Search results for: involvement

Authors: Jayakant Singh, Enu Anand

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Background: Child marriage is widely prevalent in India. It is a form of gross human right violation that succumbs a child bride to be subservient to her husband within a marital relation. We investigated the relationship between age at marriage of women and her level of empowerment with physical violence experienced 12 months preceding the survey among young women aged 20-24 in two culturally distinct states- Bihar and Tamil Nadu of India. Methods: We used the information collected from 10514 young married women (20-24 years) at all India level, 373 in Bihar and 523 in Tamil Nadu from the third round of National Family Health Survey. Empowerment index was calculated using different parameters such as mobility, economic independence and decision making power of women using Principal Component Analysis method. Bivariate analysis was performed primarily using chi square for the test of significance. Logistic regression was carried out to assess the effect of age at marriage and empowerment on physical violence. Results: Lower level of women empowerment was significantly associated with physical violence in Tamil Nadu (OR=2.38, p<0.01) whereas child marriage (marriage before age 15) was associated with physical violence in Bihar (OR=3.27, p<0.001). The mean difference in age at marriage between those who experienced physical violence and those who did not experience varied by 7 months in Bihar and 10 months in Tamil Nadu. Conclusion: Culture specific intervention may be a key to reduction of violence against women as the results showed association of different factors contributing to physical violence in Bihar and Tamil Nadu. Marrying at an appropriate age perhaps is protective of abuse because it equips a woman to assert her rights effectively. It calls for an urgent consideration to curb both violence and child marriage with stricter involvement of family, civil society and the government. In the meanwhile physical violence may be recognized as a public health problem and integrate appropriate treatment to the victims within the health care institution.

Keywords: child marriage, empowerment, India, physical violence

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Authors: Eduardo Kanagushiku Pereira, Frank Gregory Cavalcante da Silva, Barbara Soares Gonçalves, Ana Lúcia Bergamasco Galastri, Ronei Luciano Mamoni

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The inflammatory response initiates after the recognition of pathogens by receptors expressed by innate immune cells. Among these receptors, the NLRP3 was associated with the recognition of pathogenic fungi in experimental models. NLRP3 operates forming a multiproteic complex called inflammasome, which actives caspase-1, responsible for the production of the inflammatory cytokines IL-1beta and IL-18. In this study, we aimed to investigate the involvement of NLRP3 in the inflammatory response elicited in macrophages against Paracoccidioides brasiliensis (Pb), the etiologic agent of PCM. Macrophages were differentiated from THP-1 cells by treatment with phorbol-myristate-acetate. Following differentiation, macrophages were stimulated by Pb yeast cells for 24 hours, after previous treatment with specific NLRP3 (3,4-methylenedioxy-beta-nitrostyrene) and/or caspase-1 (VX-765) inhibitors, or specific inhibitors of pathways involved in NLRP3 activation such as: Reactive Oxigen Species (ROS) production (N-Acetyl-L-cysteine), K+ efflux (Glibenclamide) or phagossome acidification (Bafilomycin). Quantification of IL-1beta and IL-18 in supernatants was performed by ELISA. Our results showed that the production of IL-1beta and IL-18 by THP-1-derived-macrophages stimulated with Pb yeast cells was dependent on NLRP3 and caspase-1 activation, once the presence of their specific inhibitors diminished the production of these cytokines. Furthermore, we found that the major pathways involved in NLRP3 activation, after Pb recognition, were dependent on ROS production and K+ efflux. In conclusion, our results showed that NLRP3 participates in the recognition of Pb yeast cells by macrophages, leading to the activation of the NLRP3-inflammasome and production of IL-1beta and IL-18. Together, these cytokines can induce an inflammatory response against P. brasiliensis, essential for the establishment of the initial inflammatory response and for the development of the subsequent acquired immune response.

Keywords: inflammation, IL-1beta, IL-18, NLRP3, Paracoccidioidomycosis

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Authors: Murad Ghanim

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The citrus greening disease, also known as Huanglongbing, caused by the phloem-limited bacterium Candidatus Liberibacter asiaticus (CLas) has resulted in tremendous losses and the death of millions of citrus trees worldwide. CLas is transmitted by the Asian citrus psyllid (ACP) Diaphorina citri. The closely-related bacterium Candidatus Liberibacter solanacearum (CLso), which is associated with vegetative disorders in carrots and the zebra chips disease in potatoes, is transmitted by other psyllid species including Bactericera trigonica in carrots and B. ckockerelli in potatoes. Chemical sprays are currently the prevailing method for managing these diseases for limiting psyllid populations; however, they are limited in their effectiveness. A promising approach to prevent the transmission of these pathogens is to interfere with the vector-pathogen interactions, but our understanding of these processes is very limited. CLas induces changes in the nuclear architecture in the midgut of ACP and activates programmed cell death (apoptosis) in this organ. Strikingly, CLso displayed an opposite effect in the gut of B. trigonica, showing limited apoptosis, but widespread necrosis. Electron and fluorescent microscopy further showed that CLas induced the formation of Endoplasmic reticulum (ER) inclusion- and replication-like bodies, in which it increases and multiplies. ER involvement in bacterial replication is hypothesized to be the first stage of an immune response leading to the apoptotic and necrotic responses. ER exploitation and the subsequent events that lead to these cellular and stress responses might activate a cascade of molecular responses ending up with apoptosis and necrosis. Understanding the molecular interactions that underlay the necrotic/apoptotic responses to the bacteria will increase our knowledge of ACP-CLas, and BT-CLso interactions, and will set the foundation for developing novel, and efficient strategies to disturb these interactions and inhibit the transmission.

Keywords: Liberibacter, psyllid, transmission, apoptosis, necrosis

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Authors: Camille Lacan, Pierre Desmet

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In the crowdfunding model, a campaign succeeds by collecting the funds required over a predefined duration. The success of a CF campaign depends both on the capacity to attract members of the online communities concerned, and on the community members’ involvement in online word-of-mouth recommendations. To maximize the campaign's success probability, project creators (i.e., an organization appealing for financial resources) send messages to contributors to ask them to issue word of mouth. Internet users relay information about projects through Word of Mouth which is defined as “a critical tool for facilitating information diffusion throughout online communities”. The effectiveness of these messages depends on the message framing and the time at which they are sent to contributors (i.e., at the start of the campaign or close to the deadline). This article addresses the following question: What are the effect of message framing and temporal distance on the willingness to share word of mouth? Drawing on Perspectives Theory and Construal Level Theory, this study examines the interplay between message framing (Gains vs. Losses) and temporal distance (message while the deadline is coming vs. far) on intention to share word of mouth. A between-subject experimental design is conducted to test the research model. Results show significant differences between a loss-framed message (lack of benefits if the campaign fails) associated with a short deadline (ending tomorrow) compared to a gain-framed message (benefits if the campaign succeeds) associated with a distant deadline (ending in three months). However, this effect is moderated by the anticipated regret of a campaign failure and the temporal orientation. These moderating effects contribute to specifying the boundary condition of the framing effect. Handling the message framing and the temporal distance are thus the key decisions to influence the willingness to share word of mouth.

Keywords: construal levels, crowdfunding, message framing, word of mouth

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Authors: Mohammed Belalia Douma

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Interactive learning is considered as the most effective strategy of learning, it is an educational philosophy based on the learner's contribution and involvement mainly in classroom and how he interacts toward his small society “classroom”, and the level of his collaboration into challenge, discovering, games, participation, all these can be provided through the interactive learning, which aims to activate the learner's role in the operation of learning, which focuses on research and experimentation, and the learner's self-reliance in obtaining information, acquiring skills, and forming values and attitudes. Whereas not based on memorization only, but rather on developing thinking and the ability to solve problems, on teamwork and collaborative learning. With the exchange or roles - teacher to student- , when the student will be more active and performing operations more than the student under the interactive learning method; we might face a several issues dealing with class controlling management, noise, and stability of learning… etc. This research paper is observing the application of the interactive learning on reality “classroom” and answers several assumptions and analyzes the issues coming up of these strategies mainly: noise, class control…etc The research sample was about 150 student of the 3rd year primary school in “Chlef” district, Algeria, level: beginners in the range of age 08 to 10 years old . We provided a questionnaire of confidential fifteen questions and also analyzing the attitudes of learners during three months. it have witnessed as teachers a variety of strategies dealing with applying the interactive learning but with a different issues; time management, noise, uncontrolled classes, overcrowded classes. Finally, it summed up that although the active education is an inevitably effective method of teaching, however, there are drawbacks to this, in addition to the fact that not all theoretical strategies can be applied and we conclude with solutions of this case study.

Keywords: interactive learning, student, learners, strategies.

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Authors: Tettey Afi Pamela, Sotaro Fujii, Hidetoshi Saito, Kawaii Koichiro

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Introduction: Organisms employ adaptive mechanisms when faced with any stressor or risk of being wiped out. This has made it possible for them to survive in harsh environmental conditions such as increasing temperature, low pH, and anoxia. Some of the mechanisms they utilize include the expression of heat shock proteins, synthesis of cryoprotectants, and anhydrobiosis. Heat shock proteins (HSPs) have been widely studied to determine their involvement in stress tolerance among various organism, of which chironomid species have been no exception. We examined the survival and expression of genes encoding five (5) heat shock proteins (HSP70, HSP67, HSP60, HSP27, and HSP23) from Chironomus sulfurosus larvae reared from 1st instar at 25°C, 30°C, 35°C, and 40°C. Results: The highest survival rate was recorded at 30°C, followed by 25°C, then 35°C. Only a small percentage of C. sulfurosus survived at 40°C (14.5%). With regards to HSPs expression, some HSPs responded to an increase in high temperature. The relative expression levels were lowest at 30°C for HSP70, HSP60, HSP27, and HSP23. At 25°C and 40°C, HSP70, HSP67, HSP60, HSP27, and HSP23 had the highest expression. At 35°C, all had the lowest expression. Discussion: The expression of heat shock proteins varies from one species to another. We designated the genes HSP 70, HSP 67, HSP 60, HSP 27, and HSP 23 genes based on transcriptome analysis of C. sulfurosus. Our study can be termed as a long-heat shock study as C. sulfurosus was reared from the first instar to the fourth instar, and this might have led to a continuous induction of HSPs at 25°C. 40°C had the lowest survival but highest HSPs expression as C. sulfurosus larvae had to utilize HSPs for sustenance. These results and future high-throughput studies at both the transcriptome and proteome level will improve the information needed to predict the future geographic distribution of these species within the context of global warming.

Keywords: chironomid, heat shock proteins, high temperature, heat shock protein expression

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Authors: Emmanuel K. Aziz Saba, Sarah S. El-Tawab

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Objectives: Carpal tunnel syndrome (CTS) was found to be associated with high pressure within the Guyon’s canal. The aim of this study was to assess the involvement of sensory and/or motor ulnar nerve fibers in patients with CTS and whether this affects the accuracy of the median versus ulnar sensory and motor comparative tests. Patients and methods: The present study included 145 CTS hands and 71 asymptomatic control hands. Clinical examination was done for all patients. The following tests were done for the patients and control: (1) Sensory conduction studies: median nerve, ulnar nerve, dorsal ulnar cutaneous nerve and median versus ulnar digit (D) four sensory comparative study; (2) Motor conduction studies: median nerve, ulnar nerve and median versus ulnar motor comparative study. Results: There were no statistically significant differences between patients and control group as regards parameters of ulnar motor study and dorsal ulnar cutaneous sensory conduction study. It was found that 17 CTS hands (11.7%) had ulnar sensory abnormalities in 17 different patients. The median versus ulnar sensory and motor comparative studies were abnormal among all these 17 CTS hands. There were statistically significant negative correlations between median motor latency and both ulnar sensory amplitudes recording D5 and D4. There were statistically significant positive correlations between median sensory conduction velocity and both ulnar sensory nerve action potential amplitude recording D5 and D4. Conclusions: There is ulnar sensory nerve abnormality among CTS patients. This abnormality affects the amplitude of ulnar sensory nerve action potential. The presence of abnormalities in ulnar nerve occurs in moderate and severe degrees of CTS. This does not affect the median versus ulnar sensory and motor comparative tests accuracy and validity for use in electrophysiological diagnosis of CTS.

Keywords: carpal tunnel syndrome, ulnar nerve, median nerve, median versus ulnar comparative study, dorsal ulnar cutaneous nerve

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Authors: Pilly Joseph Kagosi

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The study aims at assessing challenges observed during the implementation of participatory irrigation management (PIM) approach for food security in semi-arid areas of Tanzania. Data were collected through questionnaire, PRA tools, key informants discussion, Focus Group Discussion (FGD), participant observation, and literature review. Data collected from the questionnaire was analysed using SPSS while PRA data was analysed with the help of local communities during PRA exercise. Data from other methods were analysed using content analysis. The study revealed that PIM approach has a contribution in improved food security at household level due to the involvement of communities in water management activities and decision making which enhanced the availability of water for irrigation and increased crop production. However, there were challenges observed during the implementation of the approach including; minimum participation of beneficiaries in decision-making during planning and designing stages, meaning inadequate devolution of power among scheme owners. Inadequate and lack of transparency on income expenditure in Water Utilization Associations’ (WUAs), water conflict among WUAs members, conflict between farmers and livestock keepers and conflict between WUAs leaders and village government regarding training opportunities and status; WUAs rules and regulation are not legally recognized by the National court and few farmers involved in planting trees around water sources. However, it was realized that some of the mentioned challenges were rectified by farmers themselves facilitated by government officials. The study recommends that the identified challenges need to be rectified for farmers to realize impotence of PIM approach as it was realized by other Asian countries.

Keywords: challenges, participatory approach, irrigation management, food security, semi arid areas

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Authors: Bernice Badal

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This article addresses a persistent challenge related to teacher agency in knowledge acquisition in professional development (PD) workshops in contexts of educational change, given that scholarship identifies a need for more teacher involvement and amplification of teacher's voices. Theoretical concepts are drawn from Bandura’s Social cognitive theory, incorporating the triadic causation model of agency to examine the reciprocal nature of the context, teacher characteristics, and systemic influences that shape how knowledge is transmitted and acquired in PD workshops. This qualitative study, using a mix of classroom observations and interviews, explored the political, contextual, and personal characteristics of teacher agency in PD through an analysis of data extracted from a PhD study. The narratives of six teachers from three township schools are examined to show how PD efforts in South Africa have failed to take account of the holistic development of teacher agency in knowledge dissemination and how this shapes teacher self-efficacy beliefs about being able to masterfully apply the tenets of the reform. Agency, teacher voice, and contextual considerations were used as markers of the quality of the training provided to understand how knowledge is acquired and meaning is made. The findings suggest that systemic influences of institutionally imposed PD offer partial understandings of the reform, which is offered in traditional formats that do not consider teacher empowerment in knowledge production and the development of teacher agency. Common in all the participants’ responses is the need for more information and training on the prescribed approach for teaching English as a second language; however, this paper holds the view that more information may not solve teachers’ dilemmas. Accordingly, it recommends a restructuring of the programme with facilitators being more cognisant of teacher agency for the development of transformative teachers. The findings of the study contribute to the field of teacher knowledge, teacher training, and professional development in the context of educational reforms.

Keywords: teacher professional development, teacher voice, teacher agency, educational reforms, teacher knowledge

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Authors: Yijie Wang, Hanwei Cheng

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Under the Chinese educational context, the materials for patriotic education typically take the form of grand narratives. However, in post-modern times the younger members of society tend to welcome elements of more micro and personal nature. It is therefore important to explore how patriotism can be integrated into an ‘everyday’, private narrative that holds more attraction for the young. Based on semi-structured interviews of eight Chinese graduate students, this research examines how Chinese young people draw materials to establish national identity and develop love for the country from everyday-life details, as well as how they perceive, interpret and articulate their patriotism through private narratives. And implications for patriotic education are proposed accordingly. Several conclusions are drawn from the pre-interviews. Firstly, sensory experiences that remind people of their country—such as the taste of Chinese delicacies and the sound of a traditional instrument—are a major source of patriotic feelings. Secondly, the love for the country often stems from and is continued to be mediated by the emotional attachment with other people, typically significant others, and patriotism is articulated (or acknowledged) by the young as a kind of ‘sentiment’ rather than ‘faith’ or ‘belief’. Thirdly, for young people who are currently studying abroad, their birth country represents a kind of familiar, well-accustomed life or lifestyle, and any nostalgic realization of it leads to increased national belonging and sense of identity. Fourthly, the awareness of the country’s transformations—positive ones and neutral ones alike—triggers young people affections towards the country, and even negative transformations may result in promoted sense of self-involvement and therefore consolidate national identity. Implications for patriotic education can be drawn accordingly, and although the research is conducted under the Chinese context, it will hopefully contribute to the understanding of relevant fields.

Keywords: national identity, patriotic education, private narrative, young people

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Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

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Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

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Authors: Florina Magdalena Anichitoae, Anca Dobrean, Ionut Stelian Florean

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Due to the fact that cyberbullying victimization is an increasing problem nowadays, affecting more and more children and adolescents around the world, we wanted to take a step forward analyzing this phenomenon. So, we took a look at some variables which haven't been studied together before, trying to develop another way to view cyberbullying victimization. We wanted to test the effects of the mother, father, and peer attachment on adolescent involvement in cyberbullying as victims through unconditional self acceptance. Furthermore, we analyzed each subscale of the IPPA-R, the instrument we have used for parents and peer attachment measurement, in regards to cyberbullying victimization through unconditional self acceptance. We have also analyzed if gender and age could be taken into consideration as moderators in this model. The analysis has been performed on 653 adolescents aged 11-17 years old from Romania. We used structural equation modeling, working in R program. For the fidelity analysis of the IPPA-R subscales, USAQ, and Cyberbullying Test, we have calculated the internal consistency index, which varies between .68-.91. We have created 2 models: the first model including peer alienation, peer trust, peer communication, self acceptance and cyberbullying victimization, having CFI=0.97, RMSEA=0.02, 90%CI [0.02, 0.03] and SRMR=0.07, and the second model including parental alienation, parental trust, parental communication, self acceptance and cyberbullying victimization and had CFI=0.97, RMSEA=0.02, 90%CI [0.02, 0.03] and SRMR=0.07. Our results were interesting: on one hand, cyberbullying victimization is predicted by peer alienation and peer communication through unconditional self acceptance. Peer trust directly, significantly, and negatively predicted the implication in cyberbullying. In this regard, considering gender and age as moderators, we found that the relationship between unconditional self acceptance and cyberbullying victimization is stronger in girls, but age does not moderate the relationship between unconditional self acceptance and cyberbullying victimization. On the other hand, regarding the degree of cyberbullying victimization as being predicted through unconditional self acceptance by parental alienation, parental communication, and parental trust, this hypothesis was not supported. Still, we could identify a direct path to positively predict victimization through parental alienation and negatively through parental trust. There are also some limitations to this study, which we've discussed in the end.

Keywords: adolescent, attachment, cyberbullying victimization, parents, peers, unconditional self-acceptance

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Authors: Jacqueline Zammit

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Currently, a considerable number of individuals from different backgrounds are being drawn to Malta due to its favourable environment for business, investment, and employment. This influx has led to a growing interest among expats in learning Maltese as a second language (ML2) to enrich their experience of working and residing in Malta. However, the intricacies of Maltese grammar, particularly challenging for second language (L2) learners unfamiliar with Arabic, can pose difficulties in the learning process. Furthermore, it's worth noting that the teaching of ML2 is an emerging field with limited existing research on effective pedagogical strategies. The realm of second language acquisition (SLA) can be notably demanding for adults, requiring well-founded interventions to facilitate learning. Among these interventions, approaches grounded in empirical evidence have incorporated artistic and musical elements to augment SLA. Both art and music have proven roles in facilitating L2 communication, aiding vocabulary retention, and improving comprehension skills. This study aims to delve into the utilization of music and art as catalysts for enhancing the progress of adult learners in mastering ML2. The research employs a qualitative methodology, employing a sample selected through convenience sampling, which encompassed 37 adult learners of ML2. These participants engaged in individual interviews. The data derived from these interviews were subjected to thorough analysis. The outcomes of the study underscore the substantial positive influence exerted by art and music on the academic advancement of adult ML2 learners. Notably, it emerged from the participants' accounts that the current ML2 curricula lack the integration of art and music. Therefore, this study advocates for the incorporation of art and music components within both traditional classroom settings and online ML2 courses. The intention is to bolster the academic accomplishments of adult learners in the realm of Maltese as a second language, bridging the current gap between theory and practice.

Keywords: academic accomplishment, mature learners, visual art, learning Maltese as a second language, musical involvement, acquiring a second language

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Authors: Ru-Yu Lien, Shih-Hsin Hung, Shu-Fen Lu, Ju-Jen Shie, Wen-Ju Yang, Yuann-Meei Tzeng, Chien-Ying Wang

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Background: The quality of care in intensive care units (ICUs) is crucial, especially for terminally ill patients. Shared decision-making (SDM) with families is essential to ensure appropriate care and reduce suffering. Aim: This study explores the effectiveness of an end-of-life decision support Patient Decision Aid (PDA) in an ICU setting. Methods: This study employed a cross-sectional research design conducted in an ICU from August 2020 to June 2023. Participants included family members of end-of-life patients aged 20 or older. A total of 319 participants. Family members of end-of-life patients received the PDA, and data were collected after they made medical decisions. Data collection involved providing family members with a PDA during family meetings. A post-PDA questionnaire with 17 questions assessed PDA effectiveness and anxiety levels. Statistical analysis was performed using SPSS 22.0. Results: The PDA significantly reduced anxiety levels among family members (p < 0.001). It helped them organize their thoughts, prepare for discussions with doctors, and understand critical decision factors. Most importantly, it influenced decision outcomes, with a shift towards palliative care and withdrawal of life-sustaining treatment. Conclusion: This study highlights the importance of family-centered end-of-life care in ICUs. PDAs promote informed decision-making, reduce conflicts, and enhance patient and family involvement. These tools align patient values and goals with medical recommendations, ultimately leading to decisions that prioritize comfort and quality of life. Implementing PDAs in healthcare systems can ensure that patients' care aligns with their values.

Keywords: shared decision-making, patient decision aid, end-of-life care, intensive care unit, family-centered care

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Authors: Susan Lanz, Gary T. Burke, Omid Omidvar

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The intention to transfer ownership control across family generations is acknowledged to be central to developing a theoretical understanding of how family businesses differ and are distinct as a business group. However, in practice, most business-owning families face challenges to transfer their business ownership from one family generation to the next. To date, researchers have paid little attention to how and when ownership is passed across family generations and what the dynamics of such transitions are. This is primarily due to the prevailing assumption that ownership transfer is an unimportant and legalistic issue that occurs within a wider family management succession process. Yet, the limited evidence available suggests that family ownership transfer occurs inside and outside of the management succession process and is a difficult process for business-owning families to navigate. As a result, many otherwise viable family businesses are closing, leading to unnecessary loss of jobs and knowledge. This qualitative paper examines how family members understand and navigate the ownership transfer process. This study uses an inductive qualitative research design, conducted through in-depth interviews within eight business-owning families. It draws on family development theory and shows how a wide range of family-related events and dynamics outside of family business involvement underlie and shape the ownership transfer process. The findings extend the theory on how these events trigger ownership transfer and how they shape the ownership meanings held within business-owning families. This study found that ownership transfer meanings extend beyond that of transferring the legal control and financial appropriation rights of shareholders. The study concludes there are three different stages in the process of ownership transfer -symbolic, re-balancing, and protectionist. Each stage creates distinct family social constructions of the rights of family members to hold business ownership, and each stage occurs within a specific family development phase.

Keywords: business-owning family, family development theory, ownership transfer, process

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Authors: A. Lubis, R. Widayanti, Z. Hikmah, A. Endaryanto, A. Harsono, A. Harianto, R. Etika, D. K. Handayani, M. Sampurna

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Neonatal lupus erythematous (NLE) is a rare disease marked by clinical characteristic and specific maternal autoantibody. Many cutaneous, cardiac, liver, and hematological manifestations could happen with affect of one organ or multiple. In this case, both babies were premature, low birth weight (LBW), small for gestational age (SGA) and born through caesarean section from a systemic lupus erythematous (SLE) mother. In the first case, we found a baby girl with dyspnea and grunting. Chest X ray showed respiratory distress syndrome (RDS) great I and echocardiography showed small atrial septal defect (ASD) and ventricular septal defect (VSD). She also developed anemia, thrombocytopenia, elevated C-reactive protein, hypoalbuminemia, increasing coagulation factors, hyperbilirubinemia, and positive blood culture of Klebsiella pneumonia. Anti-Ro/SSA and Anti-nRNP/sm were positive. Intravenous fluid, antibiotic, transfusion of blood, thrombocyte concentrate, and fresh frozen plasma were given. The second baby, male presented with necrotic tissue on the left ear and skin rashes, erythematous macula, athropic scarring, hyperpigmentation on all of his body with various size and facial haemorrhage. He also suffered from thrombocytopenia, mild elevated transaminase enzyme, hyperbilirubinemia, anti-Ro/SSA was positive. Intravenous fluid, methyprednisolone, intravenous immunoglobulin (IVIG), blood, and thrombocyte concentrate transfution were given. Two cases of neonatal lupus erythematous had been presented. Diagnosis based on clinical presentation and maternal auto antibody on neonate. Organ involvement in NLE can occur as single or multiple manifestations.

Keywords: neonatus lupus erythematous, maternal autoantibody, clinical characteristic, multiple organ manifestation

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Authors: Irfan Khan

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Both the analytical methods used to understand the phenomena of peacebuilding and the ensuing viewpoints on achieving and sustaining "sustainable peace" are broad and diverse. This new field of study draws from sociology, anthropology, political theory, and political economy, psychology, international relations, and more recently, the development sciences to examine the wide range of 'conflicts' it describes. This paper emphasizes the significance of investigating the causes of juvenile disputes. It explains how police corruption encourages youth crime and why it's so important to address this issue head-on. It also examines the historical foundations and external pressures that have increased religious extremism and sectarian strife in Pakistan. The primary argument is that peace is not only a desirable 'goal' in itself but also that it may be a means to achieve political stability and long-term prosperity. Strategies for constructing peace may take many shapes, each tailored to the specifics of a given conflict, its scope, and the individuals involved. By drawing on some existing literature and applying it to the situation in Pakistan, this article proposes a viewpoint that centers on the participation of young people in the peacebuilding process. Due to their enhanced susceptibility and penchant for demanding change, young people are more likely to get involved in a conflict when economic failure and unemployment are present. The piece also emphasizes the marginalization young people experience as a result of their absence from decision-making processes and the political system. The article claims that Pakistan's rapidly growing young population presents a significant chance for a long-term "demographic dividend" in the form of improvements in peacebuilding processes. This benefit will only materialize if serious steps are taken to increase young people's voice and agency in political decision-making.

Keywords: peacebuilding, youth-led initiatives, empowerment, conflict & violence, religious extremism, political involvement, decision-making

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Authors: N. Umasuthan, S. D. N. K. Bathige, W. S. Thulasitha, I. Whang, J. Lee

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The MyD88 is an evolutionarily conserved host-expressed adaptor protein that is essential for proper TLR/ IL1R immune-response signaling. A previously identified complete cDNA (1626 bp) of OfMyD88 comprised an ORF of 867 bp encoding a protein of 288 amino acids (32.9 kDa). The gDNA (3761 bp) of OfMyD88 revealed a quinquepartite genome organization composed of 5 exons (with the sizes of 310, 132, 178, 92 and 155 bp) separated by 4 introns. All the introns displayed splice signals consistent with the consensus GT/AG rule. A bipartite domain structure with two domains namely death domain (24-103) coded by 1st exon, and TIR domain (151-288) coded by last 3 exons were identified through in silico analysis. Moreover, homology modeling of these two domains revealed a similar quaternary folding nature between human and rock bream homologs. A comprehensive comparison of vertebrate MyD88 genes showed that they possess a 5-exonic structure. In this structure, the last three exons were strongly conserved, and this suggests that a rigid structure has been maintained during vertebrate evolution. A cluster of TATA box-like sequences were found 0.25 kb upstream of cDNA starting position. In addition, putative 5'-flanking region of OfMyD88 was predicted to have TFBS implicated with TLR signaling, including copies of NFB1, APRF/ STAT3, Sp1, IRF1 and 2 and Stat1/2. Using qPCR technique, a ubiquitous mRNA expression was detected in liver and blood. Furthermore, a significantly up-regulated transcriptional expression of OfMyD88 was detected in head kidney (12-24 h; >2-fold), spleen (6 h; 1.5-fold), liver (3 h; 1.9-fold) and intestine (24 h; ~2-fold) post-Fla challenge. These data suggest a crucial role for MyD88 in antibacterial immunity of teleosts.

Keywords: MyD88, innate immunity, flagellin, genomic analysis

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Authors: Shalu Jain, Anju Bansal, Anup Kumar, Sunita Saxena

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Objectives: The novel TMPRSS2:ERG gene fusion is a common somatic event in prostate cancer that in some studies is linked with a more aggressive disease phenotype. Thus, this study aims to determine whether clinical variables are associated with the presence of TMPRSS2:ERG-fusion gene transcript in Indian patients of prostate cancer. Methods: We evaluated the clinical variables with presence and absence of TMPRSS2:ERG gene fusion in prostate cancer and BPH association of clinical patients. Patients referred for prostate biopsy because of abnormal DRE or/and elevated sPSA were enrolled for this prospective clinical study. TMPRSS2:ERG mRNA copies in samples were quantified using a Taqman chemistry by real time PCR assay in prostate biopsy samples (N=42). The T2:ERG assay detects the gene fusion mRNA isoform TMPRSS2 exon1 to ERG exon4. Results: Histopathology report has confirmed 25 cases as prostate cancer adenocarcinoma (PCa) and 17 patients as benign prostate hyperplasia (BPH). Out of 25 PCa cases, 16 (64%) were T2: ERG fusion positive. All 17 BPH controls were fusion negative. The T2:ERG fusion transcript was exclusively specific for prostate cancer as no case of BPH was detected having T2:ERG fusion, showing 100% specificity. The positive predictive value of fusion marker for prostate cancer is thus 100% and the negative predictive value is 65.3%. The T2:ERG fusion marker is significantly associated with clinical variables like no. of positive cores in prostate biopsy, Gleason score, serum PSA, perineural invasion, perivascular invasion and periprostatic fat involvement. Conclusions: Prostate cancer is a heterogeneous disease that may be defined by molecular subtypes such as the TMPRSS2:ERG fusion. In the present prospective study, the T2:ERG quantitative assay demonstrated high specificity for predicting biopsy outcome; sensitivity was similar to the prevalence of T2:ERG gene fusions in prostate tumors. These data suggest that further improvement in diagnostic accuracy could be achieved using a nomogram that combines T2:ERG with other markers and risk factors for prostate cancer.

Keywords: prostate cancer, genetic rearrangement, TMPRSS2:ERG fusion, clinical variables

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Authors: Shu-Yuan Lin, Tung-Chin Chou

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As products become increasingly similar in competitive markets, achieving product segmentation and differentiation through packaging design has become the primary task when designing retail product packaging. When the main focus of brand marketing is no longer the product itself, emotional marketing, such as the use of humorous packaging designs, may be employed to successfully promote the brand. Such efforts will capture the hearts of consumers, generate discussions, and allow the brand to leave a deep impression in consumers. In this study, snack packaging was used to develop a relationship model that illustrated the effect of humorous packaging designs on brand awareness and brand attitude. The study was divided into three stages: In the first stage, in-depth interviews and focus group interviews were conducted with experts to construct 24 indicators for assessing humorous packaging designs. In the second stage, survey questionnaires were distributed to a young consumer group; the results showed that the group had a high and low product involvement with chocolate and dried shredded squid, respectively. Humorous packaging designs were subsequently created for two snack types to produce a study sample of 12 different packaging. In the third stage, packaging designs were evaluated by obtaining scores for the consumers’ brand awareness, brand attitude, and perceived effects of the packaging designs. Finally, a relationship model was developed to show the effect of humorous packaging designs on brand awareness and brand attitude, confirming that two perceived effects of humorous packaging designs (i.e., ‘pleasant and emotionally healing’ and ‘connected to people’s daily life’) exhibited a significant and positive effect on ‘perceived brand value,’ where the effect of ‘pleasant and emotionally healing’ was the most significant. In addition, ‘pleasant and emotionally healing’ exerted a significant and positive effect on ‘brand purchase intention.’ Furthermore, packaging designs with humorous elements helped foster brand awareness.

Keywords: brand awareness, brand attitude, humorous design, packaging design

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Authors: S. B. D. Samarasinghe, Malini Herath

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Participatory planning is a very important process for decision making and choosing the best alternative options for community welfare, development of the society and its interactions among community and professionals. People’s involvement is considered as the key guidance in participatory planning. Presently, Participatory planning is being used in many fields. It's not only limited to planning but also to disaster management, poverty, housing, etc. In the past, Disaster management practice was a top-down approach, but it raised many issues as it was converted to a bottom-up approach. There are several approaches that can aid disaster management. Community-Based Disaster Risk Management (CBDRM) is a very successful participatory approach to risk management that is often successfully applied by other disaster-prone countries. In the local context, CBDRM has been applied to prevent Diseases as well as to prevent disasters such as landslides, tsunamis and floods. From three years before, Sri Lanka has initiated the CBDRM approach to minimize landslide vulnerability. Hence, this study mainly focuses on the impact of CBDRM approaches on landslide hazards. Also to identify their successes and failures from both implementing parties and community. This research is carried out based on a qualitative method combined with a descriptive research approach. A successful framework was prepared via a literature review. Case studies were selected considering landslide CBDRM programs which were implemented by Disaster Management Center and National Building Research Organization in Badulla. Their processes were evaluated. Data collection is done through interviews and informal discussions. Then their ideas were quantified by using the Relative Effectiveness index. The resulting numerical value was used to rank the program effectiveness and their success, failures and impacting factors. Results show that there are several failures among implementing parties and the community. Overcoming those factors can make way for better conduction of future CBDRM programs.

Keywords: community-based disaster risk management, disaster management, preparedness, landslide

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Authors: Alicia Greenbank, Efrat Bengio

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The aim of this research was to examine the efficacy of the first course in Israel, whose objective is to train student teachers in the special education department to work cooperatively with parents of children with special needs. Studies often highlight the importance of cooperation between teachers and parents of students with special needs. Israel’s Special Education Law defines parents as complete partners, and the Ministry of Education encourages and even requires that partnership be present. Yet this partnership is difficult to achieve many kindergarten teachers, and teachers have a lot of difficulties establishing and managing a pattern of cooperation with their students’ parents. Often we see different perspectives on the child's development and needs, distrust, lack of appreciation, and communication difficulties on both sides – parents & teachers. The course describes a method of instilling the need for cooperation at an early stage of teacher training-in the teacher training program. 22 students in the special education program for early childhood education in the fourth year of learning took part in the course. The fourth-year is the experiential training year and the first time that students have worked in a school. The course consisted of 14 sessions. Seven parents of students with different disabilities participated at 6 of the sessions. The changes in the students' attitudes towards partnership and their ability to manage this partnership were carried out by examining the reports written by the students before the meetings with the parents and the reflections they wrote after each meeting with the parents and at the end of the course. Three themes emerged from the narrative analysis, corresponding to the three preconditions for joint activities with parents — Approach, Attitude, Appropriate Atmosphere, according to the Four A’s Model. The findings showed that a course combining meetings with parents of children with special needs offers many benefits for teacher training. The course raised student awareness of the question partnership, changed students’ approaches and attitudes towards the parents, stressed the importance of partnership, and provided students with tools for working with parents through the school. Based on the findings of this study, courses in this format can be applied in order to cooperate between teachers and parents, for example, parents of gifted children with special needs.

Keywords: Partnership with parents in special education, parents of children with disabilities, parents of children with special needs, parents’ involvement in special education

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Authors: Peter Olasupo Ogunjuyigbe, Sarafa Shittu

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This paper emphasizes the relevance of conjugal relationship and spousal communication towards enhancing men’s involvement in contraceptive use among the Yorubas of South Western Nigeria. An understanding of males influence and the role they play in reproductive decision making can throw better light on mechanisms through which egalitarianness of husband/wife decision making influences contraceptive use. The objective of this study was to investigate how close conjugal relationships can be a good indicator of joint decision making among couples using data derived from a survey conducted in three states of South Western Nigeria. The study sample consisted of five hundred and twenty one (521) male respondents aged 15-59 years and five hundred and forty seven (547) female respondents aged 15-49 years. The study used both quantitative and qualitative approached to elicit information from the respondents. In order that the study would be truly representative of the towns, each of the study locations in the capital cities was divided into four strata: The traditional area, the migrant area, the mixed area (i.e. traditional and migrant), and the elite area. In the rural areas, selection of the respondents was by simple random sampling technique. However, the random selection was made in such a way that all the different parts of the locations were represented. Generally, the data collected were analysed at univariate, bivariate, and multivariate levels. Logistic regression models were employed to examine the interrelationships between male reproductive behaviour, conjugal relationship and contraceptive use. The study indicates that current use of contraceptive is high among this major ethnic group in Nigeria because of the improved level of communication among couples. The problem, however, is that men still have lower exposure rate when it comes to question of family planning information, education and counseling. This has serious implications on fertility regulation in Nigeria.

Keywords: behavior, conjugal, communication, counseling, spouse

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Authors: S. M. Rashed Ul Islam, Shahina Tabassum, Afsana Anwar Miti

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Objective: HIV testing and counseling center (HTC) is an important component of the HIV/AIDS detection, prevention and control interventions. The service was first initiated at the Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU) since the first case detection in 1989. The present study aimed to describe the demographic profile among the attendees tested HIV positive. Methods: The present study was carried out among 219 HIV positive cases detected through screening at the Department of Virology of BSMMU during the year of 2012-2016. Data were collected through pre-structured written questionnaire during the counseling session. Data were expressed as frequency and percentages and analyzed using SPSS v20.0 program. Results: Out of 219 HIV cases detected, 77.6% were males, and 22.4% were females with a mean age (mean±SD) of 35.46±9.46 years. Among them, 70.7% belonged to the 26-45 age groups representing the sexually active age. The majority of the cases were married (86.3%) and 49.8% had primary level of education whereas, 8.7% were illiterate. Nearly 42% of cases were referred from Chittagong division (south-east part of the country) followed by Dhaka division (35.6%). The bulk of study population admitted to involvement in high-risk behaviour (90%) in the past and 42% of them had worked overseas. The Pearson Chi-square (χ2) analysis revealed significant relationship of gender with marital (χ2=7.88 at 2% level) and occupation status (χ2=120.48 at 6% level); however, no association was observed with risk behaviour and educational status. Recommendations: HIV risk behavior was found to be a prime source for HIV infection among the study population. So, there is need for health education and awareness program to bring about behavioral changes to halt the yearly increase of new cases in the country with special attention to our overseas workers on HIV/AIDS risk and safety.

Keywords: Bangladesh, health education, HIV testing and counseling (HTC), HIV/AIDS, risk behavior

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Authors: Bamidele Wale-Oshinowo, Doris Akyere Boateng, Lebura Sorbarikor

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Women play significant roles when it comes to the survival of family businesses; however, their efforts are less acknowledged across the developing world. In the case where these businesses are started by husbands, women in many instances work as hard as the men to build up the business. In spite of this, the benefits women receive are not equal to their inputs. For instance, the profits accruing from ownership of these businesses are mainly enjoyed by husbands, as they are deemed to be the legal owners of family businesses in most developing economies. Though the number of women involvement in the ownership, management, and direction of family businesses keeps increasing over the years, their efforts sometimes are ‘invisible’ and not rewarded. Using a phenomenological approach, this study purposively selected 20 businesswomen each from Ghana and Nigeria for in-depth interviews on the different roles they play in ensuring the success of their family businesses (FBs). This study also explored the challenges and opportunities that these women have within their family businesses. Among the major findings of this study is the important strategic direction that women give in terms of providing both tangible and intangible resources such as transfer of transit knowledge to the next generation. Women were also found to play a significant role in the implementation of entrepreneurial orientation within small family businesses in Ghana and Nigeria. However, the study revealed that women experience various challenges as stakeholders in family businesses, among which are: work-life balance issues, succession issues, and culture-related presuppositions about gender roles both within the business and in their families. In the light of the study’s findings, critical recommendations made include encouraging founders and/or owners of family businesses to create a conducive and viable platform for women to grow into key leadership positions within Family businesses; doing this would impact strongly on the growth rate of these form of businesses within the African Region.

Keywords: emerging economies, control, management, resources, strategy, women

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Authors: Calvin Rong, Regina Agassian, Mindy Engle-Friedman

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Climate changes, including rising sea levels and increases in global temperature, can have major effects on resource availability, leading to increased competition for resources and rising food prices. The abstract nature and often delayed consequences of many ecological problems cause people focus on immediate, specific, and personal events and circumstances that compel immediate and emotional involvement. This finding may be explained by the challenges humans have in imagining themselves in the future, a shortcoming that interferes with decision-making involving far-off rewards, and leads people to indicate a lower concern toward the future than to present circumstances. The present study sought to assess whether priming people to think of themselves in the future might strengthen the connection to their future selves and stimulate environmentally-protective behavior. We hypothesize that priming participants to think about themselves in the future would increase concern for the future environment. 45 control participants were primed to think about themselves in the present, and 42 participants were primed to think about themselves in the futures. After priming, the participants rated their concern over access to clean water, food, and energy on a scale of 1 to 10. They also rated their predicted care levels for the environment at age points 40, 50, 60, 70, 80, and 90 on a scale of 1(not at all) to 10 (very much). Predicted care levels at age 90 for the experimental group was significantly higher than for the control group. Overall the experimental group rated their concern for resources higher than the control. In comparison to the control group (M=7.60, SD=2.104) participants in the experimental group had greater concern for clean water (M=8.56, SD=1.534). In comparison to the control group (M=7.49, SD=2.041) participants in the experimental group were more concerned about food resources (M=8.41, SD=1.830). In comparison to the control group (M=7.22, SD=1.999) participants in the experimental group were more concerned about energy resources (M=8.07, SD=1.967). This study assessed whether a priming strategy could be used to encourage pro-environmental practices that protect limited resources. Future-self priming helped participants see past short term issues and focus on concern for the future environment.

Keywords: climate change, future, priming, global warming

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Authors: Saptarshi Dhar, Tahira Farzana

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In Bangladesh, particularly in rural areas, persons with disabilities are generally isolated from the mainstream and are pushed to the margins of society. They are seen as an individual problem, not as a social responsibility. As a result, persons with disabilities face challenges to actively participate in social and economic activities. The country is experiencing a steady economic and per capita growth over the past few years and entrepreneurial opportunities are also increasing. However, involvement of persons with disabilities in entrepreneurship is yet to increase. The aim of this paper is to explore the issue of entrepreneurship for persons with disabilities through contribution of individuals and corporations in the context of social responsibility. The paper is exploratory in nature and is approached through a three-month research project 'Shwanirbhor' run by the authors in Pakshi area of Pabna District in Bangladesh. The authors collected data through semi structured questionnaire, interviews and focus group discussions. Through the project, persons with disabilities were provided with financial capital (collected through contribution of individuals and corporations), business plans and advisory assistance on a need basis to help them start entrepreneurial ventures. The findings of the study indicate that in terms of contribution toward a social cause, individuals and corporations have positive attitude and are willing to offer monetary and nonmonetary assistance. When provided with entrepreneurial opportunity, persons with disabilities showed motivation in joining entrepreneurship to improve their economic standing and to be financially independent. In addition to that, the study also found that factors such as social inclusion and acceptance, economic empowerment, breaking the social and family barrier are also the reasons that drive persons with disabilities into embracing entrepreneurship. Moreover, while starting and running the entrepreneurial activities, they face constraints that range from personal, environmental, operational and infrastructural to informational barriers. The paper also proposes a strategy framework for entrepreneurship creation in Bangladesh which could be supportive for policy development for persons with disabilities.

Keywords: Bangladesh, entrepreneurship, persons with disabilities (PWD), social responsibility

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Authors: Adriane Amend, Leidiene Ferreira Santos, Daniella Pires Nunes

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The experience of assuming or caring for older persons dependents by relatives is a complex task that encompasses or affective involvement, the demand for technical activities and or psychological support. It would be necessary to understand the situations related to the caregiver, the person and the environment, which help the family difficulty, as a caregiver to lead this role. Objective: To identify the forces that drive and restrict the care process of family caregivers of the older adults. Method: Descriptive and exploratory research, with a qualitative approach, which has as a reference the Force Field Theory. Five family caregivers of older adult’s dependents residing in the city of Palmas, Tocantins, Brazil will participate. The data were collected from December 2021 to February 2022, through a semi-structured individual interview, and submitted to content analysis. Results: As forces that drive or process of caring for family caregivers were: the account of compassionate attitudes and patience of the caregiver (I); to the collaboration of the other person to the care and to the body structure of the same (Other); and the supports of other people not cared for and structural, such as adaptations in the room, read and bathroom, as in the presence of air conditioners (Environment). Among the restrictive forces of care we mention difficulties in delegating care to another person, or stress of care and other personal demands (I); imposition of the older person about care and e a transfer from bed to hip (Other); e lack of accessibility of the house and absence of air conditioning and hospital bed (Environment). Conclusion: The results show that there are driving forces with the caregiver's attitude and feelings, a bond as an idol and support for the caregiver and the environment. On the other hand, conflicting ties, absence of physical structure and daily and continuous care shifts, can significantly compromise well-being or the cycle of older adult, caregiver and care.

Keywords: caregivers, frail elderly, perception, geriatric nursing

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Authors: T. Aragaw, P. Gari

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In spite of social, political, and economic marginalization, women are still considered as the backbone of Ethiopia, one of the least developed countries in the world. The general purpose of this study was to assess factors that affect participation of women in politics, social and economic decisions at Kelem-Wollega Administrative Zone of Oromia Regional State, Ethiopia. Data used in this paper is mainly primary, and a few secondary data were incorporated. Respondents were selected using a systematic random sampling method and were placed questionnaires containing open-ended and closed-ended. Focus group discussion was also used for the study subjects in two offices. According to the information collected from the KWAZ Development and Social Service Office, a total of 18,473 tax-paying employees are present in the Zone, which is 14% of the total population of the Zone. Among the total number of employees in the Zone, 2,617 have been recruited for this study based on the criteria stated. This showed 1.8% of them were comprised of several churches and religious owned integrated development projects in the KWAZ. The 2,103 (80.34%) study participants responded personally, and they completed and returned the questionnaire to the researchers. The study revealed that in public institutions existed in KWAZ, the majority of women were having an educational status of diploma and lower, practicing lower non-decision making and leadership positions. Conclusion: Major barriers hindering women include: Socio-cultural attitudes, lack of necessary experience, education, the burden of domestic responsibilities, and lack of role models of women leaders in the Zone. Empowerment of women via social organizations, critical involvement of the government, and Affirmative action for women is critical. Further research is needed on the scope and challenges in implementing the strategies.

Keywords: women, affirmative action, leadership, empowerment, Ethiopia

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Authors: Ioannis Panagiotopoulos, Efstathios Kastritis, Anastasia Katinioti, Georgios Efthymiadis, Argyrios Doumas, Maria Koutelou

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Introduction: Transthyretin amyloidosis (ATTR) is a rare but serious infiltrative disease. Myocardial scintigraphy with DPD has emerged as the most effective, non-invasive, highly sensitive, and highly specific diagnostic method for cardiac ATTR amyloidosis. However, there are cases in which additional laboratory investigations reveal AL amyloidosis or other diseases despite a positive DPD scintigraphy. We describe the experience from the Onassis Cardiac Surgery Center and the monitoring center for infiltrative myocardial diseases of the cardiology clinic at AHEPA. Materials and Methods: All patients with clinical suspicion of cardiac or extracardiac amyloidosis undergo a myocardial scintigraphy scan with Tc-99m DPD. In this way, over 500 patients have been examined. Further diagnostic approach based on clinical and imaging findings includes laboratory investigation and invasive techniques (e.g., biopsy). Results: Out of 76 patients in total with positive myocardial scintigraphy Grade 2 or 3 according to the Perugini scale, 8 were proven to suffer from AL Amyloidosis during the investigation of paraproteinemia. Among these patients, 3 showed Grade 3 uptake, while the rest were graded as Grade 2, or 2 to 3. Additionally, one patient presented diffuse and unusual radiopharmaceutical uptake in soft tissues throughout the body without cardiac involvement. These findings raised suspicions, leading to the analysis of κ and λ light chains in the serum, as well as immunostaining of proteins in the serum and urine of these specific patients. The final diagnosis was AL amyloidosis. Conclusion: The value of DPD scintigraphy in the diagnosis of cardiac amyloidosis from transthyretin is undisputed. However, positive myocardial scintigraphy with DPD should not automatically lead to the diagnosis of ATTR amyloidosis. Laboratory differentiation between ATTR and AL amyloidosis is crucial, as both prognosis and therapeutic strategy are dramatically altered. Laboratory exclusion of paraproteinemia is a necessary and essential step in the diagnostic algorithm of ATTR amyloidosis for all positive myocardial scintigraphy with diphosphonate tracers since >20% of patients with Grade 3 and 2 uptake may conceal AL amyloidosis.

Keywords: AL amyloidosis, amyloidosis, ATTR, myocardial scintigraphy, Tc-99m DPD

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