Search results for: advanced care planning

Authors: Mohsen Shati, Seyede Salehe Mortazavi, Seyed Kazem Malakouti, Hamidreza Khanke Fazlollah Ahmadi

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Taking unnecessary or excessive medication or using drugs with no indication (polypharmacy) by people of all ages, especially the elderly, is associated with increased adverse drug reactions (ADR), medical errors, hospitalization and escalating the costs. It may be facilitated or impeded by the healthcare system. In this study, we are going to describe the role of the health system in the practice of polypharmacy in Iranian elderly. In this Inductive qualitative content analysis using Graneheim and Lundman methods, purposeful sample selection until saturation has been made. Participants have been selected from doctors, pharmacists, policy-makers and the elderly. A total of 25 persons (9 men and 16 women) have participated in this study. Data analysis after incorporating codes with similar characteristics revealed 14 subcategories and six main categories of the referral system, physicians’ accessibility, health data management, drug market, laws enforcement, and social protection. Some of the conditions of the healthcare system have given rise to polypharmacy in the elderly. In the absence of a comprehensive specialty and subspecialty referral system, patients may go to any physician office so may well be confused about numerous doctors' prescriptions. Electronic records not being prepared for the patients, failure to comply with laws, lack of robust enforcement for the existing laws and close surveillance are among the contributing factors. Inadequate insurance and supportive services are also evident. Age-specific care providing has not yet been institutionalized, while, inadequate specialist workforce playing a major role. So, one may not ignore the health system as contributing factor in designing effective interventions to fix the problem.

Keywords: elderly, polypharmacy, health system, qualitative study

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Authors: Jill Garner, Belinda Lange, Sheila Lennon, Maayken van den Berg

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Currently, there are approximately one billion people worldwide affected by a neurological condition. Many of whom are assessed and treated by a physiotherapist in a variety of settings. There is a lack of consensus in the literature related to what is clinically assessed by physiotherapists in people with neurological conditions. This study aimed to explore assessment in people with neurological conditions, including how health care setting, experience, and therapeutic approach, may influence neurological assessment. A national survey targeted Australian physiotherapists who assess adults with neurological conditions as part of their clinical practice. The survey consisted of 39 questions and was distributed to physiotherapists through the Australian Physiotherapy Association, and Chief Allied Health Officers across Australia and advertised on the National Neurological Physiotherapy Facebook page. In total, 395 respondents consented to the survey from all states within Australia. Most respondents were female (85.4%) with a mean (SD) age of 35.7 years. Respondents reported working clinically in acute, community, outpatients, and community settings. Stroke was the most assessed condition (58.0%). There is variability in domains assessed by Australian physiotherapists, with common inclusions of balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, coordination, activity tolerance, postural alignment and symmetry and upper limb. There is little evidence to support what physiotherapists assess in practice, in different settings, and in different states within Australia and not enough information to develop a decision tree regarding what is important for assessment in different settings. Further research is needed to explore this area and develop a consensus around best practices.

Keywords: physiotherapy, neurological, assessment, domains

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Authors: Azizah M. Nahari, Peter Doerner

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Phosphate (Pi) is one of the essential macronutrients in plant growth and development, and it plays a central role in metabolic processes in plants, particularly photosynthesis and respiration. Limitation of crop productivity by Pi is widespread and is likely to increase in the future. Applications of Pi fertilizers have improved soil Pi fertility and crop production; however, they have also caused environmental damage. Therefore, in order to reduce dependence on unsustainable Pi fertilizers, a better understanding of phosphate use efficiency (PUE) is required for engineering nutrient-efficient crop plants. Enhanced Pi efficiency can be achieved by improved productivity per unit Pi taken up. We aim to identify, by using association mapping, general features of the most important loci that contribute to increased PUE to allow us to delineate the physiological pathways involved in defining this trait in the model plant Arabidopsis. As PUE is in part determined by the efficiency of uptake, we designed a hydroponic system to avoid confounding effects due to differences in root system architecture leading to differences in Pi uptake. In this system, 18 parental lines and 217 lines of the MAGIC population (a Multiparent Advanced Generation Inter-Cross) grown in high and low Pi availability conditions. The results showed revealed a large variation of PUE in the parental lines, indicating that the MAGIC population was well suited to identify PUE loci and pathways. 2 of 18 parental lines had the highest PUE in low Pi while some lines responded strongly and increased PUE with increased Pi. Having examined the 217 MAGIC population, considerable variance in PUE was found. A general feature was the trend of most lines to exhibit higher PUE when grown in low Pi conditions. Association mapping is currently in progress, but initial observations indicate that a wide variety of physiological processes are involved in influencing PUE in Arabidopsis. The combination of hydroponic growth methods and genome-wide association mapping is a powerful tool to identify the physiological pathways underpinning complex quantitative traits in plants.

Keywords: hydroponic system growth, phosphate use efficiency (PUE), Genome-wide association mapping, MAGIC population

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Authors: Madison Meyer

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Dermatological conditions are one of the most viewed medical subjects on the social media platform TikTok, resulting in the rise of several prominent American board-certified dermatologists as influencers. Notably, dermatology is one of the least diverse specialties. This cross-sectional study aimed to assess individuals’ preferences related to race, gender, and sexual identity of doctors in terms of dermatology-related information on TikTok and which group posts more reliable information. This study qualitatively and quantitatively evaluated the racial, gender, and sexual diversity of the top 55 dermatologist influencers on TikTok based on their follower count. The DISCERN tool was used to determine the reliability of consumer health content based on a score ranging from 1-5. Among the top 55 dermatologist influencers, African American (54,241.60) and Latinx (6,696) groups had the lowest mean number of followers compared to Caucasian (1,046,298.50) and Asian (1,403,393.50) physicians. Latinx and African American dermatologists had the highest DISCERN scores of 2 and 1.9, respectively. None of the physicians identified as a different gender or as LGBTQIA+ in any racial category. There is a considerable lack of minority dermatologist influencers on TikTok, especially Latinx, African American, and LGBTQIA+ physicians. The lack of diversity in the dermatology specialty can lead to inequitable care and health outcomes for racial/ethnic, gender, and sexual minority patient populations. This study’s findings also suggest Latinx and African American dermatologists post more reliable content compared with their Caucasian and Asian counterparts.

Keywords: dermatology, social media, sexual and gender minorities, racial minorities, skin of color, tiktok

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Authors: F. Polito, M. Cucinotta, A. Conti, C. Lo Giudice, C. Tomasello, F. Angileri, D. La Torre, M. Aguennouz

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Glioblastoma multiforme (GBM) is the most aggressive form of brain tumors, with an extremely poor prognosis. Telomeres lenght is associated with tumor progression in several type of human cancers and telomere elongation is a common molecular feature of advanced malignancies. Among the telomeric shelterin proteins PTOP is required for telomeric protein complex assembly, telomerase recruitment and activity, and telomere length regulation through a PTOP-telomerase interaction. Previous studies suggest that PTOP upregulation is involved in radioresistance and telomere lengthening in colorectal cancer cells. Moreover, in human osteosarcoma cells PTOP deletion led to telomere shortening, increased apoptosis and radiation sensitivity enhancement. However, to date, little is known about the role of PTOP in progression of glioma cancers. In light of this background aim of the study is to investigate the expression of PTOP in different grades of human glioma and its correlation with the pathological grade of gliomas, grades of malignancy, proliferative activity and apoptosis. Fifteen Low Grade Astrocytomas (LGA), 18 Anaplastic Astrocytomas (AA) and 26 Glioblastoma Multiforme (GBM) samples were analyzed. Three samples of normal brain tissue (NBT) were used as controls. The expression levels of PTOP, h-TERT, BIRC1 and cyclin D1 were determined by real time PCR and/or western blot. Results obtained shows that PTOP expression in glioma tissues is tightly correlated with clinical grade ( p < 0.01 ). No correlation was found between PTOP expression and other clinicopathologic parameters. The expression of PTOP was positively correlated with the expression of hTERT and TERF1. Furthermore PTOP positively correlates with cyclin D1 and negatively correlates with the expression of BIRC1. Our findings indicate that PTOP might play key role in the progression of glioma regulating telomerase activity and likely through regulation of cell cycle and apoptosis. In conclusion results obtained prompted us to speculate that PTOP might represents a potential molecular bio marker and a therapeutic target for the treatment of glioblastoma tumors.

Keywords: glioblastoma, PTOP, telomere, brain tumors

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Authors: Kazi Enamul Hoque

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Initiatives on sustainable development are currently aggressively pursued throughout the world. The Malaysian government has developed key policies and strategies for over 30 years to achieve the nation’s policy objectives which are designed to mitigate the issues of security, energy efficiency and environmental impact to meet the rising energy demand. Malaysia’s current focus is on developing effective policies on renewable energy (RE) in order to reduce dependency on fossil fuel and contribute towards mitigating the effects of climate change. In this light mass awareness should be considered as the highest priority to protect the environment and to escape disaster due to climate change. Schools can be the reliable and effective foundation to prepare students to get familiar with environmental issues such as renewable and non-renewable energy sources. Teachers can play a vital role to create awareness among students about the advantages and disadvantages of using different renewable and nonrenewable energy resources. Thus, this study aims to investigate teachers’ knowledge, perceptions and attitudes towards renewable energy through a survey aiming a sustainable energy future. Five hundred sets of questionnaires were distributed to the school teachers in Malaysia. Total 420 questionnaires were returned of which 410 were complete to analyze. Finding shows that teachers are very familiar with the renewable energy like solar, wind and also geothermal. Most teachers were not sure about the Photovoltaics and biodiesel. Furthermore, teachers are also aware that primary energy in Malaysia is imported fossil fuels. Most teachers heard about the renewable energy in Malaysia and only few claims that they did not hear of such things and the others said that they never heard of it. The outcomes of the study will assist the energy policy makers to use teachers to create mass awareness of energy usages for future planning.

Keywords: Malaysia, non-renewable energy, renewable energy, school teacher

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Authors: Mutaz Dwairy

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Solid tumors have high interstitial fluid pressure (IFP), high mechanical stress, and low oxygen levels. Solid stresses may induce apoptosis, stimulate the invasiveness and metastasis of cancer cells, and lower their proliferation rate, while oxygen concentration may affect the response of cancer cells to treatment. Although tumors grow in a nonhomogeneous environment, many existing theoretical models assume homogeneous growth and tissue has uniform mechanical properties. For example, the brain consists of three primary materials: white matter, gray matter, and cerebrospinal fluid (CSF). Therefore, tissue inhomogeneity should be considered in the analysis. This study established a physical model based on convection-diffusion equations and continuum mechanics principles. The model considers the geometrical inhomogeneity of the brain by including the three different matters in the analysis: white matter, gray matter, and CSF. The model also considers fluid-solid interaction and explicitly describes the effect of mechanical factors, e.g., solid stresses and IFP, chemical factors, e.g., oxygen concentration, and biological factors, e.g., cancer cell concentration, on growing tumors. In this article, we applied the model on a brain tumor positioned within the white matter, considering the brain inhomogeneity to estimate solid stresses, IFP, the cancer cell concentration, oxygen concentration, and the deformation of the tissues within the neoplasm and the surrounding. Tumor size was estimated at different time points. This model might be clinically crucial for cancer detection and treatment planning by measuring mechanical stresses, IFP, and oxygen levels in the tissue.

Keywords: biomechanical model, interstitial fluid pressure, solid stress, tumor microenvironment

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Authors: Khadija Refouh

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Culture bound-expressions have been a bottleneck for Natural Language Processing (NLP) and comprehension, especially in the case of machine translation (MT). In the last decade, the field of machine translation has greatly advanced. Neural machine translation NMT has recently achieved considerable development in the quality of translation that outperformed previous traditional translation systems in many language pairs. Neural machine translation NMT is an Artificial Intelligence AI and deep neural networks applied to language processing. Despite this development, there remain some serious challenges that face neural machine translation NMT when translating culture bounded-expressions, especially for low resources language pairs such as Arabic-English and Arabic-French, which is not the case with well-established language pairs such as English-French. Machine translation of opaque idioms from English into French are likely to be more accurate than translating them from English into Arabic. For example, Google Translate Application translated the sentence “What a bad weather! It runs cats and dogs.” to “يا له من طقس سيء! تمطر القطط والكلاب” into the target language Arabic which is an inaccurate literal translation. The translation of the same sentence into the target language French was “Quel mauvais temps! Il pleut des cordes.” where Google Translate Application used the accurate French corresponding idioms. This paper aims to perform NMT experiments towards better translation of opaque idioms using high quality clean multilingual corpus. This Corpus will be collected analytically from human generated idiom translation. AutoML translation, a Google Neural Machine Translation Platform, is used as a custom translation model to improve the translation of opaque idioms. The automatic evaluation of the custom model will be compared to the Google NMT using Bilingual Evaluation Understudy Score BLEU. BLEU is an algorithm for evaluating the quality of text which has been machine-translated from one natural language to another. Human evaluation is integrated to test the reliability of the Blue Score. The researcher will examine syntactical, lexical, and semantic features using Halliday's functional theory.

Keywords: multilingual corpora, natural language processing (NLP), neural machine translation (NMT), opaque idioms

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Authors: B. Donkova, M. Nedyalkova, D. Mehandjiev

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Sparingly soluble manganese oxalate is an appropriate precursor for the preparation of nanosized manganese oxides, which have a wide range of technological application. During the precipitation of manganese oxalate, three crystal forms could be obtained – α-MnC₂O₄.2H₂O (SG C2/c), γ-MnC₂O₄.2H₂O (SG P212121) and orthorhombic MnC₂O₄.3H₂O (SG Pcca). The thermolysis of α-MnC₂O₄.2H₂O has been extensively studied during the years, while the literature data for the other two forms has been quite scarce. The aim of the present communication is to highlight the influence of the initial crystal structure on the decomposition mechanism of these three forms, their magnetic properties, the structure of the anhydrous oxalates, as well as the nature of the obtained oxides. For the characterization of the samples XRD, SEM, DTA, TG, DSC, nitrogen adsorption, and in situ magnetic measurements were used. The dehydration proceeds in one step with α-MnC₂O₄.2H2O and γ-MnC₂O₄.2H₂O, and in three steps with MnC₂O₄.3H2O. The values of dehydration enthalpy are 97, 149 and 132 kJ/mol, respectively, and the last two were reported for the first time, best to our knowledge. The magnetic measurements show that at room temperature all samples are antiferomagnetic, however during the dehydration of α-MnC₂O₄.2H₂O the exchange interaction is preserved, for MnC₂O₄.3H₂O it changes to ferromagnetic above 35°C, and for γ-MnC₂O₄.2H₂O it changes twice from antiferomagnetic to ferromagnetic above 70°C. The experimental results for magnetic properties are in accordance with the computational results obtained with Wien2k code. The difference in the initial crystal structure of the forms used determines different changes in the specific surface area during dehydration and different extent of Mn(II) oxidation during decomposition in the air; both being highest at α-MnC₂O₄.2H₂O. The isothermal decomposition of the different oxalate forms shows that the type and physicochemical properties of the oxides, obtained at the same annealing temperature depend on the precursor used. Based on the results from the non-isothermal and isothermal experiments, and from different methods used for characterization of the sample, a comparison of the nature, mechanism and peculiarities of the thermolysis of the different crystal forms of manganese oxalate was made, which clearly reveals the influence of the initial crystal structure. Acknowledgment: 'Science and Education for Smart Growth', project BG05M2OP001-2.009-0028, COST Action MP1306 'Modern Tools for Spectroscopy on Advanced Materials', and project DCOST-01/18 (Bulgarian Science Fund).

Keywords: crystal structure, magnetic properties, manganese oxalate, thermal behavior

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Authors: Nouira Mariem, Ennigrou Samir

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Background and aims: Healthcare-associated infections (HAI) represent a major public health problem worldwide. They represent one of the most serious adverse events in health care. The objectives of our study were to estimate the prevalence of HAI at the Charles Nicolle Hospital (CNH) and to identify the main associated factors as well as to estimate the frequency of antibiotic use. Methods: It was a cross-sectional study at the CNH with a unique passage per department (October-December 2018). All patients present at the wards for more than 48 hours were included. All patients from outpatient consultations, emergency, and dialysis departments were not included. The site definitions of infections proposed by the Centers for Disease Control and Prevention (CDC) were used. Only clinically and/or microbiologically confirmed active HAIs were included. Results: A total of 318 patients were included, with a mean age of 52 years and a sex ratio (female/male) of 1.05. A total of 41 patients had one or more active HAIs, corresponding to a prevalence of 13.1% (95% CI: 9.3%-16.9%). The most frequent site infections were urinary tract infections and pneumonia. Multivariate analysis among adult patients (>=18 years) (n=261) revealed that infection on admission (p=0.01), alcoholism (p=0.01), high blood pressure (p=0.008), having at least one invasive device inserted (p=0.004), and history of recent surgery (p=0.03), increased the risk of HAIs significantly. More than 1 of 3 patients (35.4%) were under antibiotics on the day of the survey, of which more than half (57.4%) were under two or more types of antibiotics. Conclusion: The prevalence of HAIs and antibiotic prescriptions at the CNH were considerably high. An infection prevention and control committee, as well as the development of an antibiotic stewardship program with continuous monitoring using repeated prevalence surveys, must be implemented to limit the frequency of these infections effectively.

Keywords: prevalence, healthcare associated infection, antibiotic, Tunisia

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Authors: Fazle Rabbi, Mashuda Khanom Tithi, Tasnim Mirza, Sanjida Rowshan Anannya, Ahmed Hossain

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Background: Low Back Pain (LBP) is one of the common health problems among the garment workers that causes workers absenteeism from the work. The purpose of the study is to identify the association between occupational factors and LBP among the female garment workers in Bangladesh. Materials and Methods: A cross-sectional study was conducted with 487 female garment workers from three compliant garment factories of Bangladesh. Face-to-face interview on four different LBP measures along with questions on socio-demographic, occupational, and physical factors were used to collect the data. Result: The prevalence rates for LBP lasts for at least one day during the last six months, chronic pain, intense pain, and seeking medical care for LBP were found 63.04%, 38.60%, 13.76%, and 18.89%, respectively among the female garments workers. The multivariate logistic regression analysis indicates that duration of employment (>5 years), regular weight bearing and extended weekly working hours (>48 hours) are positively associated with LBP. Besides, age, BMI, family income, marital status and number of children are also found positively associated with the LBP measures. Conclusion: The prevalence of LBP among female garment workers in Bangladesh is found high. The duration of employment (>5 years), regular weight bearing and extended weekly working hours (>48 hours) play a significant role in developing LBP among the female workers. Factories need to consider training programs on the appropriate technique of weight bearing. It is also important to conduct regular screening programs to identify LBP, especially with married, overweight/obese and older age group to reduce the occurrence of LBP.

Keywords: Bangladesh, garment workers, low back pain, occupational health

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Authors: Yessenia Parrado, Ana Barbosa, Daniela Mahe, Sebastian Toro, Jhon Garcia

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The purpose of this work is to present the identification and characterization of the barriers and enablers to public innovation in the Central Region of Colombia from a mixed methodology in a research carried out in 2020 by the Laboratory of Innovation, Creativity and New Technologies of the National University of Colombia in alliance with the National Planning Department. Based on the research, the index of barriers to regional and departmental public innovation was built, which reflects the level of difficulty of the territorial entities to overcome the barriers present around three dimensions: organizational structure of the entity, generation of public value, and governance processes. The index was built from the item response methodology and the multiple correspondence analysis from the application of an institutional information form for public entities and a perception form for public servants. This investigation had the participation of 36 entities and 1038 servers and servants from the departments of Huila, Meta, Boyacá, Cundinamarca, Tolima, and the Capital District. In this exercise, it was identified that the departmental indices range between 13 and 44 and that the regional index was 30 out of 100. From the analysis of the information, it was possible to establish that the main barriers are the lack of specialized agencies for public innovation exercises, lack of qualified personnel and work methodologies for public innovation, inadequate information management, lack of feedback between the learning from governmental and non-governmental entities, the inability of the initiatives to generate binding participation mechanisms and the lack of qualification of citizens to participate in these processes.

Keywords: item response, public innovation, quantitative analysis, compared analysis

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Authors: Tanimola Kazeem Abiodun

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In Nigeria, both formal education and distance learning opportunities are used in teacher training. Practical courses aim to improve the skills of teacher candidates in a school environment. Teacher candidates attend kindergarten classes under the supervision of a teacher. In this context, the guiding skills of teachers gain importance in terms of shaping candidates’ perceptions about teaching profession. In this study, the teachers’ perceptions related to the guiding skills within the practical courses were determined. Also, the perceptions and applications related to guiding skills were compared. A Likert scale questionnaire and an open-ended question were used to determine perceptions and applications. 120 questionnaires were taken into consideration and analyses of data were performed by using percentage distribution and QSR Nvivo 8 program. In this study, statements related to teachers’ perceptions about the guiding skills were asked and it is determined that almost all the teachers agreed about the importance of these statements. On the other hand, how these guidance skills are applied by teachers is also queried with an open-ended question. Finally, thoughts and applications related to guidance skills were compared to each other. Based on this comparison, it is seen that there are some differences between the thoughts and applications especially related with time management, planning, feedbacks, curriculum, workload, rules and guidance. It can be said that some guidance skills cannot be controlled only by teachers. For example, candidates’ motivation, attention, population and educational environment are also determinative factors for effective guidance. In summary, it is necessary to have prior conditions for teachers to apply these idealized guidance skills for training more successful candidates to pre-school education era. At this point, organization of practical courses by the faculties gains importance and in this context it is crucial for faculties to revise their applications based on more detailed researches.

Keywords: teacher training, guiding skills, education, practical courses

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Authors: Gwendy Darras, Mattias Desmet

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Previous research showed that psychological distress has a negative impact on the disease course of viral infections. For COVID-19, the same association was observed in small samples of specific segments of the population (e.g. health care workers). The present study presents a more refined analysis of this association, measuring a broader spectrum of psychological distress in a large sample (n=3084) of the general Flemish population. Several types of psychological distress (state, trait and health anxiety, depression, intra-, and interpersonal stress) are registered throughout three periods: one year before the contamination, one week before the contamination, and during the contamination. In doing so, validated scales such as DASS-21, IIP-32, and FCV-19S are used. Furthermore, the course of COVID-19 is registered in several ways: number of symptoms, number of days sick leave due to COVID-19, and number of days the symptoms have lasted. Also, different control variables such as vaccination status, medical and psychological history are taken into account. Statistical analysis shows that all types of psychological distress are positively correlated with the severity of the COVID-19 disease course. Anxiety during the contamination shows the strongest correlation, but psychological distress one year before the onset of COVID-19 was still significantly associated with the worsening of the disease course. As the assessment of the latter type of distress happened before the onset of the COVID-19 disease course, retrospective bias resulting in artificial associations between self-reported stress and COVID-19 severity is unlikely to have impacted the observations. In view of possible future pandemics, it is important to focus on general stress and anxiety reduction in the general population as soon as possible. It is also advisable to minimize the use of stress-inducing messages to encourage the population to adhere to the measures issued during a pandemic.

Keywords: anxiety, COVID-19, depression, psychoneuroimmunology, psychological distress, stress

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Authors: Emilie Zimet

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During our department meetings for teachers of children with learning disabilities and difficulties, we often discuss the best practices for supporting students who come to school with literacy difficulties. After completing Sounds Write and Writing Revolution courses, it seems there is a possibility to link approaches and still maintain fidelity to a program and provide individualised instruction to support students with such difficulties and disabilities. In this case study, the researcher has been focussing on how best to use the knowledge acquired to provide quality intervention that targets the varied areas of challenge that students require support in. Students present to school with a variety of co-occurring reading and writing deficits and with complementary approaches, such as The Writing Revolution and Sounds Write, it is possible to support students to improve their fundamental skills in these key areas. Over the next twelve weeks, the researcher will collect data on current students with whom this approach will be trialled and then compare growth with students from last year who received support using Sounds-Write only. Maintaining fidelity may be a potential challenge as each approach has been tested in a specific format for best results. The aim of this study is to determine if approaches can be combined, so the implementation will need to incorporate elements of both reading (from Sounds Write) and writing (from The Writing Revolution). A further challenge is the time length of each session (25 minutes), so the researcher will need to be creative in the use of time to ensure both writing and reading are targeted while ensuring the programs are implemented. The implementation will be documented using student work samples and planning documents. This work will include a display of findings using student learning samples to demonstrate the importance of co-targeting the reading and writing challenges students come to school with.

Keywords: literacy difficulties, intervention, individual differences, methods of provision

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Authors: Babatunde Kasim Oladele

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One of the major objectives of the Nigeria national policy on education is the provision of equal educational opportunities to all citizens at different levels of education. With regards to higher education, an aspect of the policy encourages distance learning to be organized and delivered by tertiary institutions in Nigeria. This study therefore, determines how much of the Government resources are committed, how the resources are utilized and what alternative sources of funding are available for this system of education. This study investigated the trends in recurrent costs between 2004/2005 and 2013/2014 at University of Ibadan Distance Learning Centre (DLC). A descriptive survey research design was employed for the study. Questionnaire was the research instrument used for the collection of data. The population of the study was 280 current distance learning education students, 70 academic staff and 50 administrative staff. Only 354 questionnaires were correctly filled and returned. Data collected were analyzed and coded using the frequencies, ratio, average and percentages were used to answer all the research questions. The study revealed that staff salaries and allowances of academic and non-academic staff represent the most important variable that influences the cost of education. About 55% of resources were allocated to this sector alone. The study also indicates that costs rise every year with increase in enrolment representing a situation of diseconomies of scale. This study recommends that Universities who operates distance learning program should strive to explore other internally generated revenue option to boost their revenue. University of Ibadan, being the premier university in Nigeria, should be given foreign aid and home support, both financially and materially, to enable the institute to run a formidable distance education program that would measure up in planning and implementation with those of developed nation.

Keywords: open education, distance education, University of Ibadan, Nigeria, cost of education

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Authors: Zuzana Durajova, Natasa Diatkova, Shreya Bhardwaj

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This paper introduces the project START, its activities, goals, evaluation and final results. Over the past few decades, the legal discourse surrounding mental health has resulted in improvement in patient rights (in Netherlands, etc.), the appointment of Ombudspersons for psychiatric patients (in Austria, Sweden) and facilitating the participation of patients in decision-making processes. Czech legislation already recognizes the position of “patient’s advocate” as a person of trust. However, this instrument is not very widely known and rarely used in practice. In the pilot study of the project, legal training for patient advocacy is provided to persons with experience with mental health problems/psychiatric hospitalization chosen from a Czech-based NGO. These persons (patient advocates) visit patients in involuntary hospitalization in one closed ward in the chosen psychiatric institution. During visits, the patient advocates inform patients about their legal standing, their procedural rights and also offer them individual support in contacting their counsel, family members etc. To understand the effect of the intervention, qualitative interviews and participant observations are conducted with the patients, advocates, the hospital management and staff and other identifiable stakeholders, such as government officials responsible for mental health care reform. The interviews are held before, during and after the intervention (support from patient advocates in hospitals). Given the ethical quandaries arising from using psychiatric wards as a field setting, we assume a participatory approach to ensure respect for patient boundaries and dignity. Through this project, we seek to establish a profession of patient advocates based on professional standards.

Keywords: patient advocacy, involuntary hospitalization, Czech Republic, patient Rights, professionalization

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Authors: Dar-Bin Shieh, Gwo-Bin Lee, Chen-Ming Chang, Chen Sheng Yeh, Chih-Chia Huang, Tsung-Ju Li

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Mitochondrial defects have a significant impact in many human diseases and aging associated phenotypes. The pathogenic mitochondrial DNA (mtDNA) mutations are diverse and usually present as heteroplasmic. mtDNA 4977bps deletion is one of the common mtDNA defects, and the ratio of mutated versus normal copy is significantly associated with clinical symptoms thus their quantitative detection has become an important unmet needs for advanced disease diagnosis and therapeutic guidelines. This study revealed a Micro-electro-mechanical-system (MEMS) enabled automatic microfluidic chip that only required minimal sample. The system integrated multiple laboratory operation steps into a Lab-on-a-Chip for high-sensitive and prompt measurement. The entire process including magnetic nanoparticle based mtDNA extraction in chip, mutation selective photonic DNA cleavage, and nanoparticle accelerated photonic quantitative polymerase chain reaction (qPCR). All subsystems were packed inside a miniature three-dimensional micro structured system and operated in an automatic manner. Integration of magnetic beads with microfluidic transportation could promptly extract and enrich the specific mtDNA. The near infrared responsive magnetic nanoparticles enabled micro-PCR to be operated by pulse-width-modulation controlled laser pulsing to amplify the desired mtDNA while quantified by fluorescence intensity captured by a complementary metal oxide system array detector. The proportions of pathogenic mtDNA in total DNA were thus obtained. Micro capillary electrophoresis module was used to analyze the amplicone products. In conclusion, this study demonstrated a new magnetophotonic based qPCR MEMS system that successfully detects and quantify specific disease related DNA mutations thus provides a promising future for rapid diagnosis of mitochondria diseases.

Keywords: mitochondrial DNA, micro-electro-mechanical-system, magnetophotonics, PCR

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Authors: Govindan Sudha, Mathumitha Subramaniam, Alamelu Govindasamy, Sasikala Gunasekaran

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The aim of this study was to investigate the protective effect of Hypsizygus ulmarius polysaccharides (HUP) on reducing oxidative stress, cognitive impairment and neurotoxicity in D-galactose induced aging mice. Mice were subcutaneously injected with D-galactose (150 mg/kg per day) for 6 weeks and were administered HUP simultaneously. Aged mice receiving vitamin E (100 mg/kg) served as positive control. Chronic administration of D-galactose significantly impaired cognitive performance oxidative defence and mitochondrial enzymes activities as compared to control group. The results showed that HUP (200 and 400 mg/kg) treatment significantly improved the learning and memory ability in Morris water maze test. Biochemical examination revealed that HUP significantly increased the decreased activities of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), glutathione-S-transferase (GST), mitochondrial enzymes-NADH dehydrogenase, malate dehydrogenase (MDH), isocitrate dehydrogenase (ICDH), Na+K+, Ca2+, Mg2+ATPase activities, elevated the lowered total anti-oxidation capability (TAOC), glutathione (GSH), vitamin C and decreased the raised acetylcholinesterase (AChE) activities, malondialdehyde (MDA), hydroperoxide (HPO), protein carbonyls (PCO), advanced oxidation protein products (AOPP) levels in brain of aging mice induced by D-gal in a dose-dependent manner. In conclusion, present study highlights the potential role of HUP against D-galactose induced cognitive impairment, biochemical and mitochondrial dysfunction in mice. In vitro studies on the effect of HUP on scavenging DPPH, ABTS, DMPD, OH radicals, reducing power, B-carotene bleaching and lipid peroxidation inhibition confirmed the free radical scavenging and antioxidant activity of HUP. The results suggest that HUP possesses anti-aging efficacy and may have potential in treatment of neurodegenerative diseases.

Keywords: aging, antioxidants, mushroom, neurotoxicity

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Authors: Maria Jose Mendoza Gordillo

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Introduction: Research regarding breastfeeding is devoted to how essential breastfeeding is to guarantee wellbeing for the mother and the baby from a medical standpoint relegating the cultural, material and social barriers for breastfeeding. Consequently, worldwide breastfeeding rates are low, and Ecuador is not the exception, especially among working mothers. Worldwide, health care providers have low rates of breastfeeding due to several barriers to lactation, such as the work schedule, a lack of private places for pumping while at work, and negative emotions. Goals and Methods: This study aimed to explore how do Ecuadorian women embrace their identities as nutritionists and mothers within their breastfeeding experience. The primary data come from 20 synchronous semi-structured interviews, which follow a topic guide. The interviews were recorded and transcribed verbatim. The data analysis followed the Phronetic Iterative Approach. Results: Women shifted the preconceived idea of the ideal breastfeeding that came from the medicalized discourse of breastfeeding, and that was constructed in their training as nutritionists. Although these women believe that breast milk and breastfeeding is the best way to feed a baby, the internalized ideal of breastfeeding shifted through the experience of motherhood. When these women developed their identity as mothers, they understood that the ideal breastfeeding is different from the medicalized discourse. Although they have that clash between the ideal and the external reality, they continued breastfeeding their babies and those experiences made them improve their professional practice. Conclusions: The narratives that women shared illustrate how complex it was to manage the different roles and identities that they wanted to fulfill to keep their identity of a good mother who breastfeeds her baby and, at the same time, a good healthcare provider identity. The process of breastfeeding for this group of women who are mothers and healthcare professionals appears to be a unique relational and identity negotiation process.

Keywords: breastfeeding, identity, nutritionist, qualitative

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Authors: Ben Main Piotr Ozieranski

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State government spending on pharmaceuticals stands at 1 trillion USD globally, promoting criticism of the pharmaceutical industry's monetization of drug efficacy, product cost overvaluation, and health injustice. This paper elucidates the mechanisms behind a state-institutional response to this problem through the sociological lens of the strategic relational approach to state power. To do so, 30 expert interviews, legal and policy documents are drawn on to explain how state elites in New Zealand have successfully contested a 30-year “pharmaceutical spending containment policy”. Proceeding from Jessop's notion of strategic “selectivity”, encompassing analyses of the enabling features of state actors' ability to harness state structures, a theoretical explanation is advanced. First, a strategic context is described that consists of dynamics around pharmaceutical dealmaking between the state bureaucracy, pharmaceutical pricing strategies (and their effects), and the industry. Centrally, the pricing strategy of "bundling" -deals for packages of drugs that combine older and newer patented products- reflect how state managers have instigated an “incentivization game” that is played by state and industry actors, including HTA professionals, over pharmaceutical products (both current and in development). Second, a protective context is described that is comprised of successive legislative-judicial responses to the strategic context and characterized by the regulation and the societalisation of commercial law. Third, within the policy, the achievement of increased pharmaceutical coverage (pharmaceutical “mix”) alongside contained spending is conceptualized as a state defence of a "social profit". As such, in contrast to scholarly expectations that political and economic cultures of neo-liberalism drive pharmaceutical policy-making processes, New Zealand's state elites' approach is shown to be antipathetic to neo-liberals within an overall capitalist economy. The paper contributes an analysis of state pricing strategies and how they are embedded in state regulatory structures. Additionally, through an analysis of the interconnections of state power and pharmaceutical value Abrahams's neo-liberal corporate bias model for pharmaceutical policy analysis is problematised.

Keywords: pharmaceutical governance, pharmaceutical bureaucracy, pricing strategies, state power, value theory

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Authors: Amos King'ori Githu

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Water safety is crucial for all ages, but particularly for children. In the past decade, preschool institutions in Sub-Saharan Africa have seen the inclusion of swimming as one of the co-curricular activities. However, these countries face challenges in adopting frameworks, staffing, and resources to heighten water safety, quality, and drowning prevention, hence the focus of this research. It is worth noting that drowning is a leading cause of injury-related deaths among children. Universally, the highest drowning rates occur among children aged 1-4 years and 5-9 years. Preschool children even stand a higher risk of drowning as they are active, eager, and curious to explore their environment. If not supervised closely around or in water, these children can drown quickly in just a few inches of water. Thus, this empirical review focuses on the identification, assessment, and analysis of water safety efforts to curb drowning among children and assess the quality of water to mitigate contamination that may eventually pose infection risks to the children. In addition, it outlines the use of behavioral theories and evaluation frameworks to guide the above. Notably, a search on ten databases was adopted for crucial peer-reviewed articles, and five were selected in the eventual review. This research relied extensively on secondary data to curb water infections and drowning-inflicted deaths among children. It suffices to say that interventions must be supported that adopt an array of strategies, are guided by planning and theory as well as evaluation frameworks, and are vast in intervention design, evaluation, and delivery methodology. Finally, this approach will offer solid evidence that can be shared to guide future practices and policies in preschools on child safety and drowning prevention.

Keywords: water quality and safety, drowning prevention, preschool children, sub-saharan Africa, supervision

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Authors: Joanna Maj

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Body machine interfaces (BMIs) afford users a non-invasive way coordinate movement. Vibrotactile stimulation has been incorporated into BMIs to allow feedback in real-time and guide movement control to benefit patients with cognitive deficits, such as stroke survivors. To advance research in this area, we examined vibrational discrimination thresholds at four body locations to determine suitable application sites for future multi-channel BMIs using vibration cues to guide movement planning and control. Twelve healthy adults had a pair of small vibrators (tactors) affixed to the skin at each location: forearm, shoulders, torso, and knee. A "standard" stimulus (186 Hz; 750 ms) and "probe" stimuli (11 levels ranging from 100 Hz to 235 Hz; 750 ms) were delivered. Probe and test stimulus pairs could occur sequentially or simultaneously (timing). Participants verbally indicated which stimulus felt more intense. Stimulus order was counterbalanced across tactors and body locations. Probabilities that probe stimuli felt more intense than the standard stimulus were computed and fit with a cumulative Gaussian function; the discrimination threshold was defined as one standard deviation of the underlying distribution. Threshold magnitudes depended on stimulus timing and location. Discrimination thresholds were better for stimuli applied sequentially vs. simultaneously at the torso as well as the knee. Thresholds were small (better) and relatively insensitive to timing differences for vibrations applied at the shoulder. BMI applications requiring multiple channels of simultaneous vibrotactile stimulation should therefore consider the shoulder as a deployment site for a vibrotactile BMI interface.

Keywords: electromyography, electromyogram, neuromuscular disorders, biomedical instrumentation, controls engineering

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Authors: Ines Cherif, Ghassen Kharroubi, Leila Bouabid, Adel Gharbi, Aicha Boukthir, Margaret Mccarron, Nissaf Ben Alaya, Afif Ben Salah, Jihene Bettaieb

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Healthcare workers' flu vaccination prevents influenza disease among both patients and caregivers. We aimed in this study to assess influenza vaccine (IV) coverage in 2018-2019 among Tunisian physicians and to determine factors associated with IV receipt. A cross sectional study was carried out in Tunisian primary and secondary health care facilities in the 2018-2019 influenza season. Physicians with direct patient contact were recruited according to a self-weighted multistage sampling. Data were collected through a face to face questionnaire containing questions on knowledge, attitudes, and practices regarding IV. Bivariate analysis was used in order to determine factors associated with IV receipt. A total of 167 physicians were included in the study with a mean age of 48.2 ± 7.7 years and a sex-ratio (M: F) of 0.37. Among participants, 15.1% (95% CI: [9.7%-20.3%]) were vaccinated against influenza in the 2018-2019 influenza season. Bivariate analysis revealed that previous flu immunization in the four years preceding the 2018-2019 influenza season (OR=32.3; p < 10-3), belief that vaccinating healthcare workers may reduce work absenteeism (OR=4.7, p=0.028), belief that flu vaccine should be mandatory to healthcare workers (OR=3.3, p=0.01) and high confidence towards IV efficacy in preventing influenza among caregivers (OR= 4.5, p=0.01) were associated with a higher IV receipt in 2018-2019 among physicians. Less than one fifth of Tunisian physicians were vaccinated against influenza in 2018-2019. Higher vaccine uptake was related to a higher belief in vaccine efficacy in preventing influenza disease among both patients and caregivers. This underscores the need for periodic educational campaigns to raise physicians' awareness about IV efficacy. The switch to an IV mandatory policy should also be considered.

Keywords: influenza vaccine, physicians, Tunisia, vaccination uptake

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Authors: Olabisi Badmos, Daniel Callo-Concha, Babatunde Agbola, Andreas Rienow, Klaus Greve, Carsten Jurgens

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Slums are important components of city development planning, especially in Africa where slum growth is on par with urban growth. Purposefully, our knowledge on the residential choice of slum dwellers, which contributes to population growth in slums, is limited. This is the case in Lagos, a megacity reportedly dominated by slum dwellers. Thus, this study aims to disclose the factors influencing the residential choices and causes of people to remain in Lagos slums. Data was collected through questionnaire administration and focus group discussions. Descriptive statistics were used to analyze and describe the factors influencing residential location choice; logistic regression was utilized to determine the extent to which the neighborhood and household attributes, influence slum dwellers decisions to remain in the slums. Results showed that movement to Lagos was the main cause of population growth in slums; most of the migrants were from closer geopolitical zones (in Nigeria). Further, the movement patterns observed support two theories of human mobility in slums: slum as a sink, and as a final destination. Also, the factors that brought most of the slum dwellers to the slums (cheap housing, proximity to work etc.) differs from the ones that made them stay (Gender, employment status, housing status etc.). This study concludes that residential choice and intention to stay are the major contributors to population growth in a slum. It is therefore important for Lagos state Government to incorporate these elements of residential choices of slum dwellers in their slum management policies if the city aims to be free of slums by 2030

Keywords: Lagos, population growth, residential decision choices, slum

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Authors: Nadia Naseem, Farwa Batool, Nasir Mehmood, AbdulHannan Nagi

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Background: The incidence and mortality of breast cancer vary significantly in geographically distinct populations. In Pakistan, breast cancer has shown an increase in incidence in young females and is characterized by more aggressive behavior. The tumor suppressor TP53 gene is a crucial genetic factor that plays a significant role in breast carcinogenesis. This study investigated the TP53 mutations in molecular subtypes of both nodes negative and positive breast cancer in young Pakistani patients. Material and Methods: p53, Estrogen Receptor (ER), Progesterone Receptor (PR), Her-2 neu and Ki 67 expressions were analyzed immunohistochemically in a series of 75 node negative (A) and 75 node positive (B) young (aged: 19-40 years) breast cancer patients diagnosed between 2014 to 2017 at two leading hospitals of Punjab, Pakistan. Tumor tissue specimens and peripheral blood samples were examined for TP53 mutations by direct sequencing of the gene (exons 4-9). The relation of TP53 mutations to these markers and clinicopathological data was investigated. Results: Mean age of the patients was 32.4 + 9.1 SD. Invasive breast carcinoma was the most frequent histological variant (A=92%, B=94.6%). Grade 3 carcinoma was the commonest grade (A=72%, B=81.3%). Triple negative cases (ER-, PR-, Her-2) formed most of the molecular subtypes (A=44%, B=50.6%). A total of 17.2% (A: 6.6%, B: 10.6%) patients showed TP53 mutations. Mutations were significantly more frequent in triple negative cases (A: 74.8%, B: 62.2%) compared to HER2-positive patients (P < 0.0001). In the multivariate analysis of the whole patient group, the independent prognosticator were triple negative cases (P=0.021), TP53 overexpression by IHC (P=0.001) and advanced-stage disease (P=0.007). No statistically significant correlation between TP53 mutations and clinicopathological parameters was found (P < 0.05). Conclusions: It is concluded that TP53 mutations are infrequently present in breast carcinoma of young Pakistani population and there was no significant correlation between p53 mutation and early onset disease. Immunohistochemically detected TP53 expression in our resource-constrained to set up can be beneficial in predicting mutations at the younger age in our population.

Keywords: immunohistochemistry (IHC), invasive breast carcinoma (IBC), Pakistan, TP53

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Authors: Dinoo Kirthinanda, Sujani Wijeratne

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Pseudohyperkalaemia is a common benign in vitro phenomenon caused by the release of potassium ions (K+) from cells during specimen processing. Analysis of haemolysed blood samples for predominantly intracellular electrolytes may lead to re-investigation and potentially harmful interventions. We report a case of a 52-year male with myeloproliferative disease manifested as Polycythaemia Rubra Vera, Hypertension and hypertensive nephropathy with stage 3 chronic kidney disease admitted to Neuro-intensive care unit (NICU) with an intra-cerebral haemorrhage secondary to hypertensive bleed. His initial blood investigations showed hyperkalemia with serum K+ 6.2 mmol/L yet the bedside arterial blood gas analysis yielded K+ of 4.6 mmol/L. The patient was however given hyperkalemia regime twice based on venous electrolyte analysis. The discrepancy between the bedside electrolyte analysis using arterial blood and venous blood prompted further evaluation. The 12 lead Electrocardiogram showed U waves and sinus bradycardia corresponding to the serum K+ of 2.8 mmol/L on arterial blood gas analysis. Immediate K+ replacement ensured the patient did not develop life-threatening cardiac complications. Pseudohyperkalaemia may pose diagnostic challenges in the absence of detectable haemolysis and should be suspected in susceptible patients with normal Electrocardiogram and Glomerular Filtration Rate to avoid potentially life-threatening interventions. When in doubt, rapid analysis of arterial blood gas may be useful for accurate quantification of potassium.

Keywords: patient safety, pseudohyperkalaemia, haemolysis, myeloproliferative disorder

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Authors: Santosh Kumar Yadav, Shobha Keswani, Nishat Quddus, Sohrab Ahmad Khan, Zuheb Ahmad Shiddiqui, Varsha Chorsiya

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Introduction: Early onset diabetes is more aggressive than the late onset diabetes. Diabetic individual has a greater spectrum of life period to suffer from its damage, complications, and long-term disability. This study aimed at assessing knee joint muscle performance under various durations of diabetes. Method and Materials: A total of 30 diabetic subjects (18 male and 12 females) without diabetic neuropathy were included for the study. They were divided into three groups with 5 years, 10 years and 15 years of duration of disease each. Muscle performance was evaluated through strength and flexibility. Peak torque for quadriceps muscle was measured using isokinetic dynamometer. Flexibility for quadriceps and hamstring muscles were measured through Ducan’s Elys test and 90/90 test. Results: The result showed significant difference in muscle strength (p<0.05), flexibility (p≤0.05) between groups. Discussion: Optimal muscle strength and flexibility are vital for musculoskeletal health and functional independence. Conclusion: The reduced muscle performance and functional impairment in nonneuropathic diabetic patients suggest that other mechanism besides neuropathy that contribute to altered biomechanics. These findings of this study project early management of these altered parameters through disease-specific physical therapy and assessment-based intervention. Clinical Relevance: Managing disability is more costly than managing disease. Prompt and timely identification and management strategy can dramatically reduce the cost of care for diabetic patients.

Keywords: muscle flexibility, muscle performance, muscle torque, type 2 diabetes

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Authors: J. Magerman, P. Martin

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Nursing students' clinical abilities is highly dependent on the quality of the clinical experience obtained while placed in the clinical environment. The clinical environment has amongst other, key role players which include the clinical supervisor. The primary role of the clinical supervisor is to guide nursing students to become the best practice nursing professionals. However, globally literature alludes to the failure of educating institutions to deliver competent nursing professionals to meet the needs of patients and deliver quality patient care. At the participating university, this may be due to various factors such as large student numbers and social and environmental challenges experienced by clinical supervisors. The aim of this study was to explore and describe the lived experiences of clinical supervisors who supervise nursing students at a higher education institution. The study employed a qualitative research approach utilizing a descriptive phenomenological design. Purposive sampling was used to select participants, who supervised first and second year nursing studnets at the higher education institution under study. TH esample comprised of eight clinical supervisors who supervise first and secon year nursing studnets at teh institution under study. Data was collected by means of in-depht interviews. Data was analysed using Collaizzi's seven steps method of qualitative analysis. Five major themes identified , focussed on the experiences regarding time a sa constraint to job productivity, the impact of teh organisational culture on the fluidity of support, interpersonal relationships a sa dynamic communication process, impact on the self, and limited resources. Trustworthiness of the data was ensured by means of applying Guba's model of truth value, applicability, consistency and neutrality. Reflexivity was also used by the researcher to further enhance trustworthiness.

Keywords: clinical supervision, clinical supervisors, nursing students, clinical placements

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Authors: Francesco Ceresia

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Workplace aggression is broadly recognized as a main work-related risk for healthcare organizations the world over. Scholars underlined that nonfatal workplace aggressions can be also produced by Type II workplace aggression, that occur when the aggressor has a legitimate relationship with the organization and commits an act of hostility while being served or cared for by members of the organization. Several reviews and meta-analysis highlighted the main antecedents and consequences of Type II verbal and physical workplace aggression in the healthcare sector, also focusing on its economic and psychosocial costs. However, some scholars emphasized the need for a systemic and multi-factorial approach to deeply understand and effectively respond to such kind of aggression. The main aim of the study is to propose a qualitative model of Type II workplace aggression in a health care organization in accordance with the system thinking and multi-factorial perspective. A case study research approach, conducted in an Italian non-hospital healthcare organization, is presented. Two main data collection methods have been adopted: individual and group interviews with a sample (N = 24) of physicians, nurses and clericals. A causal loop diagram (CLD) that describes the main causal relationships among the key-variables of the proposed model has been outlined. The main feedback loops and the causal link polarities have been also defined to fully describe the structure underlining the Type II workplace aggression phenomenon. The proposed qualitative model shows how the Type II workplace aggression is related with burnout, work performance, job satisfaction, turnover intentions, work motivation and emotional dissonance. Finally, strategies and policies to reduce the strength of workplace aggression’s drivers are suggested.

Keywords: healthcare, system thinking, work motivation, workplace aggression

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