Search results for: women's history

Authors: Emanuela Zilli, Antonella Ruffatto, Davide Bonaldo, Stefano Bevilacqua, Tommaso Caputo, Luisa Fontana, Carmelina Saraceno, Antonio Sturaroo, Teodoro Sava, Antonio Madia

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The new Hospital in Cittadella - ULSS 6 Euganea Health Trust, in the North-East of Italy (400 beds, project completion date in 2026), will partially take the place of the existing building. Interesting features have been suggested in order to project a modern, “environmental-friendly” and “people-friendly” building. Specific multidisciplinary meetings (involving stakeholders and professionals with different backgrounds) have been organized on a periodic basis in order to guarantee the appropriate implementation of logistic and organizational solutions related to eco-sustainability, integration with the context, and the concept of “design for all” and “humanization of care.” The resulting building will be composed of organic shapes determined by the external environment (sun movement, climate, landscape, pre-existing buildings, roads) and the needs of the internal environment (areas of care and diagnostic-treatment paths reorganized with experience gained during the pandemic), with extensive use of renewable energy, solar panels, a 4th-generation heating system, sanitised and maintainable surfaces. There is particular attention to the quality of the staff areas, which include areas dedicated to psycho-physical well-being (relax points, yoga gym), study rooms, and a centralized conference room. Outdoor recreational spaces and gardens for music and watercolour therapy will be included; atai-chi gym is dedicated to oncology patients. Integration in the urban and social context is emphasized through window placement toward the gardens (maternal-infant, mental health, and rehabilitation wards). Service areas such as dialysis, radiology, and labs have views of the medieval walls, the symbol of the city’s history. The new building has been designed to pursue the maximum level of eco-sustainability, harmony with the environment, and integration with the historical, urban, and social context; the concept of humanization of care has been considered in all the phases of the project management.

Keywords: environmental-friendly, humanization, eco-sustainability, new hospital

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Authors: Gizachew Assefa Tessema, Mohammad Afzal Mahmood, Judith Streak Gomersall, Caroline O. Laurence

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Introduction: Improving access to quality family planning services is the key to improving health of women and children. However, there is currently little evidence on the quality and scope of family planning services provided by private facilities, and this compares to the services provided in public facilities in Ethiopia. This is important, particularly in determining whether the government should further expand the roles of the private sector in the delivery of family planning facility. Methods: This study used the 2014 Ethiopian Services Provision Assessment Plus (ESPA+) survey dataset for comparing the structural aspects of quality of care in family planning services. The present analysis used a weighted sample of 1093 primary health care facilities (955 public and 138 private). This study employed logistic regression analysis to compare key structural variables between public and private facilities. While taking the structural variables as an outcome for comparison, the facility type (public vs private) were used as the key exposure of interest. Results: When comparing availability of basic amenities (infrastructure), public facilities were less likely to have functional cell phones (AOR=0.12; 95% CI: 0.07-0.21), and water supply (AOR=0.29; 95% CI: 0.15-0.58) than private facilities. However, public facilities were more likely to have staff available 24 hours in the facility (AOR=0.12; 95% CI: 0.07-0.21), providers having family planning related training in the past 24 months (AOR=4.4; 95% CI: 2.51, 7.64) and possessing guidelines/protocols (AOR= 3.1 95% CI: 1.87, 5.24) than private facilities. Moreover, comparing the availability of equipment, public facilities had higher odds of having pelvic model for IUD demonstration (AOR=2.60; 95% CI: 1.35, 5.01) and penile model for condom demonstration (AOR=2.51; 95% CI: 1.32, 4.78) than private facilities. Conclusion: The present study suggests that Ethiopian government needs to provide emphasis towards the private sector in terms of providing family planning guidelines and training on family planning services for their staff. It is also worthwhile for the public health facilities to allocate funding for improving the availability of basic amenities. Implications for policy and/ or practice: This study calls policy makers to design appropriate strategies in providing opportunities for training a health care providers working in private health facility.

Keywords: quality of care, family planning, public-private, Ethiopia

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Authors: Mosito Jonas Seabela

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Breastfeeding in public has become a contentious issue in contemporary society. Mothers are often subjected to unfair discrimination and harassment for simply responding to their maternal instinct to breastfeed their infants. The unwillingness of society to accept public breastfeeding as a natural, non-sexual act is partly influenced by the imposition of a pornified and hypersexualised Western culture, which was imported to Africa through colonisation, enforced by the apartheid regime, and is now perpetuated by Western media. The imposition of the modern nuclear family on Africans, and the coerced aspiration to subscribe to bourgeois values, has eroded the moral standing of the traditional African family and its cultural values. Western-centric perceptions of African women have altered the experience of motherhood for many, commodifying the practice of breastfeeding. As a result, the use of bottles and infant formulas is often perceived as the preferred method, while breastfeeding in public is viewed as primitive, immoral, and unacceptable. This normative study seeks to answer the question of what ought to be done to preserve the dignity of African motherhood and protect their right to breastfeed in public. The African philosophy of Ubuntu is employed to advocate for the right to breastfeed in public. This moral philosophy posits that the western perception of a person seeks to isolate people from their environment and culture, thereby undermining the process of acquiring humanity, which fosters social cohesion. The Ubuntu philosophy embodies the aphorism, “umuntu ngumuntu nga bantu”, meaning “a person is a person through other persons”, signifying people’s interconnectedness and interdependence. The application of the key principles of Ubuntu, such as “survival, the spirit of solidarity, compassion, respect, and dignity” can improve human interaction and unite the public to support the government’s efforts to increase exclusive breastfeeding rates and reduce infant mortality rates. A doctrine called “Ubuntu Lactivism” is what the author proposes as a means to advocate for breastfeeding rights in fulfilment of African traditional values.

Keywords: ubuntu, breastfeeding, Afrocentric, colonization, culture, motherhood, imperialism, objectification

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Authors: Shannon Glaspy, Gerald Boon, Jack Lambert

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Studies on AE of highly active antiretroviral therapy (HAART) in children and adolescents are rare. The aim of this study is to observe the frequency of treatment limiting adverse drug reactions against years on ARVs and specific ARV regimen. Methods: A retrospective cohort study was conducted in East London, South Africa. All patient files in the pediatric (0 – 18 years) ARV cohort were examined, selecting only those patients started on HAART. ARV regimen changes explicitly due to AE, age on ARV treatment onset, age of AE onset, and gender were extrapolated. Eligible subjects were obtained from patient folders, anonymized and cross-referenced with data obtained from electronic records. A total of 1120 patients [592 male (52.9%) and 528 female (47.1%)] were charted by incidence and year. Additional information was extrapolated in cases where the patient experienced lipodystrophy and lipoatrophy to include the number of years on ARVs prior to the onset of the AE. Results: Of the 1120 HIV infected children of the hospital cohort, a total of 105 (9.37%) AE (53.3% male) observed were deemed eligible for the study due to completeness of medical history and agreement between electronic records and paper files. The AE cited were as follows: lipoatrophy 62 (5.53% of all subjects), lipodystrophy 27 (2.41%), neuropathy 9 (0.8%), anemia 2 (0.17%), Steven Johnsons Syndrome 1 (0.08%), elevated LFTs 1 (0.8%), breast hypertrophy (0.08%), gastritis 1 (0.08%) and rash 1 (0.08%). The most prevalence ARV regimens associated with the onset of the AE are: D4T/3TC/EFV 72 cases (64.86% of all AE), D4T/3TC/LOPr 24 cases (21.62%). Lipoatrophy and lipodystrophy combined represent 84.76% (89 cases) of all adverse events documented in this cohort. Within the 60 cases of lipoatrophy, the average number of years on ARVs associated with an AE is 3.54, with 14 cases experiencing an AE between 0-2 years of HAART. Within the 29 cases of lipodystrophy, the average number of years on ARVs associated with an AE is 3.89, with 4 cases experiencing an AE between 0-2 years on HAART. The regimen D4T/3TC/EFV is associated with 43 cases (71.66%) of lipoatrophy and 21 cases (72.41%) of lipodystrophy. D4T/3TC/LOPr is associated with 15 cases (25%) of lipoatrophy and 7 cases (24.14%) of lipodystrophy. The frequency of AE associated with ARV regimens could be misrepresented due to prevalence of different 1st line regimens which were not captured in this study, particularly with the systematic change of 1st line drugs from D4T to ABC in 2010. Conclusion: In this descriptive study we found a 9.37% prevalence of AE were significant enough to be treatment limiting among our cohort. Lipoatrophy accounted for 59.04% of all documented AE. Overall, D4T/3TC/EFV was associated with 64.86% of all AE, 71.66% of lipoatrophy cases and 72.41% of lipodystrophy cases.

Keywords: ARV, adverse events, HAART, pediatric

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Authors: Sneha Manjunath

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Architecture is a continuous process of evolution that keeps changing and evolving through time and gives rise to various design solutions based on the purpose of change and the present function of the space. This evolution in design has been happening for a long time and hence a variety of climate-responsive, context-responsive and human-responsive developments in habitats are witnessed. India has been one of the hot spots for the conservation of heritage and architecture. Buildings ranging from Indus-valley civilization to modern contemporary dwellings have all evolved in one or the other way. Various historical sites such as Hampi in Karnataka, Taj Mahal in Agra and various temples in Southern India are identified and preserved under the Archeological Survey of India. The main objective of such preservation is to help in protecting, preserving and keeping it intact for the future. Study of such heritage-rich buildings and building techniques helps us in understanding the psychology, lifestyle and socio-cultural impacts it had on the complete urban fabric that developed in a region. It also gives an insight into the occupation, economic status and religious beliefs that gave rise to a pattern in an urban form that was more inclusive and appropriate as per the need of the users. Today’s generation draws various inspirations from history with respect to space planning, building services such as lighting, ventilation and sanitation systems and elevation treatments. It is important to know and understand the importance of certain urban planning techniques used to develop ancient towns or cities in a radial pattern, square pattern, or checkered pattern depending on the need of the administrative set-up of the respective town or city. It is believed that every element of design undergoes evolution and it is important for a designer to know, respect and develop the same for the future so as to acknowledge and conserve every aspect of heritage that has been a backbone in urban form generation even today. Hampi in the Karnataka state of India is a very good example of how the monuments and dwellings from 14th Century still stand strong. Temples from North India, such as Kedarnath Temple, survived heavy floods because of their building techniques. Such building materials and construction techniques are to be revived and reused for a better perspective towards space planning in urbanized cities.

Keywords: architecture, urban form, heritage, town planning

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

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

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

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Authors: Seung Oh, Satoshi Okada

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Today, religious organizations that have long existed alongside local people are being challenged by social changes in the districts they control. The influence of religious organizations is declining everywhere as locals seeking diversity and economic benefits become more interested in developing projects that attract investors and increase market value instead of opting for conservation. Religions whose moral and philosophical stance rejects materialism have a limited capacity to act as agents of local development in modern society. However, in Tokyo, the city’s oldest temple, Senso-Ji played a vital role in the local development of Asakusa, as an entertainment district while nevertheless retaining the area’s traditional character, despite almost complete destruction caused by the Tokyo air raids. The temple played a vigorous role as a mediator between the community and the Tokyo Metropolitan Government as a spokesman for common interests. This research, therefore, examines the social conflicts that Senso-Ji has confronted with regard to the pressures of development of Asakusa on the one hand, and the legitimacy of perpetuating its traditional religious and cultural role in local society on the other. First, this article examines Senso-Ji’s place in society based on its location in the history of Japanese Buddhism, which existed to offer spiritual and practical help to the ordinary people, and to investigate its social legitimacy as a local stakeholder and historical institution. Second, this paper considers the impact of the social changes that Asakusa had undergone during the Meiji and Taisho eras, by examining the social conflicts and changes in the Asakusa entertainment district, taking the Tokyo Air Raids as the Inceptive Point (IP). Third, it reconsiders how Senso-Ji responded to today’s growth-oriented local developments, as proposed by Tokyo’s Metropolitan planning authorities along lines commonly seen in all cities. Studying the role of Senso-Ji in the development of Asakusa can serve as a case study to justify the involvement of religious institutions in local issues and as a useful and practical example of progressive development which nevertheless permitted conservation of traditional features, as a result of pressure from social groups in a way that may be useful for other places facing similar problems.

Keywords: Architecture, Urban Design, Urban Planning, Preservation, Conservation, Social Science

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Authors: Bar Shapira-Youngster, Sima Amram-Vaknin, Yuliya Lipshits-Braziler

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The study examined how 811 Israelis experienced and coped with the COVID-19 lockdown. Stress, uncertainty, and loss of control were reported as common emotional experiences. Two main difficulties were reported: Loneliness and health and emotional concerns. Frequent explanations for the virus's emergence were: scientific or faith reasoning. The most prevalent coping strategies were distraction activities and acceptance. Reducing the use of maladaptive coping strategies has important implications for mental health outcomes. Objectives: COVID-19 has been recognized as a collective, continuous traumatic stressor. The present study examined how individuals experienced, perceived, and coped with this traumatic event during the lockdown in Israel in April 2020. Method: 811 Israelis (71.3% were women; mean age 43.7, SD=13.3)completed an online semi-structured questionnaire consisting two sections: In the first section, participants were asked to report background information. In the second section, they were asked to answer 8 open-ended questions about their experience, perception, and coping with the covid-19 lockdown. Participation was voluntary, and anonymity was assured, they were not offered compensation of any kind. The data were subjected to qualitative content analysis that seeks to classify the participants` answers into an effective number of categories that represent similar meanings. Our content analysis of participants’ answers extended far beyond simple word counts; our objective was to try to identify recurrent categories that characterized participants’ responses to each question. We sought to ensure that the categories regarding the different questions are as mutually exclusive and exhaustive as possible. To ensure robust analysis, the data were initially analyzed by the first author, and a second opinion was then sought from research colleagues. Contribution: The present research expands our knowledge of individuals' experiences, perceptions, and coping mechanisms with continuous traumatic events. Reducing the use of maladaptive coping strategies has important implications for mental health outcomes.

Keywords: Covid-19, emotional distress, coping, continuous traumatic event

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Authors: Nezihe Şengün, Ragip Pala

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To prevent overweight and obesity, individuals need to consume food and beverages according to their nutritional needs, engage in regular exercises, and regularly monitor their body weight. This study aimed to examine the effects of exercise, diet, or combined intervention on changes in blood lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides) and the level of malondialdehyde (MDA), a marker of oxidative stress, in parallel with the increase in body weight due to poor nutrition and sedentary lifestyle conditions. The study included a total of 48 female students aged 18-28 years with a BMI between 25.0 and 29.9 kg/m². They were divided into four groups: control (C), exercise (Ex), diet (D), and exercise+diet (Ex+D). Those in the exercise groups received aerobic exercises at 60-70% intensity (10 minutes warm-up, 30 minutes running, 10 minutes cool-down), while those in the diet groups were provided with a diet program based on the calculation of energy needs considering basal metabolic rate, physical activity level, age, and BMI. The students’ body weight, body fat mass, Body Mass Index (BMI), and waist-hip ratios were measured at the beginning (day 1) and end (day 60) of the 8-week intervention period. Their total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and MDA levels were evaluated and analyzed, considering a statistical significance level of p<0.05. As a result, female students in the Ex+D group had the largest difference in body weight, body fat mass, BMI, and waist-hip ratios, and this difference was statistically significant. Except for those in the C group, those in the other groups experienced a decrease in their total cholesterol, LDL cholesterol, and triglyceride levels and an increase in their HDL cholesterol levels. The decrease in total cholesterol, LDL cholesterol, and triglyceride levels was statistically significant for those in the D group, and the increase in HDL cholesterol level was statistically significant for those in the Ex+D group (p<0.05). A decrease in MDA level was found in all groups except those in the C group, and this decrease was significantly higher in the Ex group. In conclusion, our study revealed that the most effective way to achieve weight loss is through a combination of exercise and diet. The application of Ex+D is considered to balance blood lipid levels and suppress oxidative stress.

Keywords: obesity, exercise, diet, body mass index, blood lipids

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Authors: Hala Obeid

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Among the cities that have been touched by hard events and have been experiencing this polemic of existence, one can quote Beirut. A city that defies and confronts itself for its own existence. Beirut materialized all the social complexity; it has also preserved the memory of a society that has been able to build and reflect a certain unique identity. In spite of its glory, Lebanon’s civil war has marked a turning point in Beirut’s history. It has caused many deaths and opposed religious communities. Once this civil war has ended, the reconstruction of the city center, however, saw the spatial exclusion of manual labor, small local commerce, and middle-class residences. The urban functions that characterized the pre-war center were removed, and the city’s spontaneous evolutions were replaced by a historical urban planning, which neglected the city’s memory and identity. The social and spatial fragmentation that has erupted since the war has led to a breakdown of spatial and social boundaries within the city. The aim of this study is to evaluate the impact of fragmentation and boundaries on the city of Beirut in spatial, social, religious and ethnic terms. The method used in this research is what we call the mixed method which is a combination between the quantitative method and the qualitative one. These two approaches, in this case, do not oppose but complement each other in order to study the city of Beirut physically and socially. The main purpose of the qualitative approach is to describe and analyze the social phenomenon of the fragmentation of the city; this method can be summarized by the field observation and study. While the quantitative approach is based on filling out questionnaires that leads to statistics analyzes. Together, these two approaches will mark the course of the research. As a result, Beirut is not only a divided city but is fragmented spatially into many fragments and socially into many groups. This fragmentation is creating immaterial boundaries between fragments and therefore between groups. These urban and social boundaries are specifically religious and ethnic limits. As a conclusion, one of the most important and discussed boundary in Beirut is a spatial and religious boundary called ‘the green line’ or the demarcation line, a true caesura within the city. It marks the opposition of two urban groups and the aggravated fragmentation between them. This line divided Beirut into two compartments: East Beirut (for Christians) and West Beirut (for Muslims). This green line has become an urban void that holds the past in suspension. Finally, to think of Beirut as an urban unit becomes an insoluble problem.

Keywords: Beirut, boundaries, fragmentation, identity

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Authors: A. Georgiou, A. Galani, A. Karatza, G. E. Bampasidis

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Augmented Reality (AR) technology has become integral in enhancing visitor experiences at Greece's UNESCO World Heritage Sites. This research meticulously investigates various facets of AR applications/games associated with these revered sites. The cultural heritage represents the identity of each nation in the world. Technology can breathe life into this identity. Through Augmented Reality (AR), individuals can travel back in time, visit places they cannot access in real life, discover the history of these places, and live unique experiences. The study examines the objectives and intended goals behind the development and deployment of each augmented reality application/game pertaining to the UNESCO World Heritage Sites in Greece. It thoroughly analyzes the scenarios presented within these AR games/applications, examining how historical narratives, interactive elements, and cultural context are incorporated to engage users. Furthermore, the research identifies and assesses the technological platforms utilized for the development and implementation of these AR experiences, encompassing mobile devices, AR headsets, or specific software frameworks. It classifies and examines the types of augmented reality employed within these applications/games, including marker-based, markerless, location-based, or immersive AR experiences. Evaluation of the benefits accrued by visitors engaging with these AR applications/games, such as enhanced learning experiences, improved cultural understanding, and heightened engagement with the heritage sites, forms a crucial aspect of this study. Additionally, the research scrutinizes potential drawbacks or limitations associated with the AR applications/games, considering technological barriers, user accessibility issues, or constraints affecting user experience. By thoroughly investigating these pivotal aspects, this research aims to provide a comprehensive overview and analysis of the landscape of augmented reality applications/games linked to the UNESCO World Heritage Sites in Greece. The findings seek to contribute nuanced insights into the effectiveness, challenges, and opportunities associated with leveraging AR technology for heritage site preservation, visitor engagement, and cultural enrichment.

Keywords: augmented reality, AR applications, UNESCO sites, cultural heritage, Greece, visitor engagement, historical narratives

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Authors: Banu Hatice Gürcüm, Pınar Arslan, Mahmut Yalçın

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Fashion designers create lots of dresses, suits, shoes, and other clothing and accessories, which are purchased every year by consumers. Fashion trends, sketches of designs, accessories affect the apparel goods, but colors make the finishing touches to an outfit. In all fields of apparel men's, women's, and children's wear, including casual wear, suits, sportswear, formal wear, outerwear, maternity, and intimate apparel, color sells. Thus, specialization in color in apparel is a basic concern each season. The perception of color is the key to sales for every sector in textile business. Mechanism of color perception, cognition in brain and color emotion are unique subjects, which scientists have been investigating for many years. The parameters of color may not be corresponding to visual scales since human emotions induced by color are completely subjective. However, with a very few exception each manufacturer concern their top selling colors for each season through seasonal sales reports of apparel companies. This paper examines sensory and instrumental methods for quantifying color of fabrics and investigates the relationship between fabric color and sale numbers. 5 top selling colors for each season from 10 leading apparel companies in the same segment are taken. The compilation is based according to the sales of the companies for 5 to 10 years. The research’s main concern is the corelation with the magnitude of seasonal color selling figures and the CIE chromaticity coordinates. The colors are chosen from the globally accepted Pantone Textile Color System and the three-dimentional measurement system CIE L*a*b* (CIELAB) is used, L* representing the degree of lightness of color, a* the degree of color ranging from magenta to green, and b* the degree of color ranging from blue to yellow. The objective of this paper is to demonstrate the feasibility of relating color perceptance to a laboratory instrument yielding measurements in the CIELAB system. Our approach is to obtain a total of a hundred reference fabrics to be measured on a laboratory spectrophotometer calibrated to the CIELAB color system. Relationships between the CIE tristimulus (X, Y, Z) and CIELAB (L*, a*, b*) are examined and are reported herein.

Keywords: CIELAB, CIE tristimulus, color preference, fashion

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Authors: Tsu-Yin Wu, Jenni Hoffman, Lydia McMurrows, Sarah Lally

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Recent events of the Flint Water Crisis and elevated lead levels in Detroit public school water have highlighted a specific public health disparity and shown the need for better education of healthcare providers on lead education. Identifying children and pregnant women with a high risk for lead poisoning and ensuring lead testing is completed is critical. The purpose of this study is to explore the impact of an educational intervention on knowledge and confidence levels among nursing students enrolled in the prelicensure Bachelor of Science in Nursing (BSN) and Registered Nurse to BSN program (R2B). The study used both quantitative and qualitative research methods to assess the impact of multi-modal pedagogy on knowledge and confidence of lead screening and prevention among prelicensure and R2B nursing students. The students received lead poisoning and prevention content in addition to completing an e-learning module developed by the Pediatric Environmental Health Specialty Units. A total of 115 students completed the pre-and post-test instrument that consisted of demographic, lead knowledge, and confidence items. Despite the increase of total knowledge, three dimensions of lead poisoning, and confidence from pre- to post-test scores for both groups, there was no statistical significance on the increase between prelicensure and R2B students. Thematic analysis of qualitative data showed five themes from participants' learning experiences: lead exposure, signs and symptoms of lead poisoning, screening and diagnosis, prevention, and policy and statewide issues. The study is limited by a small sample and participants recalling some correct answers from the pretest, thus, scoring higher on the post-test. The results contribute to the minimally existent literature examining a critical public health concern regarding lead health exposure and prevention education of nursing students. Incorporating such content area into the nursing curriculum is essential in ensuring that such public health disparities are mitigated.

Keywords: lead poisoning, emerging public health issue, community health, nursing edducation

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Authors: Asma AlAmri, Ahmed Hassab Errasoul

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Background & Objectives: Psychiatric disorders are common, affecting approximately one of five adults (17.6%) of the population. While most patients can be successfully treated as outpatients, admission to psychiatric wards is required during relapses or as part of crisis intervention. The first 72h of admission could be particularly critical due to increased risk of physical violence, non-medical discharge and absconding. Many patients requiring interventions such as seclusion, physical restrain, PRN psychotropic medications. This study aims to investigate the relationship between demographical, clinical and pharmacological factors in one hand and certain outcomes (physical aggression, use of PRN medications, need for seclusions and non-medical discharges) within the first 72hours of admission to acute psychiatric wards in KKUH/Riyadh Methods: All admissions to psychiatric wards over a 20 month period, between (May 2015- January 2017) were included. Data was collected on demographics, diagnosis, psychotropic medications prescription, documented physical aggression, and seclusion, self-discharge and absconding. Results: 134 males and 171 females were admitted over the study period. Mean age was 34.2 years (SD 11.96).48.9% (n=149) were single and most patients (n=198) were either unemployed or in educations. Bipolar disorder was the most frequent diagnosis recorded on admission (39.3%, n=120); followed by Schizophrenia and related disorders (34.8%; n=106). Most patients (77.4%, n= 236) received regular psychotropic medications on admission. Vis a vis, 223 patients (73%) received PRN medications. Nominal regression model revealed positive relationship between “no psychotropics prescribed on admission” and self-discharge in women but not in men. No statistically significant relationship was found between age, gender, admission diagnosis and use of regular psychotropic medications on admission and need for seclusion, time spent in seclusion, documented physical aggression and use of PRN medications. Conclusion: Contrary to what is expected, our study does not show association between gender, physical aggression and need for seclusion. This could be due to poor documentation practices by nursing staff in male ward comparing with those in the female ward. Use of PRN psychotropics in the first 72 hours of admission was quite high possibly leading to a “ceiling effect”. A limitation of this study is the retrospective data collection.

Keywords: discharge against medical advice, physical aggression, psychotropics, seclusion

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Authors: Wajiha Javed, Arsalan Jabbar, Nelofer Mehboob, Muhammad Tafseer, Zahid Memon

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Introduction: Researchers globally have strived to explore diverse factors that augment the continuation and uptake of family planning methods. Clients’ satisfaction is one of the core determinants facilitating continuation of family planning methods. There is a major debate yet scanty evidence to contrast public and private sectors with respect to client satisfaction. The objective of this study is to compare quality-of-care provided by public and private sectors of Pakistan through a client satisfaction lens. Methods: We used Pakistan Demographic Heath Survey 2012-13 dataset (Sindh province) on a total of 3133 Married Women of Reproductive Age (MWRA) aged 15-49 years. Source of family planning (public/private sector) was the main exposure variable. Outcome variable was client satisfaction judged by ten different dimensions of client satisfaction. Means and standard deviations were calculated for continuous variable while for categorical variable frequencies and percentages were computed. For univariate analysis, Chi-square/Fisher Exact test was used to find an association between clients’ satisfaction in public and private sectors. Ten different multivariate models were made. Variables were checked for multi-collinearity, confounding, and interaction, and then advanced logistic regression was used to explore the relationship between client satisfaction and dependent outcome after adjusting for all known confounding factors and results are presented as OR and AOR (95% CI). Results: Multivariate analyses showed that clients were less satisfied in contraceptive provision from private sector as compared to public sector (AOR 0.92,95% CI 0.63-1.68) even though the result was not statistically significant. Clients were more satisfied from private sector as compared to the public sector with respect to other determinants of quality-of-care (follow-up care (AOR 3.29, 95% CI 1.95-5.55), infection prevention (AOR 2.41, 95% CI 1.60-3.62), counseling services (AOR 2.01, 95% CI 1.27-3.18, timely treatment (AOR 3.37, 95% CI 2.20-5.15), attitude of staff (AOR 2.23, 95% CI 1.50-3.33), punctuality of staff (AOR 2.28, 95% CI 1.92-4.13), timely referring (AOR 2.34, 95% CI 1.63-3.35), staff cooperation (AOR 1.75, 95% CI 1.22-2.51) and complications handling (AOR 2.27, 95% CI 1.56-3.29).

Keywords: client satisfaction, family planning, public private partnership, quality of care

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Authors: Hebah M. Musalem, Jeylan El-Mansoury, Lin M. Tuleimat, Selwa Alhazza, Abdul-Aziz A. Al Zoba

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Background: Amblyopia is a condition that affects the visual system triggering a decrease in visual acuity without a known underlying pathology. It is due to abnormal vision development in childhood or infancy. Most importantly, vision loss is preventable or reversible with the right kind of intervention in most of the cases. Strabismus, sensory defects, and anisometropia are all well-known causes of amblyopia. However, ocular misalignment in Strabismus is considered the most common form of amblyopia worldwide. The risk of developing amblyopia increases in premature children, developmentally delayed or children who had brain lesions affecting the visual pathway. The prevalence of amblyopia varies between 2 to 5 % in the world according to the literature. Objective: To determine the different causes of Amblyopia in pediatric patients seen in ophthalmology clinic of a tertiary care center, i.e. King Faisal Specialist Hospital and Research Center (KFSH&RC). Methods: This is a hospital based, random retrospective, based on reviewing patient’s files in the Ophthalmology Department of KFSH&RC in Riyadh city, Kingdom of Saudi Arabia. Inclusion criteria: amblyopic pediatric patients who attended the clinic from 2015 to 2016, who are between 6 months and 18 years old. Exclusion Criteria: patients above 18 years of age and any patient who is uncooperative to obtain an accurate vision or a proper refraction. Detailed ocular and medical history are recorded. The examination protocol includes a full ocular exam, full cycloplegic refraction, visual acuity measurement, ocular motility and strabismus evaluation. All data were organized in tables and graphs and analyzed by statistician. Results: Our preliminary results will be discussed on spot by our corresponding author. Conclusions: We focused on this study on utilizing various examination techniques which enhanced our results and highlighted a distinguished correlation between amblyopia and its’ causes. This paper recommendation emphasizes on critical testing protocols to be followed among amblyopic patient, especially in tertiary care centers.

Keywords: amblyopia, amblyopia causes, amblyopia diagnostic criterion, amblyopia prevalence, Saudi Arabia

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Authors: Nicolas Bae, Theodore L. Karavasilis

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Increasingly, a large number of new and existing tall buildings are required to improve their resilient performance against strong winds and earthquakes to minimize direct, as well as indirect damages to society. Those advent stationary functions of tall building structures in metropolitan regions can be severely hazardous, in socio-economic terms, which also increase the requirement of advanced seismic performance. To achieve these progressive requirements, the seismic reinforcement for some old, conventional buildings have become enormously costly. The methods of increasing the buildings’ resilience against wind or earthquake loads have also become more advanced. Up to now, vibration control devices, such as the passive damper system, is still regarded as an effective and an easy-to-install option, in improving the seismic resilience of buildings at affordable prices. The main purpose of this paper is to examine 1) the optimization of the shape of visco plastic brace damper (VPBD) system which is one of hybrid damper system so that it can maximize its energy dissipation capacity in tall buildings against wind and earthquake. 2) the verification of the seismic performance of the visco plastic brace damper system in tall buildings; up to forty-storey high steel frame buildings, by comparing the results of Non-Linear Response History Analysis (NLRHA), with and without a damper system. The most significant contribution of this research is to introduce the optimized hybrid damper system that is adequate for high rise buildings. The efficiency of this visco plastic brace damper system and the advantages of its use in tall buildings can be verified since tall buildings tend to be affected by wind load at its normal state and also by earthquake load after yielding of steel plates. The modeling of the prototype tall building will be conducted using the Opensees software. Three types of modeling were used to verify the performance of the damper (MRF, MRF with visco-elastic, MRF with visco-plastic model) 22-set seismic records used and the scaling procedure was followed according to the FEMA code. It is shown that MRF with viscous, visco-elastic damper, it is superior effective to reduce inelastic deformation such as roof displacement, maximum story drift, roof velocity compared to the MRF only.

Keywords: tall steel building, seismic retrofit, viscous, viscoelastic damper, performance based design, resilience based design

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Authors: Ajay Kumar Sinha, Sharad Singh, Anukriti Sinha

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Passive energy dissipation method for earthquake protection of structures is undergoing developments for improved performance. Combined use of different types of damping mechanisms has shown positive results in the near past. Different supplemental damping methods like viscous damping, frictional damping and metallic damping are being combined together for optimum performance. The conventional method of connecting passive dampers to structures is a parallel connection between the damper unit and structural member. Researchers are investigating coupling effect of different types of dampers. The most popular choice among the research community is coupling of viscous dampers and frictional dampers. The series and parallel coupling of these damping units are being studied for relative performance of the coupled system on response control of structures against earthquake. In this paper an attempt has been made to couple Fluid Viscous Dampers and Frictional Dampers in series and parallel to form a single unit of damping system. The relative performance of the coupled units has been studied on three dimensional reinforced concrete framed structure. The current theories of structural dynamics in practice for viscous damping and frictional damping have been incorporated in this study. The time history analysis of the structural system with coupled damper units, uncoupled damper units as well as of structural system without any supplemental damping has been performed in this study. The investigations reported in this study show significant improved performance of coupled system. A higher natural frequency of the system outside the forcing frequency has been obtained for structural systems with coupled damper units as against the other cases. The structural response of the structure in terms of storey displacement and storey drift show significant improvement for the case with coupled damper units as against the cases with uncoupled units or without any supplemental damping. The results are promising in terms of improved response of the structure with coupled damper units. Further investigations in this regard for a comparative performance of the series and parallel coupled systems will be carried out to study the optimum behavior of these coupled systems for enhanced response control of structural systems.

Keywords: frictional damping, parallel coupling, response control, series coupling, supplemental damping, viscous damping

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Authors: Oluwatosin Adewale

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The sustainability of built heritage has become a relevant issue in recent years due to the social and economic values associated with these buildings. Heritage buildings provide a means for human perception of culture and represent a legacy of long-existing history; they define the local character of the social world and provide a vital connection to the past with their associated aesthetical and communal benefits. The identified values of heritage buildings have increased the importance of conservation and the lifecycle management of these buildings. The recent developments of digital design technology in engineering and the built environment have led to the adoption of Building Information Modelling (BIM) by the Architecture, Engineering, Construction, and Operations (AECO) industry. BIM provides a platform for the lifecycle management of a construction project through effective collaboration among stakeholders and the analysis of a digital information model. This growth in digital design technology has also made its way into the field of architectural heritage management in the form of Historic Building Information Modelling (HBIM). A reverse engineering process for digital documentation of heritage assets that draws upon similar information management processes as the BIM process. However, despite the several scientific and technical contributions made to the development of the HBIM process, it doesn't remain easy to integrate at the most practical level of heritage asset management. The main objective identified under the scope of the study is to review the limitations and challenges faced by heritage management professionals in adopting an HBIM-based asset management procedure for historic building projects. This paper uses an exploratory study in the form of semi-structured interviews to investigate the research problem. A purposive sample of heritage industry experts and professionals were selected to take part in a semi-structured interview to appraise some of the limitations and challenges they have faced with the integration of HBIM into their project workflows. The findings from this study will present the challenges and limitations faced in applying and integrating the HBIM concept for the management of historic buildings.

Keywords: building information modelling, built heritage, heritage asset management, historic building information modelling, lifecycle management

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Authors: Jiazhen Chen, Yue Sun, Joanne Yip, Kit-Lun Yick

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The design of sports bras poses a considerable challenge due to the difficulty in accurately predicting the wearing result after computer-aided design (CAD). It needs repeated physical try-on or virtual try-on to obtain a comfortable pressure range during motion. Specifically, in the context of running, the exact support area and force exerted on the breasts remain unclear. Consequently, obtaining an effective method to design the sports bra pads shape becomes particularly challenging. This predicament hinders the successful creation and production of sports bras that cater to women's health needs. The purpose of this study is to propose an effective method to obtain the 3D shape of sports bra pads and to understand the relationship between the supporting force and the 3D shape parameters of the pads. Firstly, the static 3D shape of the sports bra pad and human motion data (Running) are obtained by using the 3D scanner and advanced 4D scanning technology. The 3D shape of the sports bra pad is parameterised and simplified by Free-form Deformation (FFD). Then the sub-models of sports bra and human body are constructed by segmenting and meshing them with MSC Apex software. The material coefficient of sports bras is obtained by material testing. The Marc software is then utilised to establish a dynamic contact model between the human breast and the sports bra pad. To realise the reverse design of the sports bra pad, this contact model serves as a forward model for calculating the inverse problem. Based on the forward contact model, the inverse problem of the 3D shape parameters of the sports bra pad with the target bra-wearing pressure range as the boundary condition is solved. Finally, the credibility and accuracy of the simulation are validated by comparing the experimental results with the simulations by the FE model on the pressure distribution. On the one hand, this research allows for a more accurate understanding of the support area and force distribution on the breasts during running. On the other hand, this study can contribute to the customization of sports bra pads for different individuals. It can help to obtain sports bra pads with comfortable dynamic pressure.

Keywords: sports bra design, breast motion, running, inverse problem, finite element dynamic model

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Authors: Brid Dinnee, Jessica Taylor, Joseph Hartland, Michael Natarajan

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Background:The third stage of labour (TSL) can be complicated by Post-Partum Haemorrhage (PPH), which can have a significant impact on maternal mortality and morbidity. In Africa, 33.9% of maternal deaths are attributable to PPH1. In order to minimise this figure, current recommendations for the developing world are that all women have active management of the third stage of labour (AMTSL). The aim of this project was to examine TSL practice in a rural Ugandan Hospital, highlight any deviation from best practice and identify barriers to change in resource limited settings as part of a 4th year medical student External Student Selected Component field trip. Method: Five key elements from the current World Health Organisation (WHO) guidelines on AMTSL were used to develop an audit tool. All daytime vaginal deliveries over a two week period in July 2016 were audited. In addition to this, a retrospective comparison of PPH rates, between 2006 (when ubiquitous use of intramuscular oxytocin for management of TSL was introduced) and 2015 was performed. Results: Eight vaginal deliveries were observed; at all of which intramuscular oxytocin was administered and controlled cord traction used. Against WHO recommendation, all umbilical cords were clamped within one minute, and no infants received early skin-to-skin contact. In only one case was uterine massage performed after placental delivery. A retrospective comparison of data rates identified a 40% reduction in total number of PPHs from November 2006 to November 2015. Maternal deaths per delivery reduced from 2% to 0.5%. Discussion: Maternal mortality and PPH are still major issues in developing countries. Maternal mortality due to PPH can be reduced by good practices regarding TSL, but not all of these are used in low-resource settings. There is a notable difference in outcomes between the developed and developing world. At Kitovu Hospital, there has been a reduction in maternal mortality and number of PPHs following introduction of IM Oxytocin administration. In order to further improve these rates, staff education and further government funding is key.

Keywords: post-partum haemorrhage, PPH, third stage labour, Uganda

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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

Procedia PDF Downloads 164

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

Procedia PDF Downloads 192

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: Amirreza Razzaghipour Sorkhab

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One of the most common disorders among humans is hearing impairment. This paper provides an evidence base that recovers understanding of Meniere’s disease and highlights the physical and mental health correlates of the disorder. Meniere's disease is more common in the elderly. The term idiopathic endolymphatic hydrops has been attributed to this disease by some in the previous. Meniere’s disease demonstrations a genetic tendency, and a family history is found in 10% of cases, with an autosomal dominant inheritance pattern. The COCH gene may be one of the hereditary factors contributing to Meniere’s disease, and the possibility of a COCH mutation should be considered in patients with Meniere’s disease symptoms. Should be considered Missense mutations in the COCH gene cause the autosomal dominant sensorineural hearing loss and vestibular disorder. Meniere’s disease is a complex, heterogeneous disorder of the inner ear and that is characterized by episodes of vertigo lasting from minutes to hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. The existing evidence supports the suggestion that age and sleep disorder are risk factors for Meniere's disease. Many factors have been reported to precipitate the progress of Menier, including endolymphatic hydrops, immunology, viral infection, inheritance, vestibular migraine, and altered intra-labyrinthine fluid dynamics. Although there is currently no treatment that has a proven helpful effect on hearing levels or on the long-term evolution of the disease, however, in the primary stages, the hearing may improve among attacks, but a permanent hearing loss occurs in the majority of cases. Current publications have proposed a role for the intratympanic use of medicine, mostly aminoglycosides, for the control of vertigo. more than 85% of patients with Meniere's disease are helped by either changes in lifestyle and medical treatment or minimally aggressive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. However, unilateral vestibular extirpation methods (intratympanic gentamicin, vestibular nerve section, or labyrinthectomy) are more predictable but invasive approaches to control the vertigo attacks. Medical therapy aimed at reducing endolymph volume, such as low-sodium diet, diuretic use, is the typical initial treatment.

Keywords: meniere's disease, endolymphatic hydrops, hearing loss, vertigo, tinnitus, COCH gene

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Authors: Jakub Młoźniak, Adam Szymański, Gabriela Stondzik, Dagny Krankowska, Tomasz Mikuła

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Nontuberculous mycobacteria (NTM) are bacterial species that cause diversely manifesting diseases mainly in immunocompromised patients. In people with HIV, NTM infection is an AIDS-defining disease and usually appears when the lymphocyte T CD4 count is below 50 cells/μl. The usage of antiretroviral therapy has decreased the prevalence of NTM among people with HIV, but the disease can still be observed especially among patients with late HIV diagnosis. Common presence in environment, human colonization, clinical similarity with tuberculosis and slow growth on culture makes NTM especially hard to diagnose. The study aimed to analyze the epidemiology and clinical course of NTM among patients with HIV. This study included patients with NTM and HIV admitted to our department between 2017 and 2023. Medical records of patients were analyzed and data on age, sex, median time from HIV diagnosis to identification of NTM infection, median CD4 count at NTM diagnosis, methods of determining NTM infection, type of species of mycobacteria identified, clinical symptoms and treatment course were gathered. Twenty-four patients (20 men, 4 women) with identified NTM were included in this study. Among them, 20 were HIV late presenters. The patients' median age was 40. The main symptoms which patients presented were fever, weight loss and cough. Pulmonary disease confirmed with positive cultures from sputum/bronchoalveolar lavage was present in 18 patients. M. avium was the most common species identified. M. marinum caused disseminated skin lesions in 1 patient. Out of all, 5 people were not treated for NTM caused by lack of symptoms and suspicion of colonization with mycobacterium. Concomitant tuberculosis was present in 6 patients. The median diagnostic time from HIV to NTM infections was 3.5 months. The median CD4 count at NTM identification was 69.5 cells/μl. Median NTM treatment time was 16 months but 7 patients haven’t finished their treatment yet. The most commonly used medications were ethambutol and clarithromycin. Among analyzed patients, 4 of them have died. NTM infections are still an important disease among patients who are HIV late presenters. This disease should be taken into consideration during the differential diagnosis of fever, weight loss and cough in people with HIV with lymphocyte T CD4 count <100 cells/μl. Presence of tuberculosis does not exclude nontuberculous mycobacterium coinfection.

Keywords: mycobacteriosis, HIV, late presenter, epidemiology

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Authors: Stanimira Ntermentzieva

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Gender studies in post-communist Eastern Europe emerged in the early 1990s after the collapse of the communist regime. It can be explained by a series of cultural and political factors. However, Bulgarian female composers’ contribution to Western art music has not been studied. This field shows us some aspects of the impact of globalization on gender issues. This paper outlines the female composers in the establishment of the modern Bulgarian state and society. It is dedicated to the Bulgarian award-winning female composers who studied in Western European and American universities in the 1990s. Many of them migrated to these regions as part of a great migration in which Bulgaria lost 2.3 to three million of its population and strived to modernize Bulgarian music. Nowadays, the Union of Bulgarian Composers has 262 members, but only 19 of them are women. The Grammy-awarded Penka Kouneva (b. 1967) is one of the few female composers in Hollywood. She composed and orchestrated film scores, music for video games and television. Anna-Maria Ravnopolska-Dean (b. 1960) is a Bulgarian/American harpist, arranger, composer, pedagogue and TV host. She wrote pieces for harp and chamber ensembles. Maria Panayotova (b. 1976) studied composition in the USA. Alexandra Fol (b. 1981) and Vania Angelova (b. 1954) work in Canada and are recipients of grants from the Canada Council for the Arts and the Bulgarian Ministry of Culture, among others. Afroditi Katmeridou, born in Bulgaria in 1956 by Greek parents, was the first woman who wrote electroacoustic music. One of the well-known contemporary composers is the British/Bulgarian Dobrinka Tabakova (b. 1980). She moved with her family to the United Kingdom when she was 11 and studied Composition at Guildhall School of Music and Drama in London. Her album String Paths was nominated for a Grammy award. Many female composers made a successful career in EU countries: Albena Petrovic-Vratchanska (Luxemburg), Yuliana Tochkova-Patrouilleau (France), Dariana Kumanova (Italy), Tveta Dimitrova (Austria), Ivajla Kirova (Germany), Alexandra Karastoyanova-Hermentin (Austria) and more.

Keywords: balgarian music, female composers, gender studies, western art music, migration

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Authors: Tasha L. Golden

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Girls in the U.S. juvenile justice system are most often arrested for truancy, drug use, or running from home, all of which are symptoms of abuse. In fact, some have called this 'The Sexual Abuse to Prison Pipeline.' Such abuse has consequences for girls' health, education, employment, and parenting, often resulting in significant health disparities. Yet when arrested, girls rarely encounter services designed to meet their unique needs. Instead, they are expected to cope with a system that was historically designed for males. In fact, even literature advocating for increased gender equity frequently fails to include girls’ voices and firsthand accounts. In response to these combined injustices, public health researchers launched a trauma-informed creative writing intervention in a southern juvenile detention facility. The program was designed to improve the health of detained girls, while also establishing innovative methods of both data collection and social justice advocacy. Girls’ poems and letters were collected and coded, adding rich qualitative data to traditional survey responses. In addition, as part of the intervention, these poems are regularly published by international literary publisher Sarabande Books—and distributed to judges, city leaders, attorneys, state representatives, and more. By utilizing a creative medium, girls generated substantial civic engagement with their concerns—thus expanding their influence and improving policy advocacy efforts. Researchers hypothesized that having access to their communities and policy makers would provide its own health benefits for incarcerated girls: cultivating self-esteem, locus of control, and a sense of leadership. This paper discusses the establishment of this intervention, examines findings from its evaluation, and includes several girls’ poems as exemplars. Grounded in social science regarding expressive writing, stigma, muted group theory, and health promotion, the paper theorizes about the application of arts-based advocacy efforts to other social justice endeavors.

Keywords: advocacy, public health, social justice, women’s health

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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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