Search results for: family history

Authors: Larasati Zuhro, Ida F Priyanto

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Background: In March 2020, Indonesia started to be affected by Covid-19, and the number of victims increased slowly but surely until finally, the highest number of victims reached the highest—about 50,000 persons—for the daily cases in the middle of 2021. Like other institutions, schools and universities were suddenly closed in March 2020, and students had to change their ways of studying from face-to-face to online. This sudden changed affected students and faculty, including LIS students and faculty because they never experienced online classes in Indonesia due to the previous regulation that academic and school activities were all conducted onsite. For almost two years, school and academic activities were held online. This indeed has affected the way students learned and faculty delivered their courses. This raises the question of whether students are now ready for their new learning activities due to the covid-19 disruption. Objectives: this study was conducted to find out the impact of covid-19 pandemic on the LIS learning process and the effectiveness of online classes for students of LIS in Indonesia. Methodology: This was qualitative research conducted among LIS students at UIN Sunan Kalijaga, Yogyakarta, Indonesia. The population are students who were studying for masters’program during covid-19 pandemic. Results: The study showed that students were ready with the online classes because they are familiar with the technology. However, the Internet and technology infrastructure do not always support the process of learning. Students mention slow WIFI is one factor that causes them not being able to study optimally. They usually compensate themselves by visiting a public library, a café, or any other places to get WIFI network. Noises come from the people surrounding them while they are studying online.Some students could not concentrate well when attending the online classes as they studied at home, and their families sometimes talk to other family members, or they asked the students while they are attending the online classes. The noise also came when they studied in a café. Another issue is that the classes were held in shorter time than that in the face-to-face. Students said they still enjoyed the onsite classes instead of online, although they do not mind to have hybrid model of learning. Conclusion: Pandemic of Covid-19 has changed the way students of LIS in Indonesia learn. They have experienced a process of migrating the way they learn from onsite to online. They also adapted their learning with the condition of internet access speed, infrastructure, and the environment. They expect to have hybrid classes in the future.

Keywords: learning, LIS students, pandemic, covid-19

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Authors: Ketan Tamirisa, Kathleen P. Tebb

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In the U.S., annually, there are over 1 million pregnancies in teenagers and most (85%) are unintended. The need for proactive prevention measures is imperative to support adolescents with their pregnancy prevention and family planning goals. To date, there is limited research examining the extent to which support from a sexual partner(s) influences contraceptive use. To address this gap, this study assessed the relationship between sexually active adolescents, sex-assigned birth as female, and their perceived support from their sexual partner(s) about their contraceptive use in the last three months. Baseline data from sexually active adolescent females, between 13-19 years who were not currently using a long-acting contraceptive device, were recruited from 32 school-based health centers (SBHCs) in seven states in the U.S. as part of a larger study to evaluate Health-E You/ Salud iTuTM, a web-based contraceptive decision support tool. Fisher’s exact test assessed the cross-sectional association between perceived sexual partner support of contraceptive use in the past three months (felt no support, felt little support, and felt a lot of support), and current use of non-barrier contraception. A total of 91 sexually active adolescent females were eligible and completed the baseline survey. The mean age was 16.7 and nearly half (49.3%) were Hispanic/Latina. Most (85.9%) indicated it was very important to avoid becoming pregnant. A total of 60 participants (65.9%) reported use of non-barrier contraception. Of these, most used birth control pills (n=26), followed by Depo-Provera injection (n=12), patch (n=1), and ring (n=1). Most of the participants (80.2%) indicated that they perceived a lot of support from their partners and 19.8% reported no or little support. Among those reporting a lot of support, 69.9% (51/73) reported current use of non-barrier contraception compared to 50% (9/18) who felt no/little support and reported contraceptive use. This difference approached but did not reach statistical significance (p=0.096). Results from this preliminary data indicate that many adolescents who are coming in for care at SBHCs are at risk of unintended pregnancy. Many participants also reported a lot of support from their sexual partner(s) to use contraception. While the associations only approached significance, this is likely due to the small sample size. This and future research can better understand this association to inform interventions aimed at sexual partners to strengthen education and social support, increase healthcare accessibility, and ultimately reduce rates of unintended pregnancy.

Keywords: adolescents, contraception, pregnancy, SBHCs, sexual partners

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Authors: D. Eranda N. Mandawala, P. A. D. Mokshi V. Perera

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The RajagalaArchaeological site (RAS) is located 26 km from Ampara town (7º29'25.22" N, 81º36'59.05" E) accessible through the Ampara-Uhana-MahaOya highway of the Eastern province of Sri Lanka. This site has recently been added to the tentative list of UNESCO world heritage site and is also a forest reserve. This dry zone forest consists of tropical mixed evergreen vegetation and scrublands on a rocky outcrop of elevation of about 350 meters above mean sea level. It is also scattered with several ponds of differing sizes on rocky outcrops, rocky cliffs, and about 50 cave dwellings. No comprehensive biodiversity survey of any sorts has been conducted at the RAS so far. Therefore, a preliminary survey was conducted to determine its butterfly fauna diversity. An opportunistic Visual Encounter Survey method was used to observe various butterfly species during the morning between 8:00am-12:00noon and in the evening between 2:00-6:00pm on 3 site visits in October 2017, February 2018, and November 2019. All encountered species were photographed using a Nikon D750 camera with Sigma 105mm f/2.8 EX DG OS HSM macro lens, and field guide books were used to identify them. Sri Lanka is home to 248 species of butterflies, of which are 26 are endemic. At RAS, we observed a total of 39 species (15%) of butterflies belonging to 5 Lepidoptera families. Out of these, one endemic species(4%) and 9 endemic subspecieswere also identified. The former was Troidesdarsius, also known as the Sri Lanka birdwing which is the national butterfly and the largest butterfly in Sri Lanka, and the latter were Plains cupid (Chiladespandavalanka), Yamfly (Loxuraatymnus arcuate), Common Cerulean (Jamidescelenotissama), Tawny Rajah(Charaxespsaphonpsaphon), Tamil Yeoman(Cirrochroathaislanka), Angled Castor(Ariadne ariadneminorata), GladeyeBushbrown(Mycalesispatnia patina), Common Crow (Euploea core asela)and Blue Mormon (Papiliopolymnestorparinda). The endemic subspecies belonged to 3 Lepidoptera families (3from Lycaenidae, 5 from Nymphalidae, and 1 from Papilionidae family). Anthropogenic activities such as unauthorized cattle farming, forest clearance, and man-made forest fires currently threaten this site. If such trends continue, it may lead to the reduction of butterfly fauna diversity within this area in the future.

Keywords: lepidoptera, rajagala, Sri Lanka birdwing, endemic

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Authors: Joshua Russell, Omar Zubair, Reuben Ndegwa

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Introduction: Mesenteric ischemia is an uncommon condition that can be challenging to diagnose in the acute setting, with the potential for significant morbidity and mortality. Very rarely has acute acalculous cholecystitis been described in the setting of mesenteric ischemia. Case: This was the case in a 78-year-old male, who initially presented with clinical and radiological evidence of small bowel obstruction, thought likely secondary to malignancy. The patient had a 6-week history of anorexia, worsening lower abdominal pain, and ~30kg of unintentional weight loss over a 12-month period and a CT- scan demonstrated a transition point in the distal ileum. The patient became increasingly hemodynamically unstable and peritonitic, and an emergency laparotomy was performed. Intra-operatively, however, no obvious transition point was identified, and instead, the gallbladder was markedly gangrenous and oedematous, consistent with acalculous cholecystitis. An open total cholecystectomy was subsequently performed. The patient was admitted to the Intensive Care Unit post-operatively and continued to deteriorate over the proceeding 48 hours, with two re-look laparotomies demonstrating progressively worsening bowel ischemia, initially in the distribution of the superior mesenteric artery and then the coeliac trunk. On review, the patient was found to have an aberrant right hepatic artery arising from the superior mesenteric artery. The extent of ischemia was considered non-survivable, and the patient was palliated. Discussion: Multiple theories currently exist for the underlying pathophysiology of acalculous cholecystitis, including biliary stasis, sepsis, and ischemia. This case lends further support to ischemia as the underlying etiology of acalculous cholecystitis. This is particularly the case when considered in the context of the patient’s aberrant right hepatic artery arising from the superior mesenteric artery, which occurs in 11-14% of patients. Conclusion: This case report adds further insight to the debate surrounding the pathophysiology of acalculous cholecystitis. It also presents acalculous cholecystitis as a complication of mesenteric ischemia that should always be considered, especially in the elderly patient and in the context of relatively common anatomical variations. Furthermore, the case brings to attention the importance of maintaining dynamic working diagnoses in the setting of evolving pathophysiology and clinical presentations.

Keywords: acalculous cholecystitis, anatomical variation, general surgery, mesenteric ischemia

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Authors: Ila Gupta

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The government hospitals in India by and large lack the necessary aesthetic therapeutic components, both in their interior and exterior space designs. These components especially in terms of color application are important to the emotional as well as physical well being of the patients and other participants of the space. The preliminary survey of few government hospitals in Uttarakhand, India, reveals that the government health care industry provides a wide scope for intervention. All most all of the spaces do not adhere to a proper therapeutic color scheme which directly helps the well-being of their patients and workers. The paper aims to conduct a survey and come up with recommendations in this regard. The government hospitals also lack a proper signage system which allows the space to be more user-friendly. The hospital spaces in totality also have scope for improvement in terms of space/landscape design which enhances the work environment in an efficient and positive way. This study will thus enable to come up with feasible recommendations for healthcare and built environment as well as retrofitting the existing spaces. The objective of the paper is mainly on few case studies. The present ambience in many government hospitals generally lacks a welcoming ambience. It is proposed to select one or two government hospitals and demonstrate application of appropriate and self-sustainable color schemes, placement of artifacts, changes in outdoor and indoor space design to bring about a change that is conducive for cognitive healing. Exterior changes to existing and old hospital buildings in depressed historic areas signify financial investment and change, and have the potential to play a significant role in both urban preservation and revitalization. Changes to exterior architectural colors are perhaps the most visible signifier of such revitalization, as the use of color changes as a tool in façade and interior improvement programs. The present project will provide its recommendations on the basis of case studies done in the Indian Public Health Care system. Furthermore, the recommendations will be in accordance with the extended study conducted in Indian Ayurvedic, Yogic texts as well as Vastu texts, which provides knowledge about built environments and healing properties of color.

Keywords: color, environment, facade, architectural color history, interior improvement programs, community development, district/government hospitals

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Authors: Susan Scott, Dina Hanna, Bassel Zebian, Gary Ruiz, Sreena Das

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Although the number of cases of TB in England has fallen over the last 4 years, it remains an important public health burden with 1 in 20 cases dying annually. The vast majority of cases present in non-UK born individuals with social risk factors. We present a case of non-pulmonary TB presenting in a healthy child born in the UK to professional parents. We present a case of a healthy 10 year old boy who developed acute back pain during school PE. Over the next 5 months, he was seen by various health and allied professionals with worsening back pain and kyphosis. He became increasing unsteady and for the 10 days prior to admission to our hospital, he developed fevers. He was admitted to his local hospital for tonsillitis where he suffered two falls on account of his leg weakness. A spinal X-ray revealed a pathological fracture and gibbus formation. He was transferred to our unit for further management. On arrival, the patient had lower motor neurone signs of his left leg. He underwent spinal fixture, laminectomy and decompression. Microbiology samples taken intra-operatively confirmed Mycobacterium Tuberculosis. He had a positive Mantoux and T-spot and treatment were commenced. There was no evidence of immune compromise. The patient was born in the UK, had a BCG scar and his only travel history had been two years prior to presentation when he travelled to the Phillipines for a short holiday. The patient continues to have issues around neuropathic pain, mobility, pill burden and mild liver side effects from treatment. Discussion: There is a paucity of case reports on spinal TB in paediatrics and diagnosis is often difficult due to the non-specific symptomatology. Although prognosis on treatment is good, a delayed diagnosis can have devastating consequences. This case highlights the continued need for higher index of suspicion and diagnosis in a world with changing patterns of migration and increase global travel. Surgical intervention is limited to the most serious cases to minimise further neurological damage and improve prognosis. There remains the need for a multi-disciplinary approach to deal with challenges of treatment and rehabilitation.

Keywords: tuberculosis, non-pulmonary TB, public health burden, diagnostic challenge

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Authors: Merle Talvik, Taimi Tulva, Kristi Puusepp, Ülle Ernits

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Background data. In 1940–1941 and 1945–1991 Estonia was occupied by Soviet Union. Paternalism was a common principle in Soviet social policy, including health care. The Soviet government, not the individuals themselves, decided on achieving a person’s quality of life. With the help of Soviet ideology, the work culture of nurses was constructed and the education system was also reshaped according to the ideology. The “new period of awakening” was initiated under Gorbachev’s perestroika and glasnost (1985–1991), leading to democratization. Aim. The qualitative study aimed to analyze nursing education in Soviet Estonia in the conditions of paternalistic orientation and ideological pressure. Method. The research was conducted in 2021 and 2023. Senior nurses (aged 69–87) who had worked for at least 20 years during the Soviet era were surveyed. Thematic interviews were conducted in written form and orally (13 interviewees), followed by a focus group interview (8 interviewees). A thematic content analysis was performed. Results. Nursing is part of society’s culture and in this sense, in - terviews with nurses provide us with critical information about the functioning of society and cultural identity at a given time. During the Soviet era the training of nurses occured within vocational training institutions. The curricula underwent a shift towards a Soviet-oriented approach. A significant portion of lessons were dedicated to imparting knowledge on the principles and tenets of Communist-Marxist ideology. Therefore, practical subjects and nursing theory were frequently allocated limited space. A paternalistic orientation prevailed in health care: just as the state regulated how to cure, spread hygiene, and healthy lifestyles propaganda, training was also determined by the management of the institution, thereby limiting the person´s autonomy to decide what kind of training was needed. The research is of significant value in the context of the history of nursing, as it helps to understand the difficulties and complexity of the development of nursing on the timeline. The Soviet era still affects Estonian society today and will continue to do so in the future. The same type of developments occurred in other post-Soviet countries.

Keywords: Estonian SSR, nursing education, paternalism, senior nurse, Soviet ideology

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Authors: Wai Sang Wu, Florence Pik Sze Mok

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Introduction: Ageing population is one of the hot topics nowadays in the world and this phenomenon is believed to exacerbate continuously in the future. According to the latest information from World Health Organization (WHO) in 2016, the proportion of people aged more than 60 years is projected to be doubled from 12% in 2015 to 22% in 2050 of the world's population. Similarly, according to figures released by the Census and Statistic Department of Hong Kong in 2015, the contribution of elderly aged more than 65 years olds is projected to increase from 15% in 2014 to 34% in 2064 in local community. On the other hand, falls in elderly is a common problem, and it can bring along many negative consequences among elders, such as reducing their mobility level as well as their quality of life. In addition, it can also increase the caring stress of their family caregivers and as well increase the reliance and burden on the medical care system of Hong Kong. Therefore, appropriate measures should be implemented in order to minimize the risk of fall among elders. The objective of this study is to evaluate the effectiveness of the chair-based exercise programme in affecting the balance of the elderly in Hong Kong. Methods: Thirteen healthy subjects (males = 2; females = 11; mean age: 76.2 ± 7.8 years old) were recruited from an elderly social centre in the community to participate in a structural chair-based exercise programme for 6 weeks (1 session per week; 60-minutes per session). Subjects were being assessed on their balance ability using three commonly used clinical assessments, namely, 1) single leg stance (SLS) test, 2) functional reach test, and 3) 360-degree turn test, before and after their participation in the chair-based exercise programme. Pre and post within-subject comparison was adopted to assess the effectiveness of the programme. Results: There was significant improvement (p < 0.05) in all balance parameters of the subjects after their participation in the exercise programme. Elderly demonstrated significant improvement in SLS (p < 0.012), functional reach (p < 0.030) and 360 degree turn (p < 0.043). Conclusions: This study showed that a community chair-based exercise programme is effective in improving the balance ability of the elders. It seems to be another exercise regime that should be promoted among the elders in order to minimize their risk of falls and its negative consequence.

Keywords: balance, chair-based exercise programme, community, elderly

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Authors: Engin Berber, Nurettin Canakoglu, Ibrahim Sozdutmaz, Merve Caliskan, Shaikh Terkis Islam Pavel, Hazel Yetiskin, Aykut Ozdarendeli

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Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus in the family Bunyaviridae, genus Nairovirus. The CCHFV genome consists of three molecules of negative-sense single-stranded RNA, each encapsulated separately. The virion particle contains viral RNA polymerase (L segment), surface glycoproteins Gn and Gc (Msegment), and a nucleocapsid protein NP (S segment). CCHF is characterized by high case mortality, occurring in Asia, Africa, the Middle East and Eastern Europe. Clinical CCHF was first recognized in Turkey in 2002. The numbers of CCHF cases have gradually increased in Turkey making the virus a public health concern. Between 2002 and 2014, more than 8000 the CCHF cases have been reported in Turkey and mortality rate is around 5%. So, Turkey is one of the countries where the epidemy has become spread to the wider geography and the biggest outbreaks of CCHF have occurred in the world. We have recently developed an inactivated cell-culture based vaccine against CCHF. We have showed that the Balb/c mice immunized with the CCHF vaccine induced the high level of neutralizing antibodies. In this study, we aimed to determine the immunodominant regions of nucleoprotein (NP) CCHFV Kelkit06 strain which stimulate T cells. For this purpose, pools of overlapping NP were used for an IFN- γ ELISPOT assay. Balb/c mice were divided into two groups for the experiment. Two groups (n = 10 each) were immunized via the intraperitoneal route with 5, or 10μg of the cell culture-based vaccine. The control group (n = 6) was mock immunized with PBS. Booster injections with the same formulation were given on days 21 and 42 after the first immunization. The higher reactivity against the CCHFV NP pools 31-40 and 80-90 was determined in the two dose groups. In order to analyze the vaccine-induced T cell responses in Balb/c mice immunized with varying doses of the vaccine, we have been also currently working on CD4+, CD8+ and CD3 + T cells by flow cytometry.

Keywords: Crimean-Congo hemorrhagic fever virus, immunodominant regions of NP, T cell response, vaccine

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Authors: Swati Gautam, Amita Jain, Shyampyari Jaiswar

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Objective: To elucidate the role of (ApaI&TaqI) VDR gene polymorphism in the pathogenesis of female genital tuberculosis (FGTB) cases. Background: Female genital TB represents about 15-20% of total extra-pulmonary TB (EPTB). Female subjects with vitamin D deficiency have been shown to be at higher risk of pulmonary TB as well as FGTB. In same context few functional polymorphism in vitamin D receptor (VDR) gene has been considered as an important genetic risk factor that modulate the development of FGTB. Therefore we aimed, to elucidate the role of (ApaI&TaqI) VDR gene polymorphism in the pathogenesis of FGTB. Study design: Case-Control study. Sample size: Cases (60) and Controls (60). Study site: Department of Obstetrics & Gynecology & Department of Microbiology, K.G.M.U. Lucknow, (UP). Inclusion criteria: Cases: Women with age group 20-35 years, premenstrual endometrial aspiration collected and included in the study, those were positive with acid-fast bacilli (AFB)/ TB-PCR/ LJ culture/ liquid culture. Controls: Women with age group 20-35 years having no history of ATT and all test negative for TB recruited as control. Exclusion criteria: -Women with endometriosis, polycystic ovaries (PCOD), positive on Chlamydia & gonorrhea, already on anti-tubercular therapy (ATT) excluded. Materials and Methods: Blood samples were collected in EDTA tubes from cases and controls stored at -20ºC. Genomic DNA extraction was carried out by salting-out method. Genotyping of VDR gene (ApaI&TaqI) polymorphism was performed by using single amplification refractory mutation system (ARMS) PCR technique. PCR products were analyzed by electrophoresis on 2% agarose gel. Statistical analysis was done by SPSS16.3 software & computing odds ratio (OR) with 95% CI. Results: Increased risk of female genital tuberculosis was observed in AA genotype (OR =1.1419-6.212 95% CI, P*<0.036) and A allele (OR =1.255-3.518, 95% CI, P* < 0.006) in FGTB as compared to controls. Moreover A allele was found more frequent in FGTB patients. No significant difference was observed in TaqI gene polymorphism of VDR gene. Conclusion: The ApaI polymorphism is significantly associated with etiology of FGTB and plays an important role as a genetic risk factor in FGTB women.

Keywords: ARMS, ATT, EPTB, FGTB, VDR

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Authors: Ayami Umemura

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The purpose of this paper is to examine the meaning of verbalization in clinical practice using the keywords silence and singularity. A patient's experience of illness and treatment is singular, irreplaceable, and irreproducible and ultimately cannot be compared with that of others. In his book Difference and Repetition, Gilles Deleuze positioned irreplaceable singularity as the opposite concept of particularity as a generalizable and substitutable property and matched the former with universality. He also said that singularity could not be represented because of its irreplaceable nature. Representation or verbalization is a procedure that converts an irreplaceable, idiosyncratic reality into something that can be substituted. Considering the act of verbalizing medical diagnosis based on this, it can be said that diagnosis is the practice of decontextualizing and generalizing the suffering embedded in the patient's irreplaceable life history as a disease. This paper examines the above with the key concept of the practice of "non-verbalization" in traditional medical practices in Sri Lanka. In the practice of Sri Lankan traditional medicine and the inheritance of medical knowledge and care techniques, there is a tendency to avoid verbalizing specific matters or stating them aloud. Specifically, the following should be avoided. The healer informs the patient of the name of the disease, mentions the name of the herb used in front of the patient, explains the patient's condition to the healer, and referring the names of poisonous animals, such as poisonous snakes that have been damaged. And so on. Furthermore, when passing on medical knowledge and skills, it is also possible to avoid verbalizing knowledge of medicinal herbs and medical treatment methods and explaining them verbally. In addition to the local belief that the soul of language in Sri Lanka is deeply involved in this background, Sri Lankan traditional medicine has a unique view of the human body and personality that is rooted in the singularity that appears in the relationship with the movement of celestial bodies and the supernatural realm. It can be pointed out that it is premised on the view. In other words, the “silence” in Sri Lankan indigenous medicine is the reason for emphasizing specificity. Furthermore, we can say that "non-verbalization" is a practice aimed at healing. Based on these discussions, this paper will focus on the unique relationships between practitioners and patients that become invisible due to verbalization, which is overlooked by clinical medicine, where informed consent, ensuring transparency, and audit culture is dominant. We will examine the experience of treatment and aim to relativize clinical medicine, which is based on audit cultures.

Keywords: audit cultures, indigenous medicine, singularity, verbalization

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Authors: Getahun Nigusie Demise

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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: The aim of this study is to assess the incidence and predictors of mortality among HIV positive children on antiretroviral therapy (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, treatment, Ethiopia

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Authors: F. Al-Fahad, J. Chakkamalayath, A. Al-Aibani

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Conventional methods of determination of concrete strength under controlled laboratory conditions will not accurately represent the actual strength of concrete developed under site curing conditions. This difference in strength measurement will be more in the extreme environment in Kuwait as it is characterized by hot marine environment with normal temperature in summer exceeding 50°C accompanied by dry wind in desert areas and salt laden wind on marine and on shore areas. Therefore, it is required to have test methods to measure the in-place properties of concrete for quality assurance and for the development of durable concrete structures. The maturity method, which defines the strength of a given concrete mix as a function of its age and temperature history, is an approach for quality control for the production of sustainable and durable concrete structures. The unique harsh environmental conditions in Kuwait make it impractical to adopt experiences and empirical equations developed from the maturity methods in other countries. Concrete curing, especially in the early age plays an important role in developing and improving the strength of the structure. This paper investigates the use of maturity method to assess the effectiveness of three different types of curing methods on the compressive and flexural strength development of one high strength concrete mix of 60 MPa produced with silica fume. This maturity approach was used to predict accurately, the concrete compressive and flexural strength at later ages under different curing conditions. Maturity curves were developed for compressive and flexure strengths for a commonly used concrete mix in Kuwait, which was cured using three different curing conditions, including water curing, external spray coating and the use of internal curing compound during concrete mixing. It was observed that the maturity curve developed for the same mix depends on the type of curing conditions. It can be used to predict the concrete strength under different exposure and curing conditions. This study showed that concrete curing with external spray curing method cannot be recommended to use as it failed to aid concrete in reaching accepted values of strength, especially for flexural strength. Using internal curing compound lead to accepted levels of strength when compared with water cuing. Utilization of the developed maturity curves will help contactors and engineers to determine the in-place concrete strength at any time, and under different curing conditions. This will help in deciding the appropriate time to remove the formwork. The reduction in construction time and cost has positive impacts towards sustainable construction.

Keywords: curing, durability, maturity, strength

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Authors: Joseph Fitoussi, Mohammadali Shirinbayan, Abbas Tcharkhtchi

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Due to material flow during processing, short fiber reinforced composites structures obtained by injection or compression molding generally present strong spatial microstructure variation. On the other hand, quasi-static, dynamic, and fatigue behavior of these materials are highly dependent on microstructure parameters such as fiber orientation distribution. Indeed, because of complex damage mechanisms, SFRC structures design is a key challenge for safety and reliability. In this paper, we propose a micromechanical model allowing prediction of damage behavior of real structures as a function of microstructure spatial distribution. To this aim, a statistical damage criterion including strain rate and fatigue effect at the local scale is introduced into a Mori and Tanaka model. A critical local damage state is identified, allowing fatigue life prediction. Moreover, the multi-scale model is coupled with an experimental intrinsic link between damage under monotonic loading and fatigue life in order to build an abacus giving Tsai-Wu failure criterion parameters as a function of microstructure and targeted fatigue life. On the other hand, the micromechanical damage model gives access to the evolution of the anisotropic stiffness tensor of SFRC submitted to complex thermomechanical loading, including quasi-static, dynamic, and cyclic loading with temperature and amplitude variations. Then, the latter is used to fill out microstructure dependent material cards in finite element analysis for design optimization in the case of complex loading history. The proposed methodology is illustrated in the case of a real automotive component made of sheet molding compound (PSA 3008 tailgate). The obtained results emphasize how the proposed micromechanical methodology opens a new path for the automotive industry to lighten vehicle bodies and thereby save energy and reduce gas emission.

Keywords: short fiber reinforced composite, structural design, damage, micromechanical modelling, fatigue, strain rate effect

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Authors: Atlal El-Assaad

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Viruses change with time through mutations and result in new variants that may persist or disappear. A Mutation refers to an actual change in the virus genetic sequence, and a variant is a viral genome that may contain one or more mutations. Critical mutations may cause the virus to be more transmissible, with high disease severity, and more vulnerable to diagnostics, therapeutics, and vaccines. Thus, variants carrying such mutations may increase the risk to human health and are considered variants of concern (VOC). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - the contagious in humans, positive-sense single-stranded RNA virus that caused coronavirus disease 2019 (COVID-19) - has been studied thoroughly, and several variants were revealed across the world with their corresponding mutations. SARS-CoV-2 has four structural proteins, known as the S (spike), E (envelope), M (membrane), and N (nucleocapsid) proteins, but prior study and vaccines development focused on genetic mutations in the S protein due to its vital role in allowing the virus to attach and fuse with the membrane of a host cell. Specifically, subunit S1 catalyzes attachment, whereas subunit S2 mediates fusion. In this perspective, we studied all charged amino acid mutations of the SARS-CoV-2 viral spike protein S1 when bound to Antibody CC12.1 in a crystal structure and assessed the effect of different mutations. We generated all missense mutants of SARS-CoV-2 protein amino acids (AAs) within the SARS-CoV-2:CC12.1 complex model. To generate the family of mutants in each complex, we mutated every charged amino acid with all other charged amino acids (Lysine (K), Arginine (R), Glutamic Acid (E), and Aspartic Acid (D)) and studied the new binding of the complex after each mutation. We applied Poisson-Boltzmann electrostatic calculations feeding into free energy calculations to determine the effect of each mutation on binding. After analyzing our data, we identified charged amino acids keys for binding. Furthermore, we validated those findings against published experimental genetic data. Our results are the first to propose in silico potential life-threatening mutations of SARS-CoV-2 beyond the present mutations found in the five common variants found worldwide.

Keywords: SARS-CoV-2, variant, ionic amino acid, protein-protein interactions, missense mutation, AESOP

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Authors: Mehdi Heydari Sanglaji

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The dramatic events of the 11 September, and their tragic repercussions, catapulted issues of the political violence in and from the ‘Muslim world’ onto the political discourse, be it in patriotic speeches of campaigning politicians or the TV and news punditry. Depending on what end of the political spectrum the politician/pundit pledges fealty to, the overall analyses of political violence in the West Asia and North Africa (WANA) tends towards two overarching categories: on the Right, the diagnosis has unanimously been, ‘they must hate our freedom.’ On the Left, however, there is the contention that the West has to be counted as the primary cause of such rage, for the years of plundering of lives and resources, through colonialism, the Cold War, coups, etc. All these analyses are premised on at least two presuppositions: the violence in and from the WANA region a) is always reactionary, in the sense that it happens only in response to something the West is or does; and b) must always already be condemned, as it is essentially immoral and wrong. It is the aim of this paper to challenge such viewpoints. Through a rigorous study of the historical discourses on political violence in the Leftist organizations active in Algeria and Lebanon, we claim there is a myriad of diverse reasons and justifications presented for advocating political violence in these countries that defy facile categorization. Inspecting such rhetoric for inciting political violence in Leftist discourses, and how some of these reasonings have percolated into other movements in the region (e.g., Islamist ones), will reveal a wealth of indigenous discourses on the subject that has been largely neglected by the Western Media punditry and even by the academia. The indigenous discourses on political violence, much of which overlaps with emancipatory projects in the region, partly follow grammar and logic, which may be different from those developed in the West, even by its more critical theories. Understanding so different epistemology of violence, and the diverse contexts in which political violence might be justifiable in the mind of ‘the other,’ necessitates a historical, materialist, and genealogical study of the discourse already in practice in the WANA region. In that regard, both critical terrorism studies and critical discourse analysis provide exemplary tools of analysis. Capitalizing on such tools, this project will focus on unearthing a history of thought that renders moot the reduction of all instances of violence in the region to an Islamic culture or imperialism/colonialism. The main argument in our research is that by studying the indigenous discourses on political violence, we will be far more equipped in understanding the reasons and the possible solutions for acts of terrorism in and from the region.

Keywords: political violence, terrorism, leftist organizations, West Asia/North Africa

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Authors: Maria Francesca Lavadia-Gumabao, Mary Antoinette Salvamante-Torallo

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Introduction: The fibrous intrauterine adhesions forming inside the uterus and/or cervix in Asherman syndrome can obstruct the internal cervical orifice and may present as a case of outflow tract obstruction. Asherman syndrome is often overlooked since it has no specific presentation and is undetectable by routine physical examinations or diagnostic procedures such as an ultrasound. This paper highlights the delay and elusive diagnosis of Asherman syndrome which negatively impacted the patient’s fertility and quality of life. Case presentation: A 33-year-old woman (gravida 3, para 3) who presented with secondary amenorrhea for thirteen years associated with cyclic pelvic pain and secondary infertility sought a consultation at our institution for evaluation and specialty management. The patient had no other well-established risk factors for Asherman syndrome aside from pregnancy. For more than a decade, she delayed seeking medical care. At presentation, history taking, physical examination, and ultrasound were not helpful in identifying the cause of outflow tract obstruction. Diagnostic hysteroscopy was then performed, during which extensive scarring and fibrosis completely obscured the internal cervical orifice were observed, consistent with the diagnosis of Asherman syndrome (Grade 5B). The patient then underwent ultrasound guided hysteroscopy outflow tract dilatation and responded well to the treatment as she had her menstrual period a month after the procedure and no longer had cyclic pelvic pain with a repeat ultrasound finding of an unremarkable uterus. The hispathology result of the tissues retrieved revealed myometrial fragments with associated old hemorrhage benign endometrial stromal tissues, which failed to show endometrial glands. Conclusion: The delay and elusive diagnosis of Asherman syndrome can be brought about by poor health seeking behavior of patients and difficulty in detecting this condition by routine physical examinations or diagnostic procedures such as an ultrasound. It is, therefore, necessary to include Asherman syndrome in the differential diagnosis of secondary amenorrhea and secondary infertility. With expertise in hysteroscopy, early diagnosis, proper classification in the advent of hysteroscopy, and optimal management can improve patient outcomes.

Keywords: Asherman syndrome, outflow tract obstruction, secondary amenorrhea, infertility, hysteroscopy

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Authors: Atara Shriki, Ilana Lavy

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Teaching for the first time an online course dealing with the history of mathematics, we were struggling with questions related to the design of a proper learning environment (LE). Thirteen high school mathematics teachers, M.Ed. students, attended the course. The teachers were engaged in independent reading of mathematical texts, a task that is recognized as complex due to the unique characteristics of such texts. In order to support the learning processes and develop skills that are essential for succeeding in learning online (e.g. self-regulated learning skills, meta-cognitive skills, reflective ability, and self-assessment skills), the LE comprised of three components aimed at “scaffolding” the learning: (1) An online "self-feedback" questionnaires that included drill-and-practice questions. Subsequent to responding the questions the online system provided a grade and the teachers were entitled to correct their answers; (2) Open-ended questions aimed at stimulating critical thinking about the mathematical contents; (3) Reflective questionnaires designed to assist the teachers in steering their learning. Using a mixed-method methodology, an inquiry study examined the learning processes, the learners' difficulties in reading the mathematical texts and on the unique contribution of each component of the LE to the ability of teachers to comprehend the mathematical contents, and support the development of their learning skills. The results indicate that the teachers found the online feedback as most helpful in developing self-regulated learning skills and ability to reflect on deficiencies in knowledge. Lacking previous experience in expressing opinion on mathematical ideas, the teachers had troubles in responding open-ended questions; however, they perceived this assignment as nurturing cognitive and meta-cognitive skills. The teachers also attested that the reflective questionnaires were useful for steering the learning. Although in general the teachers found the LE as supportive, most of them indicated the need to strengthen instructor-learners and learners-learners interactions. They suggested to generate an online forum to enable them receive direct feedback from the instructor, share ideas with other learners, and consult with them about solutions. Apparently, within online LE, supporting learning merely with respect to cognitive aspects is not sufficient. Leaners also need an emotional support and sense a social presence.

Keywords: cognitive and meta-cognitive skills, independent reading of mathematical texts, online learning environment, self-regulated learning skills

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Authors: Natalia Moreno-Castellanos, Amaia Rodriguez, Gema Frühbeck

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Introduction: In adipocytes, the cytoskeleton undergoes important expression and distribution in adipocytes rearrangements during adipogenesis and in obesity. Indeed, a role for these proteins in the regulation of adipocyte differentiation and response to insulin has been demonstrated. Recently, septins have been considered as new components of the cytoskeletal network that interact with other cytoskeletal elements (actin and tubulin) profoundly modifying their dynamics. However, these proteins have not been characterized as yet in adipose tissue. In this work, were examined the cellular, molecular and functional features of a member of this family, septin 11 (SEPT11), in adipocytes and evaluated the impact of obesity on the expression of this protein in human adipose tissue. Methods: Adipose gene and protein expression levels of SEPT11 were analysed in human samples. SEPT11 distribution was evaluated by immunocytochemistry, electronic microscopy, and subcellular fractionation techniques. GST-pull down, immunoprecipitation and a Yeast-Two Hybrid (Y2H) screening were used to identify the SEPT11 interactome. Gene silencing was employed to assess the role of SEPT11 in the regulation of insulin signaling and lipid metabolism in adipocytes. Results: SEPT11 is expressed in human adipocytes, and its levels increased in both omental and subcutaneous adipose tissue in obesity, with SEPT11 mRNA content positively correlating with parameters of insulin resistance in subcutaneous fat. In non-stimulated adipocytes, SEPT11 immunoreactivity showed a ring-like distribution at the cell surface and associated to caveolae. Biochemical analyses showed that SEPT11 interacted with the main component of caveolae, caveolin-1 (CAV1) as well as with the fatty acid-binding protein, FABP5. Notably, the three proteins redistributed and co-localized at the surface of lipid droplets upon exposure of adipocytes to oleate. In this line, SEPT11 silencing in 3T3-L1 adipocytes impaired insulin signaling and decreased insulin-induced lipogenesis. Conclusions: Those findings demonstrate that SEPT11 is a novel component of the adipocyte cytoskeleton that plays an important role in the regulation of lipid traffic, metabolism and can thus represent a potential biomarker of insulin resistance in obesity in adipocytes through its interaction with both CAV1 and FABP5.

Keywords: caveolae, lipid metabolism, obesity, septins

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Authors: Ricardo Hugo Gonzalez, Amanda Figueiredo Vasconcelos, Francisco Loureiro Neto Monteiro, Yara Luiza Freitas Silva, Ana Cristina Lindsay, Márcia Maria Tavares Machado

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The use of sport as an integration mean is a very important tool regarding the social involvement of children and teenagers in a vulnerability situation. This study aims to report the experiences of a multidisciplinary program that intends to improve the quality of life of children and teenagers in Fortaleza, in the Northeast of Brazil. More than 400 children and teenagers aging 11 and 16 years participated in this study. Poor communities experience many particular difficulties in the urban centers such as violence, poor housing conditions, unemployment, lack in health care and deficient physical education in school. Physical education, physiotherapy, odontology, medicine and pharmacy students are responsible for the activities in the project supervised by a general coordinator and a counselor teacher of each academic unit. There are classes about team sports like basketball and soccer. Lectures about sexual behavior and sexually transmitted diseases are ministered beside the ones about oral health education, basic life support education, first aids, use and care with pharmaceuticals and orientations about healthy nutrition. In order to get the children’s family closer, monthly informative lectures are ministered. There is also the concern about reflecting the actions and producing academic paperwork such as graduation final projects and books. The number of participants has oscillated lately, and one of the causes is the lack of practicing physical activities and sports regularly. However, 250 teenagers have participated regularly for at least two years. These teenagers have shown a healthier lifestyle and a better physical fitness profile. The resources for maintaining the project come from the Pro-Reitoria of Extension, Federal University of Ceara, as well as from the PROEXT/MEC, Federal Government. Actions of this nature need to be done thinking for long periods so the effects results can become effective. Public and private investments are needed due to low socioeconomic families who are most vulnerable and have fewer opportunities to enhance to health prevention services.

Keywords: children and teenagers, health, multidisciplinary program, quality of life

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Authors: Kirill Filianin, Satu-Pia Reinikainen, Tuomo Sainio

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Frequent measurements of product steam quality create a data overload that becomes more and more difficult to handle. In the current study, plant history data with multiple variables was successfully treated by principal component analysis to detect abnormal process behavior, particularly, in copper solvent extraction. The multivariate model is based on the concentration levels of main process metals recorded by the industrial on-stream x-ray fluorescence analyzer. After mean-centering and normalization of concentration data set, two-dimensional multivariate model under principal component analysis algorithm was constructed. Normal operating conditions were defined through control limits that were assigned to squared score values on x-axis and to residual values on y-axis. 80 percent of the data set were taken as the training set and the multivariate model was tested with the remaining 20 percent of data. Model testing showed successful application of control limits to detect abnormal behavior of copper solvent extraction process as early warnings. Compared to the conventional techniques of analyzing one variable at a time, the proposed model allows to detect on-line a process failure using information from all process variables simultaneously. Complex industrial equipment combined with advanced mathematical tools may be used for on-line monitoring both of process streams’ composition and final product quality. Defining normal operating conditions of the process supports reliable decision making in a process control room. Thus, industrial x-ray fluorescence analyzers equipped with integrated data processing toolbox allows more flexibility in copper plant operation. The additional multivariate process control and monitoring procedures are recommended to apply separately for the major components and for the impurities. Principal component analysis may be utilized not only in control of major elements’ content in process streams, but also for continuous monitoring of plant feed. The proposed approach has a potential in on-line instrumentation providing fast, robust and cheap application with automation abilities.

Keywords: abnormal process behavior, failure detection, principal component analysis, solvent extraction

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Authors: Dalia El Hadi, Alaa Bou Ghannam, Hala Mostafa, Hana Mansour, Ibrahim Hashim, Soubhi Tahhan, Tharwat El Zahran

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Introduction: Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. Some would require neuroimaging. Most commonly used are the CT and MRI of the Brain. They can be over-used when not indicated. Their yield remains dependent on multiple factors relating to the clinical scenario. Methods: A retrospective cross-sectional study was conducted by reviewing the electronic medical records of patients presenting to the Emergency Department (ED) with isolated neuro-ophthalmologic complaints. For each patient, data were collected on the clinical presentation, whether neuroimaging was performed (and which type), and the result of neuroimaging. Analysis of the performed neuroimaging was made, and its yield was determined. Results: A total of 211 patients were reviewed. The complaints or symptoms at presentation were: blurry vision, change in the visual field, transient vision loss, floaters, double vision, eye pain, eyelid droop, headache, dizziness and others such as nausea or vomiting. In the ED, a total of 126 neuroimaging procedures were performed. Ninety-four imagings (74.6%) were normal, while 32 (25.4%) had relevant abnormal findings. Only 2 symptoms were significant for abnormal imaging: blurry vision (p-value= 0.038) and visual field change (p-value= 0.014). While 4 physical exam findings had significant abnormal imaging: visual field defect (p-value= 0.016), abnormal pupil reactivity (p-value= 0.028), afferent pupillary defect (p-value= 0.018), and abnormal optic disc exam (p-value= 0.009). Conclusion: Risk indicators for abnormal neuroimaging in the setting of neuro-ophthalmological emergencies are blurred vision or changes in the visual field on history taking. While visual field irregularities, abnormal pupil reactivity with or without afferent pupillary defect, or abnormal optic discs, are risk factors related to physical testing. These findings, when present, should sway the ED physician towards neuroimaging but still individualizing each case is of utmost importance to prevent time-consuming, resource-draining, and sometimes unnecessary workup. In the end, it suggests a well-structured patient-centered algorithm to be followed by ED physicians.

Keywords: emergency department, neuro-ophthalmology, neuroimaging, risk indicators

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Authors: Jeffrey Siphiwe Mkhize

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Twelve years of schooling for most South African children, particularly those children from disadvantaged past, are confronted with numerous and diverse challenges. These challenges range from infrastructural limitations, language of teaching, poor resources and varying family backgrounds. Likewise, schools are categorized to signify schools’ geographic location, poverty lines, societal class and type of students that the school are likely to enroll. Such categorization perpetuates particular lines of identities that are indirectly reinforced by the same system that seeks to redress. South African universities prefer point systems to determine students’ suitability to gain access to their programmes. Once students are admitted based on the qualifying points there is an assumed equity in the manner in which they receive tuition. They are assumed as equal; noting the widened access to South African universities as means to redress past inequalities. Given the challenges, inequalities, it is necessary to view higher education as a site for knowledge construction that is accessible to all students. Epistemological access is key to all students irrespective of their socio-economic status. This paper seeks to contribute to the discourse of student engagement using lecturer-student relationship as a lens to understand this phenomenon. Data were generated using South African Survey of Student Engagement, focus group interviews, semi-structured one-on-one-interviews as well as document analysis. The focus was on students registered for the first year of a Bachelor of Education degree as well as lecturers that teach high risk modules in this qualification at the same level. The findings suggest that lecturers are challenged by overcrowded classrooms and over-enrolled modules; this challenge hampers their good intentions to become more efficient and innovative in their teaching. Students lack confidence in approaching lecturers for assistance. Collaborative learning has stronger results and students believe in self-support to deal with their challenges based on their individual strengths. Collaborative learning is key to student academic performance.

Keywords: collaborative learning, consultations, student engagement, student performance

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Authors: Chang Yu Chuan

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Background and Aim: Pressure sore is not only the consequence of any gradual damage of the skin leading to tissue defects but also an important indicator of clinical care. If hospitalized patients develop pressure sores without proper care, it would result in delayed healing, wound infection, increase patient physical pain, prolonged hospital stay and even death, which would have a negative impact on the quality of care and also increase nursing manpower and medical costs. This project is aimed at decreasing the incidence of pressure sore in one ward of internal medicine. Our data showed 53 cases (0.61%) of pressure sore in 2015, which exceeded the average (0.5%) of Taiwan Clinical Performance Indicator (TCPI) for medical centers. The purpose of this project is to reduce the incidence rate of pressure sore in the ward. After data collection and analysis from January to December 2016, the reasons of developing pressure sore were found: 1. Lack of knowledge to prevent pressure among nursing staffs; 2. No relevant courses about preventing pressure ulcers and pressure wound care being held in this unit; 3. Low complete rate of pressure sore care education that family members should receive from nursing staffs; 4. Decompression equipment is not enough; 5. Lack of standard procedures for body-turning and positioning care. After team members brainstorming, several strategies were proposed, including holding in-service education, pressure sore care seed training, purchasing decompression mattress and memory pillows, designing more elements of health education tools, such as health education pamphlet, posters and multimedia films of body-turning and positioning demonstration, formulation and promotion of standard operating procedures. In this way, nursing staffs can understand the body-turning and positioning guidelines for pressure sore prevention and enhance the quality of care. After the implementation of this project, the pressure sore density significantly decreased from 0.61%(53 cases) to 0.45%(28 cases) in this ward. The project shows good results and good example for nurses working at the ward and helps to enhance quality of care.

Keywords: body-turning and positioning, incidence density, nursing, pressure sore

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Authors: Ridwaan N. Milase, Leonardo J. Van Zyl, Marla Trindade

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American foulbrood (AFB) is the world’s most devastating honeybee disease that has drastically reduced the population of Apis mellifera capensis since 2009. The outbreak has jeopardized the South African bee keeping industry as well as the agricultural sector dependent on honeybees for honey production and pollination, leading to significant economic losses. AFB is caused by Paenibacillus larvae, a spore-forming, Gram positive facultative anaerobic and flagellated bacterium. The use of antibiotics within beehives has selected for resistant strains of P. larvae, while the current practice of burning spore contaminated beehives and equipment contributes to the economic losses in the honeybee-keeping industry. Therefore, phage therapy is proposed as a promising alternative to combat P. larvae strains affecting A. mellifera capensis. The genomes of two P. larvae strains isolated from infected combs in the Western Cape have been sequenced and annotated using bioinformatics tools. Genome analyses has revealed that these P. larvae strains are lysogens to more than 6 different prophages and possess different type of clustered regularly interspaced short palindromic repeat (CRISPRs) regions per strain. Active prophages from one of the two P. larvae strains were detected and identified using PCR. Electron microscopy was used to determine the family of the identified active prophages. Lytic bacteriophages that specifically target the two P. larvae strains were purified from sewage wastewater, beehive materials, and soil samples to investigate their potential development as anti-P. larvae agents. Another alternative treatment being investigated is the development of a prophage endolysin cocktail. Endolysin genes of the prophages have been targeted, cloned and expressed in Escherichia coli. The heterologously expressed endolysins have been purified and are currently being assessed for their lytic activity against P. larvae strains and other commensal microorganisms that compose the honeybee larvae microbiota. The study has shown that phage therapy and endolysins have a great potential as alternative control methods for AFB disease affecting A. mellifera capensis.

Keywords: American foulbrood, bacteriophage, honeybee, Paenibacillus larvae

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Authors: Estifanos H. Zeru

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Introduction: Epidemiological research is important to draw need-based rational public health policy. However, research on child and adolescent mental health in low and middle income countries, where socioeconomic, political, cultural, biological and other mental health hazards are in abundance, is almost nonexistent. To the author's knowledge, there is no published research in this field in Eritrea, whose child and adolescent population constitutes 53% of its total population. Study Aims and Objectives: The objective of this study was to determine the prevalence and patterns of DSM-IV psychiatric disorders and identify their socio-demographic correlates among children and adolescents in Mendefera, Eritrea. The study aims to provide local information to public health policymakers to guide policy in service development. Methodology: In a cross-sectional two stage procedure, both the Parent and Child versions of the SDQ were used to screen 314 children and adolescents aged 4-17 years, recruited by a multi-stage random sampling method. All parents/adult guardians also completed a socio-demographic questionnaire. All children and adolescents who screened positive for any of the SDQ abnormality sub-classes were selected for the second stage interview, which was conducted using the K-SADS-PL 2009 Working Draft version to generate specific DSM-IV diagnoses. All data gathered was entered into CSPro version 6.2 and was then transported in to and analyzed using SPSS version 20 for windows. Results: Prevalence of DSM-IV psychiatric disorders was found to be 13.1%. Adolescents 11-17 years old and males had higher prevalence than children 4-10 years old and females, respectively. Behavioral disorders were the commonest disorders (9.9%), followed by affective disorders (3.2%) and anxiety disorders (2.5). Chronic medical illness in the child, poor academic performance, difficulties with teachers in school, psychopathology in a family member and parental conflict were found to be independently associated with these disorders. Conclusion: Prevalence of child and adolescent psychiatric disorders in Eritrea is high. Promotion, prevention, treatment, and rehabilitation for child and adolescent mental health services need to be made widely available in the country. The socio-demographic correlates identified by this study can be targeted for intervention. The need for further research is emphasized.

Keywords: adolescents, children, correlates, DSM-IV psychiatric disorders, Eritrea, K-SAD-PL 2009, prevalence and correlates, SDQ

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Authors: T. S. Beerenahally, S. Amruthavalli, C. M. Munegowda, Leelavathi, Nagarathna

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Introduction: In majority of urban India, the health system is split between different authorities being responsible for the health care of urban population. We believe that, apart from poor awareness and financial barriers to care, there are other health system barriers which affect quality and access to care for people with diabetes. In this paper, we attempted to identify health system complexity that determines access to public health system for diabetes care in KG Halli, a poor urban neighborhood in Bengaluru. The KG Halli has been a locus of a health systems research from 2009 to 2015. Methodology: The source of data is from the observational field-notes written by research team as part of urban health action research project (UHARP). Field notes included data from the community and the public primary care center. The data was generated by the community health assistants and the other research team members during regular home visits and interaction with individuals who self-reported to be diabetic over four years as part of UHARP. Results: It emerged during data analysis that the patients were not keen on utilizing primary public health center for many reasons. Patient has felt that the service provided at the center was not integrated. There was lack of availability of medicines, with a regular stock out of medicines in a year and laboratory service for investigation was limited. Many of them said that the time given by the providers was not sufficient and there was also a feeling of providers not listening to them attentively. The power dynamics played a huge role in communication. Only the consultation was available for free of cost at the public primary care center. The patient had to spend for the investigations and the major portion for medicine. Conclusion: Diabetes is a chronic disease that poses an important emerging public health concern. Most of the financial burden is borne by the family as the public facilities have failed to provide free care in India. Our study indicated various factors including individual beliefs, stigma and financial constraints affecting compliance to diabetes care.

Keywords: diabetes care, disintegrated health system, quality of care, urban health

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Authors: Ayala Amir

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The paper presents interdisciplinary research which draws on the literary study and the cultural study of photography to explore a literary genre defined by nostalgia – the photographed book for children. This genre, which was popular in the second half of the 20th century, presents the romantic, nostalgic image of childhood created in the visual arts in the 18th century (as suggested by Ann Higonnet). At the same time, it capitalizes on the nostalgia inherent in the event of photography as formulated by Jennifer Green-Lewis: photography frames a moment in the present while transforming it into a past longed for in the future. Unlike Freudian melancholy, nostalgia is an effect that enables representation by acknowledging the loss and containing it in the very experience of the object. The representation and preservation of the lost object (nature, childhood, innocence) are in the center of the genre of children's photography books – a modern version of ancient pastoral. In it, the unique synergia of word and image results in a nostalgic image of childhood in an era already conquered by modernization. The nostalgic effect works both in the representation of space – an Edenic image of nature already shadowed by its demise, and of time – an image of childhood imbued by what Gill Bartholnyes calls the "looking backward aesthetics" – under the sign of loss. Little critical attention has been devoted to this genre with the exception of the work of Bettina Kümmerling-Meibauer, who noted the nostalgic effect of the well-known series of photography books by Astrid Lindgren and Anna Riwkin-Brick. This research aims to elaborate Kümmerling-Meibauer's approach using the theories of the study of photography, word-image studies, as well as current studies of childhood. The theoretical perspectives are implemented in the case study of photography books created in one of the most innovative social structures in our time – the Israeli Kibbutz. This communal way of life designed a society where children will experience their childhood in a parentless rural environment that will save them from the fate of the Oedipal fall. It is suggested that in documenting these children in a fictional format, photographers and writers, images and words cooperated in creating nostalgic works situated on the border between nature and culture, imagination and reality, utopia and its realization in history.

Keywords: nostalgia, photography , childhood, children's books, kibutz

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Authors: Andrew Wee

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As a result of the Italian Independence Wars starting in 1848, Italy began to change through unification. People gradually moved away from some of their traditional practices and values, such as the long-held belief that women were inferior to men, as part of the Risorgimento. Italians began to take interest in opera as a form of emotional release. As opera became more popular and prominent in their culture, it aided in the dissemination of ideas, especially stimulating the spread of imperialism, in the late 19th century, as Italy began extending its presence to other countries. In order to collect the information needed to analyze Italy’s foreign presence, it was necessary to consult texts concerning the culture of the Risorgimento. These texts included primary sources from operatic composers and contemporary recorded accounts. Letters from Giuseppe Verdi, a leader in opera during the Risorgimento, have been scrutinized for indications of popular attitudes of the time. The cultural context of the Risorgimento is essential to understanding the Italian motives and attitudes towards the outside world. On the more political side, research has also entailed the study of historical data of general laws, policies, and their purposes concerning geopolitical boundaries and foreign affairs, such as Edward Said’s thesis on Orientalism. By establishing these two characteristics of Italy, the paper will thoroughly illustrate Italy’s presence in foreign affairs. Texts have been searched with the intent of using information that reveals Italian attitudes toward exotic countries to determine whether their demeanor was positive or condescending. Motives behind sources have been interpreted in context in order to form a complete picture of the Italian sentiment towards foreigners. Additionally, research pertaining to Italian nationalism and imperialism such as song and literature has been used. The primary form of research has been the division of sources that are culturally based and those that are political in nature. Opera had always been developing since its creation in the 17th century, and in the 19th century, the bel canto movement revolutionized opera and its role in Italian society. This paper uses evidence that popular sentiment was influenced by opera to support the belief that the evolution of opera was as a result of the nationalist sentiment, and in turn fueled the cultural movement known as the Risorgimento. In this way, opera proceeded to affect Italian culture by spreading the idea of imperialism.

Keywords: opera, Italian unification, music history, imperialism

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Authors: Sachi Matsuoka

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This study aimed at implicating a current community health in South India focusing on a Vaidya, a non-codified traditional doctor, based on long-term field works. As the prevalence of colonic diseases is increasing in all over the world, it is needed to know the potential of non-codified medicines and how they can effectively take in a part in community health. Describing the people’s treatment seeking behaviours in a suburban village which is susceptible to modernization can give us a new insight for studying Indian medicines, that is included not only non-codified but also codified traditional ones, affected by global, national and local communities. Both qualitative and quantitative data were gathered via participatory fieldworks and open-ended interviews to a Vaidya and his 97 patients and 31 individuals who lived in a community near the Vaidya’s station. It was found that the community members seldom consulted the Vaidya while a number of patients outside the village (mainly from urban nearby area) daily visited the Vaidya. Thus, the role of the Vaidya as the community’ s primary health care provider had nearly disappeared. Nonetheless, the Vaidya was deeply respected as one of the community’ s leaders by its members because of the spiritual and financial support he provided to them. The reasons for choosing the Vaidya for the patients from urban area are characterized by several social factors of the patients such as their religious belief, seriousness, occupation and medical history. Meanwhile, not only the Vaidya but also other codified traditional medicines, e.g., Ayurveda, were less popular among the community members. It sounds paradoxical given that the traditional Indian medical system has been becoming popular as an alternative medicine in societies outside of India, such as in Europe. The community members who are less educated and engaged in religious activities in daily life preferred to allopathy, the biomedicine in Indian context. It is thus concluded that roles of non-codified medicine has changed depending on its cultural and social contexts, even though its medical system is not authorized by the government. Nowadays, traditional medical effectiveness is recognized as evidenced by scientific survey and the codified medical doctors treats diseases rather than people. However, this study implicated that people’s treatment seeking behaviors are likely based on the social context in which people live their lives even though evidenced based codified medicine is provided in their community.

Keywords: medical pluralism, non-codified medicine, south india, treatment-seeking behaviours

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