Search results for: history of sexuality

Authors: Renee Fabian, Jordan Davidson

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Current research on non-suicidal self-injury (NSSI) provides ample insights on best practices for caregivers and clinicians to address and reduce NSSI behavior among adolescents. However, the efficacy of evidenced-based NSSI interventions and their delivery from the perspective of adolescent patients does not receive significant attention, creating a gap between the efficacy of research-based NSSI interventions and adolescent perceptions of NSSI treatment and adolescent willingness to engage in NSSI interventions. To address the gap between practice and patient perspectives and inform more effective treatment outcomes, the current survey aims to identify major patient-reported adverse reactions to NSSI disclosures from caregivers, treating mental health clinicians, and medical professionals using a mixed methods survey of 2,500 people with a history of NSSI completed by editors at a consumer-facing health publication. Based on the analyzed results of the survey, a majority of adolescents with a history of NSSI found parents and caregivers ineffective at empathetically addressing NSSI, and a significant number of participants reported at least one treating mental health professional inadequately responded to NSSI behaviors, in addition to other findings of adverse reactions to NSSI disclosures that serve as a barrier to treatment. NSSI is a significant risk factor for future suicide attempts. Addressing patient-reported adverse reactions to NSSI disclosures in the adolescent population can remove barriers to the effectiveness of caregiver and clinician NSSI interventions and reduce the risk of NSSI-related harm and lower the risk of future suicide attempts or completions.

Keywords: adolescent self-injury, non-suicidal self-injury, patient perspectives, self-harm interventions

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Authors: Natalia Zhabo, Sergey Nikitin, Marina Avdonina, Mariya Nikitina

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The analysis of the activities of one of the events of the international educational and entertainment project Velonotte is provided: an evening bicycle tour with children around Florence. The aim of the project is to develop methods and techniques for increasing the sensitivity of the cycling participants and listeners of the radio broadcasts to the treasures of the national heritage, in this case, to the historical layers of the city and the ecology of the Renaissance epoch. The block of educational tasks is considered, and the issues of preserving the identity of the city are discussed. Methods. The Florentine event was prepared during more than a year. First of all the creative team selected such events of the history of the city which seem to be important for revealing the specifics of the city, its spirit - from antiquity to our days – including the forums of Internet with broad public opinion. Then a route (seven kilometers) was developed, which was proposed to the authorities and organizations of the city. The selection of speakers was conducted according to several criteria: they should be authors of books, famous scientists, connoisseurs in a certain sphere (toponymy, history of urban gardens, art history), capable and willing to talk with participants directly at the points of stops, in order to make a dialogue and so that performances could be organized with their participation. The music was chosen for each part of the itinerary to prepare the audience emotionally. Cards for coloring with images of the main content of each stop were created for children. A site was done to inform the participants and to keep photos, videos and the audio files with speakers’ speech afterward. Results: Held in April 2017, the event was dedicated to the 640th Anniversary of the Filippo Brunelleschi, Florentine architect, and to the 190th anniversary of the publication of Florence guide by Stendhal. It was supported by City of Florence and Florence Bike Festival. Florence was explored to transfer traditional elements of culture, sometimes unfairly forgotten from ancient times to Brunelleschi and Michelangelo and Tschaikovsky and David Bowie with lectures by professors of Universities. Memorable art boards were installed in public spaces. Elements of the cultural code are deeply internalized in the minds of the townspeople, the perception of the city in everyday life and human communication is comparable to such fundamental concepts of the self-awareness of the townspeople as mental comfort and the level of happiness. The format of a fun and playful walk with the ICT support gives new opportunities for enriching the city's cultural code of each citizen with new components, associations, connotations.

Keywords: edutainment, cultural code, cycling, sensitization Florence

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Authors: Camilo Andres Agudelo-Velez, Lina María Martinez-Sanchez, Natalia Perilla-Hernandez, Maria De Los Angeles Rodriguez-Gazquez, Felipe Hernandez-Restrepo, Dayana Andrea Quintero-Moreno, Camilo Ruiz-Mejia, Isabel Cristina Ortiz-Trujillo, Monica Maria Zuluaga-Quintero

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Chronic obstructive pulmonary disease is common condition, characterized by a persistent blockage of airflow, partially reversible and progressive, that represents 5% of total deaths around the world, and it is expected to become the third leading cause of death by 2030. Objective: To establish the clinical and epidemiological profile of patients with chronic obstructive pulmonary disease in a medical institution from the city of Medellin, Colombia. Methods: A cross-sectional study was performed, with a sample of 50 patients with a diagnosis of chronic obstructive pulmonary disease in a private institution in Medellin, during 2015. The software SPSS vr. 20 was used for the statistical analysis. For the quantitative variables, averages, standard deviations, and maximun and minimun values were calculated, while for ordinal and nominal qualitative variables, proportions were estimated. Results: The average age was 73.5±9.3 years, 52% of the patients were women, 50% of them had retired, 46% ere married and 80% lived in the city of Medellín. The mean time of diagnosis was 7.8±1.3 years and 100% of the patients were treated at the internal medicine service. The most common clinical features were: 36% were classified as class D for the disease, 34% had a FEV1 <30%, 88% had a history of smoking and 52% had oxygen therapy at home. Conclusion: It was found that class D was the most common, and the majority of the patients had a history of smoking, indicating the need to strengthen promotion and prevention strategies in this regard.

Keywords: pulmonary disease, chronic obstructive, pulmonary medicine, oxygen inhalation therapy

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Authors: Uhde Serenay Sunay, Alev Yalçınkaya

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Emotional abuse is one of the most challenging forms of violence to define, and many individuals often unknowingly experience emotional abuse. Existing literature has found that individuals who have experienced psychological abuse tend to suffer from depression, low self-esteem, a decreased sense of autonomy, fear, and an increased risk of suicide. Current research indicates that physical abuse in romantic relationships is often accompanied by emotional abuse, supporting the idea that identifying emotional abuse is an essential factor in romantic relationships. On the other hand, studies on emotional abuse between partners in romantic relationships are limited. This study investigated attitudes towards emotional abuse among Turkish university students. Gender differences were investigated.Additionally, the study examined whether the degree of emotional abuse was related to attitudes towards emotional abuse. A total of 243 university students participated in the research, with 156 female and 87 male participants. Participants' attitudes toward emotional abuse were measured using the Turkish adaptation of Follingstad Psychological Aggression Scale and hypothetical scenarios created by the researchers. The results revealed that attitudes of women and men vary significantly in attack looks/sexuality, fidelity, gender roles, and jealousy subscales of Follingstad Psychological Aggression Scale. Furthermore, attitudes towards moderate-level and severe-level emotional abuse exhibit statistically significant variability by gender, while attitudes towards mild-level emotional abuse do not.

Keywords: emotional abuse, gender differences, Turkish culture, university students

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Authors: Keyvan Ramin

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The geometric nonlinearity of Off-Diagonal Bracing System (ODBS) could be a complementary system to covering and extending the nonlinearity of reinforced concrete material. Finite element modeling is performed for flexural frame, x-braced frame and the ODBS braced frame system at the initial phase. Then the different models are investigated along various analyses. According to the experimental results of flexural and x-braced frame, the verification is done. Analytical assessments are performed in according to three-dimensional finite element modeling. Non-linear static analysis is considered to obtain performance level and seismic behavior, and then the response modification factors calculated from each model’s pushover curve. In the next phase, the evaluation of cracks observed in the finite element models, especially for RC members of all three systems is performed. The finite element assessment is performed on engendered cracks in ODBS braced frame for various time steps. The nonlinear dynamic time history analysis accomplished in different stories models for three records of Elcentro, Naghan, and Tabas earthquake accelerograms. Dynamic analysis is performed after scaling accelerogram on each type of flexural frame, x-braced frame and ODBS braced frame one by one. The base-point on RC frame is considered to investigate proportional displacement under each record. Hysteresis curves are assessed along continuing this study. The equivalent viscous damping for ODBS system is estimated in according to references. Results in each section show the ODBS system has an acceptable seismic behavior and their conclusions have been converged when the ODBS system is utilized in reinforced concrete frame.

Keywords: FEM, seismic behaviour, pushover analysis, geometric nonlinearity, time history analysis, equivalent viscous damping, passive control, crack investigation, hysteresis curve

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Authors: Kehabtimer Shiferaw Kotiso, Getachew Hailemariam, Abiy Seifu Estifanos

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Introduction: Despite the highest share of low birth weight (LBW) for neonatal mortality and morbidity, predicting births with LBW for better intervention preparation is challenging. This study aims to predict LBW using a dataset encompassing 53,637 birth cohorts collected from 36 primary hospitals across seven regions in Ethiopia from February 2022 to June 2024. Methods: We identified ten explanatory variables related to maternal and neonatal characteristics, including maternal education, age, residence, history of miscarriage or abortion, history of preterm birth, type of pregnancy, number of livebirths, number of stillbirths, antenatal care frequency, and sex of the fetus to predict LBW. Using WEKA 3.8.2, we developed and compared seven machine learning algorithms. Data preprocessing included handling missing values, outlier detection, and ensuring data integrity in birth weight records. Model performance was evaluated through metrics such as accuracy, precision, recall, F1-score, and area under the Receiver Operating Characteristic curve (ROC AUC) using 10-fold cross-validation. Results: The results demonstrated that the decision tree, J48, logistic regression, and gradient boosted trees model achieved the highest accuracy (94.5% to 94.6%) with a precision of 93.1% to 93.3%, F1-score of 92.7% to 93.1%, and ROC AUC of 71.8% to 76.6%. Conclusion: This study demonstrates the effectiveness of machine learning models in predicting LBW. The high accuracy and recall rates achieved indicate that these models can serve as valuable tools for healthcare policymakers and providers in identifying at-risk newborns and implementing timely interventions to achieve the sustainable developmental goal (SDG) related to neonatal mortality.

Keywords: low birth weight, machine learning, classification, neonatal mortality, Ethiopia

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Authors: Hubert Feiglstorfer

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Due to its location in a transition zone from the Pannonian to the pre-Alpine region, the east of Austria shows a small-scale diversity in the regional development of certain vernacular building techniques. In this article the relationship between natural building material resources, topography and climate will be examined. Besides environmental preconditions, social and economic historical factors have developed different construction techniques within certain regions in the Weinviertel and Burgenland, the two eastern federal states of Austria. But even within these regions, varying building techniques were found, due to the locally different use of raw materials like wood, stone, clay, lime, or organic fibres. Within these small-scale regions, building traditions were adapted over the course of time due to changes in the use of the building material, for example from wood to brick or from wood to earth. The processing of the raw materials varies from region to region, for example as rammed earth, cob, log, or brick construction. Environmental preconditions cross national borders. For that reason, developments in the neighbouring countries, the Czech Republic, Slovakia, Hungary and Slovenia are included in this analysis. As an outcome of this research a map was drawn which shows the interrelation between locally available building materials, topography, climate and local building techniques? As a result of this study, which covers the last 300 years, one can see how the local population used natural resources very sensitively adapted to local environmental preconditions. In the case of clay, for example, changes of proportions of lime and particular minerals cause structural changes that differ from region to region. Based on material analyses in the field of clay mineralogy, on ethnographic research, literature and archive research, explanations for certain local structural developments will be given for the first time over the region of East Austria.

Keywords: European crafts, material culture, architectural history, earthen architecture, earth building history

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Authors: Muhammad Shakeel Rehman Hissam

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This study aims at analyzing gender in Othello by applying Judith Butler’s Post-Structural theory of gender and gender performance. The analysis of the play provides us context by which we can examine what kinds of effects the drama have on understanding of the researchers regarding gender identity. The study sets out to examine that, is there any evidence or ground in Shakespearean selected work which leads to challenge the patriarchal taken for granted prescribed roles of gender? This would be the focal point in study of Othello that actions and performances of characters determine their gender identity rather than their sexuality. It argues that gender of Shakespearean characters has no constant, fixed and structural impression. On the contrary, they undergo consistent variations in their behavior and performance which impart fluidity and volatility to them. The focal point of the present study is Butler’s prominent work; Gender Trouble: Feminism and subversion of Identity and her post structural theory of Gender performativity as the theoretical underpinning of the text. It analyzes the selected play in Post-Structural gender perspective. The gender-centric plot of the play is riddled with fluidity of gender. The most fascinating aspect of the play is the transformations of genders on the basis of performances by different characters and through these transformations; gender identity is revealed and determined. The study reconstructs the accepted gender norms by challenging the traditional concept of gender that is based on sexual differences of characters.

Keywords: post structural, gender, performativity, socio-cultural gender norms, binaries, Othello, Butler, identity

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Authors: Paul Feyi Waboso

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This case report presents a 57-year-old female patient with a history of colon cancer, colostomy, and immunocompromise, who presented with an unusual bilateral vulval abscess, more prominent on the left side. Due to the atypical presentation, an MRI was performed, revealing a pelvic collection and a fistulous connection between the pelvis and vulva. This finding prompted an urgent surgical intervention. This case highlights the diagnostic and therapeutic challenges of managing complex abscesses and fistulas in immunocompromised patients. Introduction: Vulval abscesses in immunocompromised individuals can present with atypical features and may be associated with complex pathologies. Patients with a history of cancer, colostomy, and immunocompromise are particularly prone to infections and may present with unusual manifestations. This report discusses a case of a large bilateral vulval abscess with an underlying pelvic fistula, emphasizing the importance of advanced imaging in cases with atypical presentations. Case Presentation: A 57-year-old female with a known history of colon cancer, treated with colostomy, presented with severe pain and swelling in the vulval area. Physical examination revealed bilateral vulval swelling, with the abscess on the left side appearing larger and more pronounced than on the right. Given her immunocompromised status and the unusual nature of the presentation, we requested an MRI of the pelvis, suspecting an underlying pathology beyond a typical abscess. Investigations: MRI imaging revealed a significant pelvic collection and identified a fistulous tract between the pelvis and the vulva. This confirmed that the vulval abscess was connected to a deeper pelvic infection, necessitating urgent intervention. Management: After consultation with the multidisciplinary team (MDT), it was agreed that the patient required surgical intervention, having had 48 hours of antibiotics. The patient underwent evacuation of the left-sided vulval abscess under spinal anesthesia. During surgery, the pelvic collection was drained of 200 ml of pus. Outcome and Follow-Up: Postoperative recovery was closely monitored due to the patient’s immunocompromised state. Follow-up imaging and clinical evaluation showed improvement in symptoms, with gradual resolution of infection. The patient was scheduled for regular follow-up visits to monitor for recurrence or further complications. Discussion: Bilateral vulval abscesses are uncommon and, in an immunocompromised patient, warrant thorough investigation to rule out deeper infectious or fistulous connections. This case underscores the utility of MRI in identifying complex fistulous tracts and highlights the importance of a multidisciplinary approach in managing such high-risk patients. Conclusion: This case illustrates a rare presentation of bilateral vulval abscess with an associated pelvic fistula.

Keywords: vulval abscess, MDT team, colon cancer with pelvic fistula, vulval skin condition

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Authors: Akbar Jamali

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According to Hegel’s philosophy, constitution of any given nation is the best expression of its national Self-Consciousness. Since constitution is the place in which freedom and Universal Rights is expressed, and since the essence of Self-consciousness is freedom, the development of self-consciousness and consequently freedom, is the direct cause of the development of constitution. Self-consciousness develops in the human history according to its own internal and external dialectic; therefore, it is essentially a dynamic phenomenon. However, constitution is supposed to be a stable foundation for the legal system of state and society. Therefore, the dilemma is: how the dynamic and contradictory nature of Self-Consciousness is the foundation of constitution that supposed to be the stable base of legal system of state and society. According to Hegel’s philosophy, the contradiction between the dynamic self- consciousness and the static constitution and state has an essential role in the formation of social movements within any given state. Self-consciousness is the phenomenology of Spirit in the human history. Subjective Spirit expresses itself in the different shapes of Self-consciousness in human spirit. These different shapes of self-consciousness must be identical with its contradiction; Objective Spirit. State is the highest form of the objective Spirit. Therefore, state and its foundation namely ‘constitution’ must be identical with Self-consciousness. "Spirit cannot remain forever alienated from its expression." Hegel states. Self-consciousness is the Subjective Spirit, it freely develops according to its internal and external contradictions, but since it must be always identical with its expression namely constitution, its development results to alienation. They way by which self-consciousness became again identical with the constitution determines the nature of legal and political development of any given society and state. In the democratic states, self-consciousness shows itself partially in the public opinion. In the process of election, this public opinion changes the ruling parties that construct the government. In democracies, self-consciousness or subjective spirit is in a dialectical relationship with state or the Objective Spirit. Therefore, it cannot remain alienated with its expression that is political system and its constitution. But, in the autocracies Self-consciousness cannot easily express itself in the government and its constitution. More Self-consciousness develops more it becomes alienated with its expression that is the state and its constitution. Rebel and revolution are the symptom of alienation of Spirit (self-consciousness) with its expression (state and its constitution).

Keywords: alienation, constitution, self-consciousness, spirit

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Authors: Saeideh Soltanmohammadlou, Pilar M Guerrieri, Amir Kianfar, Sara Sadeghian, Yasaman Nafezi, Emily Irvin

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Architecture is rooted in the experiences of the residents in a place. Its foundations are based on needs and circumstances of each territory in terms of climate, available materials, economics and governmental policies, and cultural ideals and ideas of the people that live there. The architectural history of Iran echoes these architectural origins and has revealed certain trends reflecting this territory and culture. However, in recent years, new architectural patterns are developing that diverge from what has previously been considered classic forms of Iranian architecture. This article investigates architectural elements that make up the architecture created by religious minorities after the Safavid dynasty (one of the most significant ruling dynasties of Iran (from 1501 to 1736) in Iranian cities: Isfahan, Tabriz, Kerman, and Uremia. Similarities and differences are revealed between the architecture that composes neighborhoods of religious minorities in Iran and common national architectural trends in each era after this dynasty. This dynasty is specific as a point of reference in this article because Islam was identified as the state religion of Iran during this era. This decision changed the course of architecture in the country to incorporate religious motifs and meanings. The study associated with this article was conducted as a survey that sought to find links between architecture of religious minorities with Iranian national architecture. Interestingly, a merging of architectural forms and trends occur as immigrants interact with Iranian Islamic meanings. These observations are significant within the context of modern architecture around the world and within Western discourse because what are considered religious minorities in Iran are the dominant religions in Western nations. This makes Iran’s architecture particularly unique as it creates a kind of inverse relationship, than that of Western nations, to the ways in which religion influences architectural history.

Keywords: architecture, ethnic architecture, national architecture, religion architecture

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Authors: A. Akbarpour, M. R. Adib Ramezani, M. Zhian, N. Ghorbani Amirabad

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One way to improve the performance of structures against of earthquake is passive control which requires no external power source. In this research, tuned liquid column dampers which are among of systems with the capability to transfer energy between various modes of vibration, are used. For the first time, a liquid column damper for vibration control structure is presented. After modeling this structure in design building software and performing the static and dynamic analysis and obtaining the necessary parameters for the design of tuned liquid column damper, the whole structure will be analyzed in finite elements software. The tuned liquid column dampers are installed on the structure and nonlinear time-history analysis is done in two cases of structures; with and without dampers. Finally the seismic behavior of building in the two cases will be examined. In this study the nonlinear time-history analysis on a twelve-story steel structure equipped with damper subject to records of earthquake including Loma Prieta, Northridge, Imperiall Valley, Pertrolia and Landers was performed. The results of comparing between two cases show that these dampers have reduced lateral displacement and acceleration of levels on average of 10%. Roof displacement and acceleration also reduced respectively 5% and 12%. Due to structural asymmetric in the plan, the maximum displacements of surrounding structures as well as twisting were studied. The results show that the dampers lead to a 10% reduction in the maximum response of structure stories surrounding points. At the same time, placing the dampers, caused to reduce twisting on the floor plan of the structure, Base shear of structure in the different earthquakes also has been reduced on the average of 6%.

Keywords: retrofitting, passive control, tuned liquid column damper, finite element analysis

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Authors: Xianlu Zeng

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China has undergone rapid economic growth over the last three decades. During this time, China-focused study has become one of the most popular areas of research. However, even though China has one of the oldest legal traditions in the world, there is limited research available regarding the development and operation of China’s juvenile justice system. This article will provide general information about China’s juvenile justice tradition along with a review of its reformation in 2013. A discussion is presented that provides some thoughts about how successful these reforms have been and where China may need to head.

Keywords: China, history, juvenile justice, legal traditions

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Authors: Shaista Maseeh

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English Literature from the beginning itself has had psychological, social and environment concerns. Virgil, Shakespeare, John Milton, William Wordsworth to the most current Robert Hass have shown and proved their environmental and ecological interests as well as distress related to its loss. Pastoral literature is also one such genre that links literature with environment. Thanks to the contemporary literary theories that they successfully are relating Literature formally to the subjects other than written text. One of such literary theory is 'Ecocriticism.' It stands under the umbrella of the Economics term, Sustainable Development,' or it can also be understood as an ecological extension of it. Ecocriticism helps the reader to study the dynamic relation between literature and our degrading environment. It draws attention towards the ravaged condition of nature and animals, that how nature is exploited by human beings for their own benefit leaving nature at a repairable loss. For instance, deforestation is reducing the size of forest every year, injuring permanently flora, fauna and also the habitat of animals. This paper will study the ecological and environmental concerns in the latest novel by Pakistani British writer Kamila Shamsie, A God in every Stone (2014). The book is not only a literary masterpiece in elegant prose, but also a novel posing a lot of questions about 'nature and environment' in general and 'animals' in particular. It gives the glimpses of the interesting history of Temple of Zeus in Greece and Ancient Caria, and covers many episodes of history the Indian freedom struggle. In course of novel's narrative Kamila Shamsie poses disturbing question about environmental abuse, about how human beings are more 'beasts' than so call beasts, poor animals. She also glorifies the simplicity of past. The novel has enough instances to prove Shamsie's positive stand on saving the earth that is being more abused than used by human beings. This paper will provide an ecocritical approach to study A God in Every Stone (2014).

Keywords: animals, ecocriticism, environment, nature

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Authors: Surachart Koyadun

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Introduction: Plasmodium knowlesi (P. knowlesi) malaria is a zoonotic disease that is classified as type 5 of human malaria. Commonly found in macaques (Macaca fascicularis) and (Macaca nemestrina), P. knowlesi is capable of resulting in both uncomplicated and severe malaria in humans. Situation of P. knowlesi malaria in Phang-Nga province for the past 3 years from 2020 – 2022 revealed no case report in 2020, however, a total of 14 cases had been reported in 2021 - 2022. This research aimed to 1) study the epidemiology of P. knowlesi, 2) examine the clinical manifestations of P. knowlesi patients, 3) analyze the ecology and entomology of P. knowlesi, and 4) analyze the diagnosis and treatment of P. knowlesi. Method: This research was a retrospective descriptive study/case report. The study was conducted in 14 patients with P. knowlesi malaria between 2021 and 2022 in 4 districts of Phang-Nga Province, Thailand including Thapput, Kapong, Takuapa and Khuraburi. Results: The study subjects of P. knowlesi malaria were all males. Most of them were working age groups as farmers and worked in forest or plantation areas. All had no history of blood transfusions. Most of the patients did not use mosquito nets and had a history of camping in the forest prior to the onset of fever. An analysis of all 14 sources of infection unveiled the area is home to macaques, and that area has detected Anopheles mosquito, which is the carrier of the disease. Majority of them got sick in the dry season of Thailand (December-April). The main symptoms brought to the hospital were fever, chills, headache, body aches. Laboratory findings on the first day of diagnosis were as follows: The white blood cell count was found within the normal range. In the proportion of white blood cells, eosinophils were found to be slightly higher than normal. Slight anemia was found on early examination. The platelet count was found to be below normal in all cases. Severely low platelet count (2,000 cells/mm3) was found in severe cases with multiple complications. No patient was found dead but 85.7% of complications were found, with acute renal failure being the most common. Patients with delayed diagnosis and treatment of malaria (inaccurate diagnosis or late access to the hospital) had the highest severity and complications than those who had seen the doctor since the first 3-4 days of illness or the screening of symptoms and risk history by the malaria clinic staff at vector-borne disease control unit. Conclusion and Recommendation: P. knowlesi malaria is an emerging infectious disease transmitted from animals to humans. There are challenges in epidemiology, entomology, ecology for effective surveillance, prevention and control. Early diagnosis and treatment would reduce complications and prevent death.

Keywords: malaria, plasmodium knowlesi, epidemiology, ecology, entomology, diagnosis, treatment

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Authors: Aikaterini Amanatidou

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We describe the case of a 20-year-old female patient diagnosed with Ehlers-Danlos Syndrome (EDS) who was scheduled to undergo a wisdom teeth extraction in outpatient surgery. EDS is a hereditary connective tissue disorder characterized by joint hypermobility, skin hyper-extensibility, and vascular and soft tissue fragility. There are six subtypes of Ehlers-Danlos, and in our case, the patient had EDS hyper-mobility (HT) type disorder. One important clinical feature of this syndrome is chronic pain, which is often poorly understood and treated. Our patient had a long history of articular and lumbar pain when she was diagnosed. She was prescribed analgesic treatment for acute and neuropathic pain and had multiple sessions of psychotherapy and physiotherapy to ease the pain. Unfortunately, her extensive medical history was underrated by our anesthetic team, and no further measures were taken for the operation. Despite an uneventful intra-operative phase, the patient experienced several episodes of hyperalgesia during the immediate post-operative care. Management of pain was challenging for the anesthetic team: initial opioid treatment had only a temporary effect and a paradoxical reaction after a while. Final pain relief was eventually obtained with psycho-physiologic treatment, high doses of ketamine, and patient-controlled analgesia infusion of morphine-ketamine-dehydrobenzperidol. We suspected an episode of Opioid-Induced hyperalgesia. This case report supports the hypothesis that anti-hyperalgesics such as ketamine as well as lidocaine, and dexmedetomidine should be considered intra-operatively to avoid opioid-induced hyperalgesia and may be an alternative solution to manage complex chronic pain like others in neuropathic pain syndromes.

Keywords: Ehlers-Danlos, post-operative management, hyperalgesia, opioid-induced hyperalgesia, rare disease

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Authors: Shakila Singh

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This research was conducted at a selected South African university campus with women students who drink alcohol. The purpose of the study was to examine their perspectives on the role of alcohol in their lives, their understandings about women’s vulnerability to alcohol-related sexual risk and their strategies against these. The study draws on feminist principles and practices to challenge gendered inequalities that legitimate and facilitate violence against women. Recognising the danger of focusing on risk management in ways that place the burden of responsibility entirely on young women to prevent their violation, this article focuses on women students’ agency in managing risk while taking up opportunities for self-discovery. Participation was voluntary, and a student-researcher administered an open-ended questionnaire to 55 participants. The findings suggest that young women position alcohol- use as a common activity at university, and that it gives them much pleasure. They recognise that it is riskier for women and articulate valuable strategies to manage the risk to their sexual safety when drinking. These include drinking within supportive networks, avoiding financial dependence, and managing their alcohol intake. This article argues that alcohol at university is an integral part of expressions of gender and sexuality and that risk-taking is a normal part of university students’ lives. Consequently, arguments about equality need to consider risk-taking as part of young people’s lives and promote ways of managing alcohol-related risks, rather than imagining that alcohol can be avoided entirely.

Keywords: alcohol-related sexual risk, drinking at university, managing risk, women students

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Authors: Maham Leeza Adil, Mahrukh Alvi, Muhammad Osman

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Introduction: Sheehan's syndrome (SS) is a rare cause of hypopituitarism resulting from postpartum hemorrhage and pituitary necrosis. It remains an underdiagnosed condition, especially in developing countries, due to poor obstetric care and home deliveries. This case report highlights the significance of recognizing atypical presentations of SS, such as pancytopenia, to aid in early diagnosis and management. Case Presentation: A 40-year-old female presented with acute abdomen symptoms and was initially diagnosed with acalculous cholecystitis. However, a detailed history revealed a history of postpartum hemorrhage 18 years prior, leading to a provisional diagnosis of SS. Further investigations confirmed panhypopituitarism, including hypothyroidism, hypocortisolism, and hypogonadism. Notably, the patient also exhibited pancytopenia, a rarely reported hematological manifestation of SS. Discussion: SS often presents with nonspecific symptoms, leading to delayed or missed diagnoses. In this case, the patient's initial presentation of acute abdomen symptoms was attributed to secondary adrenal insufficiency due to panhypopituitarism. The presence of pancytopenia, along with hyponatremia, further complicated the clinical picture. Hormone replacement therapy led to a remarkable improvement in the patient's condition, emphasizing the importance of early diagnosis and intervention. Conclusion: SS is a common cause of panhypopituitarism in developing countries, but its atypical presentations, such as pancytopenia, are rare and often overlooked. This case highlights the need for increased awareness among clinicians to consider SS in patients with unexplained hematological abnormalities, particularly in regions with high rates of postpartum hemorrhage. Early recognition and appropriate hormone replacement therapy can significantly improve patients' outcomes and prevent long-term complications associated with this underdiagnosed syndrome.

Keywords: Sheehan syndrome, panhypopituitarism, pancytopenia, delayed diagnosis

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Authors: Farnaz Nazem

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Iranian architects had creative ways for constructing the buildings in each climate. Some of these architectural elements were made under the ground. Shovadan is one of these underground spaces in hot- humid regions in Dezfoul and Shoushtar city that had special functions and characteristics. In this paper some subjects such as the history of Shovadan, its elements and effective factors in the formation of Shovadan in Dezfool city are discussed.

Keywords: architecture, dezfoul city, Shovadan, south west of Iran

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Authors: Hardisiswo Soedjana, Inne Caroline

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Deep dermal or full thickness burns are inevitably lead to post-burn contractures. These contractures remain to be one of the most concerning late complications of burn injuries. Surgical management includes releasing the contracture followed by resurfacing the defect accompanied by post-operative rehabilitation. Optimal treatment of post-burn contractures depends on the characteristics of the contractures. This study is aimed to describe clinical characteristics, problems, and management of post-burn contractures in adults and children. A retrospective analysis was conducted from medical records of patients suffered from contractures after burn injuries admitted to Hasan Sadikin general hospital between January 2016 and January 2018. A total of 50 patients with post burn contractures were included in the study. There were 17 adults and 33 children. Most patients were male, whose age range within 15-59 years old and 5-9 years old. Educational background was mostly senior high school among adults, while there was only one third of children who have entered school. Etiology of burns was predominantly flame in adults (82.3%); whereas flame and scald were the leading cause of burn injury in children (11%). Based on anatomical regions, hands were the most common affected both in adults (35.2%) and children (48.5%). Contractures were identified in 6-12 months since the initial burns. Most post-burn hand contractures were resurfaced with full-thickness skin graft (FTSG) both in adults and children. There were 11 patients who presented with recurrent contracture after previous history of contracture release. Post-operative rehabilitation was conducted for all patients; however, it is important to highlight that it is still challenging to control splinting and exercise when patients are discharged and especially the compliance in children. In order to improve quality of life in patients with history of deep burn injuries, prevention of contractures should begin right after acute care has been established. Education for the importance of splinting and exercise should be administered as comprehensible as possible for adult patients and parents of pediatric patients.

Keywords: burn, contracture, education, exercise, splinting

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Authors: Ketevan Epadze

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The paper aims to examine conflicting historical narratives proposed by the Georgian and Abkhazian scholars on the territorial affiliation of Abkhazia in the 1950s, explain how these narratives were connected to the Soviet nationalities policy after WW II and demonstrate the dynamic of the narratives’ battle in the last years of the Soviet system, which was followed by military conflict in the post-Soviet era. Abkhazia –a breakaway region of Georgia- self-declared its independence in 1992. Historical dispute on the territorial rights of Abkhazia emerged long before the military conflict began and was connected to the theory of Abkhazian ethnogenesis written by the Georgian literary scholar Pavle Ingorokva. He argued that medieval Abkhazians were Georgians, while modern Abkhazians are newcomers in Abkhazia. After the de-Stalinization, Abkhazian historians developed historical narrative opposed to Ingorokva’s theory. In the 1980s, Georgian dissidents who strove for Georgia’s independence used Ingorokva’s thesis to oppose Abkhazians desire for self-determination and sovereignty. Abkhazian political actors in their turn employed opposite historical arguments to legitimate their rights over autonomy. Ingorokva’s theory is one of the principal issues, discussed during the Georgian-Abkhazian dialogue; it often confuses Georgians and gives the reasons to Abkhazians for complaining about the Georgian discrimination in the Soviet past. The study is based on the different kind of sources: archival materials of the 1950s (Communist Party Archive of Georgia, Soviet Journal ‘Mnatobi’), the book by Pavle Ingorokva ‘Giorgi Merchule’ (1947-1954) and Zurab Anchabadze’s responsive work to Ingorokva’s book – ‘From the medieval history of Abkhazia’ (1956-1959), political speeches of the Georgian and Abkhazian political actors in the 1980s, secondary sources on the Soviet nationalities policy from the 1950s to the 1990s.

Keywords: Soviet, history, ethnicity, nationalism, politics, post-Soviet, conflict

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Authors: Gabriela Ilie, Robert D. H. Rutledge

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A review of the literature reveals a need for longitudinal studies to properly understand the quality of life of prostate cancer survivors during their prostate cancer journey in order to identify opportunities for patient support and care during prostate cancer survivorship. In this study, mental health and relationship satisfaction were assessed longitudinally and by treatment modality among a population-based sample of Canadian adult men with a history of prostate cancer diagnosis. A total of 98 men, aged 51 or older with a history of prostate cancer completed an on-line 15-minute survey between May 2017 and February 2018, assessing mental health (Kessler Psychological Distress Scale) and relationship satisfaction (Dyadic Adjustment Scale) at baseline and at three months post-treatment with either active or nonactive prostate cancer treatment. Almost 1 in 6 men in this sample screened positive for mental health issues (17.34%, n=17) irrespective of treatment modality and most (n=11) were not currently on medication for depression, anxiety or both. Mental health outcomes were poorer for men with multimorbidity. For every instance of screening positive for mental health issues, 2.021 (95% CI:1.1 to 3.8) times more comorbidities were recorded. Relationship satisfaction and dyadic cohesion were statistically significantly lower from first assessment to 3 months for men who underwent multiple treatment modalities (surgery and radiation with hormonal therapy). Relationship satisfaction was also lower at 3 months for men who underwent radiation therapy. Almost 1 in 2 men in this sample (74%) indicated they did not attend a prostate cancer support group. Results suggest that treatment for mental health is underutilized in men with prostate cancer. Men who undergo multiple forms of active treatment appear more vulnerable to relationship dissatisfaction and feeling disconnected from their partner. Data points to important opportunities for patient education and care support during survivorship.

Keywords: prostate cancer survivorship, mental health, quality of life, relationship satisfaction

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Authors: Pantelis Sklias, Panagiota Chatzimichailidou

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This study intents to clarify the nexus of adult education and economic development within the methodological framework of political economy within EU. The main logic behind this study is that economies with a higher level of adult education have higher levels of economic development. Despite the assumption that policy making in adult education will clearly be facilitated by any ‘proofs’ of efficiency, mainly monetary, this study acknowledges the limitations following the use of the narrow economic approaches embedded in the neoclassical framework and proposes that the methodological framework of political economy is the most relevant to explore the correlation between adult education and economic development. Focusing only on neoclassical economics to explore the financial impact of adult education, it will marginalize the consideration of its history, producing a short of historical amnesia, besides the social harm, namely the devaluation of its socio-cultural influences. On the other side the political economy perspective offers a wider perception of adult education’s profits from a quantitative and a qualitative perspective too. The understanding of adult education engages questions of political economy because it is identified mainly as means of transformation, either personal or societal, serving humanistic values, besides its accepted monetary attributes. The political economy elevates questions regarding how the three institutional arrangements -the state, the market, and the civil society, are engaged in promoting adult education and therefore how adult education could reinforce economic development. Here the economic substance is still considered but it is placed into a wider social spectrum, where politics, economy, and history interact with one another. This study restricts itself in EU and explores the role of the three institutional arrangements both in the formulation of policy planning, and in the mental transformational process of the individual learners, which opens the path to a deeper understanding of the interaction between the individual and the social action, and therefore between adult education and economic development. This study also elevates the idea that economic development can have a positive impact on the unification of Europe, which encompasses economic, political, and cultural components.

Keywords: adult education, economic development, EU, political economy, unification of Europe

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Authors: Bruce Wrightsman

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Construction and design are inexorably linked. Traditional building methodologies, including those using wood, comprise a series of material layers differentiated and separated from each other. This results in the separation of two agencies of building envelope (skin) separate from the structure. However, from a material performance position reliant on additional materials, this is not an efficient strategy for the building. The merits of traditional platform framing are well known. However, its enormous effectiveness within wood-framed construction has seldom led to serious questioning and challenges in defining what it means to build. There are several downsides of using this method, which is less widely discussed. The first and perhaps biggest downside is waste. Second, its reliance on wood assemblies forming walls, floors and roofs conventionally nailed together through simple plate surfaces is structurally inefficient. It requires additional material through plates, blocking, nailers, etc., for stability that only adds to the material waste. In contrast, when we look back at the history of wood construction in airplane and boat manufacturing industries, we will see a significant transformation in the relationship of structure with skin. The history of boat construction transformed from indigenous wood practices of birch bark canoes to copper sheathing over wood to improve performance in the late 18th century and the evolution of merged assemblies that drives the industry today. In 1911, Swiss engineer Emile Ruchonnet designed the first wood monocoque structure for an airplane called the Cigare. The wing and tail assemblies consisted of thin, lightweight, and often fabric skin stretched tightly over a wood frame. This stressed skin has evolved into semi-monocoque construction, in which the skin merges with structural fins that take additional forces. It provides even greater strength with less material. The monocoque, which translates to ‘mono or single shell,’ is a structural system that supports loads and transfers them through an external enclosure system. They have largely existed outside the domain of architecture. However, this uniting of divergent systems has been demonstrated to be lighter, utilizing less material than traditional wood building practices. This paper will examine the role monocoque systems have played in the history of wood construction through lineage of boat and airplane building industries and its design potential for wood building systems in architecture through a case-study examination of a unique wood construction approach. The innovative approach uses a wood monocoque system comprised of interlocking small wood members to create thin shell assemblies for the walls, roof and floor, increasing structural efficiency and wasting less than 2% of the wood. The goal of the analysis is to expand the work of practice and the academy in order to foster deeper, more honest discourse regarding the limitations and impact of traditional wood framing.

Keywords: wood building systems, material histories, monocoque systems, construction waste

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Authors: Nadia H. Mohammed, Anmar Al-Taie, Fadia H. Al-Sultany

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Although breast cancer prevalence continues to increase, mortality has been decreasing as a result of early detection and improvement in adjuvant systemic therapy. Nevertheless, this disease required further efforts to understand and identify the associated potential risk factors that could play a role in the prevalence of this malignancy among Iraqi women. The objective of this study was to assess the perception of certain predictive risk factors on the prevalence of breast cancer types among a sample of Iraqi women diagnosed with breast cancer. This was a retrospective observational study carried out at National Cancer Research Center in College of Medicine, Baghdad University from November 2017 to January 2018. Data of 100 patients with breast cancer whose biopsies examined in the National Cancer Research Center were included in this study. Data were collected to structure a detailed assessment regarding the patients’ demographic, medical and cancer records. The majority of study participants (94%) suffered from ductal breast cancer with mean age 49.57 years. Among those women, 48.9% were obese with body mass index (BMI) 35 kg/m². 68.1% of them had positive family history of breast cancer and 66% had low parity. 40.4% had stage II ductal breast cancer followed by 25.5% with stage III. It was found that 59.6% and 68.1% had positive oestrogen receptor sensitivity and positive human epidermal growth factor (HER2/neu) receptor sensitivity respectively. In regard to the impact of prediction of certain variables on the incidence of ductal breast cancer, positive family history of breast cancer (P < 0.0001), low parity (P< 0.0001), stage I and II breast cancer (P = 0.02) and positive HER2/neu status (P < 0.0001) were significant predictive factors among the study participants. The results from this study provide relevant evidence for a significant positive and potential association between certain risk factors and the prevalence of breast cancer among Iraqi women.

Keywords: Ductal Breast Cancer, Hormone Sensitivity, Iraq, Risk Factors

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Authors: Ece Kaya

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Urban waterfront re-development is a well-established phenomenon internationally since 1960s. In cities throughout the world, old industrial waterfront land is being redeveloped into luxury housing, offices, tourist attractions, cultural amenities and shopping centres. These developments are intended to attract high-income residents, tourists and investors to the city. As urban waterfronts are iconic places for the cities and catalyst for further development. They are often referred as flagship project. In Sydney, the re-development of industrial waterfront has been exposed since 1980s with Darling Harbour Project. Darling Harbour waterfront used to be the main arrival and landing place for commercial and industrial shipping until 1970s. Its urban development has continued since the establishment of the city. It was developed as a major industrial and goods-handling precinct in 1812. This use was continued by the mid-1970s. After becoming a redundant industrial waterfront, the area was ripe for re-development in 1984. Darling Harbour is now one of the world’s fascinating waterfront leisure and entertainment destinations and its transformation has been considered as a success story. It is a contradictory statement for this paper. Data collection was carried out using an extensive archival document analysis. The data was obtained from Australian Institute of Architects, City of Sydney Council Archive, Parramatta Heritage Office, Historic Houses Trust, National Trust, and University of Sydney libraries, State Archive, State Library and Sydney Harbour Foreshore Authority Archives. Public documents, primarily newspaper articles and design plans, were analysed to identify possible differences in motives and to determine the process of implementation of the waterfront redevelopments. It was also important to obtain historical photographs and descriptions to understand how the waterfront had been altered. Sites maps in different time periods have been identified to understand what kind of changes happened on the urban landscape and how the developments affected areas. Newspaper articles and editorials have been examined in order to discover what aspects of the projects reflected the history and heritage. The thematic analysis of the archival data helped determine Darling Harbour is a historically important place as it had represented a focal point for Sydney's industrial growth and the cradle of industrial development in European Australia. It has been found that the development area was designated in order to be transformed to a place for tourist, education, recreational, entertainment, cultural and commercial activities and as a result little evidence remained of its industrial past. This paper aims to discuss the industrial significance of Darling Harbour and to explain the changes on its industrial landscape. What is absent now is the layer of its history that creates the layers of meaning to the place so its historic industrial identity is effectively lost.

Keywords: historical significance, industrial heritage, industrial waterfront, re-development

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Authors: Paras Agarwal

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Background: Initially believed to be rare, metastases to the eye are the most common ocular malignancy. The choroid’s high perfusion rate not only makes it the most susceptible ocular site for tumour seeding, but also promotes its growth. The cancers most frequently responsible for choroidal metastases originate from the breast and lung, although a significant proportion have unidentified primaries at the time of presentation. Case Presentation: This case report describes a 34 year old female presenting to the ophthalmology department with a one month history of painless distorted vision. On fundus examination, she was noted to have bilateral choroidal lesionsand subsequently underwent a comprehensive diagnostic work-up. The patient was diagnosed with metastatic pulmonary adenocarcinoma, despite lacking conventional risk factors. As she was found to have a mutation in EGFR, the patient was commenced on tyrosine-kinase inhibition with afatinib. The choroidal lesions regressed with a significant improvement in visual acuity and a dramatic anatomical reduction of the choroidal masses. Conclusions: Our case demonstrates the importance of considering metastases as a differential diagnosis for choroidal lesions. Appropriate and thorough history-taking, examination and investigations may be required in order to deduce the underlying cause. Our case is unusual in view of the choroidal lesion being the primary manifestation of metastatic lung cancer in a young patient with no known risk factors. Early recognition of choroidal metastases is important as it is often the first sign of tumour dissemination and will prompt earlier treatment with systemic medications such as chemotherapy, immunotherapy, targeted therapy or hormonal therapy. Our case report also demonstrates the efficacy of afatinib for the treatment of choroidal metastases, with morphological and functional improvements observed with regard to the choroidal metastatic tumour.

Keywords: choroidal neoplasm, choroidal naevus, pulmonary adenocarcinoma, metastases, lung cancer

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Authors: Igor Guatelli

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The universe of aesthetic perception entails impasses about sensitive divergences that each text or visual object may be subjected to. If approached through intertextuality that is not based on the misleading notion of kinships or similarities a priori admissible, the possibility of anachronistic, heterogeneous - and non-diachronic - assemblies can enhance the emergence of interval movements, intermediate, and conflicting, conducive to a method of reading, interpreting, and assigning meaning that escapes the rigid antinomies of the mere being and non-being of things. In negative, they operate in a relationship built by the lack of an adjusted meaning set by their positive existences, with no remainders; the generated interval becomes the remnant of each of them; it is the opening that obscures the stable positions of each one. Without the negative of absence, of that which is always missing or must be missing in a text, concept, or image made positive by history, nothing is perceived beyond what has been already given. Pairings or binary oppositions cannot lead only to functional syntheses; on the contrary, methodological disturbances accumulated by the approximation of signs and entities can initiate a process of becoming as an opening to an unforeseen other, transformation until a moment when the difficulties of [re]conciliation become the mainstay of a future of that sign/entity, not envisioned a priori. A counter-history can emerge from these unprecedented, misadjusted approaches, beginnings of unassigned injunctions and disjunctions, in short, difficult alliances that open cracks in a supposedly cohesive history, chained in its apparent linearity with no remains, understood as a categorical historical imperative. Interstices are minority fields that, because of their opening, are capable of causing opacity in that which, apparently, presents itself with irreducible clarity. Resulting from an incomplete and maladjusted [at the least dual] marriage between the signs/entities that originate them, this interval may destabilize and cause disorder in these entities and their own meanings. The interstitials offer a hyphenated relationship: a simultaneous union and separation, a spacing between the entity’s identity and its otherness or, alterity. One and the other may no longer be seen without the crack or fissure that now separates them, uniting, by a space-time lapse. Ontological, semantic shifts are caused by this fissure, an absence between one and the other, one with and against the other. Based on an improbable approximation between some conceptual and semantic shifts within the design production of architect Rem Koolhaas and the textual production of the philosopher Jacques Derrida, this article questions the notion of unity, coherence, affinity, and complementarity in the process of construction of thought from these ontological, epistemological, and semiological fissures that rattle the signs/entities and their stable meanings. Fissures in a thought that is considered coherent, cohesive, formatted are the negativity that constitutes the interstices that allow us to move towards what still remains as non-identity, which allows us to begin another story.

Keywords: clearing, interstice, negative, remnant, spectrum

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Authors: Rachel P. Vasconcellos

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The Russian constructivism is usually enshrined in history as another ''modernist ism'', that is, as an artistic phenomenon related to the early twentieth century‘s zeitgeist. What we aim in this essay is to analyze the constructivist movement not over the Art History field neither through the aesthetic debate, but through a geographical critical theory, taking the main idea of construction in the concrete sense of production of space. Seen from the perspective of the critique of space, the constructivist production is presented as a plan of totality, designed as socialist society‘s spatiality, contemplating and articulating all its scalar levels: the objects of everyday life, the building, the city and the territory. The constructivist avant-garde manifests a geographical ideology, launching the foundation‘s basis of modern planning ideology. Taken in its political sense, the artistic avant-garde of the Russian Revolution intended to anticipate the forms of a social future already put in progress: their plastic research pointed to new formal expressions to revolutionary contents. With the foundation of new institutions under a new State, it was given to the specialized labor of artists, architects, and planners the task of designing the socialist society, based on the thesis of scientific socialism. Their projects were developed under the politico-economics imperatives to the Soviet modernization – that is: the structural needs of industrialization and inclusion of all people in the productive work universe. This context shapes the creative atmosphere of the constructivist avant-garde, which uses the methods of engineering to the transform everyday life. Architecture, urban planning, and state planning integrated must then operate as spatial arrangement morphologically able to produce socialist life. But due to the intrinsic contradictions of the process, the rational and geometric aesthetic of the City-Machine appears, finally, as an image of a scientific socialist utopia.

Keywords: city-machine, critique of space, production of space, soviet territorialization

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Authors: Yan Wang, Wei Wu

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In recent years, with the gradual change of Chinese urban development mode from 'incremental development' to 'stock-based renewal', the urban design method of ‘grand scene’ in the past could only cope with the planning and construction of incremental spaces such as new towns and new districts, while the problems involved in the renewal of the stock lands such as historic blocks of ancient cities are more complex. 'Simplified' large-scale demolition and construction may lead to the damage of the ancient city's texture and the overall cultural atmosphere; thus it is necessary to re-explore the urban design path of historical blocks in the conservation context of the ancient city. Through the study of the cultural context of the ancient city of Suzhou in China and the interpretation of its current characteristics, this paper explores the methods and paths for the renewal of historical and cultural blocks in the ancient city. It takes No. 12 and No. 13 historical blocks in the ancient city of Suzhou as examples, coordinating the spatial layout and the landscape and shaping the regional characteristics to improve the quality of the ancient city's life. This paper analyses the idea of conservation and regeneration from the aspects of culture, life, business form, and transport. Guided by the planning concept of ‘block repair and cultural infiltration’, it puts forward the urban design path of ‘conservation priority, activation and utilization, organic renewal and strengthening guidance’, with a view to continuing the cultural context and stimulating the vitality of ancient city, so as to realize the integration of history, modernity, space and culture. As a rare research on urban design in the scope of Suzhou ancient city, the paper expects to explore the concepts and methods of urban design for the historic blocks on the basis of the conservation of the history, space, and culture and provides a reference for other similar types of urban construction.

Keywords: historical block, Suzhou ancient city, stock-based renewal, urban design

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