Search results for: music therapy intervention

Authors: Hani Malik

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Background: Clinician burnout is a growing phenomenon in current health systems worldwide. Increasing emotional exhaustion, depersonalisation, and reduced personal accomplishment threaten the effective delivery of healthcare. This can potentially be mitigated by mindfulness practice, which has shown promising results in reducing burnout, restoring compassion, and preventing moral injury in clinicians. Objectives: To conduct a scoping review and identify high-quality studies on mindfulness practice in clinician burnout, synthesize themes that emerge from these studies, and discuss the implications of the results to healthcare leadership and innovation. Methodology: A focused scoping review was carried out to investigate the effects of mindfulness practice on clinician burnout. High-ranking journals were targeted to analyse high-quality studies and synthesize common themes in the literature. Studies conducted on current, practicing physicians were included. Mindfulness practice of varying forms was the main intervention studied. Grey literature and studies conducted only on allied health personnel were excluded from this review. Analysis:31 studies were included in this scoping review. Mindfulness practice was found to decrease emotional exhaustion and depersonalisation while improving mood, responses to stress, and vigour. Self-awareness, compassion, and empathy were also increased in study participants. From this review, four themes emerged which include: innovations in mindfulness practice, mindfulness and positive psychology, the impact of mindfulness on work and patient care, and barriers and facilitators to clinician mindfulness practice. Conclusion: Mindfulness had widely been reported to benefit mental health and well-being, but the studies reviewed seemed to adopt a mono focus and omitted key considerations to healthcare leadership, systems-level culture, and practices. Mindfulness practice is a quintessential component of positive psychology and is inherently linked to effective leadership. A mindful and compassionate clinician leader will play a crucial role in addressing gaps in current practice, prioritise staff mental health, and provide a supportive platform for innovation.

Keywords: mindfulness practice, clinician burnout, healthcare leadership, COVID-19

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Authors: Caglayan Hizal, Kutay Yuceturk, Ertugrul Turker Uzun, Hasan Ceylan, Engin Aktas, Gursoy Turan

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Monitoring concepts for structural systems have been investigated by researchers for decades since such tools are quite convenient to determine intervention planning of structures. Despite the considerable development in this regard, the efficient use of monitoring data in reliability assessment, and prediction models are still in need of improvement in their efficiency. More specifically, reliability-based seismic risk assessment of engineering structures may play a crucial role in the post-earthquake decision-making process for the structures. After an earthquake, professionals could identify heavily damaged structures based on visual observations. Among these, it is hard to identify the ones with minimum signs of damages, even if they would experience considerable structural degradation. Besides, visual observations are open to human interpretations, which make the decision process controversial, and thus, less reliable. In this context, when a continuous monitoring system has been previously installed on the corresponding structure, this decision process might be completed rapidly and with higher confidence by means of the observed data. At this stage, the Structural Health Monitoring (SHM) procedure has an important role since it can make it possible to estimate the system reliability based on a recursively updated mathematical model. Therefore, integrating an SHM procedure into the reliability assessment process comes forward as an important challenge due to the arising uncertainties for the updated model in case of the environmental, material and earthquake induced changes. In this context, this study presents a case study on SHM-integrated reliability assessment of the continuously monitored progressively damaged systems. The objective of this study is to get instant feedback on the current state of the structure after an extreme event, such as earthquakes, by involving the observed data rather than the visual inspections. Thus, the decision-making process after such an event can be carried out on a rational basis. In the near future, this can give wing to the design of self-reported structures which can warn about its current situation after an extreme event.

Keywords: condition assessment, vibration-based SHM, reliability analysis, seismic risk assessment

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Authors: Zeynep Tanriverdi̇

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Sustainable architecture is a design approach that provides healthy, comfortable, safe, clean space production as well as utilizes minimum resources for efficient and economical use of natural resources and energy. Traditional houses located in rural areas are sustainable structures built at the design and implementation stage in accordance with the climatic environmental data of the region and also effectively using natural energy resources. The fact that these structures are located in an earthquake geography like Türkiye brings their earthquake resistance to the agenda. Since the construction of these structures, which contain the architectural and technological cultural knowledge of the past, is shaped according to the characteristics of the regions where they are located, their resistance to earthquakes also differs. Analyses in rural areas after the earthquake show that there are light-damaged structures that can survive, severely damaged structures, and completely destroyed structures. In this regard, experts can implement repair, consolidation, and reconstruction applications, respectively. While simple repair interventions are carried out in accordance with the original data in traditional houses that have shown great resistance to earthquakes, reinforcement work blended with new technologies can be applied in damaged structures. In reconstruction work, a wide variety of applications can be seen with the possibilities of modern technologies. In rural areas experiencing earthquakes around the world, there are experimental new housing applications that are renewable, environmentally friendly, and sustainable with modern construction techniques in the light of scientific data. With these new residences, it is aimed to create earthquake-resistant, economical, healthy, and pain-relieving therapy spaces for people whose daily lives have been interrupted by disasters. In this study, the preservation of high earthquake-prone rural areas will be discussed through the knowledge transfer of traditional architecture and also permanent housing practices using new sustainable technologies to improve the area. In this way, it will be possible to keep losses to a minimum with sustainable, reliable applications prepared for the worst aspects of the disaster situation and to establish a link between the knowledge of the past and the new technologies of the future.

Keywords: sustainability, conservation, traditional construction systems and materials, new technologies, earthquake resistance

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Authors: Carlos Joel Tchawouo Mbiada

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At the back of the apartheid era, South Africa embarked on a democratic drive of all its institution underpinned by a social justice perspective to eradicate past injustices. These democratic values based on fundamental human rights and equality informed all rights enshrined in the Constitution of the Republic of South Africa, 1996. This means that all rights are therefore infused by social justice perspective and labour rights are no exception. Labour law is therefore regulated to the extent that it is viewed as too rigid. Hence a call for more flexibility to enhance investment and boost job creation. This view articulated by the Free Market Foundation fell on deaf ears as the opponents believe in what is termed regulated flexibility which affords greater protection to vulnerable workers while promoting business opportunities and investment. The question that this paper seeks to examine is to what extent the regulation of labour law will go to protect employees. This question is prompted by the recent Constitutional Court’s judgment of National Union of Metalworkers of South Africa v Trenstar which barred the employer from employing labour replacement in response to the strike action by its employees. The question whether employers may use replacement labour and have recourse to lock-outs in response to strike action is considered in the context of the dichotomy between the Free market foundation and social justice perspectives which are at loggerheads in the South African collective bargaining process. With the current unemployment rate soaring constantly, the aftermath of the Covid 19 pandemic, the effects of the war in Ukraine and lately the financial burden of load shedding on companies to run their businesses, this paper argues for a policy shift toward deregulation or a lesser state and judiciary intervention. This initiative will relieve the burden on companies to run a viable business while at the same time protecting existing jobs.

Keywords: labour law, replacement labour, right to strike, free market foundation perspective, social justice perspective

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Authors: Larissa Pliska, Isabel Neitzel, Michael Buschermöhle, Olga Kunina-Habenicht, Ute Ritterfeld

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Visual preferences, which can be assessed using eye tracking technologies, are considered one of the defining hallmarks of Autism Spectrum Disorder (ASD). Specifically, children with ASD show a decreased preference for social images rather than geometric images compared to typically developed (TD) children. Such differences are already prevalent at a very early age and indicate the severity of the disorder: toddlers with ASD who preferred geometric images when confronted with social and geometric images showed higher ASD symptom severity than toddlers with ASD who showed higher social attention. Furthermore, the complexity of social pictures (one child playing vs. two children playing together) as well as the mode of stimulus presentation (video or image), are not decisive for the marker. The average age of diagnosis for ASD in Germany is 6.5 years, and visual preference data on this age group is missing. In the present study, we therefore investigated whether visual preferences persist into school age. We examined the visual preferences of 16 boys aged 6 to 11 with ASD and unimpaired cognition as well as TD children (1:1 matching based on children's age and the parent's level of education) within an experimental setting. Different stimulus presentation formats (images vs. videos) and different levels of stimulus complexity were included. Children with and without ASD received pairs of social and non-social images and video stimuli on a screen while eye movements (i.e., eye position and gaze direction) were recorded. For this specific use case, KIZMO GmbH developed a customized, native iOS app (KIZMO Face-Analyzer) for use on iPads. Neither the format of stimulus presentation nor the complexity of the social images had a significant effect on the visual preference of children with and without ASD in this study. Despite the tendency for a difference between the groups for the video stimuli, there were no significant differences. Overall, no statistical differences in visual preference occurred between boys with and without ASD, suggesting that gaze preference in these groups is similar at primary school age. One limitation is that the children with ASD were already receiving Autism-specific intervention. The potential of a visual preference task as an indicator of ASD can be emphasized. The article discusses the clinical relevance of this marker in elementary school children.

Keywords: autism spectrum disorder, eye tracking, hallmark, visual preference

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Authors: Mohamed Gherbi

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The informal trade has invaded the Algerian cities, especially in their peripherals. About 1368 informal markets have been registrated during 2013 where the important ones are known by Doubaï Markets. They appeared since the adoption of the new system of the economy market in 1990. It permitted the intervention of new actors: the importers but also the fake ones. The majority of them were 'ex-Trabendistes' who have chosen to settle and invest in big and small cities of center and east of Algeria, mainly Algiers, El Eulma, Aïn El Fekroun, Tadjnenent, and Aïn M’lila. This study will focus on the case of the city of El Eulma which contains more of 1000 importers (most of them are fake). They have changed the image and architecture of some important streets of the city, without respecting rules of urbanism such as those included in the building permit for instance. The case of 'Doubaï' place in El Eulma illustrates this situation. This area is not covered by a Soil Occupation Plan (responsible of the design of urban spaces), even if this last covers other zones nearby surrounding of it. These importers helped by the wholesale and retail traders installed in 'Doubaï' place, have converted spaces inside and outside of residential buildings in deposits and sales of goods. They have squatted sidewalks to expose their goods imported predominantly from the South-East Asian countries. The scenery that reigns resembles partly to the bazaar of the Middle East and Chinese cities like Yiwu. These signs characterize the local ambiance and give the particularity to this part of the city. A customer tide from different cities and outside of Algeria comes daily to visit this district. The other zones surrounding have underwent the same change and have followed the model of 'Doubaï' place. Consequently, the mechanical movement has finished by stifling an important part of the city and the prices of land and real estate have reached exorbitant values and can be compared to prices charged in Paris due to the rampant speculation that has reached alarming dimensions. Similarly, renting commercial premises did not escape this logic. This paper will explain the reasons responsible of this change, the logic of importers through their acts in different spaces of the city.

Keywords: Doubaï place, design of urban spaces, fake importers, informal trade

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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: Berie Abebe Getahun

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The tourism sector has been identified by the Ethiopian government as one of the priority economic sectors and planned to make Ethiopia among the top five African destinations by 2020. It is obvious international tourism demand for Ethiopia lags behind other African countries like South Africa, Egypt, Morocco, Tanzania, and Kenya. Meanwhile, the number of international tourists’ arrival to Ethiopia increases continuously. The main purpose of this study was to find out potentials, challenges, and opportunities of Ethiopian Cultural Center for tourism product development. Therefore, an attempt has been made to identify potentials over which tourism product development can be enhanced, and opportunities that promote tourism product development in Ethiopia. To achieve this objective, data have been collected by using observation, interview and focus group discussion with selected informants working the ministry of tourism and culture. The collected data has been analyzed by transcribing materials, and by using thematic analysis method based on the research objective. Likewise, the analyzed data has been discussed in the context of prevailing literature. As revealed in finding, Ethiopian cultural center has untapped potential for tourism product development that includes: meetings, incentives, conferences, events, availability of concerned stakeholders and demand of visitors. On the other hand, lack of awareness about tourism product development, financial constraints, skilled manpower, absence of tour guiding service and interpretation of heritages have been identified as the major challenges that hindering tourism product development in the cultural center. Moreover, the growth of domestic tourism, distinctive presence and rich culture of Ethiopia, and policy of Ethiopia that promotes the growth and preservation of indigenous cultures are deemed important opportunities for tourism product development in the country. And lastly, conducting a research based on tourism product development, reviewing the existing marketing and promotion strategies, training manpower, working harmoniously with the concerned stakeholders, and a careful examination of opportunities present in order to best utilize resources were implications drawn for future intervention.

Keywords: challenges and opportunities of tourism, Ethiopian tourism potential, tourism product, tourism product development

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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: Yasser Y. Lenis, Amy Jo Montgomery, Diego F. Carrillo-Gonzalez

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Introduction: The use of didactic instruments in different learning environments plays a pivotal role in enhancing the level of knowledge in veterinary science students. The direct instruction of basic animal reproduction concepts in students enrolled in veterinary medicine programs allows them to elucidate the biological and molecular mechanisms that perpetuate the animal species in an ecosystem. Therefore, universities must implement didactic strategies that facilitate the teaching and learning processes for students and, in turn, enrich learning environments. Objective: to evaluate the effect of the use of a didactic textbook on the level of theoretical knowledge in embryo-maternal recognition for veterinary medicine students. Methods: the participants (n=24) were divided into two experimental groups: control (Ctrl) and treatment (Treat). Both groups received 4 hours of theoretical training regarding the basic concepts in bovine embryo-maternal recognition. However, the Treat group was also exposed to a guided lecture and the activity play-to-learn from a cow reproduction didactic textbook. A pre-test and a post-test were applied to assess the prior and subsequent knowledge in the participants. Descriptive statistics were applied to identify the success rates for each of the tests. Afterwards, a repeated measures model was applied where the effect of the intervention was considered. Results: no significant difference (p>0,05) was observed in the number of right answers for groups Ctrl (54,2%±12,7) and Treat (40,8%±16,8) in the pre-test. There was no difference (p>0,05) compering the number of right answers in Ctrl pre-test (54,2%±12,7) and post-test (60,8±18,8). However, the Treat group showed a significant (p>0,05) difference in the number of right answers when comparing pre-test (40,8%±16,8) and post-test (71,7%±14,7). Finally, after the theoretical training and the didactic activity in the Treat group, an increase of 10.9% (p<0,05) in the number of right answers was found when compared with the Ctrl group. Conclusion: the use of didactic tools that include guided lectures and activities like play-to-learn from a didactic textbook enhances the level of knowledge in an animal reproduction course for veterinary medicine students.

Keywords: animal reproduction, pedagogic, level of knowledge, learning environment

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Authors: Andrey Makarov

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This article will focus on the development of antitrust policy in transition economies in the context of preventing explicit and tacit collusion. Experience of BRICS, CIS (Ukraine, Kazakhstan) and CEE countries (Bulgaria, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, Slovenia, Czech Republic, Estonia) in the creation of antitrust institutions was analyzed, including both legislation and enforcement practice. Most of these countries in the early 90th were forced to develop completely new legislation in the field of protection of competition and it is important to compare different ways of building antitrust institutions and policy results. The article proposes a special approach to evaluation of preventing collusion mechanisms. This approach takes into account such enforcement problems as: classification problems (tacit vs explicit collusion, vertical vs horizontal agreements), flexibility of prohibitions (the balance between “per se” vs “rule of reason” approaches de jure and in practice), design of sanctions, private enforcement challenge, leniency program mechanisms, the role of antitrust authorities etc. The analysis is conducted using both official data, published by competition authorities, and expert assessments. The paper will show how the integration process within the EU predetermined some aspects of the development of antitrust policy in CEE countries, including the trend of the use of "rule of reason" approach. Simultaneously was analyzed the experience of CEE countries in special mechanisms of government intervention. CIS countries in the development of antitrust policy followed more or less original ways, without such a great impact from the European Union, more attention will be given to Russian experience in this field, including the analysis of judicial decisions in antitrust cases. Main problems and challenges for transition economies in this field will be shown, including: Legal uncertainty problem; Problem of rigidity of prohibitions; Enforcement priorities of the regulator; Interaction of administrative and criminal law, limited effectiveness of criminal sanctions in the antitrust field; The effectiveness of leniency program design; Private enforcement challenge.

Keywords: collusion, antitrust policy, leniency program, transition economies, Russia, CEE

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Authors: Ching-Yi Yiu, Hui-Chen Hsu

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Objectives: Obstructive sleep apnea syndrome (OSAS) is a popular problem in the modern society. It usually leads to sleep disorder, excessive daytime sleepiness and associated with cardiovascular diseases, cognitive dysfunction and even death. The nonsurgical therapies include continuous positive airway pressure (CPAP), diet and oral appliances. The surgical approaches have nasal surgery, tonsillectomy, adenoidectomy, uvulopalatopharyngoplasty (UPPP) and transoral robotic surgery (TORS).We compare the impact of surgical treatments on these kinds of patients. Methods: Between January 2018 to September 2022, We have enrolled 125 OSAS patients including 82 male and 43 female in Chi Mei Medical Center, Liouying, Taiwan. The age distribution from 6 to 71 years old (y/o) with mean age 36.1 y/o. The averaged body mass index (BMI) is 25 kg/m2 in male and 25.5 kg/m2 in female. In this cohort, we evaluated their upper airway obstruction sites with nasopharyngoscopy and scheduled a planned surgery. Some of cases received polysomnography (PSG) preoperatively, the averaged apnea-hypopnea index (AHI) is 37.7 events/hour. We have 68 patients received tonsillectomy, 9 received UPPP, 42 received UPPP and septomeatoplasty (SMP) and 6 received adenoidectomy and tonsillectomy (A and T). The subjective daytime sleepiness was evaluated with the Epworth sleepiness scale (ESS). Results: In the 68 tonsillectomy group, the averaged BMI is 24.9 kg/m2. In the UPPP group, the averaged BMI is 28.9 kg/m2. In UPPP and SMP group, the averaged BMI is 27.9 kg/m2. In the A and T group, the averaged BMI is 17.2 kg/m2. The reduction of AHI less than 20 is 58% postoperatively. The ESS reduced from 10.9 to 4.9 after surgery. Conclusion: Obstructive sleep apnea syndrome is a common upper airway disturbance in the general population. The prevalence rate is ranging high depending on different regions, age, sex and race. It leads to severe morbidity and mortality including car accident, stroke, nocturnal desaand sudden death and should be considered to be a major public health problem. The CPAP is effective to improve daytime sleepiness but the long-term compliance is low. The surgical treatment with different modalities can produce 50% decrease in AHI and ESS after surgery in the 6 to 12 months short-term period.

Keywords: apnea-hypopnea index, obstructive sleep apnea syndrome, polysomnography, uvulopalatopharyngoplasty

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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: Verarisa Ujung

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The Anthropocene – as scientists define as a new geological epoch where human intervention has the dominant influence on the geological, atmospheric, and ecological processes challenges the contemporary discourse in architecture and interior. The dominant influence characterises the incapability to distinguish the notion of nature, subnature, human and non-human. Consequently, living in the Anthropocene demands sensitivity and responsiveness to heighten our sense of the rhythm of transformation and recognition of our environment as a product of natural, social and historical processes. The notion of subnature is particularly emphasised in this paper to investigate the poetic sense of living with subnature. It could be associated with the critical tool for exploring the aesthetic and programmatic implications of subnature on interiority. The ephemeral immaterial attached to subnature promotes the sense of atmospheric delineation of interiority, the very inner significance of body-surface interaction, which central to interior architecture discourse. This would then reflect human’s activities; examine the transformative change, the architectural motion and the traces that left between moments. In this way, engaging the notion of subnature enable us to better understand the critical subject on interiority and might provide an in-depth study on interior architecture. Incorporating the exploration on the form, materiality, and pattern of subnature, this research seeks to grasp the inner significance of micro to macro approaches so that the future of interior might be compelled to depend more on the investigation and development of responsive environment. To reflect upon the form, materiality and intensity of subnature that specifically characterized by the natural, social and historical processes, this research examines a volcanic land, White Island/Whakaari, New Zealand as the chosen site of investigation. Emitting various forms and intensities of subnatures - smokes, mud, sulphur gas, this volcanic land also open to the new inhabitation within the sulphur factory ruins that reflects human’s past occupation. In this way, temporal and natural selected manifestations of materiality, artefact, and performance can be traced out and might reveal the meaningful relations among space, inhabitation, and well-being of inhabitants in the Anthropocene.

Keywords: anthropocene, body, intensification, intensity, interior architecture, subnature, surface

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Authors: Tamara Zappaterra

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The Learning Difficulties have an evolutionary nature. The international research has focused its analysis on the characteristics of Learning Difficulties in childhood, but we are still far from a thorough understanding of the nature of such disorders in adolescence and adulthood. Such issues become even more urgent in the university context. Spelling, meaning, and appropriate use of the specific vocabulary of the various disciplines represent an additional challenge for the dyslexic student. This paper explores the characteristics of Learning Difficulties in adulthood and the impact with the university teaching. It presents the results of an interdisciplinary project (educational, medical and engineering area) at University of Florence. The purpose of project is to design of a protocol for usability of teaching and individual study at university level. The project, after a first reconnaissance of user needs that have been reached with the participation of the very same protagonists, is at the stage of guidelines drafting for inclusion and education, to be used by teachers, students and administrative staff. The methodologies used are a questionnaire built on purpose and a series of focus groups with users. For collecting data during the focus groups it was decided to use a method typical of the Quality Function Deployment, a tool originally used for quality management, whose versatility makes it easy to use in a number of different context. The paper presents furthermore the findings of the project, the most significant elements of the guidelines for teaching, i.e. the section for teachers, whose aim is to implement a Learning Difficulties-friendly teaching, even at the university level, in compliance with italian Law 170/2010. The Guidelines for the didactic and inclusion of Learning Difficulties students of the University of Florence are articulated around a global and systemic plan of action, meant to accompany and protect the students during their study career, even before enrolling at the University, with different declination: the logistical, relational, educational, and didactic levels have been considered. These guidelines in Italy received the endorsement of the CNUDD. It is a systemic intervention plan for Learning Difficulties students, which roused and keeps rousing the interest of all the university system, with a radical consideration on academic teaching. Since while we try to provide the best Learning Difficulties-friendly didactic in compliance with the rules, no one can be exempted from a wider consideration on the nature and the quality of university teaching offered to all students.

Keywords: didactic tools, learning difficulties, special and inclusive education, university teaching

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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: 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: Mina Salamatmanesh, Elizabeth Fitzpatrick, Tim Ramsay, Josee Lagacé, Lindsey Sikora, JoAnne Whittingham

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Introduction: Hearing loss (HL) is one of the most common disorders that presents at birth and in early childhood. Universal newborn hearing screening (UNHS) has been adopted based on the assumption that with early identification of HL, children will have access to optimal amplification and intervention at younger ages, therefore, taking advantage of the brain’s maximal plasticity. One particular challenge for parents in the early years is achieving consistent hearing aid (HA) use which is critical to the child’s development and constitutes the first step in the rehabilitation process. This study examined the consistency of hearing aid use in young children based on data logging information documented during audiology sessions in the first three years after hearing aid fitting. Methodology: The first 100 children who were diagnosed with bilateral HL before 72 months of age since 2003 to 2015 in a pediatric audiology clinic and who had at least two hearing aid follow-up sessions with available data logging information were included in the study. Data from each audiology session (age of child at the session, average hours of use per day (for each ear) in the first three years after HA fitting) were collected. Clinical characteristics (degree of hearing loss, age of HA fitting) were also documented to further understanding of factors that impact HA use. Results: Preliminary analysis of the results of the first 20 children shows that all of them (100%) have at least one data logging session recorded in the clinical audiology system (Noah). Of the 20 children, 17(85%) have three data logging events recorded in the first three years after HA fitting. Based on the statistical analysis of the first 20 cases, the median hours of use in the first follow-up session after the hearing aid fitting in the right ear is 3.9 hours with an interquartile range (IQR) of 10.2h. For the left ear the median is 4.4 and the IQR is 9.7h. In the first session 47% of the children use their hearing aids ≤5 hours, 12% use them between 5 to 10 hours and 22% use them ≥10 hours a day. However, these children showed increased use by the third follow-up session with a median (IQR) of 9.1 hours for the right ear and 2.5, and of 8.2 hours for left ear (IQR) IQR is 5.6 By the third follow-up session, 14% of children used hearing aids ≤5 hours, while 38% of children used them ≥10 hours. Based on the primary results, factors like age and level of HL significantly impact the hours of use. Conclusion: The use of data logging information to assess the actual hours of HA provides an opportunity to examine the: a) challenges of families of young children with HAs, b) factors that impact use in very young children. Data logging when used collaboratively with parents, can be a powerful tool to identify problems and to encourage and assist families in maximizing their child’s hearing potential.

Keywords: hearing loss, hearing aid, data logging, hours of use

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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: 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: Maznieda Mahjom, Rohaida Ismail, Masita Arip, Mohd Shaiful Azlan, Nor’Ashikin Othman, Hafizah Abdullah, nor Zahrin Hasran, Joshita Jothimanickam, Syaqilah Shawaluddin, Nadia Mohamad, Raheel Nazakat, Tuan Mohd Amin, Mizanurfakhri Ghazali, Rosmanajihah Mat Lazim

Abstract:

COVID-19 outbreak is particularly detrimental to the mental health of everyone as well as leaving a long devastating crisis in the healthcare sector. Daily increment of COVID-19 cases and close contact, necessitating the testing of a large number of samples, thus increasing the workload and burden to laboratory personnel. This study aims to determine the prevalence of personal-, work- and client-related burnout as well as to measure the concentration of salivary cortisol among laboratory personnel in the main laboratories in Klang Valley, Malaysia. This cross-sectional study was conducted in late 2021 and recruited a total of 404 respondents from three laboratories in Klang Valley, Malaysia. The level of burnout was assessed using Copenhagen Burnout Inventory (CBI) comprising three sub-dimensions of personal-, work- and client-related burnout. The cut-off score of 50% and above indicated possible burnout. Meanwhile, salivary cortisol was measured using a competitive enzyme immunoassay kit (Salimetrics, State College, PA, USA). Normal levels of salivary cortisol concentration in adults are within 0.094 to 1.551 μg/dl (morning) and can be none detected to 0.359 μg/dl (evening). The prevalence of personal-, work- and client-related burnout among laboratory personnel were 36.1%, 17.8% and 7.2% respectively. Meanwhile, the abnormal morning and evening cortisol concentration recorded were 29.5% and 21.8% excluding 6.9%-7.4% missing data. While the IgA level is normal for most of the respondents, which recorded at 95.53%. Laboratory personnel were at risk of suffering burnout during the COVID-19 pandemic. Thus, mental health programs need to be addressed at the department and hospital level by regularly screening healthcare workers and designing an intervention program. It is also vital to improve the coping skills of laboratory personnel by increasing the awareness of good coping skill techniques. The training must be in an innovative way to ensure that the lab personnel can internalise the technique and practise it in real life.

Keywords: burnout, COVID-19, laborotary personnel, salivary cortisol

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Authors: AliAkbar Hafezi, Jamshid Abedi, Jalal Taherian, Behnam Kadkhodaei, Mahsa Elahi

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Background. Peripheral neuropathy is a common side effect of the administration of neurotoxic chemotherapy agents. This adverse effect is a major dose-limiting factor of many commonly used chemotherapy drugs. Currently, there are no Food and Drug Administration (FDA) approved medications for the prevention or treatment of chemotherapy-induced peripheral neuropathy. Therefore, this study was performed to investigate the efficacy and safety of metformin on paclitaxel-induced peripheral neuropathy (PIPN). Methods. In this randomized clinical trial, cancer patients who were candidates for chemotherapy with paclitaxel referred to the radiation oncology departments in Iran from 2022 to 2023 were studied. Patients were randomly divided into two groups; 1- Case group (n = 30) received metformin 500 mg orally twice a day after meals during chemotherapy with paclitaxel, and 2- Control group (30 people) received chemotherapy without metformin or any additional medication. Patients were visited in terms of numbness or other neurological symptoms two weeks before chemotherapy, 1-2 days before and weekly during chemotherapy, and at the end of the study. They were assessed by nerve conduction study (NCS) before intervention and one week after the end of chemotherapy. The primary outcome was the efficacy in reducing PIPN and the secondary outcome was adverse effects. Eventually, the outcomes were compared between the two groups of patients. Results. A total of 60 female cancer patients receiving chemotherapy with paclitaxel were evaluated in two groups. The groups were matched in terms of age, body mass index, fasting blood sugar, smoking, pathologic stage, and creatinine levels. The results showed that 18 patients (60.0 %) in the case group and 23 patients (76.6 %) in the control group had PIPN clinically (P = 0.267), and NCS showed 11 patients (36.6 %) in the case group and 15 patients (50.0 %) in the control group suffered from PIPN which no significant difference was observed between the two groups (P = 0.435). Diarrhea (n = 3; 10.0 %) and nausea (n = 3; 10.0 %) were the most common side effects of metformin in the case group and no serious side effects (lactic acidosis and anemia) were found in these patients. Conclusion. This study indicated that metformin did not significantly prevent PIPN in cancer patients receiving chemotherapy, although the frequency of peripheral neuropathy in the case group was lower than in the control group. The use of metformin in the patients had acceptable safety and no serious side effects were reported.

Keywords: peripheral neuropathy, chemotherapy, paclitaxel, metformin

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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: F. Moghtaderi, M. Burke, J. Troelsen

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There has been a significant decline in active travel as well as the massive increase use of car-dependent travel mode in many countries during past two decades. Evidential risks for people’s physical and mental health problems are followed by this increased use of motorized travel mode. These problems range from overweight and obesity to increasing air pollution. In response to these rising concerns, local councils and other interested organizations around the world have introduced a variety of initiatives regarding reduce the dominance of cars for the daily journeys. However, the nature of these kinds of interventions, which related to the human behavior, make lots of complexities. People’s travel behavior and changing this behavior, has two different aspects. People’s attitudes and perceptions toward the sustainable and healthy modes of travel, and motorized travel modes (especially private car use) is one these two aspects. The other one related to people’s behavior change processes. There are no comprehensive model in order to guide policy interventions to increase the level of succeed of such interventions. A comprehensive theoretical framework is required in accordance to facilitate and guide the processes of data collection and analysis to achieve the best possible guidelines for policy makers. Regarding this gaps in the travel behavior change research, this paper attempted to identify and suggest a multidimensional framework in order to facilitate planning interventions. A structured mixed-method is suggested regarding the expand the scope and improve the analytic power of the result according to the complexity of human behavior. In order to recognize people’s attitudes, a theory with the focus on people’s attitudes towards a particular travel behavior was needed. The literature around the theory of planned behavior (TPB) was the most useful, and had been proven to be a good predictor of behavior change. Another aspect of the research, related to the people’s decision-making process regarding explore guidelines for the further interventions. Therefore, a theory was needed to facilitate and direct the interventions’ design. The concept of the transtheoretical model of behavior change (TTM) was used regarding reach a set of useful guidelines for the further interventions with the aim to increase active travel and sustainable modes of travel. Consequently, a combination of these two theories (TTM and TPB) had presented as an appropriate concept to identify and design implemented travel behavior change interventions.

Keywords: behavior change theories, theoretical framework, travel behavior change interventions, urban research

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Authors: Manahil Alfuraydan, Jodie Croxall, Lisa Hurt, Mike Kerr, Sinead Brophy

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Autism Spectrum Disorder (ASD) is a developmental condition characterised by impairment in terms of social communication, social interaction, and a repetitive or restricted pattern of interest, behaviour, and activity. There is a significant delay between seeking help and a confirmed diagnosis of ASD. This may result in delay in receiving early intervention services, which are critical for positive outcomes. The long wait times also cause stress for the individuals and their families. Telehealth potentially offers a way of improving the diagnostic pathway for ASD. This review of the literature aims to examine which telehealth approaches have been used in the diagnosis and assessment of autism in children and adults, whether they are feasible and acceptable, and how they compare with face-to-face diagnosis and assessment methods. A comprehensive search of following databases- MEDLINE, CINAHL Plus with Full text, Business Sources Complete, Web of Science, Scopus, PsycINFO and trail and systematic review databases including Cochrane Library, Health Technology Assessment, Database of Abstracts and Reviews of Effectiveness and NHS Economic Evaluation was conducted, combining the terms of autism and telehealth from 2000 to 2018. A total of 10 studies were identified for inclusion in the review. This review of the literature found there to be two methods of using telehealth: (a) video conferencing to enable teams in different areas to consult with the families and to assess the child/adult in real time and (b) a video upload to a web portal that enables the clinical assessment of behaviours in the family home. The findings were positive, finding there to be high agreement in terms of the diagnosis between remote methods and face to face methods and with high levels of satisfaction among the families and clinicians. This field is in the very early stages, and so only studies with small sample size were identified, but the findings suggest that there is potential for telehealth methods to improve assessment and diagnosis of autism used in conjunction with existing methods, especially for those with clear autism traits and adults with autism. Larger randomised controlled trials of this technology are warranted.

Keywords: assessment, autism spectrum disorder, diagnosis, telehealth

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Authors: F. Argurio, F. G. Vaccaro

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In a global environment defined by ever-increasing health issues, in spite of the progress made by modern medicine, this paper seeks to readdress the question of global health in an international relations perspective. The research hypothesis is: the lower the security environment, the higher the spread of communicable diseases. This question will be channeled by re-scaling the connotation of 'global' and 'international' dimension through the theoretical lens of glocalization, a theory by Bauman that starts its analysis from simple systems to get to the most complex ones. Glocalization theory will be operationalized by analyzing health in an armed-conflict context. In this respect, the independent variable 'low security environment' translates into the cases of Syria and Yemen, which provide a clear example of the all-encompassing nature of conflict on national health and the effects on regional development. In fact, Syria and Yemen have been affected by poliomyelitis and cholera outbreaks respectively. The dependent variable will be constructed on said communicable diseases which belong to the families of sanitation-related and vaccine-preventable diseases. The research will be both qualitative and quantitative, based on primary (interviews) and secondary (WHO and other NGO’s reports) sources. The methodology is based on the assessment of the vaccine coverage and case-analysis in time and space using epidemiological data. Moreover, local health facilities’ functioning and efficiency will be studied. The article posits that the intervention and cooperation of international organizations with the local authorities becomes crucial to provide the local populations with their primary health needs. In Yemen, the majority of fatal cholera cases were in the regions controlled by the Houthi rebels, not officially accredited by the International Community. Similarly, the polio outbreak in Syria primarily affected the areas not controlled by the Syrian Arab Republic forces, recognized as the leading interlocutor by the WHO. The jeopardized possibilities to access these countries have been pivotal to the determining the problem in controlling sanitation-related and vaccine preventable diseases. This represents a potential threat to global health.

Keywords: health in conflict-affected areas, cholera, polio, Yemen, Syria, glocalization

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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: 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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