Search results for: medical assistance in dying

Authors: Seyedfateh Moradi

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Medical issues mark the beginning of a new form of epistemology in nineteenth-century Iran. The emergence of epidemic diseases led to the formation of a medical discourse and conflict over the body which displayed itself in the concept of health progress and development. The discourse attributed to this development in the health system defines the general structure of the given period. This discourse manifested itself in the conflict between the traditional and new medicine. The regulation and classification of body and population reveal the nature of this period. The government attempted to adapt itself to the modern and progressive discourse. This paper seeks to reveal part of this rupture and adaptation around epidemics and modern medical discourse. Also, accepting part of the traditional discourse in the new era, or adapting and integrating parts of it indicate a delegation of part of the power of traditional authorities. The delegation of power arose in the context of the discursive hegemony of Western modernism from which there was no escape. This provided the ground for the acceptance of government and emergence of other discourses. Finally, during the reign of Reza Shah (1922-1942), body and population planning changed into the key issues of government, which created serious tensions in society.

Keywords: epidemic, population, body, cholera, plague

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Authors: Ajay Pinjani, Minha Khan, Ayesha Mehkeri, Anum Iftikhar

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There is much research available on the benefits of adopting mother tongue-based multilingual education (MTB MLE) in primary school classrooms, but there is limited guidance available on how to design such programs for low-resource and linguistically diverse contexts. This paper is an effort to bridge the gap between theory and practice by offering a practitioner’s perspective on designing an MTB MLE program for linguistically heterogeneous contexts. The research compounds findings from current academic literature on MTB MLE, the study of global MTB MLE programs, interviews with practitioners, policy-makers, and academics worldwide, and a socio-linguistic survey carried out in parts of Tharparkar, Pakistan, the area selected for envisioned pilot implementation. These findings enabled the creation of ‘guiding principles’ which provide structure for the development of a contextualized and holistic MTB-MLE program. The guiding principles direct the creation of teaching and learning materials, creating effective teaching and learning environment, community engagement, and program evaluation. Additionally, the paper demonstrates the development of a context-specific language ladder framework which outlines the language journey of a child’s education, beginning with the mother tongue/ most familiar language in the early years and then gradually transitioning into other languages. Both the guiding principles and language ladder can be adapted to any multilingual context. Thus, this research provides MTB MLE practitioners with assistance in developing an MTB MLE model, which is best suited for their context.

Keywords: mother tongue based multilingual education, education design, language ladder, language issues, heterogeneous contexts

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Authors: Marica Pidor-Quingco, Francis Cabatingan

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Background: One of the essential roles of a physician is to assess a patient’s worth and support them in making decisions regarding their future preferences when it comes to medical care. Advance Directives is a patient-centered approach which is liked to a better-quality treatment at the end of life. General Objective: To assess and describe the knowledge, attitudes and practices of resident physicians regarding advance directive among the resident physicians in Vicente Sotto Memorial Medical Study. Methods: An analytical cross-sectional study was conducted at Vicente Sotto Memorial Medical Center. There was a total of 129 respondents who gave their consent and was given survey questionnaire containing the demographic profile, knowledge, attitude and practices. Categorical variables were presented as frequency and percentage. Chi Square Test was used to determine the association of demographic profile with knowledge and attitude. Man-Whitney U test was utilized for the association of age with knowledge and attitude. Results: Out of 129 respondents, 36.59% were in favor towards self-determination and autonomy. Majority of the revealed an adequate knowledge and positive attitude regarding advance directives. Based on the results, there were no significant correlations between sociodemographic of the residents towards to knowledge and attitude. Over 66.7% of the respondents had used Advance Directives to their patients but 25% were not comfortable about it. Though most of the respondents was able to discuss AD with their patients, 7.0% of them are not willing to open the topic to the family. Conclusion: VSMMC is a tertiary hospital which also caters Hospice, Palliative and Supportive care to the patients. One of the services offered is initiating Advance Directives which may be a factor for a positive knowledge, attitude and practices towards this topic.

Keywords: advance directives, philippines, physicians, palliative

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Authors: Ali Seddiki, Mohamed Djebbouri, Driss Guerchi

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Medical imaging produces human body pictures in digital form. Since these imaging techniques produce prohibitive amounts of data, compression is necessary for storage and communication purposes. In some areas in medicine, it may be sufficient to maintain high image quality only in region of interest (ROI). This paper discusses a contribution to quality purpose compression in the region of interest of scintigraphic images based on dual tree complex wavelet transform (DT-CWT) using Run-Length coding (RLE) and Huffman coding (HC).

Keywords: DT-CWT, region of interest, run length coding, Scintigraphic images

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Authors: Gysele Lima Ricci, Jose Miguel Rodriguez Anton

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Companies in the tourism sector need to achieve competitive advantages for their survival in the market. In this way, the models based on association, cooperation, complementarity, distribution, exchange and mutual assistance arise as a possibility of organizational development, taking as reference the concept of networks. Many companies seek to partner in local networks as clusters to act together and associate. The main objective of the present research is to identify the specificities of management and the practices of cooperation in the tourist destination of São Paulo - Brazil, and to propose a new management model with possible cluster of tourism. The empirical analysis was carried out in three phases. As a first phase, a research was made by the companies, associations and tourism organizations existing in São Paulo, analyzing the characteristics of their business. In the second phase, the management specificities and cooperation practice used in the tourist destination. And in the third phase, identifying the possible strengths and weaknesses that potential or potential tourist cluster could have, proposing the development of the management model of the same adapted to the needs of the companies, associations and organizations. As a main result, it has been identified that companies, associations and organizations could be looking for synergies with each other and collaborate through a Hiperred organizational structure, in which they share their knowledge, try to make the most of the collaboration and to benefit from three concepts: flexibility, learning and collaboration. Finally, it is concluded that, the proposed tourism cluster management model is viable for the development of tourism destinations because it makes it possible to strategically address agents which are responsible for public policies, as well as public and private companies and organizations in their strategies competitiveness and cooperation.

Keywords: cluster, management model, networks, tourism sector

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Authors: Rahaf Mandura

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Background: Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure (ICP) more than 250 mm H₂O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. The aim of this research is to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. Methodology: This is a retrospective observational study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital (JEH), Saudi Arabia. A total of fifty-one patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. Results: Most of the patients were females (43, 91.5%) with a mean age of presentation of 30.83±11.40 years. The most common presenting symptom was headache (40 patients, 85.1%), followed by transient visual obscuration (20 patients, 42.6%), and reduced visual acuity (15 patients, 31.9%). All 47 patients were started on medical treatment with oral acetazolamide with four patients (8.5%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.5%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. Conclusion: The present study has shown that IIH-related papilledema is common in young female patients with headaches, transient visual obscurations and reduced visual acuity. Those are the commonest symptoms in our IIH population. Medical treatment of IIH is significantly efficacious and should be considered in order to enhance the prognosis of IIH-related complications. Therefore, the visual status should be frequently monitored for these patients.

Keywords: idiopathic intracranial hypertension, intracranial hypertension, papilledema, headache

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Authors: Shibinu S, Mohamed Haseeb N

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In times of crisis, the diaspora's role and the help it offers are seen to be vital in determining how many countries, particularly low- and middle-income nations that significantly rely on remittances, recover. Twenty-one lakh twenty thousand Keralites have emigrated abroad, with 81.2 percent of these outflows occurring in the Gulf Cooperative Council (GCC). Most of them are semi-skilled or low-skilled laborers employed in GCC nations. Additionally, a sizeable portion of migrants are employed in industrialized nations like the UK and the US. These nations have seen the development of a highly robust Indian Diaspora. India's development is largely dependent on the generosity of its diaspora, and the nation has benefited greatly from the substantial contributions made by several emigrant generations. Its strength was noticeable during the COVID-19 and Kerala floods. Millions of people were displaced, millions of properties were damaged, and many people died as a result of the 2018 Kerala floods. The Malayalee diaspora played a crucial role in the reconstruction of Kerala by providing support for the rescue efforts underway on the ground through their extensive worldwide network. During COVID-19, an analogous outreach was also noted, in which the diaspora assisted stranded migrants across the globe. Together with the work the diaspora has done for the state's development and recovery, there has also been a recent outpouring of assistance during the COVID-19 pandemic. The study focuses on the subtleties of diaspora philanthropic scholarship and how Kerala was able to recover from the COVID-19 pandemic and floods thanks to it. Semi-structured in-depth interviews with migrants, migrant organizations, and beneficiaries from the diaspora through snowball sampling to better understand the role that diaspora philanthropy plays in times of crisis.

Keywords: crises, diaspora, remittances, COVID-19, flood, economic development of Kerala

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Authors: Siti Salbiah Samsudin, Hamzah Arof, Ainuddin Wahid Abdul Wahab, Mohd Yamani Idna Idris

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Standard X-ray spine images produced by conventional screen-film technique have a limited field of view. This limitation may obstruct a complete inspection of the spine unless images of different parts of the spine are placed next to each other contiguously to form a complete structure. Another solution to producing a whole spine image is by assembling the digitized x-ray images of its parts automatically using image stitching. This paper presents a new Medical Image Stitching (MIS) method that utilizes Minimum Average Correlation Energy (MACE) filters to identify and merge pairs of x-ray medical images. The effectiveness of the proposed method is demonstrated in two sets of experiments involving two databases which contain a total of 40 pairs of overlapping and non-overlapping spine images. The experimental results are compared to those produced by the Normalized Cross Correlation (NCC) and Phase Only Correlation (POC) methods for comparison. It is found that the proposed method outperforms those of the NCC and POC methods in identifying both the overlapping and non-overlapping medical images. The efficacy of the proposed method is further vindicated by its average execution time which is about two to five times shorter than those of the POC and NCC methods.

Keywords: image stitching, MACE filter, panorama image, scoliosis

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Authors: Sheema Shuja Khattak, Gule Saman, Imran Khan, Abdus Salam

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Image segmentation plays an important role in medical imaging applications. Therefore, accurate methods are needed for the successful segmentation of medical images for diagnosis and detection of various diseases. In this paper, we have used maximum entropy to achieve image segmentation. Maximum entropy has been calculated using Shannon, Renyi, and Tsallis entropies. This work has novelty based on the detection of skin lesion caused by the bite of a parasite called Sand Fly causing the disease is called Cutaneous Leishmaniasis.

Keywords: shannon, maximum entropy, Renyi, Tsallis entropy

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Authors: Chisom N. Nwaigwe, Blessing N. Egbulefu, Angela Uwakwem

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A study on Stress and its’ effect on the health of workers in Federal Medical Centres in Nigeria is presented. The aim is to evaluate how much stress related hazards health workers in our tertiary health institutions are exposed to and to create awareness and reduce the rate at which stress affect the health of the working population in Nigeria, using workers in Federal Medical Centre, Umuahia as a case study. The descriptive survey design was adopted with the aid of 100 questionnaires delivered to the respondents in order to obtain first-hand information. From the findings, the major causes of stress were identified as inadequate staffing, unresolved family problems and psychological/cultural factors like the return of a lactating mother to work after three months post-delivery. The effects of stress on the workers were identified as hypertension, poor job performances, depression, asthma, and peptic ulcers. The study recommended instituting counseling units for stress management, holding seminars on stress management and increasing the salary scale (remuneration) and proper roster planning as solutions to stress reduction in our hospitals. This study is important to management in planning staffing, roaster, and a rehabilitation programme for her staff.

Keywords: stress, causes, effects, workers

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Authors: Umedov Mekhroz, Griaznova Svetlana

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In connection with the growth of oncological diseases, the design of centers for diagnostics and the production of radiopharmaceuticals is the most relevant area of healthcare facilities. The design of new nuclear medicine centers should be carried out from the standpoint of solving the following tasks: the availability of medical care, functionality, environmental friendliness, sustainable development, improving the safety of drugs, the use of which requires special care, reducing the rate of environmental pollution, ensuring comfortable conditions for the internal microclimate, adaptability. The purpose of this article is to substantiate architectural and planning solutions, formulate recommendations and principles for the design of nuclear medicine centers and determine the connections between the production and medical functions of a building. The advantages of combining the production of radiopharmaceuticals and the department of medical care: less radiation activity is accumulated, the cost of the final product is lower, and there is no need to hire a transport company with a special license for transportation. A medical imaging department is a structural unit of a medical institution in which diagnostic procedures are carried out in order to gain an idea of the internal structure of various organs of the body for clinical analysis. Depending on the needs of a particular institution, the department may include various rooms that provide medical imaging using radiography, ultrasound diagnostics, and the phenomenon of nuclear magnetic resonance. The production of radiopharmaceuticals is an object intended for the production of a pharmaceutical substance containing a radionuclide and intended for introduction into the human body or laboratory animal for the purpose of diagnosis, evaluation of the effectiveness of treatment, or for biomedical research. The research methodology includes the following subjects: study and generalization of international experience in scientific research, literature, standards, teaching aids, and design materials on the topic of research; An integrated approach to the study of existing international experience of PET / CT scan centers and the production of radiopharmaceuticals; Elaboration of graphical analysis and diagrams based on the system analysis of the processed information; Identification of methods and principles of functional zoning of nuclear medicine centers. The result of the research is the identification of the design principles of nuclear medicine centers with the functions of the production of radiopharmaceuticals and the department of medical imaging. This research will be applied to the design and construction of healthcare facilities in the field of nuclear medicine.

Keywords: architectural planning solutions, functional zoning, nuclear medicine, PET/CT scan, production of radiopharmaceuticals, radiotherapy

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Authors: Alua Masalimova, Dameli Sulubecova, Talgat Isaev, Raushan Magzumova

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The usual relation to nurses of heads of medical organizations in Kazakhstan is to use them only for per performing medical manipulations, but new economic conditions require the introduction of nursing innovations. There is an increasing need for managers of hospital departments and regions of ambulatory clinics to ensure comfortable conditions for doctors, nurses, aides, as well as monitoring marketing technology (the needs and satisfaction of staff work, the patient satisfaction of the department). It is going to the past the nursing activities as physician assistant performing his prescriptions passively. We are suggesting a model for the developing the head nurse as the manager on the example of Blood Service. We have studied in the scientific-production center of blood transfusion head nurses by the standard method of interviewing for involvement in coordinating the flow of information, promoting the competitiveness of the department. Results: the average age of the respondents 43,1 ± 9,8, female - 100%; manager in the Organization – 9,3 ± 10,3 years. Received positive responses to the knowledge of the nearest offices in providing similar medical service - 14,2%. The cost of similar medical services in other competitive organizations did not know 100%, did a study of employee satisfaction Division labour-85,7% answered negatively, the satisfaction donors work staff studied in 50.0% of cases involved in attracting paid Services Division showed a 28.5% of the respondent. Participation in management decisions medical organization: strategic planning - 14,2%, forming analysis report for the year – 14,2%, recruitment-30.0%, equipment-14.2%. Participation in the social and technical designing workplaces Division staff showed 85,0% of senior nurses. Participate in the cohesion of the staff of the Division method of the team used the 10.0% of respondents. Further, we have studied the behavioral competencies for senior sisters: customer focus – 20,0% of respondents have attended, the ability to work in a team – 40,0%. Personal qualities senior nurses were apparent: sociability – 80,0%, the ability to manage information – 40,0%, to make their own decisions - 14,2%, 28,5% creativity, the desire to improve their professionalism – 50,0%. Thus, the modern market conditions dictate this organization, which works for the rights of economic management; include the competence of the post of the senior nurse knowledge and skills of Marketing Management Department. Skills to analyses the information collected and use of management offers superior medical leadership organization. The medical organization in the recruitment of the senior nurse offices take into account personal qualities: flexibility, fluency of thinking, communication skills and ability to work in a team. As well as leadership qualities, ambition, high emotional and social intelligence, that will bring out the medical unit on competitiveness within the country and abroad.

Keywords: blood service, head nurse, manager, skills

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Authors: Shazia Almas, Jaffar Iqbal, Nazia Almas

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In most of the South Asian countries like Pakistan medical profession is one the most valued and respectful professions yet being a medical professional requires an enormous amount of responsibilities and work overload at the same time which possibly can be in contrast with family role of a doctor. Job and family are two primary spheres of a person's life no matter whatever the profession one adopts and the type of family one is running. There is a bi-directional relationship between job and family. The type and nature of work, time schedules, working shifts in medical profession are very demanding in the countries like Pakistan where number of patients is far more higher than the number of doctors available. The work life also have significant impact on family life and vice versa. Because of the sensitivity and interdependency of these relations, today’s overarching and competing demands remain dissatisfactory. The main objective of the current research is to investigate how interpersonal relationships affect work and work affects interpersonal relationships of medical professionals. In line with identifying these facts, the current study aimed to examine the predictive role of psychological capital (self-efficacy, hope, optimism, and resilience), in organizational outcome (job satisfaction) and personal outcome (family satisfaction) amongst male and medical professionals. A total of 350 participants from public and private sector hospitals of Pakistan were recruited through simple random and stratified sampling techniques, with age ranges from 26-50 years. The questionnaire including established and certified self-report measures of Psychological Capital Questionnaire, Job Satisfaction, and Family Satisfaction were adopted to collect the data. The reliability and validity of mentioned instruments were established through Cronbach’s alpha and factor analyses (exploratory and confirmatory) respectively using Structural Equation Modeling (SEM) by AMOS. The proposed hypotheses were tested using Pearson’s Correlation and Regression analyses for predicting effect whereas, t-Test was deployed to verify the difference between male and female health professionals. The results revealed that self-efficacy and optimism predicted job satisfaction while, self-efficacy, hope, and resilience predicted family satisfaction. Moreover, the results depicted significant gender differences in job satisfaction where females were higher on job satisfaction as compared to male medical professionals but no significant differences were observed in levels of family satisfaction between both genders. The study has implications for social, organizational and work policy designers. The study also paves for more researches with positive psychological approach to promote work-family harmony.

Keywords: family satisfaction, job satisfaction, medical professionals, psychological capital

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Authors: Luphumlo Ncanywa, Paul Watts

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Malaria is a disease that kills approximately one million people annually. Children and pregnant women in sub-Saharan Africa lost their lives due to malaria. Malaria continues to be one of the major causes of death, especially in poor countries in Africa. Decrease the burden of malaria and save lives is very essential. There is a major concern about malaria parasites being able to develop resistance towards antimalarial drugs. People are still dying due to lack of medicine affordability in less well-off countries in the world. If more people could receive treatment by reducing the cost of drugs, the number of deaths in Africa could be massively reduced. There is a shortage of pharmaceutical manufacturing capability within many of the countries in Africa. However one has to question how Africa would actually manufacture drugs, active pharmaceutical ingredients or medicines developed within these research programs. It is quite likely that such manufacturing would be outsourced overseas, hence increasing the cost of production and potentially limiting the full benefit of the original research. As a result the last few years has seen major interest in developing more effective and cheaper technology for manufacturing generic pharmaceutical products. Micro-reactor technology (MRT) is an emerging technique that enables those working in research and development to rapidly screen reactions utilizing continuous flow, leading to the identification of reaction conditions that are suitable for usage at a production level. This emerging technique will be used to develop antimalarial drugs. It is this system flexibility that has the potential to reduce both the time was taken and risk associated with transferring reaction methodology from research to production. Using an approach referred to as scale-out or numbering up, a reaction is first optimized within the laboratory using a single micro-reactor, and in order to increase production volume, the number of reactors employed is simply increased. The overall aim of this research project is to develop and optimize synthetic process of antimalarial drugs in the continuous processing. This will provide a step change in pharmaceutical manufacturing technology that will increase the availability and affordability of antimalarial drugs on a worldwide scale, with a particular emphasis on Africa in the first instance. The research will determine the best chemistry and technology to define the lowest cost manufacturing route to pharmaceutical products. We are currently developing a method to synthesize Lumefantrine in continuous flow using batch process as bench mark. Lumefantrine is a dichlorobenzylidine derivative effective for the treatment of various types of malaria. Lumefantrine is an antimalarial drug used with artemether for the treatment of uncomplicated malaria. The results obtained when synthesizing Lumefantrine in a batch process are transferred into a continuous flow process in order to develop an even better and reproducible process. Therefore, development of an appropriate synthetic route for Lumefantrine is significant in pharmaceutical industry. Consequently, if better (and cheaper) manufacturing routes to antimalarial drugs could be developed and implemented where needed, it is far more likely to enable antimalarial drugs to be available to those in need.

Keywords: antimalarial, flow, lumefantrine, synthesis

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Authors: Vineeta Kaushik, Manisha Goel

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Chaperones are proteins that help other proteins fold correctly, and are found in all domains of life i.e., prokaryotes, eukaryotes and archaea. Various comparative genomic studies have suggested that the archaeal protein folding machinery appears to be highly similar to that found in eukaryotes. In case of protein folding; slow rotation of peptide prolyl-imide bond is often the rate limiting step. Formation of the prolyl-imide bond during the folding of a protein requires the assistance of other proteins, termed as peptide prolyl cis-trans isomerases (PPIases). Cyclophilins constitute the class of peptide prolyl isomerases with a wide range of biological function like protein folding, signaling and chaperoning. Most of the cyclophilins exhibit PPIase enzymatic activity and play active role in substrate protein folding which classifies them as a category of molecular chaperones. Till date, there is not very much data available in the literature on archaeal cyclophilins. We aim to compare the structural and biochemical features of the cyclophilin protein from within the three domains to elucidate the features affecting their stability and enzyme activity. In the present study, we carry out in-silico analysis of the cyclophilin proteins to predict their conserved residues, sites under positive selection and compare these proteins to their bacterial and eukaryotic counterparts to predict functional divergence. We also aim to clone and express these proteins in heterologous system and study their biophysical characteristics in detail using techniques like CD and fluorescence spectroscopy. Overall we aim to understand the features contributing to the folding, stability and dynamics of the archaeal cyclophilin proteins.

Keywords: biophysical characterization, x-ray crystallography, chaperone-like activity, cyclophilin, PPIase activity

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Authors: Mohammad A. U. Khan, Omar A. Kittaneh, M. Akbar, Tariq M. Khan, Husam A. Bayoud

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The Shannon Entropy measure has been widely used for measuring uncertainty. However, in partial settings, the histogram is used to estimate the underlying distribution. The histogram is dependent on the number of bins used. In this paper, a modification is proposed that makes the Shannon entropy based on histogram consistent. For providing the benefits, two application are picked in medical image processing applications. The simulations are carried out to show the superiority of this modified measure for image segmentation problem. The improvement may be contributed to robustness shown to uneven background in images.

Keywords: Shannon entropy, medical image processing, image segmentation, modification

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Authors: Sejuti Malakar

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Textile sensors have gained a lot of interest in recent years as it is instrumental in monitoring physiological and environmental changes, for a better diagnosis that can be useful in various fields like medical textiles, sports textiles, protective textiles, agro textiles, and geo-textiles. Moreover, with the development of flexible textile-based wearable sensors, the functionality of smart clothing is augmented for a more improved user experience when it comes to technical textiles. In this context, conductive textiles using new composites and nanomaterials are being developed while considering its compatibility with the textile manufacturing processes. This review aims to provide a comprehensive and detailed overview of the contemporary advancements in textile-based wearable physical sensors, used in the field of medical, security, surveillance, and protection, from a global perspective. The methodology used is through analysing various examples of integration of wearable textile-based sensors with clothing for daily use, keeping in mind the technological advances in the same. By comparing various case studies, we come across various challenges textile sensors, in terms of stability, the comfort of movement, and reliable sensing components to enable accurate measurements, in spite of progress in the engineering of the wearable. Addressing such concerns is critical for the future success of wearable sensors.

Keywords: flexible textile-based wearable sensors, contemporary advancements, conductive textiles, body conformal design

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Authors: Oluwaponmile David Alao

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Due to an increase in the death rate as a result of heart attack. There is need to develop a system that can be useful in the diagnosis of the disease at the medical centre. This system will help in preventing misdiagnosis that may occur from the medical practitioner or the physicians. In this research work, heart disease dataset obtained from UCI repository has been used to develop an intelligent prediction diagnosis system. The system is modeled on a feedforwad neural network and trained with back propagation neural network. A recognition rate of 86% is obtained from the testing of the network.

Keywords: heart disease, artificial neural network, diagnosis, prediction system

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Authors: Brian Moore, Stuart Woodcock, Dean Dudley

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Mental health problems have significant social and economic consequences; however, many individuals do not seek traditional assistance for mental health difficulties. Martial arts training may provide an inexpensive alternative to traditional psychological therapy. While limited research has suggested martial arts training may be an efficacious intervention, the validity and reliability of this are questionable given the small number of relevant studies and other methodological problems. The study examined the effects of 10-week martial arts-based psycho-social intervention which was evaluated using a randomized controlled trial. The intervention was delivered to 283 secondary school students, aged between 12-14 years, who were recruited from government and catholic secondary schools in New South Wales, Australia. The intervention was delivered in a group format onsite at participating schools and had an intervention dose of 10 x 50-60 minute sessions, once per week for 10 weeks. Data were collected at baseline, post-intervention, and 12-week follow-up. Results found a consistent pattern for strength based wellbeing outcomes. All primary and secondary measures relating to resilience and self-efficacy improved for the intervention group and declined for the control group. As these findings were derived from a robust design and rigorous evaluation, they provide valid and reliable evidence that martial arts-based psycho-social interventions can be considered as an efficacious method of improving strength and wellbeing outcomes.

Keywords: martial arts, mental health, resilience, self-efficacy

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Authors: Genevieve Jorolan-Quintero

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The recording as well as the preservation of indigenous literature is an important task as it deals with a significant heritage of pre-colonial culture. The beliefs and traditions of a people are reflected in their oral narratives, such as the folk epic, which must be written down to insure their preservation. The epic poem for instance, known as dawot among the Mandaya, one of the indigenous communities in the southern region of the Philippines, narrates the customs, the ways of life, and the adventures of an ancient people. Nabayra, an expert on Philippine folkloric studies, stresses that still extant after centuries of unknown origin, the dawot was handed down to the magdadawot (bard) by word of mouth, forming the greatest bulk of Mandaya oral tradition. Unhampered by modern means of communication to distract her/him, the magdadawot has a sharp memory of the intricacies of the ancient art of chanting the panayday (verses) of the epic poem. The dawot has several hullubaton (episodes), each of which takes several nights to chant . The language used in these oral traditions is archaic Mandaya, no longer spoken or clearly understood by the present generation. There is urgency to the task of recording and writing down what remain of the epic poem since the singers and storytellers who have retained the memory and the skill of chanting and narrating the dawot and other forms of oral tradition in their original forms are getting fewer. The few who are gifted and skilled to transmit these ancient arts and wisdom are old and dying. Unlike the other Philippine epics (i.e. the Darangen, the Ulahingan, the Hinilawod, etc.), the Mandaya epic is yet to be recognized and given its rightful place among the recorded epics in Philippine Folk Literature. The general aim of this study was to put together and preserve an intangible heritage, the Mandaya hullubaton (episodes of the dawot), in order to preserve and promote appreciation for the oral traditions and cultural legacy of the Mandaya. It was able to record, transcribe, and translate four hullubaton of the folk epic into two languages, Visayan and English to insure understanding of their contents and significance among non-Mandaya audiences. Evident in the contents of the episodes are the cultural practices, ideals, life values, and traditions of the ancient Mandaya. While the conquests and adventures of the Mandaya heroes Lumungtad, Dilam, and Gambong highlight heroic virtues, the role of the Mandaya matriarch in family affairs is likewise stressed. The recording and the translation of the hullubaton and the dawot into commonly spoken languages will not only promote knowledge and understanding about their culture, but will also stimulate in the members of this cultural community a sense of pride for their literature and culture. Knowledge about indigenous cultural system and philosophy derived from their oral literature will serve as a springboard to further comparative researches dealing with indigenous mores and belief systems among the different tribes in the Philippines, in Asia, in Africa, and other countries in the world.

Keywords: Dawot, epic poem, Mandaya, Philippine folk literature

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Authors: Rosemary Saunders, Courtney Glass, Karla Seaman, Karen Gullick, Julie Andrew, Anne Wilkinson, Ashwini Davray

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Current literature demonstrates that most Australians receive end-of-life care in a hospital setting, despite most hoping to die within their own home. The necessity for high quality end-of-life care has been emphasised by the Australian Commission on Safety and Quality in Health Care and the National Safety and Quality in Health Services Standards depict the requirement for comprehensive care at the end of life (Action 5.20), reinforcing the obligation for continual organisational assessment to determine if these standards are suitably achieved. Limited research exploring clinical staff perspectives of end-of-life care delivery has been conducted within an Australian private health context. This study aimed to investigate clinical staff member perceptions of end-of-life care delivery at a private hospital in Western Australia. The study comprised of a multi-faceted mixed-methods methodology, part of a larger study. Data was obtained from clinical staff utilising surveys and focus groups. A total of 133 questionnaires were completed by clinical staff, including registered nurses (61.4%), enrolled nurses (22.7%), allied health professionals (9.9%), non-palliative care consultants (3.8%) and junior doctors (2.2%). A total of 14.7% of respondents were palliative care ward staff members. Additionally, seven staff focus groups were conducted with physicians (n=3), nurses (n=26) and allied health professionals including social workers (n=1), dietitians (n=2), physiotherapists (n=5) and speech pathologists (n=3). Key findings from the surveys highlighted that the majority of staff agreed it was part of their role to talk to doctors about the care of patients who they thought may be dying, and recognised the importance of communication, appropriate training and support for clinical staff to provide quality end-of-life care. Thematic analysis of the qualitative data generated three key themes: creating the setting which highlighted the importance of adequate resourcing and conducive physical environments for end-of-life care and to support staff and families; planning and care delivery which emphasised the necessity for collaboration between staff, families and patients to develop care plans and treatment directives; and collaborating in end-of-life care, with effective communication and teamwork leading to achievable care delivery expectations. These findings contribute to health professionals better understanding of end-of-life care provision and the importance of collaborating with patients and families in care delivery. It is crucial that health care providers implement strategies to overcome gaps in care, so quality end-of-life care is provided. Findings from this study have been translated into practice, with the development and implementation of resources, training opportunities, support networks and guidelines for the delivery of quality end-of-life care.

Keywords: clinical staff, end-of-life care, mixed-methods, private hospital.

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Authors: Marta Czechowska-Bieluga

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Social work education in Poland focuses mostly on developing competencies that address the needs of individuals and families affected by a variety of life's problems. As a result of the ageing of the Polish population, much attention is equally devoted to adults, including the elderly. However, social work with children and young people is the area of education which should be given more consideration. Social work students are mostly trained to cater to the needs of families and the competencies aimed to respond to the needs of children and young people do not receive enough attention and are only offered as elective classes. This paper strives to review the social work programmes offered by the selected higher education institutions in Poland in terms of social work training aimed at helping children and young people to address their life problems. The analysis conducted in this study indicates that university education for social work focuses on training professionals who will provide assistance only to adults. Due to changes in the social and political situation, including, in particular, changes in social policy implemented for the needy, it is necessary to extend this area of education to include the specificity of the support for children and young people; especially, in the light of the appearance of new support professions within the area of social work. For example, family assistants, whose task is to support parents in performing their roles as guardians and educators, also assist children. Therefore, it becomes necessary to equip social work professionals with competencies which include issues related to the quality of life of underage people living in families. Social work curricula should be extended to include the issues of child and young person development and the patterns governing this phase of life.

Keywords: social work education, social work programmes, social worker, university

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Authors: K. Pankaj, R. K. Chaudhary, B. P. Mishra, S. Kochar

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Introduction: Consultation-Liaison psychiatry is a branch of psychiatry that includes clinical service, teaching and research. A consultation-liaison psychiatrist plays a role in having an expert opinion and linking the patients to other medical professionals and the patient’s bio-psycho-social aspects that may be leading to his/her symptoms. Consultation-Liaison psychiatry has been recognised as 'The guardian of the holistic approach to the patient', underlining its pre-eminent role in the management of patients who are admitted in a tertiary care hospital. Aims/ Objectives: The aim of the study was to analyse the utilization of psychiatric services and reasons for referrals in a tertiary care hospital. Materials and Methods: The study was done in a tertiary care hospital. The study included all the cases referred from different Inpatient wards to the psychiatry department for consultation. The study was conducted on 300 patients over a 3 month period. International classification of diseases 10 was used to diagnose the referred cases. Results: The majority of the referral was from the Medical Intensive care unit (22%) followed by general medical wards (18.66%). Majority of the referral was taken for altered sensorium (24.66%), followed by low mood or unexplained medical symptoms (21%). Majority of the referrals had a diagnosis of alcohol withdrawal syndrome (21%) as per International classification of diseases criteria, followed by unipolar Depression and Anxiety disorder (~ 14%), followed by Schizophrenia (5%) and Polysubstance abuse (2.6%). Conclusions: Our study concludes the importance of utilization of consultation-liaison psychiatric services. Also, the study signifies the need for sensitization of our colleagues regarding psychiatric sign and symptoms from time to time and seek psychiatric consult timely to decrease morbidity.

Keywords: consultation-liaison, psychiatry, referral, tertiary care hospital

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Authors: Geraldine G. Granados Vazquez

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Every human being is exposed to the risk of dying; wherein some of them are more susceptible than others depending on the cause. Therefore, the cause could be the hazard to die that a group or individual has, making this irreversible damage the condition of vulnerability. Risk is a dynamic concept; which means that it depends on the environmental, social, economic and political conditions. Thus vulnerability may only be evaluated in terms of relative parameters. This research is focusing specifically on building a model that evaluate the risk or propensity of death in past urban societies in connection with the everyday life of individuals, considering that death can be a consequence of two coexisting issues: hazard and the deterioration of the resistance to destruction. One of the most important discussions in bioarchaeology refers to health and life conditions in ancient groups; the researchers are looking for more flexible models that evaluate these topics. In that way, this research proposes a theoretical-methodological model that assess the vulnerability of death in past urban groups. This model pretends to be useful to evaluate the risk of death, considering their sociohistorical context, and their intrinsic biological features. This theoretical and methodological model, propose four areas to assess vulnerability. The first three areas use statistical methods or quantitative analysis. While the last and fourth area, which corresponds to the embodiment, is based on qualitative analysis. The four areas and their techniques proposed are a) Demographic dynamics. From the distribution of age at the time of death, the analysis of mortality will be performed using life tables. From here, four aspects may be inferred: population structure, fertility, mortality-survival, and productivity-migration, b) Frailty. Selective mortality and heterogeneity in frailty can be assessed through the relationship between characteristics and the age at death. There are two indicators used in contemporary populations to evaluate stress: height and linear enamel hypoplasias. Height estimates may account for the individual’s nutrition and health history in specific groups; while enamel hypoplasias are an account of the individual’s first years of life, c) Inequality. Space reflects various sectors of society, also in ancient cities. In general terms, the spatial analysis uses measures of association to show the relationship between frail variables and space, d) Embodiment. The story of everyone leaves some evidence on the body, even in the bones. That led us to think about the dynamic individual's relations in terms of time and space; consequently, the micro analysis of persons will assess vulnerability from the everyday life, where the symbolic meaning also plays a major role. In sum, using some Mesoamerica examples, as study cases, this research demonstrates that not only the intrinsic characteristics related to the age and sex of individuals are conducive to vulnerability, but also the social and historical context that determines their state of frailty before death. An attenuating factor for past groups is that some basic aspects –such as the role they played in everyday life– escape our comprehension, and are still under discussion.

Keywords: bioarchaeology, frailty, Mesoamerica, vulnerability

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Authors: Yu-Chuan Huang

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Introduction: There is a higher mortality rate for unplanned transfer to intensive care units. It also needs a longer length of stay and makes the intensive care unit beds cannot be effectively used. It affects the immediate medical treatment of critically ill patients, resulting in a drop in the quality of medical care. Purpose: The purpose of this study was using SOFA and APACHEII score to analyze the mortality rate of the cases transferred from ED to ICU. According to the score that should be provide an appropriate care as early as possible. Methods: This study was a descriptive experimental design. The sample size was estimated at 220 to reach a power of 0.8 for detecting a medium effect size of 0.30, with a 0.05 significance level, using G-power. Considering an estimated follow-up loss, the required sample size was estimated as 242 participants. Data were calculated by medical system of SOFA and APACHEII score that cases transferred from ED to ICU in 2016. Results: There were 233 participants meet the study. The medical records showed 33 participants’ mortality. Age and sex with QSOFA , SOFA and sex with APACHEII showed p>0.05. Age with APCHHII in ED and ICU showed r=0.150, 0,268 (p < 0.001**). The score with mortality risk showed: ED QSOFA is r=0.235 (p < 0.001**), exp(B)=1.685(p = 0.007); ICU SOFA 0.78 (p < 0.001**), exp(B)=1.205(p < 0.001). APACHII in ED and ICU showed r= 0.253, 0.286 (p < 0.001**), exp(B) = 1.041,1.073(p = 0.017,0.001). For SOFA, a cutoff score of above 15 points was identified as a predictor of the 95% mortality risk. Conclusions: The SOFA and APACHE II were calculated based on initial laboratory data in the Emergency Department, and during the first 24 hours of ICU admission. In conclusion, the SOFA and APACHII score is significantly associated with mortality and strongly predicting mortality. Early predictors of morbidity and mortality, which we can according the predicting score, and provide patients with a detail assessment and proper care, thereby reducing mortality and length of stay.

Keywords: SOFA, APACHEII, mortality, ICU

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Authors: Shayan Rezvanigilkolaei, Shayesteh Vefaghnematollahi

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Electrical impedance tomography is a non-invasive medical imaging technique suitable for medical applications. This paper describes an electrical impedance tomography device with the ability to navigate a robotic arm to manipulate a target object. The design of the device includes various hardware and software sections to perform medical imaging and control the robotic arm. In its hardware section an image is formed by 16 electrodes which are located around a container. This image is used to navigate a 3DOF robotic arm to reach the exact location of the target object. The data set to form the impedance imaging is obtained by having repeated current injections and voltage measurements between all electrode pairs. After performing the necessary calculations to obtain the impedance, information is transmitted to the computer. This data is fed and then executed in MATLAB which is interfaced with EIDORS (Electrical Impedance Tomography Reconstruction Software) to reconstruct the image based on the acquired data. In the next step, the coordinates of the center of the target object are calculated by image processing toolbox of MATLAB (IPT). Finally, these coordinates are used to calculate the angles of each joint of the robotic arm. The robotic arm moves to the desired tissue with the user command.

Keywords: electrical impedance tomography, EIT, surgeon robot, image processing of electrical impedance tomography

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Authors: Maya Agarwala

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Objectives: Audit the quality of clinical photographs taken for Orthodontic patients at Queen’s hospital, Romford. Design and setting: All Orthodontic photographs are taken in the Medical Photography Department at Queen’s Hospital. Retrospective audit with data collected between January - March 2023. Gold standard: Institute of Medical Illustrators (IMI) standard 12 photographs: 6 extraoral and 6 intraoral. 100% of patients to have the standard 12 photographs meeting a satisfactory diagnostic quality. Materials and methods: 30 patients randomly selected. All photographs analysed against the IMI gold standard. Results: A total of 360 photographs were analysed. 100% of the photographs had the 12 photographic views. Of which, 93.1% met the gold standard. Of the extraoral photos: 99.4% met the gold standard, 0.6% had incorrect head positioning. Of the intraoral photographs: 87.2% met the gold standard. The most common intraoral errors were: the presence of saliva pooling (7.2%), insufficient soft tissue retraction (3.3%), incomplete occlusal surface visibility (2.2%) and mirror fogging (1.1%). Conclusion: The gold standard was not met, however the overall standard of Orthodontic photographs is high. Further training of the Medical Photography team is needed to improve the quality of photographs. Following the training, the audit will be repeated. High-quality clinical photographs are an important part of clinical record keeping.

Keywords: orthodontics, paediatric, photography, audit

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Authors: Chau-Kuang Chen, John Hughes, Jr., A. Dexter Samuels

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The prediction models for the United States Medical Licensure Examination (USMLE) Steps 1 and 2 performances were constructed by the Monte Carlo simulation modeling approach via linear regression. The purpose of this study was to build robust simulation models to accurately identify the most important predictors and yield the valid range estimations of the Steps 1 and 2 scores. The application of simulation modeling approach was deemed an effective way in predicting student performances on licensure examinations. Also, sensitivity analysis (a/k/a what-if analysis) in the simulation models was used to predict the magnitudes of Steps 1 and 2 affected by changes in the National Board of Medical Examiners (NBME) Basic Science Subject Board scores. In addition, the study results indicated that the Medical College Admission Test (MCAT) Verbal Reasoning score and Step 1 score were significant predictors of the Step 2 performance. Hence, institutions could screen qualified student applicants for interviews and document the effectiveness of basic science education program based on the simulation results.

Keywords: prediction model, sensitivity analysis, simulation method, USMLE

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Authors: Zoltán Höhling, Sarah-Lu Oberschelp, Niklas Gilsdorf, Michael Wirsching, Andrea Kuhnert

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A majority of medical students at the University of Freiburg reported stress-related psychosomatic symptoms which are often associated with their studies. International research supports these findings, as medical students worldwide seem to be at special risk for mental health problems. In some countries and institutions, psychologically based interventions that assist medical students in coping with their stressors have been implemented. It turned out that anonymity is an important aspect here. Many students fear a potential damage of reputation when being associated with mental health problems, which may be due to a high level of competitiveness in classes. Therefore, we launched an online-platform where medical students could anonymously seek help and exchange their experiences with fellow students and experts. Medical students of all semesters have access to it through the university’s learning management system (called “ILIAS”). The informative part of the platform consists of exemplary videos showing medical students (actors) who act out scenes that demonstrate the antecedents of stress-related psychosomatic disorders. These videos are linked to different expert comments, describing the exhibited symptoms in an understandable and normalizing way. The (inter-)active part of the platform consists of self-help tools (such as meditation exercises or general tips for stress-coping) and an anonymous interactive forum where students can describe their stress-related problems and seek guidance from experts and/or share their experiences with fellow students. Besides creating an immediate proposal to help affected students, we expect that competitiveness between students might be diminished and bondage improved through mutual support between them. In the initial phase after the platform’s launch, it was accessed by a considerable number of medical students. On a closer look it appeared that platform sections like general information on psychosomatic-symptoms and self-treatment tools were accessed far more often than the online-forum during the first months after the platform launch. Although initial acceptance of the platform was relatively high, students showed a rather passive way of using our platform. While user statistics showed a clear demand for information on stress-related psychosomatic symptoms and its possible remedies, active engagement in the interactive online-forum was rare. We are currently advertising the platform intensively and trying to point out the assured anonymity of the platform and its interactive forum. Our plans, to assure students their anonymity through the use of an e-learning facility and promote active engagement in the online forum, did not (yet) turn out as expected. The reasons behind this may be manifold and based on either e-learning related issues or issues related to students’ individual needs. Students might, for example, question the assured anonymity due to a lack of trust in the technological functioning university’s learning management system. However, one may also conclude that reluctance to discuss stress-related psychosomatic symptoms with peer medical students may not be solely based on anonymity concerns, but could be rooted in more complex issues such as general mistrust between students.

Keywords: e-tutoring, stress-coping, student support, online forum

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Authors: A. Hoppe, T. Kagele, B. Hall, A. Nichols, B. Messner

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The Spokane Street Medicine (SSM) Program aims to deliver medical care to members of Spokane, Washington, experiencing homelessness. Street medicine is designed to function in a non-traditional setting to help deliver healthcare to the underserved homeless population. In this analysis, clinical charts from street and shelter encounters made by the Spokane Street Medicine Program in early 2021 were reviewed in order to better understand the healthcare inequities prevalent among people experiencing homelessness in Spokane, WA. Pain, wound-care, and follow-up efforts were predominant concerns among the homeless population. More than half of the conditions addressed were acute, and almost a quarter of all chief complaints involved chronic unmanaged conditions. This analysis gives reason for the priorities of the SSM Program to be focused on pain, wound-care, and follow-up efforts. Understanding the specific medical needs of this population will allow for better resource allocation and improved health outcomes among people experiencing homelessness.

Keywords: equity issues in public health, health disparities, health services accessibility, medical public health, street medicine

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