Search results for: patient’s rights

Authors: Ngoc Thao Linh Dang

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Urban waterfront redevelopment is a global phenomenon, and thousands of schemes are being carried out in large metropoles, medium-sized cities, and even small towns all over the world. This opportunity brings the city back to the river and rediscovers waterfront revitalization as a unique opportunity for cities to reconnect with their unique historical and cultural image. The redevelopment can encourage economic investments, serve as a social platform for public interactions, and allow dwellers to express their rights to the city. Many coastal cities have effectively transformed the perception of their waterfront area through years of redevelopment initiatives, having been neglected for over a century. However, this process has never been easy due to the particular complexity of the space: local culture, history, and market-led development. Moreover, municipal governments work out the balance of diverse stakeholder interests, especially when repurposing high-profile and redundant spaces that form the core of urban economic investment while also accommodating the present and future generations in sustainable environments. Urban critics consistently grapple with the effectiveness of the planning process on the new waterfront, where public spaces are criticized for presenting a lack of opportunities for actual public participation due to privatization and authoritarian governance while no longer doing what they are ‘meant to’: all arise in reaction to the perceived failure of these places to meet expectations. The planning culture and the decision-making context determine the level of public involvement in the planning process; however, in the context of competing market forces and commercial interests dominating cities’ planning agendas, planning for public space in urban waterfronts tends to be for economic gain rather than supporting residents' social needs. These newly pleasing settings satisfied the cluster of middle-class individuals, new communities living along the waterfront, and tourists. A trend of public participatory exclusion is primarily determined by the nature of the planning being undertaken and the decision-making context in which it is embedded. Starting from this context, the research investigates the influence of planning on waterfront regeneration and the role of participation in this process. The research aims to look specifically at the characteristics of the planning process of the waterfront in Da Nang and its impact on the regeneration of the place to regain the city’s historical value and enhance local cultural identity and images. Vietnam runs a top-down planning system where municipal governments have control or power over what happens in their city following the approved planning from the national government. The community has never been excluded from development; however, their participation is still marginalized. In order to ensure social equality, a proposed approach called "bottom-up" should be considered and implemented alongside the traditional "top-down" process and provide a balance of perspectives, as it allows for the voices of the most underprivileged social group involved in a planning project to be heard, rather than ignored. The research provides new insights into the influence of the planning process on the waterfront regeneration in the context of Da Nang.

Keywords: planning process, public participation, top-down planning, waterfront regeneration

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Authors: Lakshmi Sujeesh, Aaron Ramzeen, Ricky Ziming Guo, Abhishek Agrawal

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Introduction: Range of motion (ROM) is often measured by physiotherapists using hand-held goniometer as part of mobility assessment for diagnosis. Due to the nature of hand-held goniometer measurement procedure, readings often tend to have some variations depending on the physical therapist taking the measurements (Riddle et al.). This study aims to validate computer vision software readings against goniometric measurements for quick and consistent ROM measurements to be taken by clinicians. The use of this computer vision software hopes to improve the future of musculoskeletal space with more efficient diagnosis from recording of patient’s ROM with minimal human error across different physical therapists. Methods: Using the hand-held long arm goniometer measurements as the “gold-standard”, healthy study participants (n = 20) were made to perform 4 exercises: Front elevation, Abduction, Internal Rotation, and External Rotation, using both arms. Assessment of active ROM using computer vision software at different angles set by goniometer for each exercise was done. Interclass Correlation Coefficient (ICC) using 2-way random effects model, Box-Whisker plots, and Root Mean Square error (RMSE) were used to find the degree of correlation and absolute error measured between set and recorded angles across the repeated trials by the same rater. Results: ICC (2,1) values for all 4 exercises are above 0.9, indicating excellent reliability. Lowest overall RMSE was for external rotation (5.67°) and highest for front elevation (8.00°). Box-whisker plots showed have showed that there is a potential zero error in the measurements done by the computer vision software for abduction, where absolute error for measurements taken at 0 degree are shifted away from the ideal 0 line, with its lowest recorded error being 8°. Conclusion: Our results indicate that the use of computer vision software is valid and reliable to use in clinical settings by physiotherapists for measuring shoulder ROM. Overall, computer vision helps improve accessibility to quality care provided for individual patients, with the ability to assess ROM for their condition at home throughout a full cycle of musculoskeletal care (American Academy of Orthopaedic Surgeons) without the need for a trained therapist.

Keywords: physiotherapy, frozen shoulder, joint range of motion, computer vision

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Authors: Amr Saeb, Khalid Al-Rubeaan, Mohamed Abouelhoda, Manojkumar Selvaraju, Hamsa Tayeb

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Background: P. mirabilis is a common uropathogenic bacterium that can cause major complications in patients with long-standing indwelling catheters or patients with urinary tract anomalies. In addition, P. mirabilis is a common cause of chronic osteomyelitis in diabetic foot ulcer (DFU) patients. Methodology: P. mirabilis SCDR1 was isolated from a diabetic ulcer patient. We examined P. mirabilis SCDR1 levels of resistance against nano-silver colloids, the commercial nano-silver and silver containing bandages and commonly used antibiotics. We utilized next generation sequencing techniques (NGS), bioinformatics, phylogenetic analysis and pathogenomics in the identification and characterization of the infectious pathogen. Results: P. mirabilis SCDR1 is a multi-drug resistant isolate that also showed high levels of resistance against nano-silver colloids, nano-silver chitosan composite and the commercially available nano-silver and silver bandages. The P. mirabilis-SCDR1 genome size is 3,815,621 bp with G+C content of 38.44%. P. mirabilis-SCDR1 genome contains a total of 3,533 genes, 3,414 coding DNA sequence genes, 11, 10, 18 rRNAs (5S, 16S, and 23S), and 76 tRNAs. Our isolate contains all the required pathogenicity and virulence factors to establish a successful infection. P. mirabilis SCDR1 isolate is a potential virulent pathogen that despite its original isolation site, wound, it can establish kidney infection and its associated complications. P. mirabilis SCDR1 contains several mechanisms for antibiotics and metals resistance including, biofilm formation, swarming mobility, efflux systems, and enzymatic detoxification. Conclusion: P. mirabilis SCDR1 is the spontaneous nano-silver resistant bacterial strain. P. mirabilis SCDR1 strain contains all reported pathogenic and virulence factors characteristic for the species. In addition, it possesses several mechanisms that may lead to the observed nano-silver resistance.

Keywords: Proteus mirabilis, multi-drug resistance, silver nanoparticles, resistance, next generation sequencing techniques, genome analysis, bioinformatics, phylogeny, pathogenomics, diabetic foot ulcer, xenobiotics, multidrug resistance efflux, biofilm formation, swarming mobility, resistome, glutathione S-transferase, copper/silver efflux system, altruism

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Authors: Miyoko Taniguchi

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Conflict and violence have prevailed over the last four decades in conflict-affected areas in Muslim Mindanao, despite the signing of several peace agreements between the Philippine government and Islamic separatist insurgents (the Moro National Liberation Front (MNLF) and the Moro Islamic Liberation Front (MILF)), and peacebuilding activities on the ground. In the meantime, the peace talks had been facilitated and mediated by international actors such as the Organization of Islamic Cooperation (OIC) and its member countries such as Indonesia, and Malaysia, and Japan. In 2014, both the Government of the Philippines (GPH) and the MILF finally reached a Comprehensive Peace Agreement (CAB) in 2014 under the Aquino III administration, though a Bangsamoro Basic Law (BBL) based on the CAB was not enacted at the Catholic-majority of the Philippine Congress. After a long process of deliberations at the Congress, Republic Act 11054, known as the Bangsamoro Organic Law (BOL), was enacted in 2018 under the Duterate administration. In the beginning, President Duterte adopted an 'inclusive approach' that involves the MILF, all factions of the MNLF, non-Islamized indigenous peoples, and other influential clan leaders to align all peace processes under a single Bangsamoro peace process. A notable difference from past administrations, there is an explicit recognition of all agreements and legislations based on the rights of each stakeholder. This created a new identity as 'Bangsamoro', the residents of Muslim Mindanao, enhancing political legitimacy. Besides, it should be noted an important role of 'insider mediators' -a platform for the Bangsamoro from diverse sectors attempting to work within their respective organizations in Moro society. Give the above background, this paper aims at probing the effectiveness of insider mediation as one of the alternative approaches for mediation in the peace process. For the objectives, this research uses qualitative methods such as process-tracing and semi-structured interviews from diverse groups of stakeholders at from the state to the regional level, including the government officials involved in peace process under the Presidential Office, rebels (MILF and MNLF), civil society organizations involved in lobbying and facilitating peace process, especially in the legislative process. The key outcomes and findings are that the Insider Mediators Group, formed in 2016, had taken on a significant role in facilitating the achievement of a wider consensus among stakeholders on major Moro issues such as BBL’s passing during the last administration to call for unity among the Bangsamoro. Most of its members are well-educated professionals affiliated with the MILF, the MNLF, and influential clans. One of the group’s biggest achievements has been the lobbying and provision of legal advice to legislators who were not necessarily knowledgeable about the peace process during the deliberation of the bicameral conference of the BBL, which eventually led to its passage. It can be concluded that in the long run, strengthening vertical and horizontal relations between the Moro society and the State and among the Moro peoples that can be viewed as a means to sustainable peace.

Keywords: insider mediation, Mindanao, peace process, Moro Islamic liberation front

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Authors: Dzeawoni Atlee

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Cameroon is endowed with a rich cultural heritage which presents in the formof monuments, architecture, material culture, geological formations, cultural festivals, forestsandanimal/bird reserves. This heritage has been under threat from looters, hazards, public works, industrialization, urbanization, war and the non-respect of legislation in force. Existing institutions, legislation, conventions and charters play a primordial role when it comes to protecting cultural heritage. In 1982, Cameroon ratified the UNESCO Convention on the protection of world cultural andnatural heritage. Prior to this, the Federal Act of 1963 bearing on the protection of monuments, objects and sites of historic or artistic interest was the first legal instrument in force. It was followedby the creation of a Directorate of culture in 1972, whose activities received a boast fromthe Africancharter of human and peoples’ rights of 1981. Presently, Law No. 91/008 of 1991 bearingontheprotection of the national cultural patrimony and other related Charters ratified by Cameroon remainin force. Despite these strives, the problem of protecting cultural and natural sites persist, andthecountry has not tapped maximum benefits from the sector. In 2002 Haman Mohaman andLazareEloundou of ICOMOS Cameroon signaled that, this issue needed urgent attention; otherwise it wouldresult to the disappearance of the rich cultural heritage of the country. This paper thus focuses ontheexisting legislative and institutional framework in Cameroon, with the objective to single out areasthat should be improved upon. The spatial scope of the paper is the Grassfields of Cameroon, andthesynchronic scope runs from 1963 to 2024. This paper argues that, the existing legislative framework, charters and conventions ratified by Cameroon can sustain its cultural/natural heritage. It is rather thedisjointed form of the legislation and dispersed action by institutions and stake holders/actors onthefield which raises an issue. The methodology applied the qualitative and quantitative approaches. Sources gleaned on decrees, conventions, charters and literature on cultural policy and interviews. Onthe field, surveys were accompanied by questionnaires targeting delegates of culture, tourism, publicworks, curators and custodians of cultural/geological formations. Findings reveal that, ,intheGrassfields, spectacular progress has been made in the West Region of Cameroon to preserveandvalorize its cultural heritage, when compared to the North West Region and other parts of the country. The paper concludes that, the inclusion of the Bamoun Nguon and Douala Ngondo festivals in2024into the UNESCO list of intangible cultural heritage of humanity; together with a plethora of cultural heritage sites in the West Region; emanated from the use of existing laws, better protectionandsynergy of action on the field. The paper recommends that, a Cameroon cultural, tourismandenvironmental protection blue print 2035 is charted out. It also recommends the creation of oneMinistry to manage all aspects of Cameroon’s Cultural Heritage and by implication, a newlegislativeframework.

Keywords: Cameroon, cultural heritage, grassfields, legislation, protection.

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Authors: Adel Khorramrouz, Monireh Ahmadi Bani, Ehsan Norouzi

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Background:-Due to the essential role of the foot in movement, foot disorders (FDs) have significant impacts on activity and quality of life. Many studies confirmed the association between FDs and demographic characteristics. On the other hand, recent advances in data collection and statistical analysis led to an increase in the volume of databases. Analysis of patient’s data through the decision tree can be used to explore the relationship between demographic characteristics and FDs. Significance of the study: This study aimed to investigate the relationship between demographic characteristics with common FDs. The second purpose is to better inform foot intervention, we classify FDs based on demographic variables. Methodologies: We analyzed 2323 subjects with pes-planus (PP), pes-cavus (PC), hallux-valgus (HV) and plantar-fasciitis (PF) who were referred to a foot therapy clinic between 2015 and 2021. Subjects had to fulfill the following inclusion criteria: (1) weight between 14 to 150 kilogram, (2) height between 30 to 220, (3) age between 3 to 100 years old, and (4) BMI between 12 to 35. Medical archives of 2323 subjects were recorded retrospectively and all the subjects examined by an experienced physician. Age and BMI were classified into five and four groups, respectively. 80% of the data were randomly selected as training data and 20% tested. We build a decision tree model to classify FDs using demographic characteristics. Findings: Results demonstrated 981 subjects from 2323 (41.9%) of people who were referred to the clinic with FDs were diagnosed as PP, 657 (28.2%) PC, 628 (27%) HV and 213 (9%) identified with PF. The results revealed that the prevalence of PP decreased in people over 18 years of age and in children over 7 years. In adults, the prevalence depends first on BMI and then on gender. About 10% of adults and 81% of children with low BMI have PP. There is no relationship between gender and PP. PC is more dependent on age and gender. In children under 7 years, the prevalence was twice in girls (10%) than boys (5%) and in adults over 18 years slightly higher in men (62% vs 57%). HV increased with age in women and decreased in men. Aging and obesity have increased the prevalence of PF. We conclude that the accuracy of our approach is sufficient for most research applications in FDs. Conclusion:-The increased prevalence of PP in children is probably due to the formation of the arch of the foot at this age. Increasing BMI by applying high pressure on the foot can increase the prevalence of this disorder in the foot. In PC, the Increasing prevalence of PC from women to men with age may be due to genetics and innate susceptibility of men to this disorder. HV is more common in adult women, which may be due to environmental reasons such as shoes, and the prevalence of PF in obese adult women may also be due to higher foot pressure and housekeeping activities.

Keywords: decision tree, demographic characteristics, foot disorders, machine learning

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Authors: Gurbanova J., Majidova N., Ali-Zade S., Hasanova A., Mikailzade P.

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Currently, the problem of oncogynecological diseases is widespread and remains relevant in terms of quantitative growth. It is known that due to the increase in the number of benign diseases of the cervix, the development of precancerous conditions occurs. Benign diseases of the cervix represent the most common gynecological problem, which are often precursors of malignant neoplasms, especially cervical cancer. According to statistics, benign diseases of the cervix cover 25-45% of all gynecological diseases. Among women's oncogynecological diseases, cervical cancer ranks second in the world after breast cancer and ranks first in the mortality rate among oncological diseases in economically underdeveloped countries. We performed a comprehensive clinical and laboratory examination of 130 women aged 18 to 73 with benign cervical diseases. 59 (38.5%) women of reproductive age, as well as 39 (30%) premenopausal and 41 (31.5%) menopausal patients, participated in the study. Detailed anamnesis was collected from all patients, objective and gynecological examination was performed, laboratory and instrumental examinations (USM, IPV DNA, smear microscopy, and PCR bacteriological examination of sexually transmitted infections), simple and extended colposcopy, liquid-based РАР-smear smear and РАР-classic smear examinations were conducted. As a result of the research, the following nosological forms were found in women with benign diseases of the cervix: non-specific vaginitis in 10 (7.7%) cases; ectopia, endocervicitis - 60(46.2%); cervical ectropion - 7(5.4%); cervical polyp - 9(6.9%); cervical leukoplakia - 15(11.5%); atrophic vaginitis - 7(5.4%); condyloma - 12(9.2%); cervical stenosis - 2(1.5%); endometriosis of the cervix - was noted in 8 (6.2%) cases (p<0.001), respectively. Characteristics of the menstrual cycle among the examined women: normal cycle in 97 (74.6%) cases; oligomenorrhea – 23 (17.7%); polymenorrhea – 4(3.1%); algomenorrhea – noted in 6 (4.6%) cases (p<0.001). Cytological examination showed that: the specificity of liquid-based cytology was 76.2%, and the traditional PAP test was set at 70.6%. The overall diagnostic value was calculated to be 86% in liquid-based cytology and 78.5% in conventional PAP tests. Treatment of women with benign diseases of the cervix was carried out by diathermocoagulation method and "FOTEK EA 141M" device. It should be noted that 6 months after the treatment, after treatment with the "FOTEK EA 141M" device, there was no relapse in any patient. Recurrence was found in 23.7% of patients after diathermoelectrocoagulation. Thus, it is clear from the above that the study of cervical pathologies, the determination of optimal examinations, and effective treatment methods is one of the urgent problems facing obstetrics and gynecology.

Keywords: cervical cancer, cytological examination, PAP-smear, non-specific vaginitis

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Authors: Madhusudana S. N., Reeta Mani, Ashwini S. Satishchandra P., Netravati, Udhani V., Fiaz A., Karande S.

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Rabies is an acute encephalitis which is considered 100% fatal despite occasional reports of survivors. However, in recent times more cases of human rabies survivors are being reported. In the last 5 years, there are six laboratories confirmed human rabies survivors in India alone. All cases were children below 15 years and all contracted the disease by dog bites. All of them also had received the full or partial course of rabies vaccination and 4 out of 6 had also received rabies immunoglobulin. All cases were treated in intensive care units in hospitals at Bangalore, Mumbai, Chandigarh, Lucknow and Goa. We report here the results of immunological and virological studies conducted at our laboratory on these patients. The clinical samples that were obtained from these patients were Serum, CSF, nuchal skin biopsy and saliva. Serum and CSF samples were subjected to standard RFFIT for estimation of rabies neutralizing antibodies. Skin biopsy, CSF and saliva were processed by TaqMan real-time PCR for detection of viral RNA. CSF, saliva and skin homogenates were also processed for virus isolation by inoculation of suckling mice. The PBMCs isolated from fresh blood was subjected to ELISPOT assay to determine the type of immune response (Th1/Th2). Both CSF and serum were also investigated for selected cytokines by Luminex assay. The level of antibodies to virus G protein and N protein were determined by ELISA. All survivors had very high titers of RVNA in serum and CSF 100 fold higher than non-survivors and vaccine controls. A five-fold rise in titer could be demonstrated in 4 out of 6 patients. All survivors had a significant increase in antibodies to G protein in both CSF and serum when compared to non-survivors. There was a profound and robust Th1 response in all survivors indicating that interferon gamma could play an important factor in virus clearance. We could isolate viral RNA in only one patient four years after he had developed symptoms. The partial N gene sequencing revealed 99% homology to species I strain prevalent in India. Levels of selected cytokines in CSF and serum did not reveal any difference between survivors and non-survivors. To conclude, survival from rabies is mediated by virus-specific immune responses of the host and clearance of rabies virus from CNS may involve the participation of both Th2 and Th1 immune responses.

Keywords: rabies, rabies treatment, rabies survivors, immune reponse in rabies encephalitis

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Authors: Marilou P. Angeles

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Seniors are a growing number of population all over the world, and they are getting sick with illnesses like diabetes, high blood, and high cholesterol. It is necessary to see the relationship of their physical illness and its effect on their quality of life. Having chronic illnesses also can affect the mood of the elderly; becoming cranky, lonely, not eating, etc. Therefore, there is a need to study the relationship of the quality of life of the elderly and the level of depression. Depression for elderly is known as late onset depression or vascular depression since it is tied to the vascular illnesses they are experiencing, although this is not homogeneous. There is heterogeneity in seniors. The purpose of the study is to determine how keep the satisfaction in life i.e., quality of life of seniors, as long as possible. This study was made in 4 barangays in Longos, Potrero, Tonsuya and Catmon, in Malabon, Metro Manila, Philippines. These Filipino seniors are availing of free medicines for their diabetes, high blood, and high cholesterol ailments in the barangay health centers, given freely by the Department of Health. Two instruments were used; quality of life (CASP-19) and patient health questionnaire(PHQ-19). The quality of life questionnaire was based on the theory of Abraham Maslow, human: beings are motivated to action by needs, starting from the lowest, physiological to the highest self-transcendence. Severity of depression is determined by PHQ-9, and according to the unified model of depression by Aaron Beck and Kurt B. Bredemeier, depression happens when a person cannot cope with life has not able to satisfy his needs as a person. The Pearson R correlation was used to determine the significance of the relationship between quality of life and depression. Finding is there is negative relationship between quality of life and depression. It means that a high value of quality of life lowers or minimizes depression. CASP-19 found that the Filipino elderly were in control, independent, enjoying their lives even if they are poor, and this is shown by the significant results. Self-transcendence, a need to give back to others, is important for Filipino elderly. Although the seniors have difficulty with money and they were affected by their illnesses, they are full of optimism, they are ignoring their physical pain because they are focusing on helping their loved ones (i.e., self-transcendence), their children and grandchildrenothers, and if problems come, they are resilient accepting of the challenges, because they have strong faith in God. They are also having pleasures interacting with their friends and neighbors who, like them, have the same health problems. And these two coping strategies for the elderlies allow them to live a meaningful life, a life high in quality. Thus, where there is high quality of life, there is none or minimal depression. Recommendation for future study is finding the relationship of spirituality to quality of life of seniors.

Keywords: CASP-19, depression, quality of life, PHQ-9, senior citizen

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Authors: Karimova Sitora Yuldashevna

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The August 2021 resurgence of Taliban as a ruling force in Afghanistan once again challenged the global community into dealing with an unprecedentedly unlike-minded government. To express their disapproval of the new regime, Western governments and intergovernmental institutions have suspended their infrastructural projects and other forms of support. Moreover, the Afghan offshore reserves were frozen, and Afghanistan was disconnected from the international financial system, which impeded even independent aid agencies’ work. The already poor provision of aid was then further complicated with political conditionality. The purpose of this paper is to investigate the efficacy of conditional aid policy in the Afghan peacebuilding under Taliban rule and provide recommendations to international donors on further course of action. Arguing that conditionality of aid is a counterproductive factor in the peacebuilding process, this paper employs scholarly literature on peacebuilding alongside reports from International non-governmental organizations INGOs who operate directly in Afghanistan. The existing debate on peacebuilding in Afghanistan revolves around aid as a means of building democratic foundation for achieving peace on communal and national levels and why the previous attempts to do so were unsuccessful. This paper focuses on how to recalibrate the approach to aid provision and peacebuilding in the new reality. In the early 2000s, amid the weak Post-Cold War international will for a profound engagement in the conflict, humanitarian and development aid became the new means of achieving peace. Aid agencies provided resources directly to communities, minimizing the risk of local disputes. Through subsidizing education, governance reforms, and infrastructural projects, international aid accelerated school enrollment, introduced peace education, funded provincial council and parliamentary elections, and helped rebuild a conflict-torn country.When the Taliban seized power, the international community called on them to build an inclusive government based on respect for human rights, particularly girls’ and women’s schooling and work, as a condition to retain the aid flow. As the Taliban clearly failed to meet the demands, development aid was withdrawn. Some key United Nation agencies also refrained from collaborating with the de-facto authorities. However, contrary to the intended change in Talibs’ behavior, such a move has only led to further deprivation of those whom the donors strived to protect. This is because concern for civilians has always been the second priority for the warring parties. This paper consists of four parts. First, it describes the scope of the humanitarian crisis that began in Afghanistan in 2001. Second, it examines the previous peacebuilding attempts undertaken by the international community and the contribution that the international aid had in the peacebuilding process. Third, the paper describes the current regime and its relationships with the international donors. Finally, the paper concludes with recommendations for donors who would have to be more realistic and reconsider their priorities. While it is certainly not suggested that the Taliban regime is legitimized internationally, the crisis calls upon donors to be more flexible in collaborating with the de-facto authorities for the sake of the civilians.

Keywords: Afghanistan, international aid, donors, peacebuilding

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Authors: Allyson Augusta Shrikhande, Alexa Rains, Tayyaba Ahmed, Marjorie Mamsaang, Rakhi Vyas, Janaki Natarajan, Erika Moody, Christian Reutter, Kimberlee Leishear, Yogita Tailor, Sandra Sandhu-Restaino, Lora Liu, Neha James, Rosemarie Filart

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Characterized by consistent difficulty getting and keeping an erection firm enough for intercourse, Erectile Dysfunction may affect up to 15% of adult men. Although awareness and access to treatment have improved in recent years, many patients do not actively seek diagnosis or treatment due to the stigma surrounding this condition. Patients who do seek treatment are often dissatisfied by the efficacy of the medication. The condition inhibits patients’ quality of life by worsening mental health and relationships. The purpose of this study was to test the effectiveness of an outpatient neuromuscular treatment protocol in treating the symptoms of Chronic Pelvic Pain and Erectile Dysfunction, improving pain and function. 56 patients ages 20-79 presented to an outpatient clinic for treatment of pelvic pain and Erectile Dysfunction symptoms. These symptoms had persisted for an average of 4 years. All patients underwent external ultrasound-guided hydro-dissection technique targeted at pelvic peripheral nerves in combination with pelvic floor musculature trigger-point injections. To measure the effects of this treatment, a five question Erectile Dysfunction questionnaire was completed by each patient at their first visit to a clinic and three months after treatment began. Answers were summed for a total score of 5-25, with a higher score indicating optimal function. The average score before treatment was 14.125 (SD 5.411) (a=0.05; CI 12.708-15.542), which increased by 18% to an average of 16.625 (SD 6.423) (a=0.05; CI 14.943-18.307) after treatment (P=0.0004). Secondary outcome variables included a Visual Analogue Scale (VAS) to measure pelvic pain intensity and the Functional Pelvic Pain Scale (FPPS) to measure function across multiple areas. VAS scores reduced by 51% after three months. Before treatment, the mean VAS score was 5.87, and the posttreatment mean VAS score was 2.89. Pelvic pain functionality improved by 34% after three months. Pretreatment FPPS scores averaged at 7.48, decreasing to 4.91 after treatment. These results indicate that this unique treatment was very effective at relieving pain and increasing function for patients with Erectile Dysfunction.

Keywords: chronic pelvic pain, erectile dysfunction, nonsurgical, outpatient, trigger point injections

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Authors: Zbigniew Izdebski, Alicja Kozakiewicz, Maciej Białorudzki, Joanna Mazur

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Work is an extremely important part of everyone's life and affects functioning in daily life. Healthcare workers (HCW) are suffering from negative actions in and out of the workplace, such as harassment, abuse, long working hours, mental suffering, exhaustion, and professional burnout. Staff burnout is detrimental not only in terms of individual employees but also to working with patients and to the healthcare institution as a whole. The purpose of this study was to explore the level of professional burnout among HCW working in medical institutions during the COVID-19 pandemic in Poland. The extent to which selected sociodemographic factors and perceived stress increase the risk of professional burnout was assessed. In addition, the frequency of use of professional psychological help and less formal support groups by HCW in relation to the level of professional burnout was presented. The survey was conducted as part of a larger project on the humanization of medicine and clinical communication from February-April 2022. This study used a self-administered online survey (CAWI) technique and PAPI (pen and paper interview) technique. The BAT-12 scale was used to measure burnout, the PSS-4 scale was used to measure stress, and questions formulated by the research team were also used. For the purpose of analysis, the sample was limited to 2196 HCWs who worked on a daily basis with patients during the COVID-19 pandemic. Frequency distributions were analyzed, and multivariate logistic regression was performed. The mean scores (scores) of job burnout as measured by the BAT-12 scale ranged among the professional groups from 2.15(0.69) to 2.30 (0.69) and remained highest for the nurses' group. The groups differed significantly in levels of burnout (chi-sq=17.719; d.f.=8; p<0.023). In the final model, raised stress most likely increased the risk of burnout (OR=3.88; 95%CI <3.13-3.81>; p<0,001). Other significant predictors of burnout included: traumatic work-related experience (OR=1.91, p<0.001), mobbing (OR=1.83, p<0.001), and a higher workload than before the pandemic (OR=1.41, p=0.002). Only 7% of respondents decided to use various forms of psychological support during the pandemic. HCW experiences challenges in dealing with an unpredictable pandemic. Limited preparedness can lead to physical and psychological problems such as high-stress levels, anxiety, fear, helplessness, hopelessness, anger and stigma. The workload can lead to professional burnout, as well as threaten patient safety.

Keywords: burnout, work, healthcare, healthcare worker, stress

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Authors: Kavitha Puthanveedu, Kasi Sekar, Preeti Jacob, Kavita Jangam

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In India, The Juvenile Justice (Care and Protection of Children) Act, 2015, the law related to children alleged and found to be in conflict with law, proposes to address to the rehabilitation of children in conflict with law by catering to the basic rights by providing care and protection, development, treatment, and social re-integration. A major concern in addressing the issues of children in conflict with law in Kerala the southernmost state in India identified were: 1. Lack of psychological assessment for children in conflict with law, 2. Poor psychosocial intervention for children in conflict with law on bail, 3. Lack of psychosocial intervention or proper care and protection of CCL residing at observation and special home, 4. Lack convergence with systems related with mental health care. Aim: To develop individual care plan for children in conflict with law. Methodology: NIMHANS a premier Institute of Mental Health and Neurosciences, collaborated with Social Justice Department, Govt. of Kerala to address this issue by developing a participatory methodology to implement psychosocial care in the existing services by integrating the activities through multidisciplinary and multisectoral approach as per the Sec. 18 of JJAct 2015. Developing individual care plan: Key informant interviews, focus group discussion with multiple stakeholders consisting of legal officers, police, child protection officials, counselors, and home staff were conducted. Case studies were conducted among children in conflict with law. A checklist on 80 psychosocial problems among children in conflict with law was prepared with eight major issues identified through the quantitative process such as family and parental characteristic, family interactions and relationships, stressful life event, social and environmental factors, child’s individual characteristics, education, child labour and high-risk behavior. Standardised scales were used to identify the anxiety, caseness, suicidality and substance use among the children. This provided a background data understand the psychosocial problems experienced by children in conflict with law. In the second stage, a detailed plan of action was developed involving multiple stakeholders that include Special juvenile police unit, DCPO, JJB, and NGOs. The individual care plan was reviewed by a panel of 4 experts working in the area of children, followed by the review by multiple stakeholders in juvenile justice system such as Magistrates, JJB members, legal cum probation officers, district child protection officers, social workers and counselors. Necessary changes were made in the individual care plan in each stage which was pilot tested with 45 children for a period of one month and standardized for administering among children in conflict with law. Result: The individual care plan developed through scientific process was standardized and currently administered among children in conflict with law in the state of Kerala in the 3 districts that will be further implemented in other 14 districts. The program was successful in developing a systematic approach for the psychosocial intervention of children in conflict with law that can be a forerunner for other states in India.

Keywords: psychosocial care, individual care plan, multidisciplinary, multisectoral

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Authors: Carlos V. Gonzalez

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Background: Providers of in-home and community based services strive for the elimination of preventable harm to the people under their care as well as to the employees who support them. Traditional models of safety and protection from harm have assumed that the absence of incidents of harm is a good indicator of safe practices. However, this model creates an illusion of safety that is easily shaken by sudden and inadvertent harmful events. As an alternative, we have developed and implemented an evidence-based resilient model of safety known as C.O.P.E. (Caring, Observing, Predicting and Evaluating). Within this model, safety is not defined by the absence of harmful incidents, but by the presence of continuous monitoring, anticipation, learning, and rapid response to events that may lead to harm. Objective: The objective was to evaluate the effectiveness of the C.O.P.E. model for the reduction of harm to individuals with mental disabilities who receive home and community based services. Methods: Over the course of 2 years we counted the number of incidents of harm and near misses. We trained employees on strategies to eliminate incidents before they fully escalated. We trained employees to track different levels of patient status within a scale from 0 to 10. Additionally, we provided direct support professionals and supervisors with customized smart phone applications to track and notify the team of changes in that status every 30 minutes. Finally, the information that we collected was saved in a private computer network that analyzes and graphs the outcome of each incident. Result and conclusions: The use of the COPE model resulted in: A reduction in incidents of harm. A reduction the use of restraints and other physical interventions. An increase in Direct Support Professional’s ability to detect and respond to health problems. Improvement in employee alertness by decreasing sleeping on duty. Improvement in caring and positive interaction between Direct Support Professionals and the person who is supported. Developing a method to globally measure and assess the effectiveness of prevention from harm plans. Future applications of the COPE model for the reduction of harm to people who receive home and community based services are discussed.

Keywords: harm, patients, resilience, safety, mental illness, disability

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Authors: Irene Buj-Corral, Ali Bagheri, Alejandro Dominguez-Fernandez

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In recent years, use of ceramic prostheses as an implant in some parts of body has become common. In the present study, research has focused on replacement of the acetabulum bone, which is a part of the pelvis bone. Metallic prostheses have shown some problems such as release of metal ions into patient's blood. In addition, fracture of liners and squeezing between surface of femoral head and inner surface of acetabulum have been reported. Ceramic prostheses have the advantage of low debris and high strength, although they are more difficult to be manufactured than metallic ones. Specifically, new designs try to attempt an acetabulum in which the outer surface will be porous for proliferation of cells and fixation of the prostheses by means of osteointegration, while inner surface must be smooth enough to assure that the movement between femoral head and inner surface will be carried out with on feasibility. In the present study, 3D printing technologies are used for manufacturing ceramic prostheses. In Fused Deposition Modelling (FDM) process, 3D printed plastic prostheses are obtained by means of melting of a plastic filament and subsequent deposition on a glass surface. A similar process is applied to ceramics in which ceramic powders need to be mixed with a liquid polymer before depositing them. After 3D printing, parts are subjected to a sintering process in an oven so that they can achieve final strength. In the present paper, influence of printing parameters on surface roughness 3D printed ceramic parts are presented. Three parameter full factorial design of experiments was used. Selected variables were layer height, infill and nozzle diameter. Responses were average roughness Ra and mean roughness depth Rz. Regression analysis was applied to responses in order to obtain mathematical models for responses. Results showed that surface roughness depends mainly on layer height and nozzle diameter employed, while infill was found not to be significant. In order to get low surface roughness, low layer height and low infill should be selected. As a conclusion, layer height and infill are important parameters for obtaining good surface finish in ceramic 3D printed prostheses. However, use of too low infill could lead to prostheses with low mechanical strength. Such prostheses could not be able to bear the static and dynamic charges to which they are subjected once they are implanted in the body. This issue will be addressed in further research.

Keywords: ceramic, hip prostheses, surface roughness, 3D printing

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Authors: Ella Tyuryumina, Alexey Neznanov

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Finding algorithms to predict the growth of tumors has piqued the interest of researchers ever since the early days of cancer research. A number of studies were carried out as an attempt to obtain reliable data on the natural history of breast cancer growth. Mathematical modeling can play a very important role in the prognosis of tumor process of breast cancer. However, mathematical models describe primary tumor growth and metastases growth separately. Consequently, we propose a mathematical growth model for primary tumor and primary metastases which may help to improve predicting accuracy of breast cancer progression using an original mathematical model referred to CoM-IV and corresponding software. We are interested in: 1) modelling the whole natural history of primary tumor and primary metastases; 2) developing adequate and precise CoM-IV which reflects relations between PT and MTS; 3) analyzing the CoM-IV scope of application; 4) implementing the model as a software tool. The CoM-IV is based on exponential tumor growth model and consists of a system of determinate nonlinear and linear equations; corresponds to TNM classification. It allows to calculate different growth periods of primary tumor and primary metastases: 1) ‘non-visible period’ for primary tumor; 2) ‘non-visible period’ for primary metastases; 3) ‘visible period’ for primary metastases. The new predictive tool: 1) is a solid foundation to develop future studies of breast cancer models; 2) does not require any expensive diagnostic tests; 3) is the first predictor which makes forecast using only current patient data, the others are based on the additional statistical data. Thus, the CoM-IV model and predictive software: a) detect different growth periods of primary tumor and primary metastases; b) make forecast of the period of primary metastases appearance; c) have higher average prediction accuracy than the other tools; d) can improve forecasts on survival of BC and facilitate optimization of diagnostic tests. The following are calculated by CoM-IV: the number of doublings for ‘nonvisible’ and ‘visible’ growth period of primary metastases; tumor volume doubling time (days) for ‘nonvisible’ and ‘visible’ growth period of primary metastases. The CoM-IV enables, for the first time, to predict the whole natural history of primary tumor and primary metastases growth on each stage (pT1, pT2, pT3, pT4) relying only on primary tumor sizes. Summarizing: a) CoM-IV describes correctly primary tumor and primary distant metastases growth of IV (T1-4N0-3M1) stage with (N1-3) or without regional metastases in lymph nodes (N0); b) facilitates the understanding of the appearance period and manifestation of primary metastases.

Keywords: breast cancer, exponential growth model, mathematical modelling, primary metastases, primary tumor, survival

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Authors: Brandon Knopp, Matthew Harris

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Purpose: Tip-apex distance (TAD) has long been discussed as a metric for determining risk of failure in the fixation of peritrochanteric fractures. TAD measurements over 25 millimeters (mm) have been associated with higher rates of screw cut out and other complications in the first several months after surgery. However, there is limited evidence for the efficacy of this measurement in predicting the long-term risk of negative outcomes following hip fixation surgery. The purpose of our study was to investigate risk factors including TAD for hospital readmission, loss of pre-injury ambulation and development of complications within 1 year after hip fixation surgery. Methods: A retrospective review of proximal hip fractures treated with single screw intramedullary devices between 2016 and 2020 was performed at a 327-bed regional medical center. Patients included had a postoperative follow-up of at least 12 months or surgery-related complications developing within that time. Results: 44 of the 67 patients in this study met the inclusion criteria with adequate follow-up post-surgery. There was a total of 10 males (22.7%) and 34 females (77.3%) meeting inclusion criteria with a mean age of 82.1 (± 12.3) at the time of surgery. The average TAD in our study population was 19.57mm and the average 1-year readmission rate was 15.9%. 3 out of 6 patients (50%) with a TAD > 25mm were readmitted within one year due to surgery-related complications. In contrast, 3 out of 38 patients (7.9%) with a TAD < 25mm were readmitted within one year due to surgery-related complications (p=0.0254). Individual TAD measurements, averaging 22.05mm in patients readmitted within 1 year of surgery and 19.18mm in patients not readmitted within 1 year of surgery, were not significantly different between the two groups (p=0.2113). Conclusions: Our data indicate a significant improvement in hospital readmission rates up to one year after hip fixation surgery in patients with a TAD < 25mm with a decrease in readmissions of over 40% (50% vs 7.9%). This result builds upon past investigations by extending the follow-up time to 1 year after surgery and utilizing hospital readmissions as a metric for surgical success. With the well-documented physical and financial costs of hospital readmission after hip surgery, our study highlights a reduction of TAD < 25mm as an effective method of improving patient outcomes and reducing financial costs to patients and medical institutions. No relationship was found between TAD measurements and secondary outcomes, including loss of pre-injury ambulation and development of complications.

Keywords: hip fractures, hip reductions, readmission rates, open reduction internal fixation

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Authors: May Fadheel Estephan, Richard Perks

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Context: Cancer is a serious health concern that affects millions of people worldwide. Early detection and treatment are essential for improving patient outcomes. However, current methods for cancer detection have limitations, such as low sensitivity and specificity. Research Aim: The aim of this study was to develop an optical sensor for cancer detection using elastic light scattering spectroscopy (ELSS). ELSS is a noninvasive optical technique that can be used to characterize the size and concentration of particles in a solution. Methodology: An optical probe was fabricated with a 100-μm-diameter core and a 132-μm centre-to-centre separation. The probe was used to measure the ELSS spectra of polystyrene spheres with diameters of 2, 0.8, and 0.413 μm. The spectra were then analysed to determine the size and concentration of the spheres. Findings: The results showed that the optical probe was able to differentiate between the three different sizes of polystyrene spheres. The probe was also able to detect the presence of polystyrene spheres in suspension concentrations as low as 0.01%. Theoretical Importance: The results of this study demonstrate the potential of ELSS for cancer detection. ELSS is a noninvasive technique that can be used to characterize the size and concentration of cells in a tissue sample. This information can be used to identify cancer cells and assess the stage of the disease. Data Collection: The data for this study were collected by measuring the ELSS spectra of polystyrene spheres with different diameters. The spectra were collected using a spectrometer and a computer. Analysis Procedures: The ELSS spectra were analysed using a software program to determine the size and concentration of the spheres. The software program used a mathematical algorithm to fit the spectra to a theoretical model. Question Addressed: The question addressed by this study was whether ELSS could be used to detect cancer cells. The results of the study showed that ELSS could be used to differentiate between different sizes of cells, suggesting that it could be used to detect cancer cells. Conclusion: The findings of this research show the utility of ELSS in the early identification of cancer. ELSS is a noninvasive method for characterizing the number and size of cells in a tissue sample. To determine cancer cells and determine the disease's stage, this information can be employed. Further research is needed to evaluate the clinical performance of ELSS for cancer detection.

Keywords: elastic light scattering spectroscopy, polystyrene spheres in suspension, optical probe, fibre optics

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Authors: Sheng-Yu Lee

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Aim: Opioid use disorder is often characterized by repetitive drug-seeking and drug-taking behaviors with severe public health consequences. Animal model showed that opioid-induced perturbations in the gut microbiota causally relate to neuroinflammation, deficits in reward responding, and opioid tolerance, possibly due to changes in gut microbiota. Therefore, we propose that the dysbiosis of gut microbiota can be associated with pathogenesis of opioid dependence. In this current study, we explored the differences in gut microbiota between patients and normal controls and in patients before and after initiation of methadone treatment program for 12 weeks. Methods: Patients with opioid use disorder between 20 and 65 years were recruited from the methadone maintenance outpatient clinic in 2 medical centers in the Southern Taiwan. Healthy controls without any family history of major psychiatric disorders (schizophrenia, bipolar disorder and major depressive disorder) were recruited from the community. After initial screening, 15 patients with opioid use disorder joined the study for initial evaluation (Week 0), 12 of them completed the 12-week follow-up while receiving methadone treatment and ceased heroin use (Week 12). Fecal samples were collected from the patients at baseline and the end of 12th week. A one-time fecal sample was collected from the healthy controls. The microbiota of fecal samples were investigated using 16S rRNA V3V4 amplicon sequencing, followed by bioinformatics and statistical analyses. Results: We found no significant differences in species diversity in opioid dependent patients between Week 0 and Week 12, nor compared between patients at both points and controls. For beta diversity, using principal component analysis, we found no significant differences between patients at Week 0 and Week 12, however, both patient groups showed significant differences compared to control (P=0.011). Furthermore, the linear discriminant analysis effect size (LEfSe) analysis was used to identify differentially enriched bacteria between opioid use patients and healthy controls. Compared to controls, the relative abundance of Lactobacillaceae Lactobacillus (L. Lactobacillus), Megasphaera Megasphaerahexanoica (M. Megasphaerahexanoica) and Caecibacter Caecibactermassiliensis (C Caecibactermassiliensis) were increased in patients at Week 0, while Coriobacteriales Atopobiaceae (C. Atopobiaceae), Acidaminococcus Acidaminococcusintestini (A. Acidaminococcusintestini) and Tractidigestivibacter Tractidigestivibacterscatoligenes (T. Tractidigestivibacterscatoligenes) were increased in patients at Week 12. Conclusion: In conclusion, we suggest that the gut microbiome community maybe linked to opioid use disorder, such differences may not be altered even after 12-week of cessation of opioid use.

Keywords: opioid use disorder, gut microbiota, methadone treatment, follow up study

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Authors: Isalira Peroba Ramos, Cherley Borba Vieira de Andrade, Grazielle Suhett, Camila Salata, Paulo Cesar Canary, Guilherme Visconde Brasil, Antonio Carlos Campos de Carvalho, Regina Coeli dos Santos Goldenberg

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Background: The therapeutic options for patients with cancer now include increasingly complex combinations of medications, radiation therapy (RT), and surgical intervention. Many of these treatments have important potential adverse cardiac effects and are likely to have significant effects on patient outcomes. Cell therapy appears to be promising for the treatment of chronic and degenerative diseases, including cardiomyopathy induced by RT, as the current therapeutic options are insufficient. Aims: To evaluate the potential of bone marrow mesenchymal cells (BMMCs) in radioinduced cardiac damage Methods: Female Wistar rats, 3 months old (Ethics Committee 054/14), were divided into 2 groups, non-treated irradiated group (IR n=15) and irradiated and BMMC treated (IRT n=10). Echocardiography was performed to evaluate heart function. After euthanasia, 3 months post treatment; the left ventricle was removed and prepared for RT-qPCR (VEGF and Pro Collagen I) and histological (picrosirius) analysis. Results: In both groups, 45 days after irradiation, ejection fraction (EF) was in the normal range for these animals (> 70%). However, the BMMC treated group had EF (83.1%±2.6) while the non-treated IR group showed a significant reduction (76.1%±2.6) in relation to the treated group. In addition, we observed an increase in VEGF gene expression and a decrease in Pro Collagen I in IRT when compared to IR group. We also observed by histology that the collagen deposition was reduced in IRT (10.26%±0.83) when compared to IR group (25.29%±0.96). Conclusions: Treatment with BMMCs was able to prevent ejection fraction reduction and collagen deposition in irradiated animals. The increase of VEGF and the decrease of pro collagen I gene expression might explain, at least in part, the cell therapy benefits. All authors disclose no financial or personal relationships with individuals or organizations that could be perceived to bias their work. Sources of funding: FAPERJ, CAPES, CNPq, MCT.

Keywords: mesenchymal cells, radioation, cardiotoxicity, bone marrow

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Authors: Jessie Rapoza, Petr Moroshkin, Jimmy Xu

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Chirality is omnipresent, in nature, in life, and in the field of physics. One intriguing example is the homochirality that has remained a great secret of life. Another is the pairs of mirror-image molecules – enantiomers. They are identical in atomic composition and therefore indistinguishable in the scalar physical properties. Yet, they can be either therapeutic or toxic, depending on their chirality. Recent studies suggest a potential link between abnormal levels of certain D-amino acids and some serious health impairments, including schizophrenia, amyotrophic lateral sclerosis, and potentially cancer. Although indistinguishable in their scalar properties, the chirality of a molecule reveals itself in interaction with the surrounding of a certain chirality, or more generally, a broken mirror-symmetry. In this work, we report on a system for chiral molecule detection, in which the mirror-symmetry is doubly broken, first by asymmetric structuring a nanopatterned plasmonic surface than by the incidence of circularly polarized light (CPL). In this system, the incident circularly-polarized light induces a surface plasmon polariton (SPP) wave, propagating along the asymmetric plasmonic surface. This SPP field itself is chiral, evanescently bound to a near-field zone on the surface (~10nm thick), but with an amplitude greatly intensified (by up to 104) over that of the incident light. It hence probes just the molecules on the surface instead of those in the volume. In coupling to molecules along its path on the surface, the chiral SPP wave favors one chirality over the other, allowing for chirality detection via the change in an optical rectification current measured at the edges of the sample. The asymmetrically structured surface converts the high-frequency electron plasmonic-oscillations in the SPP wave into a net DC drift current that can be measured at the edge of the sample via the mechanism of optical rectification. The measured results validate these design concepts and principles. The observed optical rectification current exhibits a clear differentiation between a pair of enantiomers. Experiments were performed by focusing a 1064nm CW laser light at the sample - a gold grating microchip submerged in an approximately 1.82M solution of either L-arabinose or D-arabinose and water. A measurement of the current output was then recorded under both rights and left circularly polarized lights. Measurements were recorded at various angles of incidence to optimize the coupling between the spin-momentums of the incident light and that of the SPP, that is, spin-momentum locking. In order to suppress the background, the values of the photocurrent for the right CPL are subtracted from those for the left CPL. Comparison between the two arabinose enantiomers reveals a preferential signal response of one enantiomer to left CPL and the other enantiomer to right CPL. In sum, this work reports on the first experimental evidence of the feasibility of chiral molecule detection via optical rectification in a metal meta-grating. This nanoscale interfaced electrical detection technology is advantageous over other detection methods due to its size, cost, ease of use, and integration ability with read-out electronic circuits for data processing and interpretation.

Keywords: Chirality, detection, molecule, spin

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Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

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Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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Authors: Dana El-Mughayyar, Neil Manson, Erin Bigney, Eden Richardson, Dean Tripp, Edward Abraham

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Use of narcotics to treat pain has increased over the past two decades and is a contributing factor to the current public health crisis. Understanding the pre-operative risks of chronic narcotic use may be aided through investigation of psychological measures. The objective of the reported study is to determine predictors of narcotic use two years post-surgery in a thoracolumbar spine surgery population, including an array of psychological factors. A prospective observational study of 191 consecutively enrolled adult patients having undergone thoracolumbar spine surgery is presented. Baseline measures of interest included the Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia, Multidimensional Scale for Perceived Social Support (MSPSS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Oswestry Disability Index (ODI), Numeric Rating Scales for back and leg pain (NRS-B/L), SF-12’s Mental Component Summary (MCS), narcotic use and demographic variables. The post-operative measure of interest is narcotic use at 2-year follow-up. Narcotic use is collapsed into binary categories of use and no use. Descriptive statistics are run. Chi Square analysis is used for categorical variables and an ANOVA for continuous variables. Significant variables are built into a hierarchical logistic regression to determine predictors of post-operative narcotic use. Significance is set at α < 0.05. Results: A total of 27.23% of the sample were using narcotics two years after surgery. The regression model included ODI, NRS-Leg, time with condition, chief complaint, pre-operative drug use, gender, MCS, PCS subscale helplessness, and CPAQ subscale pain willingness and was significant χ² (13, N=191)= 54.99; p = .000. The model accounted for 39.6% of the variance in narcotic use and correctly predicted in 79.7% of cases. Psychological variables accounted for 9.6% of the variance over and above the other predictors. Conclusions: Managing chronic narcotic usage is central to the patient’s overall health and quality of life. Psychological factors in the preoperative period are significant predictors of narcotic use 2 years post-operatively. The psychological variables are malleable, potentially allowing surgeons to direct their patients to preventative resources prior to surgery.

Keywords: narcotics, psychological factors, quality of life, spine surgery

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Authors: Ehsan K. Hazaveh

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This research project explores creative methods of storytelling through photography to portray a vulnerable and marginalised community: former refugees living in Wellington, New Zealand. The project explores photographic representational techniques that can not only empower and give voice to those communities but also challenge dominant stereotypes about refugees and support humanitarian actions. The aims of this study are to develop insights surrounding issues associated with the photographic representation of refugees and to explore the collaborative construction of possible counter-narratives that might lead to the formulation of a practice framework for representing refugees using photography. In other words, the goal of this study is to explore representational and narrative strategies that frame refugees as active community members and as individuals with specific histories and expertise. These counter-narratives will bring the diversity of refugees to the surface by offering personal stories, contextualising their experience, raising awareness about the plight and human rights of the refugee community in New Zealand, evoking empathy and, therefore, facilitating the process of social change. The study has designed a photographic narrative framework by determining effective methods of photo storytelling, framing, and aesthetic techniques, focusing on different ways of taking, selecting, editing and curating photographs. Photo elicitation interviews have been used to ‘explore’, ‘produce’ and ‘co-curate’ the counter-narrative along with participants. Photo elicitation is a qualitative research method that employs images to evoke data in order to find out how other people experience their world - the researcher shows photographs to the participant and asks open-ended questions to get them to talk about their life experiences and the world around them. The qualitative data have been collected and produced through interactions with four former refugees living in Wellington, New Zealand. In this way, this project offers a unique account of their conditions and basic knowledge about their living experience and their stories. The participants of this study have engaged with PhotoVoice, a photo elicitation methodology that employs photography and storytelling, to share activities, emotions, hopes, and aspects of their lived experiences. PhotoVoice was designed to empower members of marginalised populations. It involves a series of meeting sessions, in which participants share photographs they have taken and discuss stories about the photographs to identify, represent, and enhance the issues important to their lives and communities. Finally, the data provide a basis for systematically producing visual counter-narratives that highlight the experiences of former- refugees. By employing these methods, refugees can represent their world as well as interpret it. The process of developing this research framing has enabled the development of powerful counter-narratives that challenge prevailing stereotypical depictions which in turn have the potential to shape improved humanitarian outcomes, shifts in public attitudes and political perspectives in New Zealand.

Keywords: media, photography, refugees, photo-elicitation, storytelling

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Authors: Aishwarya Pothula

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Euthanasia in India is a politically dormant policy issue in the sense that discussions around it are sporadic in nature (usually with developments in specific cases) and it stays as a dominant issue in the public domain for a fleeting period. In other words, it is a non-political issue that has been unable to successfully get on the policy agenda. This paper studies how the Supreme Court of India (SC) plays a role in euthanasia’s policy making. In 2011, the SC independently put a law in place that legalized passive euthanasia through its judgement in the Aruna Shanbaug v. Union of India case. According to this, it is no longer illegal to withhold/withdraw a patient’s medical treatment in certain cases. This judgement, therefore, is the empirical focus of this paper. The paper essentially employs two techniques of discourse analysis to study the SC’s system of argumentation. The two methods, Text Analysis using Gasper’s Analysis Table and Frame Analysis – are complemented by two discourse techniques called metaphor analysis and lexical analysis. The framework within which the analysis is conducted lies in 1) the judicial process of India, i.e. the SC procedures and the Constitutional rules and provisions, and 2) John W. Kingdon’s theory of policy windows and policy entrepreneurs. The results of this paper are three-fold: first, the SC dismiss the petitioner’s request for passive euthanasia on inadequate and weak grounds, thereby setting no precedent for the historic law they put in place. In other words, they leave the decision open for the Parliament to act upon. Hence the judgement, as opposed to arguments by many, is by no means an instance of judicial activism/overreach. Second, they define euthanasia in a way that resonates with existing broader societal themes. They combine this with a remarkable use of authoritative and protective tones/stances to settle at an intermediate position that balances the possible opposition to their role in the process and what they (perhaps) perceive to be an optimal solution. Third, they soften up the policy community (including the public) to the idea of passive euthanasia leading it towards a Parliamentarian legislation. They achieve this by shaping prevalent principles, provisions and worldviews through an astute use of the legal instruments at their disposal. This paper refers to this unconventional role of the SC as ‘judicial entrepreneurship’ which is also the first scholarly contribution towards research on euthanasia as a policy issue in India.

Keywords: argumentation analysis, Aruna Ramachandra Shanbaug, discourse analysis, euthanasia, judicial entrepreneurship, policy-making process, supreme court of India

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Authors: Weixiao Wei, Chris Shei

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This paper describes Mandate of Heaven as a source of justification for the ruling regime from ancient China approximately three thousand years ago. Initially, the kings of Shang dynasty simply nominated themselves as the sons of Heaven sent to Earth to rule the common people. As the last generation of the kings became corrupted and ruled withbrutal force and crueltywhich directly caused their destruction, the successive kings of Zhou dynasty realised the importance of virtue and the provision of goods to the people. Legitimacy of the ruling regimes became rested not entirely on random allocation of the throne by an unknown supernatural force but on a foundation comprising morality and the ability to provide goods. The latter composite was picked up by the current ruling regime, the Chinese Communist Party, and became the cornerstone of its political legitimacy, also known as ‘performance legitimacy’ where economic development accounts for the satisfaction of the people in place of election and other democratic means of providing legal-rational legitimacy. Under this circumstance, it becomes important as well for the ruling party to use political rhetoric to convince people of the good performance of the government in the economy, morality, and foreign policy. Thus, we see a lot of propaganda materials in both government policy statements and international press conference announcements. The former consists mainly of important speeches made by prominent figures in Party conferences which are not only made publicly available on the government websites but also become obligatory reading materials for university entrance examinations. The later consists of announcements about foreign policies and strategies and actions taken by the government regarding foreign affairsmade in international conferences and offered in Chinese-English bilingual versions on official websites. This documentation strategy creates an impressive image of the Chinese Communist Party that is domestically competent and international strong, taking care of the people it governs in terms of economic needs and defending the country against any foreign interference and global adversities. This political discourse system comprising reading materials fully extractable from government websites also becomes excellent repertoire for teaching and researching in contemporary Chinese language, discourse and rhetoric, Chinese culture and tradition, Chinese political ideology, and Chinese-English translation. This paper aims to provide a detailed and comprehensive description of the current Chinese political discourse system, arguing about its lineage from the rhetorical convention of Mandate of Heaven in ancient China and its current concentration on serving the people in place of election, human rights, and freedom of speech. The paper will also provide guidelines as to how this discourse system and the manifestation of official documents created under this system can become excellent research and teaching materials in applied linguistics.

Keywords: mandate of heaven, Chinese communist party, performance legitimacy, serving the people, political discourse

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Authors: Adrian Craig, Jonathan Easaw, Rose Jordan, Ben Hall

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The prescription of intravenous fluids is a fundamental component of inpatient management, but it is one which usually lacks thought. Fluids are a drug, which like any other can cause harm when prescribed inappropriately or wrongly. However, it is well recognised that it is poorly done, especially in the acute portals. The National Institute for Health and Care Excellence (NICE) recommends 1mmol/kg of potassium, sodium, and chloride per day. With various options of fluids, clinicians tend to face difficulty in choosing the most appropriate maintenance fluid, and there is a reluctance to prescribe potassium as part of an intravenous maintenance fluid regime. The aim was to prospectively audit the prescription of the first bag of intravenous maintenance fluids, the use of urea and electrolytes results to guide the choice of fluid and the use of fluid prescription charts, in a busy emergency department of a major trauma centre in Stoke-on-Trent, United Kingdom. This was undertaken over a week in early November 2016. Of those prescribed maintenance fluid only 8.9% were prescribed a fluid which was most appropriate for their daily electrolyte requirements. This audit has helped to highlight further the issues that are faced in busy Emergency Departments within hospitals that are stretched and lack capacity for prompt transfer to a ward. It has supported the findings of NICE, that emergency admission portals such as Emergency Departments poorly prescribed intravenous fluid therapy. The findings have enabled simple steps to be taken to educate clinicians about their fluid of choice. This has included: posters to remind clinicians to consider the urea and electrolyte values before prescription, suggesting the inclusion of a suggested intravenous fluid of choice in the prescription chart of the trust and the inclusion of a session within the introduction programme revising intravenous fluid therapy and daily electrolyte requirements. Moving forward, once the interventions have been implemented then, the data will be reaudited in six months to note any improvement in maintenance fluid choice. Alongside this, an audit of the rate of intravenous maintenance fluid therapy would be proposed to further increase patient safety by avoiding unintentional fluid overload which may cause unnecessary harm to patients within the hospital. In conclusion, prescription of maintenance fluid therapy was poor within the Emergency Department, and there is a great deal of opportunity for improvement. Therefore, the measures listed above will be implemented and the data reaudited.

Keywords: chloride, electrolyte, emergency department, emergency medicine, fluid, fluid therapy, intravenous, maintenance, major trauma, potassium, sodium, trauma

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Authors: Sezen Aslan, N. Aydan Sat

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The society of 21st century constantly faces with complex otherness that emerges in various forms and justifications. Otherness caused by class, race or ethnicity inevitably reflects to urban areas, and in this way, cities are diversified into totally self-centered and closed-off urban enclaves. One of the most important dynamics that creates otherness in contemporary society is migration. Immigration on an international scale is one of the most important events that have reshaped the world, and the number of immigrants in the world is increasing day by day. Forced migration and refugee statements constitute the major part of countries' immigration policies and practices. Domestic problems such as racism, violence, war, censorship and silencing, attitudes contrary to human rights, different cultural or religious identities cause populations to migrate. Immigration is one of the most important reasons for the formation of urban enclaves within cities. Turkey, which was used to face a higher rate of outward migration, has begun to host immigrant groups from foreign countries. 1980s is the breaking point about the issue as a result of internal disturbances in the Middle East. After Iranian, Iraqi and Afghan immigrants, Turkey faces the largest external migration in its story with Syrian population. Turkey has been hosting approximate three million Syrian people after Syrian Civil War which started in 2011. 92% of Syrian refugees are currently living in different urban areas in Turkey instead of camps. Syrian refugees are experiencing a spontaneous spatiality due to the lack of specific settlement and housing policies of the country. This spontaneity is one of the most important factors in the creation of urban enclaves. From this point of view, the aim of this study is to clarify processes that lead the creation of urban enclaves and to explain socio-spatial effects of these urban enclaves to the other parts of the cities. Ankara, which is one of the most registered Syrian hosting Province in Turkey, is selected as a case study area. About 55% of the total Syrian population lives in the Altındağ district in Ankara. They settled specifically in two neighborhoods in Altındağ district, named as Önder and Ulubey. These neighborhoods are old slum areas, and they were evacuated due to urban renewal on the same dates with the migration of the Syrians. Before demolition of these old slums, Syrians are settled into them as tenants. In the first part of the study, a brief explanation of the concept of urban enclave, its occurrence parameters and possible socio-spatial threats, examples from previous immigrant urban enclaves caused internal migration will be given. Emergence of slums, planning history and social processes in the case study area will be described in the second part of the study. The third part will be focused on the Syrian refugees and their socio-spatial relationship in the case study area and in-depth interviews with refugees and spatial analysis will be realized. Suggestions for the future of the case study area and recommendations to prevent immigrant groups from social and spatial exclusion will be discussed in the conclusion part of the study.

Keywords: migration, immigration, Syrian refugees, urban enclaves, Ankara

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Authors: Shir Daphna-Tekoah, Nurit Eitan-Gutman, Uri Balla

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Background: Systemic documentation is essential in social work practice. Collaboration between an institution of higher education and social work health care services enabled adaptation of the medical documentation model of SOAP in the field of social work, by creating the ISOAPS model (Introduction, Subjective, Objective, Assessment, Plan, Summary) model. Aims: The article describes the ISOAPS model and its implementation in the field of social work, as a tool for standardization of documentation and the enhancement of multidisciplinary collaboration. Methods: We examined the changes in standardization using a mixed methods study, both before and after implementation of the model. A review of social workers’ documentation was carried out by medical staff and social workers in the Clalit Healthcare Services, the largest provider of public and semi-private health services in Israel. After implementation of the model, semi-structured qualitative interviews were undertaken. Main findings: The percentage of reviewers who evaluated their documentation as correct increased from 46%, prior to implementation, to 61% after implementation. After implementation, 81% of the social workers noted that their documentation had become standardized. The training process prepared them for the change in documentation and most of them (83%) started using the model on a regular basis. The qualitative data indicate that the use of the ISOAPS model creates uniform documentation, improves standards and is important to teach social work students. Conclusions: The ISOAPS model standardizes documentation and promotes communication between social workers and medical staffs. Implications for practice: In the intricate realm of healthcare, efficient documentation systems are pivotal to ensuring coherent interdisciplinary communication and patient care. The ISOAPS model emerges as a quintessential instrument, meticulously tailored to the nuances of social work documentation. While it extends its utility across the broad spectrum of social work, its specificity is most pronounced in the medical domain. This model not only exemplifies rigorous academic and professional standards but also serves as a testament to the potential of contextualized documentation systems in elevating the overall stature of social work within healthcare. Such a strategic documentation tool can not only streamline the intricate processes inherent in medical social work but also underscore the indispensable role that social workers play in the broader healthcare ecosystem.

Keywords: ISOAPS, professional documentation, medial social-work, social work

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Authors: Yun Chan Lee

Abstract:

Background: End-of-life care is a large area of all nursing practice and student nurses are likely to meet dying patients in many placement areas. It is therefore important to understand the emotional responses and coping strategies of student nurses in order for nursing education systems to have some appreciation of how nursing students might be supported in the future. Methodology: This research used a qualitative phenomenological approach. Six student nurses understanding a degree-level adult nursing course were interviewed. Their responses to questions were analyzed using interpretative phenomenological analysis. Finding: The findings identified 3 main themes. First, the common experience of ‘unpreparedness’. A very small number of participants felt that this was unavoidable and that ‘no preparation is possible’, the majority felt that they were unprepared because of ‘insufficient input’ from the university and as a result of wider ‘social taboos’ around death and dying. The second theme showed that emotions were affected by ‘the personal connection to the patient’ and the important sub-themes of ‘the evoking of memories’, ‘involvement in care’ and ‘sense of responsibility’. The third theme, the coping strategies used by students, seemed to fall into two broad areas those ‘internal’ with the student and those ‘external’. In terms of the internal coping strategies, ‘detachment’, ‘faith’, ‘rationalization’ and ‘reflective skills’ are the important components of this part. Regarding the external coping strategies, ‘clinical staff’ and ‘the importance of family and friends’ are the importance of accessing external forms of support. Implication: It is clear that student nurses are affected emotionally by caring for dying patients and many of them have apprehension even before they begin on their placements but very often this is unspoken. Those anxieties before the placement become more pronounced during and continue after the placements. This has implications for when support is offered and possibly its duration. Another significant point of the study is that participants often highlighted their wish to speak to qualified nurses after their experiences of being involved in end-of-life care and especially when they had been present at the time of death. Many of the students spoke that qualified nurses were not available to them. This seemed to be due to a number of reasons. Because the qualified nurses were not available, students had to make use of family members and friends to talk to. Consequently, the implication of this study is not only to educate student nurses but also to educate the qualified mentors on the importance of providing emotional support to students.

Keywords: nursing students, coping strategies, end-of-life care, emotional responses

Procedia PDF Downloads 162