Search results for: care skills

Authors: Afshan Channa, Sameeha Aleem, Harim Mohsin

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First rank symptoms (FRS) are considered to be pathognomic for Schizophrenia. However, FRS is not a distinctive feature of Schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. The presence of FRS in Mania leads to misdiagnosis of psychotic illness, further complicating the management and delay of appropriate treatment. FRS in Mania is associated with poor clinical and functional outcome. Its existence in the first episode of bipolar disorder may be a predictor of poor short-term outcome and decompensating course of illness. FRS in Mania is studied in west. However, the cultural divergence and detriments make it pertinent to study the frequency of FRS in affective disorder independently in Pakistan. Objective: The frequency of first rank symptoms in manic patients, who were under treatment at psychiatric services of tertiary care hospital. Method: The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015. The patients who were unable to comprehend Urdu or had comorbid psychiatric or organic disorder were excluded. FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool. Result: The mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a p-value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness. 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity. 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception. Conclusion: The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders. Being married had no protective effect on the presence of FRS.

Keywords: first rank symptoms, Mania, psychosis, present state examination

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Authors: Inaam Khalaf, Nadin M. Abdel Razeq, Hamza Alduraidi, Suhaila Halasa, Omayyah S. Nassar, Eman Al-Horani, Jumana Shehadeh, Anna Talal

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Background: Nursing researchers are responsible for generating knowledge that corresponds to national and global research priorities in order to promote, restore, and maintain the health of individuals and societies. The objectives of this scoping review of Jordanian literature are to assess the existing research on pediatric nursing in terms of evolution, authorship and collaborations, funding sources, methodologies, topics of research, and pediatric subjects' age groups so as to identify gaps in research. Methodology: A search was conducted using related keywords obtained from national and international databases. The reviewed literature included pediatric health articles published through December 2019 in English and Arabic, authored by nursing researchers. The investigators assessed the retrieved studies and extracted data using a data-mining checklist. Results: The review included 265 articles authored by Jordanian nursing researchers concerning children's health, published between 1987 and 2019; 95% were published between 2009 and 2019. The most commonly applied research methodology was the descriptive non-experimental method (76%). The main generic topics were health promotion and disease prevention (23%), chronic physical conditions (19%), mental health, behavioral disorders, and forensic issues (16%). Conclusion: The review findings identified a grave shortage of evidence concerning nursing care issues for children below five years of age, especially those between ages two and five years. The research priorities identified in this review resonate with those identified in international reports. Implications: Nursing researchers are encouraged to conduct more research targeting topics of national-level importance in collaboration with clinically involved nurses and international scholars.

Keywords: Jordan, scoping review, children health nursing, pediatric, adolescents

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Authors: Paul Kipchumba

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Kenya is an East African Country lying at the Equator. It had a population of 46 million in 2015 with an annual growth rate of 2.7%, making a population of at least 65 million in 2030. Kenya’s GDP in 2015 was about 63 billion USD with per capita GDP of about 1400 USD. The rural population is 74%, whereas urban population is 26%. Kenya grapples with not only access to energy but also with energy security. There is direct correlation between economic growth, population growth, and energy consumption. Kenya’s energy composition is at least 74.5% from renewable energy with hydro power and geothermal forming the bulk of it; 68% from wood fuel; 22% from petroleum; 9% from electricity; and 1% from coal and other sources. Wood fuel is used by majority of rural and poor urban population. Electricity is mostly used for lighting. As of March 2015 Kenya had installed electricity capacity of 2295 MW, making a per capital electricity consumption of 0.0499 KW. The overall retail cost of electricity in 2015 was 0.009915 USD/ KWh (KES 19.85/ KWh), for installed capacity over 10MW. The actual demand for electricity in 2015 was 3400 MW and the projected demand in 2030 is 18000 MW. Kenya is working on vision 2030 that aims at making it a prosperous middle income economy and targets 23 GW of generated electricity. However, cost and non-cost factors affect generation and consumption of electricity in Kenya. Kenya does not care more about CO2 emissions than on economic growth. Carbon emissions are most likely to be paid by future costs of carbon emissions and penalties imposed on local generating companies by sheer disregard of international law on C02 emissions and climate change. The study methodology was a simulated application of carbon tax on all carbon emitting sources of electricity generation. It should cost only USD 30/tCO2 tax on all emitting sources of electricity generation to have solar as the only source of electricity generation in Kenya. The country has the best evenly distributed global horizontal irradiation. Solar potential after accounting for technology efficiencies such as 14-16% for solar PV and 15-22% for solar thermal is 143.94 GW. Therefore, the paper recommends adoption of solar power for generating all electricity in Kenya in order to attain zero carbon electricity generation in the country.

Keywords: co2 emissions, cost factors, electricity generation, non-cost factors

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Authors: Mohammed Alasel, Michael Keusgen

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Gold is a noble metal; in its nano-scale level (e.g. spherical nanoparticles), the conduction electrons are triggered to collectively oscillate with a resonant frequency when certain wavelengths of electromagnetic radiation interact with its surface; this phenomenon is known as surface plasmon resonance (SPR). SPR is responsible for giving the gold nanoparticles its intense red color depending mainly on its size, shape and distance between nanoparticles. A decreased distance between gold nanoparticles results in aggregation of them causing a change in color from red to blue. This aggregation enables gold nanoparticles to serve as a sensitive biosensoric indicator. In the proposed work, gold nanoparticles were modified with two proteins: i) Borrelia antigen, variable lipoprotein surface-exposed protein (VlsE), and ii) protein A. VlsE antigen induces a strong antibody response against Lyme disease and can be detected from early to late phase during the disease in humans infected with Borrelia. In addition, it shows low cross-reaction with the other non-pathogenic Borrelia strains. The high specificity of VlsE antigen to anti-Borrelia antibodies, combined simultaneously with the high specificity of protein A to the Fc region of all IgG human antibodies, was utilized to develop a rapid test for serological point of care diagnosis of borreliosis in human serum. Only in the presence of anti-Borrelia antibodies in the serum probe, an aggregation of gold nanoparticles can be observed, which is visible by a concentration-dependent colour shift from red (low IgG) to blue (high IgG). Experiments showed it is clearly possible to distinguish between positive and negative sera samples using a simple suspension of the two-protein modified gold nanoparticles in a very short time (30 minutes). The proposed work showed the potential of using such modified gold nanoparticles generally for serological diagnosis. Improved specificity and reduced assay time can be archived in applying increased salt concentrations combined with decreased pH values (pH 5).

Keywords: gold nanoparticles, gold aggregation, serological diagnosis, protein A, lyme borreliosis

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Authors: Ana Cristina Lindsay, Mary L. Greaney

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Background: Racial/ethnic minority children of low-income immigrant families remain at increased risk of obesity. Consistent with high rates of childhood obesity among racial/ethnic minority children are high rates of physical inactivity and increased levels of sedentary behaviors (e.g., TV and other screen viewing). Brazilians comprise a fast-growing immigrant population group in the US, yet little research has focused on the health issues affecting Brazilian immigrant children. The purpose of this qualitative study was to explore how Brazilian-born immigrant mothers living in the United States obtain information about physical activity and screen-time for their young children. Methods: Qualitative research including focus groups with Brazilian immigrant mothers of preschool-age children living in the U.S. Results: Results revealed that Brazilian immigrant mothers obtain information on young children’s physical activity and screen-time from a variety of sources including interpersonal communication, television and magazines, government health care programs (WIC program) and professionals (e.g., nurses and pediatricians). A noteworthy finding is the significant role of foreign information sources (Brazilian TV shows and magazines) on mothers’ access to information about these early behaviors. Future research is needed to quantify and better understanding Brazilian parents’ access to accurate and sound information related to young children’s physical activity and screen-viewing behaviors. Conclusions: To our knowledge, no existing research has examined how Brazilian immigrant mothers living in the United States obtain information about these behaviors. This information is crucial for the design of culturally appropriate early childhood obesity prevention interventions tailored to the specific needs of this ethnic group.

Keywords: physical activity, scree-time, information, immigrant, mothers, Brazilian, United States

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Authors: Nidia Thalia Alva Rangel, Ferran Padros Blazquez, Ma. Ines Gomez Del Campo Del Paso

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Happiness has been since antiquity a concept of interest around the world. Positive psychology is the science that begins to study happiness in a more precise and controlled way, obtaining wide amount of research which can be applied. One of the central constructs of Positive Psychology is Carol Ryff’s psychological well-being model as eudaimonic happiness, which comprehends six dimensions: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Humanistic psychology is a clear precedent of Positive Psychology, which has studied human development topics and it features a great variety of intervention techniques nevertheless has little evidence with controlled research. Therefore, the present research had the aim to evaluate the efficacy of a humanistic intervention program to increase psychological well-being in healthy adults through a mixed methods study. Before and after the intervention, it was applied Carol Ryff’s psychological well-being scale (PWBS) and the Symptom Check List 90 as pretest and posttest. In addition, a questionnaire of five open questions was applied after each session. The intervention program was designed in experiential workshop format, based on the foundational attitudes defined by Carl Rogers: congruence, unconditional positive regard and empathy, integrating humanistic intervention strategies from gestalt, psychodrama, logotherapy and psychological body therapy, with the aim to strengthen skills in the six dimensions of psychological well-being model. The workshop was applied to six volunteer adults in 12 sessions of 2 hours each. Finally, quantitative data were analyzed with Wilcoxon statistic test through the SPSS program, obtaining as results differences statistically significant in pathology symptoms between prettest and postest, also levels of dimensions of psychological well-being were increased, on the other hand for qualitative strand, by open questionnaires it showed how the participants were experiencing the techniques and changing through the sessions. Thus, the humanistic psychology program was effective to increase psychological well-being. Working to promote well-being prompts to be an effective way to reduce pathological symptoms as a secondary gain. Experiential workshops are a useful tool for small groups. There exists the need for research to count with more evidence of humanistic psychology interventions in different contexts and impulse the application of Positive Psychology knowledge.

Keywords: happiness, humanistic psychology, positive psychology, psychological well-being, workshop

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Authors: Fatma Koksal Cakirlar, Murat Gunaydin, Nevri̇ye Gonullu, Nuri Kiraz

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During the last few decades, the increasing prevalence of methicillin resistant-CoNS isolates has become a common problem worldwide. Macrolide-lincosamide-streptogramin B (MLSB) antibiotics are effectively used for the treatment of CoNS infections. However, resistance to MLSB antibiotics is prevalent among staphylococci. The aim of this study is to determine species distribution and the incidence of inducible clindamycin resistance in CoNS isolates caused nosocomial bacteremia in our hospital. Between January 2014 and October 2015, a total of 484 coagulase-negative CoNS isolates were isolated from blood samples of patients with true bacteremia who were hospitalized in intensive care units and in other departments of Istanbul University Cerrahpasa Medical Hospital. Blood cultures were analyzed with the BACTEC 9120 system (Becton Dickinson, USA). The identification and antimicrobial resistance of isolates were determined by Phoenix automated system (BD Diagnostic Systems, Sparks, MD). Inducible clindamycin resistance was detected using D-test. The species distribution was as follows: Staphylococcus epidermidis 211 (43%), S. hominis 154 (32%), S. haemolyticus 69 (14%), S. capitis 28 (6%), S. saprophyticus 11 (2%), S. warnerii 7 (1%), S. schleiferi 5 (1%) and S. lugdunensis 1 (0.2%). Resistance to methicillin was detected in 74.6% of CoNS isolates. Methicillin resistance was highest in S.hemoliticus isolates (89%). Resistance rates of CoNS strains to the antibacterial agents, respectively, were as follows: ampicillin 77%, gentamicin 20%, erythromycin 71%, clindamycin 22%, trimethoprim-sulfamethoxazole 45%, ciprofloxacin 52%, tetracycline 34%, rifampicin 20%, daptomycin 0.2% and linezolid 0.2%. None of the strains were resistant to vancomycin and teicoplanin. Fifteen (3%) CoNS isolates were D-test positive, inducible MLSB resistance type (iMLSB-phenotype), 94 (19%) were constitutively resistant (cMLSB -phenotype), and 237 (46,76%) isolates were found D-test negative, indicating truly clindamycin-susceptible MS phenotype (M-phenotype resistance). The incidence of iMLSB-phenotypes was higher in S. epidermidis isolates (4,7%) compared to other CoNS isolates.

Keywords: bacteremia, inducible MLSB resistance phenotype, methicillin-resistant, staphylococci

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Authors: Kholood A. Baron

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While radiologist numbers specialized in spine interventional procedures are limited in Kuwait, the number of patients demanding these procedures is increasing rapidly. Due to this high demand, the workload of radiologists is increasing, which might represent a radiation exposure concern. During these procedures, the doctor’s hands are in very close proximity to the main radiation beam/ if not within it. The aim of this study is to measure the radiation dose for radiologists during several interventional procedures for the spine. Methods: Two doctors carrying different workloads were included. (DR1) was performing procedures in the morning and afternoon shifts, while (DR2) was performing procedures in the morning shift only. Comparing the radiation exposures that the hand of each doctor is receiving will assess radiation safety and help to set up workload regulations for radiologists carrying a heavy schedule of such procedures. Entrance Skin Dose (ESD) was measured via TLD (ThermoLuminescent Dosimetry) placed at the right wrist of the radiologists. DR1 was covering the morning shift in one hospital (Mubarak Al-Kabeer Hospital) and the afternoon shift in another hospital (Dar Alshifa Hospital). The TLD chip was placed in his gloves during the 2 shifts for a whole week. Since DR2 was covering the morning shift only in Al Razi Hospital, he wore the TLD during the morning shift for a week. It is worth mentioning that DR1 was performing 4-5 spine procedures/day in the morning and the same number in the afternoon and DR2 was performing 5-7 procedures/day. This procedure was repeated for 4 consecutive weeks in order to calculate the ESD value that a hand receives in a month. Results: In general, radiation doses that the hand received in a week ranged from 0.12 to 1.12 mSv. The ESD values for DR1 for the four consecutive weeks were 1.12, 0.32, 0.83, 0.22 mSv, thus for a month (4 weeks), this equals 2.49 mSv and calculated to be 27.39 per year (11 months-since each radiologist have 45 days of leave in each year). For DR2, the weekly ESD values are 0.43, 0.74, 0.12, 0.61 mSv, and thus, for a month, this equals 1.9 mSv, and for a year, this equals 20.9 mSv /year. These values are below the standard level and way below the maximum limit of 500 mSv per year (set by ICRP = International Council of Radiation Protection). However, it is worth mentioning that DR1 was a senior consultant and hence needed less fluoro-time during each procedure. This is evident from the low ESD values of the second week (0.32) and the fourth week (0.22), even though he was performing nearly 10-12 procedures in a day /5 days a week. These values were lower or in the same range as those for DR2 (who was a junior consultant). This highlighted the importance of increasing the radiologist's skills and awareness of fluoroscopy time effect. In conclusion, the radiation dose that radiologists received during spine interventional radiology in our setting was below standard dose limits.

Keywords: radiation protection, interventional radiology dosimetry, ESD measurements, radiologist radiation exposure

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Authors: Mariam Matiashvili

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Argumentation is an integral part of our daily communications - formal or informal. Argumentative reasoning, techniques, and language tools are used both in personal conversations and in the business environment. Verbalization of the opinions requires the use of extraordinary syntactic-pragmatic structural quantities - arguments that add credibility to the statement. The study of argumentative structures allows us to identify the linguistic features that make the text argumentative. Knowing what elements make up an argumentative text in a particular language helps the users of that language improve their skills. Also, natural language processing (NLP) has become especially relevant recently. In this context, one of the main emphases is on the computational processing of argumentative texts, which will enable the automatic recognition and analysis of large volumes of textual data. The research deals with the linguistic analysis of the argumentative structures of Georgian political speeches - particularly the linguistic structure, characteristics, and functions of the parts of the argumentative text - claims, support, and attack statements. The research aims to describe the linguistic cues that give the sentence a judgmental/controversial character and helps to identify reasoning parts of the argumentative text. The empirical data comes from the Georgian Political Corpus, particularly TV debates. Consequently, the texts are of a dialogical nature, representing a discussion between two or more people (most often between a journalist and a politician). The research uses the following approaches to identify and analyze the argumentative structures Lexical Classification & Analysis - Identify lexical items that are relevant in argumentative texts creating process - Creating the lexicon of argumentation (presents groups of words gathered from a semantic point of view); Grammatical Analysis and Classification - means grammatical analysis of the words and phrases identified based on the arguing lexicon. Argumentation Schemas - Describe and identify the Argumentation Schemes that are most likely used in Georgian Political Speeches. As a final step, we analyzed the relations between the above mentioned components. For example, If an identified argument scheme is “Argument from Analogy”, identified lexical items semantically express analogy too, and they are most likely adverbs in Georgian. As a result, we created the lexicon with the words that play a significant role in creating Georgian argumentative structures. Linguistic analysis has shown that verbs play a crucial role in creating argumentative structures.

Keywords: georgian, argumentation schemas, argumentation structures, argumentation lexicon

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Authors: Sonia Saddiqui, Maya Marcus

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UTS STEAMpunk Girls is an educational program for young women (aged 12-16), to empower them to be more informed and active members of the 21st century workforce. With the number of STEM graduates on the decline, especially among young women, an additional aim of the program is to trial a STEAM (Science, Technology, Engineering, Arts/Humanities/Social Sciences, Mathematics), inter-disciplinary approach to improving STEM engagement. In-line with UNESCO’s recent focus on promoting ‘transversal competencies’ in future graduates, the program utilised co-design, project-based learning, entrepreneurial processes, and inter-disciplinary learning. The program consists of two phases. Taking a participatory design approach, the first phase (co-design workshops) provided valuable insight into student perspectives around engaging young women in STEM and inter-disciplinary thinking. The workshops positioned 26 young women from three schools as subject matter experts (SMEs), providing a platform for them to share their opinions, experiences and findings around the STEAM disciplines. The second (pilot) phase put the co-design phase findings into practice, with 64 students from four schools working in groups to articulate problems with real-world implications, and utilising design-thinking to solve them. The pilot phase utilised project-based learning to engage young women in entrepreneurial and STEAM frameworks and processes. Scalable program design and educational resources were trialed to determine appropriate mechanisms for engaging young women in STEM and in STEAM thinking. Across both phases, data was collected via longitudinal surveys to obtain pre-program, baseline attitudinal information, and compare that against post-program responses. Preliminary findings revealed students’ improved understanding of the STEM disciplines, industries and professions, improved awareness of STEAM as a concept, and improved understanding regarding inter-disciplinary and design thinking. Program outcomes will be of interest to high-school educators in both STEM and the Arts, Humanities and Social Sciences fields, and will hopefully inform future programmatic approaches to introducing inter-disciplinary STEAM learning in STEM curriculum.

Keywords: co-design, STEM, STEAM, project-based learning, inter-disciplinary

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Authors: Radwa Elshorbagy, Alaa Elden Balbaa, Khaled Ayad, Waleed Reda

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Introduction: Ankle sprain is a common lower limb injury that is complicated by high recurrence rate. The cause of recurrence is not clear; however, changes in motor control have been postulated. Objective: to determine the contribution of proximal hip strategy to dynamic postural control in patients with recurrent ankle sprain. Methods: Fifteen subjects with recurrent ankle sprain (group A) and fifteen healthy control subjects (group B) participated in this study. Abductor-adductors as well as flexor-extensor hip musculatures control was abolished by fatigue using the Biodex Isokinetic System. Dynamic postural control was measured before and after fatigue by the Biodex Balance System. Results: Repeated measures MANOVA was used to compare between and within group differences, in group A fatiguing of hip muscles (flexors-extensors and abductors-adductors) increased overall stability index (OASI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI) significantly (p=0.00) whereas; in group B fatiguing of hip flexors-extensors increased significantly OASI and APSI only (p= 0.017, 0.010; respectively) while fatiguing of hip abductors-adductors has no significant effect on these variables. Moreover, patients with ankle sprain had significantly lower dynamic balance after hip muscles fatigue compared to the control group. Specifically, after hip flexor-extensor fatigue, the OASI, APSI and MLSI were increased significantly than those of the control values (p= 0.002, 0.011, and 0.003, respectively) whereas fatiguing of hip abductors-adductors increased significantly in OASI and APSI only (p=0.012, 0.026, respectively). Conclusion: To maintain dynamic balance, patients with recurrent ankle sprain seem to rely more on the hip strategy. This means that those patients depend on a top to down instead of down to top strategy clinical relevance: patients with recurrent ankle sprain less efficient in maintaining the dynamic postural control due to the change in motor strategies. Indicating that health care providers and rehabilitation specialists should treat CAI as a global/central and not just as a simple local or peripheral injury.

Keywords: hip strategy, ankle strategy, postural control, dynamic balance

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Authors: Constance Singo, Choja Oduaran

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Child mental disorders are strongly associated with different forms of challenges, including behavioural problems. The burden of care for children with a mental disorder is high and put primary caregivers, parents in particular, at risk of poor mental wellbeing. Understanding the experience of parents of children with mental disorders is crucial to developing a relevant intervention to assist them to attain optimal mental wellbeing. The aim of this study was to explore the experiences of parents of children with conduct disorder by focussing on the psychological and social stress experience of the parents in raising and caring for their children with conduct disorder. A qualitative research approach, using in-depth interview was utilized in this study. Purposive and snowballing sampling techniques were used to select 9 parents of children with conduct disorder in Thulamela Municipality, Limpopo Province of South Africa. Participants comprising of 2 males and 7 females aged between 30 years and 49 years were interviewed individually at scheduled appointment in-home setting. Interviews were conducted in both English and Setswana language. Data collected in Setswana language were translated to English by 'expert in language translation'. Ethical approval was obtained from appropriate authority before data collection. Thematic analysis was conducted to analyse the collected data. The findings identified anger, fear, depressive symptoms, denial, and suicidal ideation as predominant psychological experiences of the parents. Furthermore, deteriorated interpersonal relationships with family and community members, financial stress, and stigma emerged as social problems being the experience of the parents. It was concluded that parents of children with conduct disorder are highly traumatized by the challenges of caring for their children. We recommend professional engagement in terms of counselling service to support the parents. There is also a need for massive enlightenment programmes for members of the community in order to support the parents of children with child mental disorders.

Keywords: conduct disorder, parents, psychosocial experiences, South Africa

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Authors: Dejana Bouillet, Vlatka Domović

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Both policymakers and researchers recognize that participating in early childhood education and care (ECEC) is useful for all children, especially for those who are exposed to the high risk of social exclusion. Social exclusion of children is understood as a multidimensional construct including economic, social, cultural, health, and other aspects of disadvantage and deprivation, which individually or combined can have an unfavorable effect on the current life and development of a child, as well as on the child’s development and on disadvantaged life chances in adult life. ECEC institutions should be able to promote educational approaches that portray developmental, cultural, language, and other diversity amongst children. However, little is known about the ways in which Croatian ECEC institutions recognize and respect the diversity of children and their families and how they respond to their educational needs. That is why this paper is dedicated to the analysis of the capacities of ECEC professionals to respond to the demands of educational needs of this very diverse group of children and their families. The results obtained in the frame of the project “Models of response to educational needs of children at risk of social exclusion in ECEC institutions,” funded by the Croatian Science Foundation, will be presented. The research methodology arises from explanations of educational processes and risks of social exclusion as a complex and heterogeneous phenomenon. The preliminary results of the qualitative data analysis of educational practices regarding capacities to identify and appropriately respond to the requirements of children at risk of social exclusion will be presented. The data have been collected by interviewing educational staff in 10 Croatian ECEC institutions (n = 10). The questions in the interviews were related to various aspects of inclusive institutional policy, culture, and practices. According to the analysis, it is possible to conclude that Croatian ECEC professionals are still faced with great challenges in the process of implementation of inclusive policies, culture, and practices. There are several baselines of this conclusion. The interviewed educational professionals are not familiar enough with the whole complexity and diversity of needs of children at risk of social exclusion, and the ECEC institutions do not have enough resources to provide all interventions that these children and their families need.

Keywords: children at risk of social exclusion, ECEC professionals, inclusive policies, culture and practices, quallitative analysis

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Authors: Moustafa Ali Elwan, Ibrahim Salem Abdelrafa, Ashraf Moharm

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed oral and topical drugs worldwide. Moreover, NSAIDs are responsible for most of all adverse drug reactions. For several decades, there are numerous attempts to use the cutaneous layers as a gate into the body for the local delivery of the therapeutic agent. Transdermal drug delivery is a validated technology contributing significantly to global pharmaceutical care. Transdermal Drug Delivery systems can be improved by using therapeutic agents. Moreover, Transdermal Drug Delivery systems can be improved by using chemical enhancers like ultrasound or iontophoresis. Iontophoresis provides a mechanism to enhance the penetration of hydrophilic and charged molecules across the skin. Objective: to compare the drug administration by ‘iontophoresis’ versus the oral rule. Methods: This study was conducted at the Faculty of Physical Therapy, Modern University for technology and information, Cairo, Egypt, on 20 participants (8 female & 12 male) who complained of tennis elbow. Their mean age was (25.45 ± 3.98) years, and all participants were assessed in many aspects: Pain threshold was assessed by algometer. Range of motion was assessed by electro goniometer, and isometric strength was assessed by a portable hand-held dynamometer. Then Participants were randomly assigned into two groups: group A was treated with oral NSAID (diclofenac) while group B was treated via administration of NSAIDs (diclofenac) via an iontophoresis device. All the participants were subjected to blood samples analysis in both pre-administration of the drug and post-administration of the drug for 24 hours (sample/every 6 hours). Results: The results demonstrated that there was a significant improvement in group b, “iontophoresis NSAIDs group,” more than in group B,” oral NSAIDs group,” in all measurements ‘ pain threshold, strength, and range of motion. Also, the iontophoresis method shows higher maximum plasma concentrations (Cmax) and concentration-time curves than the oral method.

Keywords: diclofenac, iontophoresis, NSAIDs, oral, tennis elbow

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Authors: Maria Tagarelli De Monte

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In 2021, the passage of the law recognizing Italian Sign Language (LIS) as the language of the Italian deaf minority was the input for including this visual-gestural language in the curricula of interpreters and translators choosing the academic setting for their training. Yet, a gap remains concerning LIS education of teachers and communication assistants as referring figures for people who are deaf or hard of hearing in mainstream education. As well documented in the related scientific literature, deaf children often experience severe difficulties with the languages spoken in the country where they grow up, manifesting in all levels of literacy competence. In the research introduced here, the experience of deaf students (and their teachers) attending schools is explored in areas that are characterized by strong native bilingualism, such as Friuli-Venezia Giulia (FVG), facing Italian Northeast borders. This region is peculiar as the native population may be bilingual Italian and Friulian (50% of the local population), German, and/or Slovenian. The research involved all schools of all levels in Friuli to understand the relationship between the language skills expressed by teachers and those shown by deaf learners with a background in sign language. In addition to collecting specific information on the degree of preparation of teachers in deaf-related matters and LIS, the research has allowed to highlight the role, often poorly considered, covered by the communication assistants who work alongside deaf students. On several occasions, teachers and assistants were unanimous in affirming the importance of mutual collaboration and adequate consideration of the educational-rehabilitative history of the deaf child and her family. The research was based on a mixed method of structured questionnaires and semi-structured interviews with the referring teachers. As a result, a varied and complex framework emerged, showing an asymmetry in preparing personnel dedicated to the deaf learner. Considering how Italian education has long invested in creating an inclusive and accessible school system (i.e. with the "Ten Theses for Democratic Language Education"), a constructive analysis will complete the discussion in an attempt to understand how linguistic (and modal) differences can become levers of inclusion.

Keywords: FVG, LIS, linguistic needs, deafness, teacher education, bilingual bimodal children, communication assistants, inclusion model

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Authors: Hamza Ikhlaq, Stephen Franks

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Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders affecting women of reproductive age. The aetiology behind PCOS is poorly understood but influencing ethnic, environmental, and genetic factors have been recognised. However, literature examining the impact of ethnicity is scarce. We hypothesised Body Mass Index (BMI) and ethnicity influence the clinical, metabolic, and biochemical presentations of PCOS, with an interaction between these factors. Methods: A database of 1081 women with PCOS and a control group of 72 women were analysed. BMIs were grouped using the World Health Organisation classification into normal weight, overweight and obese groups. Ethnicities were classified into European, South Asian, and Afro-Caribbean groups. Biochemical and clinical presentations were compared amongst these groups, and statistical analyses were performed to assess significance. Results: This study revealed ethnicity significantly influences biochemical and clinical presentations of PCOS. A greater proportion of South Asian women are impacted by menstrual cycle disturbances and hirsutism than European and Afro-Caribbean women. South Asian and Afro-Caribbean women show greater measures of insulin resistance and weight gain when compared to their European peers. Women with increased BMI are shown to have an increased prevalence of PCOS phenotypes alongside increased levels of insulin resistance and testosterone. Furthermore, significantly different relationships between the waist-hip ratio and measures of insulin and glucose control for Afro-Caribbean women were identified compared to other ethnic groups. Conclusions: The findings of this study show ethnicity significantly influence the phenotypic and biochemical presentations of PCOS, with an interaction between body habitus and ethnicity found. Furthermore, we provide further data on the influences of BMI on the manifestations of PCOS. Therefore, we highlight the need to consider these factors when reviewing diagnostic criteria and delivering clinical care for these groups.

Keywords: PCOS, ethnicity, BMI, clinical

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Authors: Noreen Noreen, Aamir Ijaz, Hamza Akhtar

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Background: Screening plays a major role to detect chromosomal abnormalities, Down syndrome, neural tube defects and other inborn diseases of the newborn. Serum biomarkers in the second trimester are useful in determining risk of most common chromosomal anomalies; these test include Alpha-fetoprotein (AFP), Human chorionic gonadotropin (hCG), Unconjugated Oestriol (UEȝ)and inhibin-A. Quadruple biomarkers are worth test in diagnosing the congenital pathology during pregnancy, these procedures does not form a part of routine health care of pregnant women in Pakistan, so the median value is lacking for population in Pakistan. Objective: To determine median values of biochemical maternal serum markers in local population during second trimester maternal screening. Study settings: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP) Rawalpindi. Methods: Cross-Sectional study for estimation of reference values. Non-probability consecutive sampling, 155 healthy pregnant women, of 30-40 years of age, will be included. As non-parametric statistics will be used, the minimum sample size is 120. Result: Total 155 women were enrolled into this study. The age of all women enrolled ranged from 30 to39 yrs. Among them, 39 per cent of women were less than 34 years. Mean maternal age 33.46±2.35 SD and maternal body weight were 54.98±2.88. Median value of quadruple markers calculated from 15-18th week of gestation that will be used for calculation of MOM for screening of trisomy21 in this gestational age. Median value at 15 week of gestation were observed hCG 36650 mIU/ml, AFP 23.3 IU/ml, UEȝ 3.5 nmol/L, InhibinA 198 ng/L, at 16 week of gestation hCG 29050 mIU/ml, AFP 35.4 IU/ml, UEȝ 4.1 nmol/L, InhibinA 179 ng/L, at 17 week of gestation hCG 28450 mIU/ml, AFP 36.0 IU/ml, UEȝ 6.7 nmol/L, InhibinA 176 ng/L and at 18 week of gestation hCG 25200 mIU/ml, AFP 38.2 IU/ml, UEȝ 8.2 nmol/L, InhibinA 190 ng/L respectively.All the comparisons were significant (p-Value <0.005) with 95% confidence Interval (CI) and level of significance of study set by going through literature and set at 5%. Conclusion: The median values for these four biomarkers in Pakistani pregnant women can be used to calculate MoM.

Keywords: screening, down syndrome, quadruple test, second trimester, serum biomarkers

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Authors: Thidilweli Denga, Bessie Malila, Lucretia Petersen

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The Coronavirus Disease of 2019 (COVID-19) pandemic should be taken as a wake-up call on the importance of hearing health care considering amongst other things the electronic methods of communication used. The World Health Organization (WHO) estimated that by 2050, there will be more than 2.5 billion people living with hearing loss. These numbers show that more people will need rehabilitation services. Studies have shown that most people living with hearing loss reside in Low-Middle Income Countries (LIMC). Innovative technological solutions such as digital health interventions that can be used to deliver hearing health services to remote areas now exist. Tele-audiology implementation can potentially enable the delivery of hearing loss services to rural and remote areas. This study aimed to establish the concurrent validity of the tele-audiology practice in school-based hearing screening. The study employed a cross-sectional design with a within-group comparison. The portable KUDUwave Audiometer was used to conduct hearing screening from 50 participants (n=50). In phase I of the study, the audiologist conducted on-site hearing screening, while the synchronous remote hearing screening (tele-audiology) using a 5G network was done in phase II. On-site hearing screening results were obtained for the first 25 participants (aged between 5-6 years). The second half started with the synchronous tele-audiology model to avoid order-effect. Repeated sample t-tests compared threshold results obtained in the left and right ears for onsite and remote screening. There was a good correspondence between the two methods with a threshold average within ±5 dB (decibels). The synchronous tele-audiology model has the potential to reduce the audiologists' case overload, while at the same time reaching populations that lack access due to distance, and shortage of hearing professionals in their areas of reach. With reliable and broadband connectivity, tele-audiology delivers the same service quality as the conventional method while reducing the travel costs of audiologists.

Keywords: hearing screening, low-resource communities, portable audiometer, tele-audiology

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Authors: Katherine Karayianis

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Children with Attention Deficit Hyperactivity Disorder (ADHD) have trouble learning in traditional classrooms. These children miss out on important developmental opportunities in school, which leads to challenges starting in early childhood, and these problems persist throughout their adult lives. Despite receiving supplemental support in school, children with ADHD still perform below their non-ADHD peers. Thus, there is a great need to find better ways of facilitating learning in children with ADHD. Evidence has shown that children with ADHD learn best through interactive engagement, but this is not always possible in schools, given classroom restraints and the large student-to-teacher ratio. Redesigning classrooms may not be feasible, so informal learning opportunities provide a possible alternative. One popular informal learning opportunity is educational TV shows like Sesame Street. These types of educational shows can teach children foundational skills taught in pre-K and early elementary school. One downside to these shows is the lack of interactive dialogue between the TV characters and the child viewers. Pseudo-interaction is often deployed, but the benefits are limited if the characters can neither understand nor contingently respond to the child. AI technology has become extremely advanced and is now popular in many electronic devices that both children and adults have access to. AI has been successfully used to create interactive dialogue in children’s educational TV shows, and results show that this enhances children’s learning and engagement, especially when children perceive the character as a reliable teacher. It is likely that children with ADHD, whose minds may otherwise wander, may especially benefit from this type of interactive technology, possibly to a greater extent depending on their perception of the animated dialogic agent. To investigate this issue, I have begun examining the moderating role of inattention among children’s learning from an educational TV show with different types of dialogic interactions. Preliminary results have shown that when character interactions are neither immediate nor accurate, children who are more easily distracted will have greater difficulty learning from the show, but contingent interactions with a TV character seem to buffer these negative effects of distractibility by keeping the child engaged. To extend this line of work, the moderating role of the child’s perception of the dialogic agent as a reliable teacher will be examined in the association between children’s attention and the type of dialogic interaction in the TV show. As such, the current study will investigate this moderated moderation.

Keywords: attention, dialogic TV, informal learning, educational TV, perception of teacher

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Authors: Radwa El Shorbagy, Alaa El Din Balbaa, Khaled Ayad, Waleed Reda

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Introduction: Ankle sprain is a common lower limb injury that is complicated by high recurrence rate. The cause of recurrence is not clear; however, changes in motor control have been postulated. Objective: to determine the contribution of proximal hip strategy to dynamic postural control in patients with recurrent ankle sprain. Methods: Fifteen subjects with recurrent ankle sprain (group A) and fifteen healthy control subjects (group B) participated in this study. Abductor-adductors as well as flexor-extensor hip musculatures control was abolished by fatigue using the Biodex Isokinetic System. Dynamic postural control was measured before and after fatigue by the Biodex Balance System Results: Repeated measures MANOVA was used to compare between and within group differences, In group A fatiguing of hip muscles (flexors-extensors and abductors-adductors) increased overall stability index (OASI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI) significantly (p= 0.00) whereas; in group B fatiguing of hip flexors-extensors increased significantly OASI and APSI only (p= 0.017, 0.010; respectively) while fatiguing of hip abductors-adductors has no significant effect on these variables. Moreover, patients with ankle sprain had significantly lower dynamic balance after hip muscles fatigue compared to the control group. Specifically, after hip flexor-extensor fatigue, the OASI, APSI and MLSI were increased significantly than those of the control values (p= 0.002, 0.011, and 0.003, respectively) whereas fatiguing of hip abductors-adductors increased significantly in OASI and APSI only (p=0.012, 0.026, respectively). Conclusion: To maintain dynamic balance, patients with recurrent ankle sprain seem to relay more on the hip strategy. This means that those patients depend on a top to down instead of down to top strategy clinical relevance: patients with recurrent ankle sprain less efficient in maintaining the dynamic postural control due to the change in motor strategies. Indicating that health care providers and rehabilitation specialists should treat CAI as a global/central and not just as a simple local or peripheral injury.

Keywords: ankle sprain, fatigue hip muscles, dynamic balance

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Authors: Meltem Anafarta Şendağ, Funda Kutlu

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Attachment theory has some major postulates that direct attention of psychologists from many different domains. First, the theory suggests that attachment is a lifetime process. This means that every human being from cradle to grave needs someone stronger to depend on in times of stress. Second, the attachment is a dynamic process and as one goes through developmental stages it is being transferred from one figure to another (friends, romantic partners). Third, the quality of attachment relationships later in time directly affected by the earliest attachment relationship established between the mother and the infant. Depending on these postulates, attachment literature focuses mostly on mother – child attachment during childhood and romantic relationship during adulthood. However, although romantic partners are important attachment figures in adults’ life, parents are not dropped out from the attachment hierarchy but they keep being important attachment figures. Despite the fact that parents could still be an important figure in adults’ life, adult – parent attachment is overlooked in the literature. Accordingly, this study focuses on adult daughters’ current attachment to their old mothers in relation with early parental bonding and current attachment to husbands. Participants of the study were 383 adult women (Average age = 40, ranging between 23 and 70) whose mothers were still alive and who were married at the time of the study. Participants were completed Adult Attachment Scale, Parental Bonding Instrument, and Experiences in Close Relationship – II together with demographic questionnaire. Results revealed that daughters’ attachment to their mothers weakens as they get older, have more children, and have longer marriages. Stronger attachment to mothers was found positively correlated with current satisfaction with the relationship, perception of maternal care before the age of 12 and negatively correlated with perception of controlling behavior before the age 12. Considering the relationship between current parental attachment and romantic attachment, it was found that as the current attachment to mother strengthens attachment avoidance towards husband decreases. Results revealed that although attachment between the adult daughters and old mothers weakens, the relationship is still critical in daughters’ lives. The strength of current attachment with the mother is related both with the early relationship with the mother and current attachment with the husband. The current study is thought to contribute to attachment theory emphasizing the attachment as a lifetime construct.

Keywords: adult daughter, attachment, old mothers, parental bonding

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Authors: Pradip Kumar Das

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Phenomenal growth of population and industry exploits the environment in varied ways. Consequently, the greenhouse effect and other allied problems are threatening mankind the world over. Protection and up gradation of environment have, therefore, become the prime necessity all of mankind for the sustainable development of environment. People in humbler walks of life including the corporate citizens have become aware of the impacts of environmental pollution. Governments of various nations have entered the picture with laws and regulations to correct and cure the effects of present and past violations of environmental practices and to obstruct future violations of good environmental disciplines. In this perspective, environmental audit directs verification and validation to ensure that the various environmental laws are complied with and adequate care has been taken towards environmental protection and preservation. The discipline of environmental audit has experienced expressive development throughout the world. It examines the positive and negative effects of the activities of an enterprise on environment and provides an in-depth study of the company processes any growth in realizing long-term strategic goals. Environmental audit helps corporations assess its achievement, correct deficiencies and reduce risk to the health and improving safety. Environmental audit being a strong management tool should be administered by industry for its own self-assessment. Developed countries all over the globe have gone ahead in environment quantification; but unfortunately, there is a lack of awareness about pollution and environmental hazards among the common people in India. In the light of this situation, the conceptual analysis of this study is concerned with the rationale of environmental audit on the industry and the society as a whole and highlights the emerging dimensions in the auditing theory and practices. A modest attempt has been made to throw light on the recent development in environmental audit in developing nations like India and the problems associated with the implementation of environmental audit. The conceptual study also reflects that despite different obstacles, environmental audit is becoming an increasing aspect within the corporate sectors in India and lastly, conclusions along with suggestions have been offered to improve the current scenario.

Keywords: environmental audit, environmental hazards, environmental laws, environmental protection, environmental preservation

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Authors: Ahmed Eid, Amita Gupta

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Abstract: Background: Background Medical gases are estimated to contribute to 5% of the carbon footprints produced by hospitals, Desflurane has the largest impact, but all increase significantly when used with N2O admixture. Climate Change Act 2008, we must reduce our carbon emission by 80% of the 1990 baseline by 2050.NHS carbon emissions have reduced by 18.5% (2007-2017). The NHS Long Term Plan has outlined measures to achieve this objective, including a 2% reduction by transforming anaesthetic practices. FGF is an important variable that determines the utilization of inhalational agents and can be tightly controlled by the anaesthetist. Aims and Objectives Environmental safety, Identification of areas of high N20 and different anaesthetic agents used across the St Helier operating theatres and consider improvising on the current practice. Methods: Data was collected from St Helier operating theatres and retrieved daily from Care Station 650 anaesthetic machines. 60 cases were included in the sample. Collected data (average flow rate, amount and type of agent used, duration of surgery, type of surgery, duration, and the total amount of Air, O2 and N2O used. AAGBI impact anaesthesia calculator was used to identify the amount of CO2 produced and also the cost per hour for every pt. Communication via reminder emails to staff emphasized the significance of low-flow anaesthesia and departmental meeting presentations aimed at heightening awareness of LFA, Distribution of AAGBI calculator QR codes in all theatres enables the calculation of volatile anaesthetic consumption and CO2e post each case, facilitating informed environmental impact assessment. Results: A significant reduction in the flow rate use in the 2nd sample was observed, flow rate usage between 0-1L was 60% which means a great reduction of the consumption of volatile anaesthetics and also Co2e. By using LFA we can save money but most importantly we can make our lives much greener and save the planet.

Keywords: low flow anesthesia, sustainability project, N₂0, Co2e

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Authors: T. Frawley, G. O'Kelly

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The UCD School of Nursing, Midwifery and Health Systems Higher Diploma in Mental Health (HDMH) nursing programme commenced in January 2017. Forty students successfully completed the programme. Programme evaluation was conducted from the outset. Research ethics approval was granted by the UCD Human Research Ethics Committee – Sciences in November 2016 (LS-E-16-163). Plan for Sustainability: Each iteration of the programme continues to be evaluated and adjusted accordingly. Aims: The ultimate purpose of the HDMH programme is to prepare registered nurses (registered children’s nurse (RCN), registered nurse in intellectual disability (RNID) and registered general nurse (RGN)) to function as effective registered psychiatric nurses in all settings which provide care and treatment for people experiencing mental health difficulties. Curriculum evaluation is essential to ensure that the programme achieves its purpose, that aims and expected outcomes are met and that required changes are highlighted for the programme’s continuing positive development. Methods: Both quantitative and qualitative methods were used in the evaluation. A series of questionnaires were used (the majority pre and post programme) to determine student perceptions of the programme, behaviour and attitudinal change from commencement to completion. These included the student assessment of learning gains (SALG); mental health knowledge schedule (MAKS); mental health clinician attitudes scale (MICA); reported and intended behaviour scale (RIBS); and community attitudes towards the mentally ill (CAMI). In addition, student and staff focus groups were conducted. Evaluation methods also incorporated module feedback. Outcome/Results: The evaluation highlighted a very positive response in relation to the achievement of programme outcomes and preparation for future work as registered psychiatric nursing. Some areas were highlighted for further development, which have been taken cognisance of in the 2019 iteration of the programme.

Keywords: learning gains, mental health, nursing, stigma

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Authors: Estelle Ardanouy, Helene Delage, Pascal Zesiger

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Morphological awareness contributes to the acquisition of reading and spelling in typical learners as well as in children with learning disorders. Indeed, the acquisition of phoneme-grapheme correspondences is not sufficient to master spelling, especially in inconsistent orthographic systems such as English or French. Several meta-analyses show the benefit of explicit training in derivational morphology on reading and spelling in old children (who have already learned the main grapheme-phoneme correspondences), but highlight the lack of studies with younger children, particularly in French. In this study, we chose to focus on the efficiency of an intensive training in derivational morphology on spelling skills in French-speaking four-graders (9-10 years of age). The training consisted of 1) learning how to divide words into morphemes (ex: para/pente in French, paraglider in English), as well as 2) working on the meaning of affixes in relation to existing words (ex: para/pente: to protect against – para - the slope -pente). One group of pupils (N = 37, M age = 9.5) received this experimental group training in morphology while an alternative training group (N = 34, M age = 9.6) received a visuo-semantic training based on visual cues to memorize the spelling difficulties of complex words (such as the doubling of “r” in “verre” in French -or "glass" in English-which are represented by the drawing of two glasses). Both trainings lasted a total of 15 hours at a rate of four 45 minutes sessions per week, resulting in five weeks of training in the school setting. Our preliminary results show a significant improvement in the experimental group in the spelling of affixes on the trained (p < 0.001) and untrained word lists (p <0.001), but also in the root of words on the trained (p <0.001) and untrained word lists group (p <0.001). The training effect is also present on both trained and untrained morphologically composed words. By contrast, the alternative training group shows no progress on these previous measures (p >0.15). Further analyses testing the effects of both trainings on other measures such as morphological awareness and reading of morphologically compose words are in progress. These first results support the effectiveness of explicitly teaching derivational morphology to improve spelling in school-aged children. The study is currently extended to a group of children with developmental dyslexia because these children are known for their severe and persistent spelling difficulties.

Keywords: developmental dyslexia, derivational morphology, reading, school-aged children, spelling, training

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Authors: Akram Sadat Jafari Roodbandi, Alireza Choobineh, Nazanin Hosseini, Vafa Feyzi

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Introduction: Physical fitness and optimum functional movement are essential for efficiently performing job tasks without fatigue and injury. Functional Movement Screening (FMS) tests are used in screening of athletes and military forces. Nurses and emergency medical staff are obliged to perform many physical activities such as transporting patients, CPR operations, etc. due to the nature of their jobs. This study aimed to assess relationship between FMS test score and the prevalence of musculoskeletal disorders (MSDs) in emergency nurses and emergency medical services (EMS) staff. Methods: 134 male and female emergency nurses and EMS technicians participated in this cross-sectional, descriptive-analytical study. After video tutorial and practical training of how to do FMS test, the participants carried out the test while they were wearing comfortable clothes. The final score of the FMS test ranges from 0 to 21. The score of 14 is considered weak in the functional movement base on FMS test protocol. In addition to the demographic data questionnaire, the Nordic musculoskeletal questionnaire was also completed for each participant. SPSS software was used for statistical analysis with a significance level of 0.05. Results: Totally, 49.3% (n=66) of the subjects were female. The mean age and work experience of the subjects were 35.3 ± 8.7 and 11.4 ± 7.7, respectively. The highest prevalence of MSDs was observed at the knee and lower back with 32.8% (n=44) and 23.1% (n=31), respectively. 26 (19.4%) health worker had FMS test score of 14 and less. The results of the Spearman correlation test showed that the FMS test score was significantly associated with MSDs (r=-0.419, p < 0.0001). It meant that MSDs increased with the decrease of the FMS test score. Age, sex, and MSDs were the remaining significant factors in linear regression logistic model with dependent variable of FMS test score. Conclusion: FMS test seems to be a usable screening tool in pre-employment and periodic medical tests for occupations that require physical fitness and optimum functional movements.

Keywords: functional movement, musculoskeletal disorders, health care worker, screening test

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Authors: Carmen Silvia Gabriel, Dsniele Bernardi da Costa, Andrea Bernardes, Sabrina Elias Mikael, Daniele da Silva Ramos

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The goal of this quantitative study is to investigate patient safety culture from the perspective of professional from the hospital nursing team.It was conducted in two Brazilian hospitals,.The sample included 282 nurses Data collection occurred in 2013, through the questionnaire Hospital Survey on Patient Safety Culture.Based on the assessment of the dimensions is stressed that, in the dimension teamwork across hospital units, 69.4% of professionals agree that when a lot of work needs to be done quickly, they work together as a team; about the dimension supervisor/ manager expectations and actions promoting safety, 70.2% agree that their supervisor overlooks patient safety problems.Related to organizational learning and continuous improvement, 56.5% agree that there is evaluation of the effectiveness of the changes after its implementation.On hospital management support for patient safety, 52.8% refer that the actions of hospital management show that patient safety is a top priority.On the overall perception of patient safety, 57.2% disagree that patient safety is never compromised due to higher amount of work to be completed.In what refers to feedback and communication about error, 57.7% refer that always and usually receive such information. Relative to communication openness, 42.9% said they never or rarely feel free to question the decisions / actions of their superiors.On frequency of event reporting, 64.7% said often and always notify events with no damages to patients..About teamwork across hospital units is noted similarity between the percentages of agreement and disagreement, as on the item there is a good cooperation among hospital units that need to work together, that indicates 41.4% and 40.5% respectively.Related to adequacy of professionals, 77.8 % disagree on the existence of sufficient amount of employees to do the job, 52.4% agree that shift changes are problematic for patients. On nonpunitive response to errors, 71.7% indicate that when an event is reported it seems that the focus is on the person.On the patient safety grade of the institution, 41.6 % classified it as very good. it is concluded that there are positive points in the safety culture, and some weaknesses as a punitive culture and impaired patient safety due to work overload .

Keywords: quality of health care, health services evaluation, safety culture, patient safety, nursing team

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Authors: Amina El-Warari, Agata Vitale, Laura Caulfield, Jennifer Kinloch

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Background: Unemployment levels among refugees in the UK are much higher than voluntary migrants and UK-born citizens. The lack of employment and/or of suitable employment has detrimental consequences on refugees’ ability to integrate and become active citizens in the host country. Research indicates that, when individuals are forced to migrate, one of the most significant aspects to building their identity is their previous profession; this particularly applies to qualified refugees. Despite this, there is little support available to them. The current study is set in this context and aims to explore highly qualified refugees’ employment-related experiences in the UK as well as their suggestions on how to develop specific interventions that can support them in finding suitable employment. Methods: A qualitative study design was employed. Qualitative methods are in fact well suited to research with refugees, as they allow them to give their direct opinion, rather than this being filtered by stakeholders. Listening to ‘the refugee’s voice’ means developing ‘a refugee centered perspective’ where the diverse narratives told by participants are organized to tell their direct collective story. A total of 12 refugees, attending a non-profit refugee organization in the south-west of England, took part in the study. The selection criteria were being over 18, having a level of English that allows them to sustain a conversation, and having a University degree and/or professional qualification. All participants were interviewed individually; the data were transcribed and analyzed thematically. Findings: Participants had very little support in finding suitable employment; this often only consisted of a few sessions in their local job centers and English tutorials. They indicated that being unemployed/underemployed negatively affected their sense of identity, their acculturative stress, and their in-group/ out-group relations. They suggested that specific employment interventions for qualified refugees should be delivered to them individually in order to address their specific needs. Furthermore, most participants suggested that these interventions should support them in volunteering in organizations that match their skills/ qualifications. They also indicated that the employment interventions should support them in having their qualifications recognized in the UK as well as building links with universities/ centers where they can receive adequate training on how to understand and adapt to the employments needs in the UK. Conclusions: These findings will provide the basis for the second stage of the research where specific employment interventions will be designed and tested with highly qualified refugees. In addition, these findings shed light refugee integration policy.

Keywords: employment interventions, identity, integration, qualified refugees

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Authors: Naim Izet Kajtazi

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

Keywords: Behcet disease, optic neuritis, IIH, CVT

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Authors: Jakub Marek, Marie Vagnerova, Ladislav Csemy

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Background: The length of time spent on the street influences the degree of adjustment to homelessness. Over the years spent sleeping rough, homeless people gradually lose the ability to control their lives and their return to mainstream society becomes less and less likely. Goals: The aim of the study was to discover whether and how men who have been sleeping rough for more than ten years differ from those who have been homeless for four years or less. Methods: The research was based on a narrative analysis of in-depth interviews focused on the respondent’s entire life story, i.e. their childhood, adolescence, and the period of adulthood preceding homelessness. It also asked the respondents about how they envisaged the future. The group under examination comprised 51 homeless men aged 37 – 54. The first subgroup contained 29 men who have been sleeping rough for 10 – 21 years, the second group contained 22 men who have been homeless for four years or less. Results: Men who have been sleeping rough for more than ten years had problems adapting as children. They grew up in a problematic family or in an institution and acquired only a rudimentary education. From the start they had problems at work, found it difficult to apply themselves, and found it difficult to hold down a job. They tend to have high-risk personality traits and often a personality disorder. Early in life they had problems with alcohol or drugs and their relationships were unsuccessful. If they have children, they do not look after them. They are reckless even in respect of the law and often commit crime. They usually ended up on the street in their thirties. Most of this subgroup of homeless people lack motivation and the will to make any fundamental change to their lives. They identify with the homeless community and have no other contacts. Men who have been sleeping rough for four years or less form two subgroups. There are those who had a normal childhood, attended school and found work. They started a family but began to drink, and as a consequence lost their family and their job. Such men end up on the street between the ages of 35 and 40. And then there are men who become homeless after the age of 40 because of an inability to cope with a difficult situation, e.g. divorce or indebtedness. They are not substance abusers and do not have a criminal record. Such people can be offered effective assistance to return to mainstream society by the social services because they have not yet fully self-identified with the homeless community and most of them have retained the necessary abilities and skills. Conclusion: The length of time a person has been homeless is an important factor in respect of social prevention. It is clear that the longer a person is homeless, the worse are their chances of being reintegrated into mainstream society.

Keywords: risk factors, homelessness, chronicity, narrative analysis

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