deficits, seizures, and conscious disturbance are well-known in acute CVT. However, visual loss is not commonly associated with this disease, except in the case of secondary IIH associated with it. Process: We report a case of a 40-year-old male with Behçet’s disease and cerebral venous thrombosis, and other multiple comorbidities admitted with a four-day history of increasing headache and rapidly progressive visual loss bilaterally. The neurological examination was positive for bilateral papilledema of grade 3 with light perception on the left eye and counting fingers on the right eye. Brain imaging showed old findings of cerebral venous thrombosis without any intraparenchymal lesions to suggest a flare-up of Behçet’s disease. The lumbar puncture, followed by the lumbar drain insertion, gave no benefit in headache or vision. However, he completely lost sight. The right optic nerve sheath fenestration did not result in vision improvement. The acute spinal shock complicated the lumbar drain removal due to epidural hematoma. An urgent lumbar laminectomy with hematoma evacuation undertook. Intra-operatively, the neurosurgeon noted suspicious abnormal vessels at conus medullaris with the possibility of an arteriovenous malformation. Outcome: In a few days following the spinal surgery, the patient vision started to improve. Further improvement was achieved after plasma exchange sessions followed by cyclophosphamide. In the recent follow-up in the clinic, he reported better vision, drove, and completed his Ph.D. studies. Relevance: Visual loss in patients with Behçet’s disease should always be anticipated and taken reasonable care of, ensuring that they receive well-combined immunosuppression with anticoagulation and agents to reduce intracranial pressure. This patient’s story is significant for a high disease burden and complicated hospital course by acute spinal shock due to spinal lumbar drain removal with a possible underlying spinal arteriovenous malformation.

Keywords: Behcet disease, optic neuritis, IIH, CVT

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Authors: Karina Peron, Ricardo Ghelman, Monica Taminato, Katia R. Oliveira, Debora C. A. Rodrigues, Juliana R. C. Mumme, Olga K. M. Sunakozaua, Georg Seifert, Vicente O. Filho

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The nurse is the most available health professional for the interventions of support in the integrative approach in hospital environment, therefore a professional group key to changes in the model of care. The central components in the performance of anthroposophic nursing procedures are direct physical contact, promotion of proper rhythm, thermal regulation and the construction of a calm and empathic atmosphere, safe for patients and their caregivers. The procedures of anthroposophic external therapies (AET), basically composed of the application of compresses and the use of natural products, provide an opportunity to intensify the therapeutic results through an innovative, complementary and integrative model in the university hospital. The objective of this work is to report the implementation of a program of nursing techniques (AET) through a partnership between the Pediatric Oncology Sector of the Department of Pediatrics of the Faculty of Medicine of the University of Sao Paulo and Charite University of Berlin, with lecturers from Berlin's Integrative Hospital Havelhöhe and Witten-Herdecke Integrative Hospital, both in Germany. Intensive training activities of the Hospital's nursing staff and a survey on AET needs were developed based on the most prevalent complaints in pediatric oncology patients in the three environments of the Hospital of Pediatric Oncology: Bone Marrow Transplantation Unit, Intensive Care Unit and Division of Internal Patients. We obtained the approval of the clinical protocol of external anthroposophic therapies for nursing care by the Ethics Committee and the Academic Council of the Hospital. With this project, we highlight the key AET needs that will be part of the standard program of pediatric oncology care with appropriate scientific support. The results of the prevalent symptoms were: vomiting, nausea, pain, difficulty in starting sleep, constipation, cold extremities, mood disorder and psychomotor agitation. This project was the pioneer within the Integrative Pediatrics Program, as an innovative concept of Medicine and Integrative Health presented at scientific meetings.

Keywords: integrative health care, integrative nursing, pediatric nursing, pediatric oncology

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Authors: Bibiana Betancur-Corredor, Juan Carlos Loaiza, Manfred Denich, Christian Borgemeister

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Alluvial gold mining generates a vast amount of deposits that cover the natural soil and negatively impacts riverbeds and valleys, causing loss of livelihood opportunities for farmers of these regions. In Colombia, more than 79,000 ha are affected by alluvial gold mining, therefore developing strategies to return this land to productivity is of crucial importance for the country. A novel restoration strategy has been created by a mining company, where the land is restored through the establishment of agroforestry systems, in which agricultural crops and livestock are combined to complement reforestation in the area. The purpose of this study is to capture the knowledge of farmers who perform agroforestry in areas with deposits created by alluvial gold mining activities. Semi structured interviews were conducted with farmers with regard to the following: indicators of soil fertility, management practices, soil heterogeneity, pest outbreaks and weeds. In order to compare the perceptions of soil fertility of farmers with physicochemical properties of soils, the farmers were asked to identify spots within their farms that have exhibited good and poor yields. Soil samples were collected in order to correlate farmer’s perceptions with soil physicochemical properties. The findings suggest that the main challenge that farmers face is the identification of fertile soil for crop establishment. They identify the fertile soil through visually analyzing soil color and compaction as well as the use of spontaneous growth of specific plants as indicator of soil fertility. For less fertile areas, nitrogen fixing plants are used as green manure to restore soil fertility for crop establishment. The findings of this study imply that if gold mining is followed by reclamation practices that involve the successful establishment of productive farmlands, agricultural productivity of these lands might improve, increasing food security of the affected communities.

Keywords: agroforestry, knowledge, mining, restoration

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Authors: Reem Alshiha, Tanzila Saba

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Physical rehabilitation is the process of helping people to recover and be able to go back to their former activities that have been delayed due to external factors such as car accidents, old age and victims of strokes (chronic diseases and accidents, and those related to sport activities).The cost of hiring a personal nurse or driving the patient to and from the hospital could be costly and time-consuming. Also, there are other factors to take into account such as forgetfulness, boredom and lack of motivation. In order to solve this dilemma, some experts came up with rehabilitation software to be used with Microsoft Kinect to help the patients and their families for in-home rehabilitation. In home rehabilitation software is becoming more and more popular, since it is more convenient for all parties affiliated with the patient. In contrast to the other costly market-based systems that have no portability, Microsoft’s Kinect is a portable motion sensor that reads body movements and interprets it. New software development has made rehabilitation games available to be used at home for the convenience of the patient. The game will benefit its users (rehabilitation patients) in saving time and money. There are many software's that are used with the Kinect for rehabilitation, but the software that is chosen in this research is Kinectotherapy. Kinectotherapy software is used for rehabilitation patients in Riyadh clinics to test its acceptance by patients and their physicians. In this study, we used Kinect because it was affordable, portable and easy to access in contrast to expensive market-based motion sensors. This paper explores the importance of in-home rehabilitation by using Kinect with Kinectotherapy software. The software targets both upper and lower limbs, but in this research, the main focus is on upper-limb functionality. However, the in-home rehabilitation is applicable to be used by all patients with motor disability, since the patient must have some self-reliance. The targeted subjects are patients with minor motor impairment that are somewhat independent in their mobility. The presented work is the first to consider the implementation of in-home rehabilitation with real-time feedback to the patient and physician. This research proposes the implementation of in-home rehabilitation in Riyadh, Saudi Arabia. The findings show that most of the patients are interested and motivated in using the in-home rehabilitation system in the future. The main value of the software application is due to these factors: improve patient engagement through stimulating rehabilitation, be a low cost rehabilitation tool and reduce the need for expensive one-to-one clinical contact. Rehabilitation is a crucial treatment that can improve the quality of life and confidence of the patient as well as their self-esteem.

Keywords: x-box, rehabilitation, physical therapy, rehabilitation software, kinect

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Authors: Manu Manu, Pardha J. Saradhi, Ramana M. V. Murthy

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Wind Energy is accepted as one of the most developed, cost effective and proven renewable energy technologies to meet increasing electricity demands in a sustainable manner. Preliminary assessment studies along Indian Coastline by Ministry of New and Renewable Energy have indicated prospects for development of offshore wind power along Tamil Nadu Coast, India. The commercial viability of a wind project mainly depends on wind characteristics on site. Hence, it is internationally recommended to perform site-specific wind resource assessment based on two years’ wind profile as a part of the feasibility study. Conventionally, guy wire met mast are used onshore for the collection of wind profile. Installation of similar structure in offshore requires complex marine spread and are very expensive. In the present study, an attempt is made to develop 120 m long lattice tower supported on the jacket, piled to the seabed at Rameshwaram, Tamil Nadu, India. Offshore met-masts are subjected to combined wind and hydrodynamic loads, and these lateral loads should be safely transferred to soil. The wind loads are estimated based on gust factor method, and the hydrodynamic loads are estimated by Morison’s equation along with suitable wave theory. The soil is modeled as three nonlinear orthogonal springs based on API standards. The structure configuration and optimum member sizes are obtained for extreme cyclone events. The dynamic behavior of mast under coupled wind and wave loads is also studied. The static responses of a mast with jacket type offshore platform have been studied using a frame model in SESAM. It is found from the study that the maximum displacement at the top of the mast for the random wave is 0.003 m and that of the tower for wind is 0.08 m during the steady state. The dynamic analysis results indicate that the structure is safe against coupled wind and wave loading.

Keywords: offshore wind, mast, static, aerodynamic load, hydrodynamic load

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Authors: Andrea Gatti, Federica Coppotelli, Ma Primavera, Laura Palmieri, Umberto Tarantino

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Aim of study: Scientific literature is scarce of studies and reviews valuing the pros and cons of the paratricipital approach for the treatment of humeral shaft fractures; the lateral paratricipital approach is a valid alternative to the classical posterior approach to the humeral shaft as it preserves both the triceps muscle and the elbow extensor mechanisms; based on our experience, this retrospective analysis aims at analyzing outcome, risks and benefits of the lateral paratricipital approach for humeral shaft fractures. Methods: Our study includes 14 patients treated between 2018 and 2019 for unilateral humeral shaft fractures: 13 with a B1 or B2 and a patient with a C fracture type (according to the AO/ATO Classification); 6 of our patients identified as male while 8 as female; age average was 57.8 years old (range 21-73 years old). A lateral paratricipital approach was performed on all 14 patients, sparing the triceps muscle by avoiding the olecranon osteotomy and by assessing the integrity and the preservation of the radial nerve; the humeral shaft fracture osteosynthesis was performed by means of plates and screws. After surgery all patients have started elbow functional rehabilitation with acceptable pain management. Post-operative follow-up has been carried out by assessing radiographs, MEPS (Mayo Elbow Performance Score) and DASH (Disability of Arm Shoulder and Hand) functional assessment and ROM of the affected joint. Results: All 14 patients had an optimal post-operative follow-up with an adequate osteosynthesis and functional rehabilitations by entirely preserving the operated elbow joint; the mean elbow ROM was 0-118.6 degree (range of 0-130) while the average MEPS score was 86 (range75-100) and 79.9 for the DASH (range 21.7-86.1). Just 2 patients suffered of temporary radial nerve apraxia, healed in the subsequent follow-ups. CONCLUSION: The lateral paratricipital approach preserve both the integrity of the triceps muscle and the elbow biomechanism but we do strongly recommend additional studies to be carried out to highlight differences between it and the classical posterior approach in treating humeral shaft fractures.

Keywords: paratricepital approach, humerus shaft fracture, posterior approach humeral shaft, paratricipital postero-lateral approach

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Authors: Sakshi Kaul, Sundeep Verma

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The focus of the current paper is to evaluate the therapeutic power of words. This will be done by critically evaluating the impact reading, writing and storytelling have on individuals. When we read, tell or listen to a story we are exercising our imagination. Imagination becomes the source of activation of thoughts and actions. This enables and helps the reader, writer or the listener to express the suppressed emotions or desires. The stories told, untold may bring various human emotions and attributes to forth such as hope, optimism, fear, happiness. Each story narrated evokes different emotions, at times they help us unravel ourselves in the world of the teller thereby bringing solace. Stories heard or told add to individual’s life by creating a community around, giving wings of thoughts that enable individual to be more imaginative and creative thereby fostering positively and happiness. Reading if looked at from the reader’s point of view can broaden the horizon of information and ideas about facts and life laws giving more meaning to life. From ‘once upon a time’ to ‘to happily ever after’, all that stories talk about is life’s learning. The power of words sometimes may be negated, this paper would reiterate the power of words by critically evaluating how words can become powerful and therapeutic in various structures and forms in the society. There is a story behind every situation, action and reaction. Hence it is of prime importance to understand each story, to enable a person to deal with whatever he or she may be going through. For example, if a client is going through some trauma in his or her life, the counsellor needs to know exactly what is the turmoil that is being faced so that the client can be assisted accordingly. Counselling is considered a process of healing through words or as Talk therapy, where merely through words we try to heal the client. In a counselling session, the counsellor focuses on working with the clients to bring a positive change. The counsellor allows the client to express themselves which is referred to as catharsis. The words spoken, written or heard transcend to heal and can be therapeutic. The therapeutic power of words has been seen in various cultural practices and belief systems. The underlining belief that words have the power to heal, save and bring change has existed from ages. Many religious and spiritual practices also acclaim the power of the words. Through this empirical paper, we have tried to bring to light how reading, writing, and storytelling have been used as mediums of healing and have been therapeutic in nature.

Keywords: reading, storytelling, therapeutic, words

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Authors: Nikhil Kumar, Asish Bandyopadhyay

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Laser welding process is a capable technology for forming the automobile, microelectronics, marine and aerospace parts etc. In the present work, a mathematical and statistical approach is adopted to study the laser welding of AISI 304 stainless steel. A robotic control 500 W pulsed Nd:YAG laser source with 1064 nm wavelength has been used for welding purpose. Butt joints are made. The effects of welding parameters, namely; laser power, scanning speed and pulse width on the seam width and depth of penetration has been investigated using the empirical models developed by response surface methodology (RSM). Weld quality is directly correlated with the weld geometry. Twenty sets of experiments have been conducted as per central composite design (CCD) design matrix. The second order mathematical model has been developed for predicting the desired responses. The results of ANOVA indicate that the laser power has the most significant effect on responses. Microstructural analysis as well as hardness of the selected weld specimens has been carried out to understand the metallurgical and mechanical behaviour of the weld. Average micro-hardness of the weld is observed to be higher than the base metal. Higher hardness of the weld is the resultant of grain refinement and δ-ferrite formation in the weld structure. The result suggests that the lower line energy generally produce fine grain structure and improved mechanical properties than the high line energy. The combined effects of input parameters on responses have been analyzed with the help of developed 3-D response surface and contour plots. Finally, multi-objective optimization has been conducted for producing weld joint with complete penetration, minimum seam width and acceptable welding profile. Confirmatory tests have been conducted at optimum parametric conditions to validate the applied optimization technique.

Keywords: ANOVA, laser welding, modeling and optimization, response surface methodology

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Authors: Badawia Ibrahim, Iman Hussein, Samar El Sheikh, Fatma Abou Elkasem, Hazem Abo Ismael

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Background: Response of breast carcinoma to neoadjuvant chemotherapy (NAC) varies regarding many factors including hormonal receptor status. Breast cancer is a heterogenous disease with different outcomes, hence a need arises for new markers predicting the outcome of NAC especially for the triple negative group when estrogen, progesterone receptors and Her2/neu are negative. FOXP3 is a promising target with unclear role. Aim: To examine the value of FOXP3 expression in locally advanced triple negative breast cancer tumoral cells as well as tumor infiltrating lymphocytes (TILs) and to elucidate its relation to the extent of NAC response. Material and Methods: Forty five cases of immunohistochemically confirmed to be triple negative breast carcinoma were evaluated for NAC (Doxorubicin, Cyclophosphamide AC x 4 cycles + Paclitaxel x 12 weeks, patients with ejection fraction less than 60% received Taxotere or Cyclophosphamide, Methotrexate, Fluorouracil CMF) response in both tumour and lymph nodes status according to Miller & Payne's and Sataloff's systems. FOXP3 expression in tumor as well as TILs evaluated in the pretherapy biopsies was correlated with NAC response in breast tumor and lymph nodes as well as other clinicopathological factors. Results: Breast tumour cells showed FOXP3 positive cytoplasmic expression in (42%) of cases. High FOXP3 expression percentage was detected in (47%) of cases. High infiltration by FOXP3+TILs was detected in (49%) of cases. Positive FOXP3 expression was associated with negative lymph node metastasis. High FOXP3 expression percentage and high infiltration by FOXP3+TILs were significantly associated with complete therapy response in axillary lymph nodes. High FOXP3 expression in tumour cells was associated with high infiltration by FOXP3+TILs. Conclusion: This result may provide evidence that FOXP3 marker is a good prognostic and predictive marker for triple negative breast cancer (TNBC) indicated for neoadjuvant chemotherapy and can be used for stratifications of TNBC cases indicated for NAC. As well, this study confirmed the fact that the tumour cells and the surrounding microenvironment interact with each other and the tumour microenvironment can influence the treatment outcomes of TNBC.

Keywords: breast cancer, FOXP3 expression, prediction of neoadjuvant chemotherapy effect, triple negative

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Authors: Vijay Sodhi, Charanjit Singh, Neelam Sodhi, Puneet P. S. Cheema, Reena Sharma, Mithilesh K. Jha

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The management and secure disposal of the biosludge generated from widely commercialized conventional activated sludge (CAS) treatments become a potential environmental issue. Thus, a sustainable technological upgradation to the CAS for sludge yield minimization has recently been gained serious attention of the scientific community. A number of recently reported studies effectively addressed the remedial technological advancements that in monopoly limited to the municipal wastewater. Moreover, the critical review of the literature signifies side-stream sludge minimization as a complex task to maintain. In this work, therefore, a hybrid moving bed biofilm reactor (MBBR) configuration (named as AMOMOX process) for in-situ minimization of the excess biosludge generated from high organic strength tannery wastewater has been demonstrated. The AMOMOX collectively stands for anoxic MBBR (as AM), aerobic MBBR (OM) and an oxic CAS (OX). The AMOMOX configuration involved a combined arrangement of an anoxic MBBR and oxic MBBR coupled with the aerobic CAS. The AMOMOX system was run in parallel with an identical CAS reactor. Both system configurations were fed with same influent to judge the real-time operational changes. For the AMOMOX process, the strict maintenance of operational strategies resulted about 95% removal of NH4-N and SCOD from tannery wastewater. Here, the nourishment of filamentous microbiota and purposeful promotion of cell-lysis effectively sustained sludge yield (Yobs) lowering upto 0.51 kgVSS/kgCOD. As a result, the volatile sludge scarcity apparent in the AMOMOX system succeeded upto 47% reduction of the excess biosludge. The corroborated was further supported by FE-SEM imaging and thermogravimetric analysis. However, the detection of microbial strains habitat underlying extended SRT (23-26 days) of the AMOMOX system would be the matter of further research.

Keywords: tannery wastewater, moving bed biofilm reactor, sludhe yield, sludge minimization, solids retention time

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Authors: Simon B. N. Thompson

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Early indicator of neurological disease has been proposed by the expanded Thompson Cortisol Hypothesis which suggests that yawning is linked to rises in cortisol levels. Cortisol is essential to the regulation of the immune system and pathological yawning is a symptom of multiple sclerosis (MS). Electromyography activity (EMG) in the jaw muscles typically rises when the muscles are moved – extended or flexed; and yawning has been shown to be highly correlated with cortisol levels in healthy people. It is likely that these elevated cortisol levels are also seen in people with MS. The possible link between EMG in the jaw muscles and rises in saliva cortisol levels during yawning were investigated in a randomized controlled trial of 60 volunteers aged 18-69 years who were exposed to conditions that were designed to elicit the yawning response. Saliva samples were collected at the start and after yawning, or at the end of the presentation of yawning-provoking stimuli, in the absence of a yawn, and EMG data was additionally collected during rest and yawning phases. Hospital Anxiety and Depression Scale, Yawning Susceptibility Scale, General Health Questionnaire, demographic, and health details were collected and the following exclusion criteria were adopted: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiple sclerosis, and stroke. Significant differences were found between the saliva cortisol samples for the yawners, t (23) = -4.263, p = 0.000, as compared with the non-yawners between rest and post-stimuli, which was non-significant. There were also significant differences between yawners and non-yawners for the EMG potentials with the yawners having higher rest and post-yawning potentials. Significant evidence was found to support the Thompson Cortisol Hypothesis suggesting that rises in cortisol levels are associated with the yawning response. Further research is underway to explore the use of cortisol as a potential diagnostic tool as an assist to the early diagnosis of symptoms related to neurological disorders. Bournemouth University Research & Ethics approval granted: JC28/1/13-KA6/9/13. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission. Trials identification number: ISRCTN61942768. http://www.controlled-trials.com/isrctn/

Keywords: cortisol, electromyography, neurology, yawning

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Authors: S. Pathak, R. Lazarus

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A 25-year-old male HIV patient (CD4 cells 20/µL and HIV viral load 14200000 copies/ml) with a past medical history of duodenal ulcer, pneumocystis carinii pneumonia, oesophageal candidiasis presented with fever and a seizure to hospital. The only recent travel had been a religious pilgrimage from Singapore to Malaysia 5 days prior; during the trip he sustained skin abrasions. The patient had recently started highly active antiretroviral therapy 2 months prior. Clinical examination was unremarkable other than a temperature of 38.8°C and perianal warts. Laboratory tests showed a leukocyte count 12.5x109 cells/L, haemoglobin 9.4 g/dL, normal biochemistry and a C-reactive protein 121 mg/L. CT head and MRI head were unremarkable and cerebrospinal fluid analysis performed after a delay (due to technical difficulties) of 11 days was unremarkable. Blood cultures (three sets) taken on admission showed Gram-negative rods in the anaerobic bottles only at the end of incubation with culture result confirmed by molecular sequencing showing Helicobacter cinaedi. The patient was treated empirically with ceftriaxone for seven days and this was converted to oral co-amoxiclav for a further seven days after the blood cultures became positive. A Transthoracic echocardiogram was unremarkable. The patient made a full recovery. Helicobacter cinaedi is a gram-negative anaerobic fastidious organism affecting patients with comorbidity. Infection may manifest as cellulitius, colitis or as in this case as bloodstream infection – the latter is often attributed to faeco-oral infection. Laboratory identification requires prolonged culture. Therapeutic options may be limited by resistance to macrolides and fluoroquinolones. The likely pathogen inoculation routes in the case described include gastrointestinal translocation due to proctitis at the site of perianal warts, or breach of the skin via abrasions occurring during the pilgrimage. Such organisms are increasing in prevalence as our patient population ages and patients have multiple comorbidities including HIV. It may be necessary in patients with unexplained fever to prolong incubation of sterile sites including blood in order to identify this unusual fastidious organism.

Keywords: fastidious, Helicobacter cinaedi, HIV, immunocompromised

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Authors: Emel Sonmezer, Hayri Baran Yosmaoglu

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The negative impact of chronic pain syndromes on sexual function has been reported in several studies; however, the influences of treatment strategies on sexual dysfunction have not been evaluated widely. The aim of this study was to determine the effects of pelvic floor exercise on sexual dysfunction in female patients with chronic low back pain. Forty-two patient with chronic low back pain were enrolled this study. Subjects were divided into two groups. Group 1 received conventional physiotherapy consist of heat therapy, ergonomic education, William flexion exercise during 6 weeks. Group 2 received pelvic floor exercises in addition to conventional physiotherapy. Female Sexual Function Index (FSFI) was used for the assessment of sexual function. Pain intensity was assessed with Visual Analogue Scale. Quality of life was assessed with World Health Organization Quality of Life Scale. All measurements were taken before and after treatment. In conventional physiotherapy group; there were significant improvement in pain intensity (p= 0,003), physical health (p=0,011), psychological health (p=0,042) subscales of quality of life scale, arousal (p=0,042), lubrication (p=0,028) and pain (p= 0,034) subscales of FSFI. In additional pelvic floor exercise group; there were significant improvement in pain intensity (p= 0,005), physical health (p=0,012) psychological health (p=0,039) subscales of quality of life scale, arousal (p=0,024), lubrication (p=0,011), orgasm (p=0,035) and pain (p= 0,015) subscales and total score (p=0,016) of FSFI. Total FSFI score (p=0,025) and orgasm (p=0,017) subscale of FSFI were significantly higher for the additional pelvic floor exercise group than the conventional physiotherapy group.The outcome of this study suggested that conventional physiotherapy may contribute to improve pain, quality of life and some parameters of the sexual function in patients with low back pain. Although additional pelvic floor exercise did not reveal more treatment effect in terms of quality of life and pain intensity, it caused significant improvement in sexual function. It is recommended that pelvic floor exercise should be added to treatment programs in order to manage sexual dysfunction more effectively in patients with chronic low back pain.

Keywords: physiotherapy, chronic pain, sexual dysfunction, pelvic floor

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Authors: Gideon Baffoe, Hirotaka Matsuda

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Rural livelihood systems are known to be inherently vulnerable. Attempt to reduce vulnerability is linked to developing resilience to both internal and external shocks, thereby increasing the overall sustainability of livelihood systems. The shocks and stresses could be induced by natural processes such as the climate and/or by social dynamics such as institutional failure. In this wise, livelihood vulnerability is understood as a combined effect of biophysical, economic, and social processes. However, previous empirical studies on livelihood vulnerability in the context of rural areas across the globe have tended to focus more on climate-induced vulnerability assessment with few studies empirically partially considering the multiple dimensions of livelihood vulnerability. This has left a gap in our understanding of the subject. Using the Livelihood Vulnerability Index (LVI), this study aims to comprehensively assess the livelihood vulnerability level of rural households using Ehiamenkyene, a community in the forest zone of Eastern Ghana as a case study. Though the present study adopts the LVI approach, it differs from the original framework in two respects; (1) it introduces institutional influence into the framework and (2) it appreciates the gender differences in livelihood vulnerability. The study utilized empirical data collected from 110 households’ in the community. The overall study results show a high livelihood vulnerability situation in the community with male-headed households likely to be more vulnerable than their female counterparts. Out of the seven subcomponents assessed, only two (socio-demographic profile and livelihood strategies) recorded low vulnerability scores of less than 0.5 with the remaining five (health status, food security, water accessibility, institutional influence and natural disasters and climate variability) recording scores above 0.5, with institutional influence being the component with the highest impact score. The results suggest that to improve the livelihood conditions of the people; there is the need to prioritize issues related to the operations of both internal and external institutions, health status, food security, water and climate variability in the community.

Keywords: assessment, gender, livelihood, rural, vulnerability

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Authors: Abdul Qadir Jangda, Khadija Mariam, Usman Ahmed, Sharib Ahmed

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The Gafchromic EBT3 film has the characteristic of high spatial resolution, weak energy dependence and near tissue equivalence which makes them viable to be used for in-vivo dosimetry in External Beam and Brachytherapy applications. The aim of this study is to assess the smallest film dimension that may be feasible for the use in in-vivo dosimetry. To evaluate the viability, the film sizes from 3 x 3 mm to 20 x 20 mm were calibrated with 6 MV Photon and 6 MeV electron beams. The Gafchromic EBT3 (Lot no. A05151201, Make: ISP) film was cut into five different sizes in order to establish the relationship between absorbed dose vs. film dimensions. The film dimension were 3 x 3, 5 x 5, 10 x 10, 15 x 15, and 20 x 20 mm. The films were irradiated on Varian Clinac® 2100C linear accelerator for dose range from 0 to 1000 cGy using PTW solid water phantom. The irradiation was performed as per clinical absolute dose rate calibratin setup, i.e. 100 cm SAD, 5.0 cm depth and field size of 10x10 cm2 and 100 cm SSD, 1.4 cm depth and 15x15 cm2 applicator for photon and electron respectively. The irradiated films were scanned with the landscape orientation and a post development time of 48 hours (minimum). Film scanning accomplished using Epson Expression 10000 XL Flatbed Scanner and quantitative analysis carried out with ImageJ freeware software. Results show that the dose variation with different film dimension ranging from 3 x 3 mm to 20 x 20 mm is very minimal with a maximum standard deviation of 0.0058 in Optical Density for a dose level of 3000 cGy and the the standard deviation increases with the increase in dose level. So the precaution must be taken while using the small dimension films for higher doses. Analysis shows that there is insignificant variation in the absorbed dose with a change in film dimension of EBT3 film. Study concludes that the film dimension upto 3 x 3 mm can safely be used up to a dose level of 3000 cGy without the need of recalibration for particular dimension in use for dosimetric application. However, for higher dose levels, one may need to calibrate the films for a particular dimension in use for higher accuracy. It was also noticed that the crystalline structure of the film got damage at the edges while cutting the film, which can contribute to the wrong dose if the region of interest includes the damage area of the film

Keywords: external beam radiotherapy, film calibration, film dosimetery, in-vivo dosimetery

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Authors: Mohamad Mohsen Yavarizadeh

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Polystyrene (PS) and related homopolymers are brittle materials that typically fail in tensile tests at very low strains. These polymers can be toughened by the addition of rubbery particles which initiate a large number of crazes that produce substantial plastic strain at relatively low stresses. Considerable energy is dissipated in the formation of these crazes, producing a relatively tough material that shows an impact toughness of more than 5 times of pure PS. While cross linking of rubbery phase is necessary in aforementioned mechanism of toughening, another mechanism of toughening was also introduced in which low molecular weight liquid rubbers can also toughen PS when dispersed in the form of small pools in the glassy matrix without any cross linking. However, this new mechanism which is based on local plasticization, fails to act properly at high strain rate deformations, i.e. impact tests. In this work, the idea of combination of these two mechanisms was tried. To do so, Polybutadiene rubbers (PB) with bimodal distribution of molecular weight were prepared in which, comparable fractions of very high and very low molecular weight rubbers were mixed. Incorporation of these materials in PS matrix in a reactive process resulted in more significant increases in toughness of PS. In other words, although low molecular weight PB is ineffective in high strain rate impact test by itself, it showed a significant synergistic effect when combined with high molecular weight PB. Surprisingly, incorporation of just 10% of low molecular weight PB doubled the impact toughness of regular high impact PS (HIPS). It was observed that most of rubbery particles could initiate crazes. The effectiveness of low molecular weight PB in impact test was attributed to low strain rate deformation of each individual craze as a result of producing a large number of crazes in this material. In other words, high molecular weight PB chains make it possible to have an appropriate dispersion of rubbery phase in order to create a large number of crazes in the PS matrix and consequently decrease the velocity of each craze. Low molecular weight PB, in turn, would have enough time to locally plasticize craze fibrils and enhance the energy dissipation.

Keywords: molecular weight distribution, polystyrene, toughness, homopolymer

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Authors: Choonsik Lee, Les Folio

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Pregnant patients may undergo CT in emergencies unrelated with pregnancy, and potential risk to the developing fetus is of concern. It is critical to accurately estimate fetal organ doses in CT scans. We developed a fetal organ dose calculation tool using pregnancy-specific computational phantoms combined with Monte Carlo radiation transport techniques. We adopted a series of pregnancy computational phantoms developed at the University of Florida at the gestational ages of 8, 10, 15, 20, 25, 30, 35, and 38 weeks (Maynard et al. 2011). More than 30 organs and tissues and 20 skeletal sites are defined in each fetus model. We calculated fetal organ dose-normalized by CTDIvol to derive organ dose conversion coefficients (mGy/mGy) for the eight fetuses for consequential slice locations ranging from the top to the bottom of the pregnancy phantoms with 1 cm slice thickness. Organ dose from helical scans was approximated by the summation of doses from multiple axial slices included in the given scan range of interest. We then compared dose conversion coefficients for major fetal organs in the abdominal-pelvis CT scan of pregnancy phantoms with the uterine dose of a non-pregnant adult female computational phantom. A comprehensive library of organ conversion coefficients was established for the eight developing fetuses undergoing CT. They were implemented into an in-house graphical user interface-based computer program for convenient estimation of fetal organ doses by inputting CT technical parameters as well as the age of the fetus. We found that the esophagus received the least dose, whereas the kidneys received the greatest dose in all fetuses in AP scans of the pregnancy phantoms. We also found that when the uterine dose of a non-pregnant adult female phantom is used as a surrogate for fetal organ doses, root-mean-square-error ranged from 0.08 mGy (8 weeks) to 0.38 mGy (38 weeks). The uterine dose was up to 1.7-fold greater than the esophagus dose of the 38-week fetus model. The calculation tool should be useful in cases requiring fetal organ dose in emergency CT scans as well as patient dose monitoring.

Keywords: computed tomography, fetal dose, pregnant women, radiation dose

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Authors: Alireza Hassanshahi, Xanthe Strudwick, Zlatko Kopecki, Allison J Cowin

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Studies have shown that Flightless (Flii) is elevated in human wounds, including burns, and reducing the level of Flii is a promising approach for improving wound repair and reducing scar formation. The most effective approach has been to neutralise Flii activity using localized, intradermal application of function blocking monoclonal antibodies. However, large surface area burns are difficult to treat by intradermal injection of therapeutics, so the aim of this study was to investigate if a systemic injection of a monoclonal antibody against Flii could improve healing in mice following burn injury. Flii neutralizing antibodies (FnAbs) were labelled with Alxa-Fluor-680 for biodistribution studies and the healing effects of systemically administered FnAbs to mice with burn injuries. A partial thickness, 7% (70mm2) total body surface area scald burn injury was created on the dorsal surface of mice (n=10/group), and 100µL of Alexa-Flour-680-labeled FnAbs were injected into the intraperitoneal cavity (IP) at time of injury. The burns were imaged on days 0, 1, 2, 3, 4, and 7 using IVIS Lumina S5 Imaging System, and healing was assessed macroscopically, histologically, and using immunohistochemistry. Fluorescent radiance efficiency measurements showed that IP injected Alexa-Fluor-680-FnAbs localized at the site of burn injury from day 1, remaining there for the whole 7-day study. The burns treated with FnAbs showed a reduction in macroscopic wound area and an increased rate of epithelialization compared to controls. Immunohistochemistry for NIMP-R14 showed a reduction in the inflammatory infiltrate, while CD31/VEGF staining showed improved angiogenesis post-systemic FnAb treatment. These results suggest that systemically administered FnAbs are active within the burn site and can improve healing outcomes. The clinical application of systemically injected Flii monoclonal antibodies could therefore be a potential approach for promoting the healing of large surface area burns immediately after injury.

Keywords: biodistribution, burn, flightless, systemic, fnAbs

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Authors: Getahun Nigusie

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Background; antiretroviral treatment reduce HIV-related morbidity, and prolonged survival of patients however, there is lack of up-to-date information concerning the treatment long term effect on the survival of HIV positive children especially in the study area. Objective: To assess incidence and predictors of mortality among HIV positive children on ART in public hospitals of Harer town who were enrolled from 2011 to 2021. Methodology: Institution based retrospective cohort study was conducted among 429 HIV positive children enrolled in ART clinic from January 1st 2011 to December30th 2021. Data were collected from medical cards by using a data extraction form, Descriptive analyses were used to Summarized the results, and life table was used to estimate survival probability at specific point of time after introduction of ART. Kaplan Meier survival curve together with log rank test was used to compare survival between different categories of covariates, and Multivariate Cox-proportional hazard regression model was used to estimate adjusted Hazard rate. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables. Results: The study participants had followed for a total of 2549.6 child-years (30596 child months) with an overall mortality rate of 1.5 (95% CI: 1.1, 2.04) per 100 child-years. Their median survival time was 112 months (95% CI: 101–117). There were 38 children with unknown outcome, 39 deaths, and 55 children transfer out to different facility. The overall survival at 6, 12, 24, 48 months were 98%, 96%, 95%, 94% respectively. being in WHO clinical Stage four (AHR=4.55, 95% CI:1.36, 15.24), having anemia(AHR=2.56, 95% CI:1.11, 5.93), baseline low absolute CD4 count (AHR=2.95, 95% CI: 1.22, 7.12), stunting (AHR=4.1, 95% CI: 1.11, 15.42), wasting (AHR=4.93, 95% CI: 1.31, 18.76), poor adherence to treatment (AHR=3.37, 95% CI: 1.25, 9.11), having TB infection at enrollment (AHR=3.26, 95% CI: 1.25, 8.49),and no history of change their regimen(AHR=7.1, 95% CI: 2.74, 18.24), were independent predictors of death. Conclusion: more than half of death occurs within 2 years. Prevalent tuberculosis, anemia, wasting, and stunting nutritional status, socioeconomic factors, and baseline opportunistic infection were independent predictors of death. Increasing early screening and managing those predictors are required.

Keywords: human immunodeficiency virus-positive children, anti-retroviral therapy, survival, Ethiopia

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Authors: Mateusz Jeżowski, Jadwiga Fila, Paweł Poszytek

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This abstract summarizes the combined findings of several analyses carried out by the authors on the barriers to accessing international education mobility programs by people with fewer opportunities, especially those with a low level of cultural and social capital. Two flagship educational mobility initiatives of the European Union – the Erasmus+ Program and the European Solidarity Corps are aimed at equipping young people and participants of all ages with the qualifications and skills needed for their meaningful participation in a democratic society intercultural understanding and successful transition in the labour market. The heart of these programs is to come closer to people with fewer opportunities, including people with disabilities, migrants, as well as those facing socio-economic difficulties and displaying a low level of social and cultural capital. Still, people who participate in such initiatives usually demonstrate higher than average cultural and social capital, as understood by Pierre Bourdieu. First of all, the educational attainment of their parents is higher than the average. Secondly, they mostly live in large agglomerations, with good access to education and culture, which affects their foreign language skills as well as social and cultural competencies. Finally, participation in Erasmus+ Program or European Solidarity Corps is not their first educational mobility experience. It is therefore justified to state that their social and cultural capital, already high before taking part in Erasmus+ and European Solidarity Corps, becomes even higher once their international mobility activities have been over, at the expense of those people with fewer opportunities, who, in theory, could participate in those initiatives, nonetheless did not, for the following reasons: lack of sufficient information on such programs, financial obstacles or unappreciation of the value of international mobility. In their work, the authors will discuss what are, in the light of Bourdieu’s perception of social and cultural capital, the main obstacles for young people to participate in international mobility programs of the European Union and will offer comprehensive solutions rooted in their vast experience in management and implementation of Erasmus+ Program and European Solidarity Corps.

Keywords: cultural capital, educational mobility, Erasmus+, European solidarity corps, inclusion, social capital

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Authors: Tyler T. Procko, Steve Collins

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New features in .NET (6 and above) permit streamlined access to information residing in JSON-capable relational databases, such as SQL Server (2016 and above). Traditional methods of data access now comparatively involve unnecessary steps which compromise system performance. This work posits that the established ORM (Object Relational Mapping) based methods of data access in applications and APIs result in common issues, e.g., object-relational impedance mismatch. Recent developments in C# and .NET Core combined with a framework of modern SQL Server coding conventions have allowed better technical solutions to the problem. As an amelioration, this work details the language features and coding conventions which enable this streamlined approach, resulting in an open-source .NET library implementation called Codeless Data Access (CODA). Canonical approaches rely on ad-hoc mapping code to perform type conversions between the client and back-end database; with CODA, no mapping code is needed, as JSON is freely mapped to SQL and vice versa. CODA streamlines API data access by improving on three aspects of immediate concern to web developers, database engineers and cybersecurity professionals: Simplicity, Speed and Security. Simplicity is engendered by cutting out the “middleman” steps, effectively making API data access a whitebox, whereas traditional methods are blackbox. Speed is improved because of the fewer translational steps taken, and security is improved as attack surfaces are minimized. An empirical evaluation of the speed of the CODA approach in comparison to ORM approaches ] is provided and demonstrates that the CODA approach is significantly faster. CODA presents substantial benefits for API developer workflows by simplifying data access, resulting in better speed and security and allowing developers to focus on productive development rather than being mired in data access code. Future considerations include a generalization of the CODA method and extension outside of the .NET ecosystem to other programming languages.

Keywords: API data access, database, JSON, .NET core, SQL server

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Authors: Davide D’Aria, Paolo Falcone, Luigi Maggi, Aldo Cero, Giovanni Amoroso

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The paper presents a methodology for real-time structural health monitoring and geophysical applications. The key elements of the system are a high performance MIMO RADAR sensor, an optical camera and a dedicated set of software algorithms encompassing interferometry, tomography and photogrammetry. The MIMO Radar sensor proposed in this work, provides an extremely high sensitivity to displacements making the system able to react to tiny deformations (up to tens of microns) with a time scale which spans from milliseconds to hours. The MIMO feature of the system makes the system capable of providing a set of two-dimensional images of the observed scene, each mapped on the azimuth-range directions with noticeably resolution in both the dimensions and with an outstanding repetition rate. The back-scattered energy, which is distributed in the 3D space, is projected on a 2D plane, where each pixel has as coordinates the Line-Of-Sight distance and the cross-range azimuthal angle. At the same time, the high performing processing unit allows to sense the observed scene with remarkable refresh periods (up to milliseconds), thus opening the way for combined static and dynamic structural health monitoring. Thanks to the smart TX/RX antenna array layout, the MIMO data can be processed through a tomographic approach to reconstruct the three-dimensional map of the observed scene. This 3D point cloud is then accurately mapped on a 2D digital optical image through photogrammetric techniques, allowing for easy and straightforward interpretations of the measurements. Once the three-dimensional image is reconstructed, a 'repeat-pass' interferometric approach is exploited to provide the user of the system with high frequency three-dimensional motion/vibration estimation of each point of the reconstructed image. At this stage, the methodology leverages consolidated atmospheric correction algorithms to provide reliable displacement and vibration measurements.

Keywords: interferometry, MIMO RADAR, SAR, tomography

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Authors: Lakmali Anthony, Madeline Gillies

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Background Breast cancer (BC) is usually managed with surgical resection. Many outcomes traditionally used to define successful operative management, such as resection margin, do not adequately reflect patients’ experience. Patient-reported outcomes (PRO) such as Health-Related Quality of life (HRQoL) provide a means by which the impact of surgery for cancer can be reported in a patient-centered way. This exploratory cross-sectional study aims to; (1) describe postoperative HRQoL in patients who underwent primary resection in a regional Australian hospital; (2) describe the prevalence of anxiety, depression and clinically significant fear of cancer recurrence (FCR) in this population; and (3) identify demographic, psychosocial, disease and treatment factors associated with poorer self-reported HRQoL. Methods Patients who had resection of BC in a regional Australian hospital between 2015 and 2022 were eligible. Participants were asked to complete a survey designed to assess HRQoL, as well as validated instruments that assess several other psychosocial PROs hypothesized to be associated with HRQoL; emotional distress, fear of cancer recurrence, social support, dispositional optimism, body image and spirituality. Results Forty-six patients completed the survey. Clinically significant levels of FCR and emotional distress were present in this group. Many domains of HRQoL were significantly worse than an Australian reference population for BC. Demographic and disease factors associated with poor HRQoL included smoking and ongoing adjuvant systemic therapy. The primary operation was not associated with HRQoL for breast cancer. All psychosocial factors measured were associated with HRQoL. Conclusion HRQoL is an important outcome in surgery for both research and clinical practice. This study provides an overview of the quality of life in a regional Australian population of postoperative breast cancer patients and the factors that affect it. Understanding HRQoL and awareness of patients particularly vulnerable to poor outcomes should be used to aid the informed consent and shared decision-making process between surgeon and patient.

Keywords: breast cancer, surgery, quality of life, regional population

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Authors: Yasemin Akar, Jan G. Wissink, Herlina Herlina

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The effect of various levels of contamination on the interfacial air–water gas transfer velocity is studied by Direct Numerical Simulation (DNS). The interfacial gas transfer is driven by isotropic turbulence, introduced at the bottom of the computational domain, diffusing upwards. The isotropic turbulence is generated in a separate, concurrently running the large-eddy simulation (LES). The flow fields in the main DNS and the LES are solved using fourth-order discretisations of convection and diffusion. To solve the transport of dissolved gases in water, a fifth-order-accurate WENO scheme is used for scalar convection combined with a fourth-order central discretisation for scalar diffusion. The damping effect of the surfactant contamination on the near surface (horizontal) velocities in the DNS is modelled using horizontal gradients of the surfactant concentration. An important parameter in this model, which corresponds to the level of contamination, is ReMa⁄We, where Re is the Reynolds number, Ma is the Marangoni number, and We is the Weber number. It was previously found that even small levels of contamination (ReMa⁄We small) lead to a significant drop in the interfacial gas transfer velocity KL. It is known that KL depends on both the Schmidt number Sc (ratio of the kinematic viscosity and the gas diffusivity in water) and the surface divergence β, i.e. K_L∝√(β⁄Sc). Previously it has been shown that this relation works well for surfaces with low to moderate contamination. However, it will break down for β close to zero. To study the validity of this dependence in the presence of surface contamination, simulations were carried out for ReMa⁄We=0,0.12,0.6,1.2,6,30 and Sc = 2, 4, 8, 16, 32. First, it will be shown that the scaling of KL with Sc remains valid also for larger ReMa⁄We. This is an important result that indicates that - for various levels of contamination - the numerical results obtained at low Schmidt numbers are also valid for significantly higher and more realistic Sc. Subsequently, it will be shown that - with increasing levels of ReMa⁄We - the dependency of KL on β begins to break down as the increased damping of near surface fluctuations results in an increased damping of β. Especially for large levels of contamination, this damping is so severe that KL is found to be underestimated significantly.

Keywords: contamination, gas transfer, surfactants, turbulence

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Authors: Rolando Volzone

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The Congregation of Saint Paul of Serra de Ossa (Ossa Mountain) was founded in 1482, originated by the eremitic movement of the homens da pobre vida (poor life men), which is documented since 1366. The community of hermits expanded up to the first half of the 15th century, mostly in southern Portugal in the Alentejo region. In 1578, following a process of institutionalization led by the Church, an autonomous congregation was set up, affiliated in the Hungarian Order of Saint Paul the First Hermit, until 1834, when the decree of dissolution of the religious orders disbanded all the convents and monasteries in Portugal. The architectural evidences that reached our days as a legacy of the hermitical movement in Serra de Ossa, although studied and analysed from an historical point of view, are still little known with respect to the architectural characteristics of its physical implantation and its relationship with the natural systems. This research intends to expose the appropriation process of the locus eremus as a starting point for the interpretation of this landscape, evidencing the close relationship between the religious experience and the physical space chosen to reach the perfection of the soul. The locus eremus is thus determined not only by practical aspects such as the absolute and relative location, orography, existence of water resources, or the King’s favoring to the religious and settlement action of the hermits, but also by spiritual aspects related to the symbolism of the physical elements present and the solitary walk of these men. These aspects, combined with the built architectural elements and other exerted human action, may be fertile ground for the definition of a hypothetical hermitical landscape based on the sufficiently distinctive characteristics that sustain it. The landscape built by these hermits is established as a cultural and material heritage, and its preservation is of utmost importance. They deeply understood this place and took advantage of its natural resources, manipulating them in an ecological and economically sustainable way, respecting the place, without overcoming its own genius loci but becoming part of it.

Keywords: architecture, congregation of Saint Paul of Serra de Ossa, heremitical landscape, locus eremus

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Authors: Alessandra Rossodivita, Alexei Tikhomirov, Andrey Trufanov, Nikolay Kinash, Olga Berestneva, Svetlana Nikitina, Fabio Casati, Alessandro Visconti, Tommaso Saporito

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It is well known that world and national societies are exposed to diverse threats: anthropogenic, technological, and natural. Anthropogenic ones are of greater risks and, thus, attract special interest to researchers within wide spectrum of disciplines in efforts to lower the pertinent risks. Some researchers showed by means of multilayered, complex network models how media promotes the prevention of disease spread. To go further, not only are mass-media sources included in scope the paper suggests but also personificated social bots (socbots) linked according to reflexive theory. The novel scope considers information spread over conscious and unconscious agents while counteracting both natural and man-made threats, i.e., infections and terrorist hazards. Contrary to numerous publications on misinformation disseminated by ‘bad’ bots within social networks, this study focuses on ‘good’ bots, which should be mobilized to counter the former ones. These social bots deployed mixture with real social actors that are engaged in concerted actions at spreading, receiving and analyzing information. All the contemporary complex network platforms (multiplexes, interdependent networks, combined stem networks et al.) are comprised to describe and test socbots activities within competing information sharing tools, namely mass-media hubs, social networks, messengers, and e-mail at all phases of disasters. The scope and concomitant techniques present evidence that embedding such socbots into information sharing process crucially change the network topology of actor interactions. The change might improve or impair robustness of social network environment: it depends on who and how controls the socbots. It is demonstrated that the topological approach elucidates techno-social processes within the field and outline the roadmap to a safer world.

Keywords: complex network platform, counterterrorism, information sharing topology, social bots

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Authors: Atitallah Sofien, Bouyahia Olfa, Attar Souleima, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Ciliopathies are a spectrum of diseases that have in common a defect in the synthesis of ciliary proteins. It is a rare cause of neonatal cholestasis. Clinical presentation varies extremely, and the main affected organs are the kidneys, liver, and pancreas. Methodology: This is a descriptive case report of a newborn who was admitted for exploration of neonatal cholestasis in the Paediatric Department C at the Children’s Hospital of Tunis, where the investigations concluded with a rare genetic mutation. Results: This is the case of a newborn male with no family history of hepatic and renal diseases, born to consanguineous parents, and from a well-monitored uneventful pregnancy. He developed jaundice on the second day of life, for which he received conventional phototherapy in the neonatal intensive care unit. He was admitted at 15 days for mild bronchiolitis. On clinical examination, intense jaundice was noted with normal stool and urine colour. Initial blood work showed an elevation in conjugated bilirubin and a high gamma-glutamyl transferase level. Transaminases and prothrombin time were normal. Abdominal sonography revealed hepatomegaly, splenomegaly, and undifferentiated renal cortex with bilateral medullar micro-cysts. Kidney function tests were normal. The infant received ursodeoxycholic acid and vitamin therapy. Genetic testing showed a homozygous mutation in the DCDC2 gene that hadn’t been documented before confirming the diagnosis of renal-hepatic ciliopathy. The patient has regular follow-ups, and his conjugated bilirubin and gamma-glutamyl transferase levels have been decreasing. Conclusion: Genetic testing has revolutionized the approach to etiological diagnosis in pediatric cholestasis. It enables personalised treatment strategies to better enhance the quality of life of patients and prevent potential complications following adequate long-term monitoring.

Keywords: cholestasis, newborn, ciliopathy, DCDC2, genetic

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Authors: Chen-Ya Juan

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Problem-Based Learning uses vague questions to guide student thinking and enhance their self-learning and collaboration. Most teachers implement PBL in a physical classroom, where teachers can monitor and evaluate students’ learning progress and guide them to search resources for answers. However, the prevalence of the Covid-19 in the world had changed from physical teaching to distance teaching. This instruction used many cases and applied Problem-Based Learning combined on the distance teaching via the internet for college students. This study involved an experimental group with PBL and a control group without PBL. The teacher divided all students in PBL class into eight groups, and 7~8 students in each group. The teacher assigned different cases for each group of the PBL class. Three stages of instruction were developed, including background knowledge of Learning, case analysis, and solving problems for each case. This study used a quantitative research method, a two-sample t-test, to find a significant difference in groups with PBL and without PBL. Findings indicated that PBL incased the average score of special education knowledge. The average score was improved by 20.46% in the PBL group and 15.4% without PBL. Results didn’t show significant differences (0.589>0.05) in special education professional knowledge. However, the feedback of the PBL students implied learning more about the application, problem-solving skills, and critical thinking. PBL students were more likely to apply professional knowledge on the actual case, find questions, resources, and answers. Most of them understood the importance of collaboration, working as a team, and communicating with other team members. The suggestions of this study included that (a) different web-based teaching instruments influenced student’s Learning; (b) it is difficult to monitor online PBL progress; (c) online PBL should be implemented flexible and multi-oriented; (d) although PBL did not show a significant difference on the group with PBL and without PBL, it did increase student’s problem-solving skills and critical thinking.

Keywords: problem-based learning, college students, distance learning, case analysis, problem-solving

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