Search results for: healthcare narratives

Authors: Mihika Shivkumar, Krishna Kumar, C. Perisamy

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3D printing is a method of manufacturing wherein materials, such as plastic or metal, are deposited in layers one on top of the other to produce a three dimensional object. 3D printing is most commonly associated with creating engineering prototypes. However, its applications in the field of human health care have been frequently disregarded. Medical applications for 3D printing are expanding rapidly and are envisaged to revolutionize health care. Medical applications for 3D printing, both present and its potential, can be categorized broadly, including: creation of customized prosthetics tissue and organ fabrication; creation of implants, and anatomical models and pharmaceutical research regarding drug dosage forms. This piece breaks down bioprinting in the healthcare sector. It focuses on the better subtle elements of every particular point, including how 3D printing functions in the present, its impediments, and future applications in the health care sector.

Keywords: bio-printing, prototype, drug delivery, organ regeneration

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Authors: Emad Mohammed Sani

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Women encounter exclusion and discrimination in varying degrees, particularly those who marry as minors. The detrimental custom of getting married young is still prevalent worldwide and affects millions of people. It has been less common over time, although it is still widespread in underdeveloped nations. Oromia Regional State is the region in Ethiopia with the highest proportion of child brides. This study aimed at evaluating the effects of early marriage on its survivors’ life conditions – specifically, empowerment and household decision-making – in Eastern Hararghe Zone of Oromia Region. This study employed community-based cross-sectional study design. It adopted mixed method approach – survey, in-depth interview and focus group discussion (FGD) – to collect, analyses and interpret data on early marriage and its effects on household decision-making processes. Narratives and analytical descriptions were integrated to substantiate and/or explain observed quantitative results, or generate contextual themes. According to this study, married women who were married at or after the age of eighteen participated more in household decision-making than child brides. Child brides were more likely to be victims of violence and other types of spousal abuse in their marriages. These changes are mostly caused by an individual's age at first marriage. Delaying marriage had a large positive impact on women's empowerment at the household level, and age at first marriage had a considerable negative impact. In order to advance women's welfare and emancipation, we advise more research to concentrate on the relationship between the home and the social-structural forms that appear at the individual and communal levels.

Keywords: child-bride, early marriage, women, ethiopia

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Authors: Ruth Green, Samantha Milton, Rinal Desai

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Background/Aims: Eye pain/swelling/redness is a common presentation to Barnet General Hospital (a district general hospital), pediatric emergency department, and is managed by both the pediatric and emergency teams. The management of each child differs dramatically depending on the healthcare professional who reviews them. There also appears to be confusion in diagnosis between periorbital cellulitis, pre-septal cellulitis, and orbital cellulitis. Pre septal cellulitis refers to an inflammation of the eyelids and soft tissue anterior to the orbital septum. In contrast, orbital cellulitis is a serious, rapidly progressive infection of soft tissues located posterior to the orbital septum. Pre-septal cellulitis is more prevalent and less serious than orbital cellulitis, although it may be part of a continuous spectrum if untreated. Pre-septal cellulitis should there be diagnosed and treated urgently to prevent spread to the septum. For the purpose of the audit, the term periorbital cellulitis has been used as an umbrella term for all spectrums of this infection. The audit aimed to look at, how as a whole, the department is diagnosing and managing orbital and pre-septal cellulitis. Gold Standard: Patients of the same age and diagnosis should be treated with the same medication, advice, and follow-up. Method: Data was collected retrospectively from pediatric patients ( < 18years) who attended the emergency department from June 2019 to February 2020 who had been coded as pre-septal cellulitis, periorbital cellulitis, orbital cellulitis, or eye pain/swelling/redness. Demographics, signs and symptoms, management, and follow-up were recorded for all patients with any of the diagnoses of pre-septal, periorbital, or orbital cellulitis. A Microsoft Excel spreadsheet was used to record the anonymised data. Results: There were vast discrepancies in the diagnosis, management, and follow-up of patients with periorbital cellulitis. Conclusion/Discussion: The audit concluded there is no uniform approach to managing periorbital cellulitis in Barnet General Hospital Paediatric Emergency Department. Healthcare professionals misdiagnosed conjunctivitis as periorbital cellulitis, and adequate steps did not appear to be documented on excluding red flag signs and symptoms of patients presenting. There was no consistency in follow-up, with some patients having timely phone reviews or clinical reviews for mild symptoms. Advice given by the staff was appropriate, and patients did return when symptoms got worse and were treated accordingly. Plan: Given the inconsistency, a gold standard care pathway or local easily accessible clinical guideline can be developed to help with the diagnosis and management of periorbital cellulitis. Along with this, a teaching session can be carried out for the staff of the pediatric team and emergency department to disseminate the teaching. Following the introduction of a guideline and teaching sessions, patients notes can be re-reviewed to check improvement in patient care.

Keywords: periorbital cellulitis, preseptal cellulitis, orbital cellulitis, erythematous eyelid

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Authors: Bu Kyung Park

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Background: The survival rate of pediatric cancer patients has been increased. Thus, the needs of long-term management and follow-up education after discharge continue to grow. Purpose: The purpose of this study was to explore the experiences of pediatric cancer patients and their families from first diagnosis to returning their social life. The ultimate goal of this study was to assess which information and intervention did pediatric cancer patients and their families required and needed, so that this could provide fundamental information for developing educational content of web-based intervention program for pediatric cancer patients. Research Approach: This study was based on a descriptive qualitative research design using semi-structured focus group interview. Participants: Twelve pediatric cancer patients and 12 family members participated in a total six focus group interview sessions. Methods: All interviews were audiotaped after obtaining participants’ approval. The recordings were transcribed. Qualitative Content analysis using the inductive coding approach was performed on the transcriptions by three coders. Findings: Eighteen categories emerged from the six main themes: 1) Information needs, 2) Support system, 3) Barriers to treatment, 4) Facilitators to treatment, 5) Return to social life, 6) Healthcare system issues. Each theme had both pediatric cancer patients’ codes and their family members’ codes. Patients and family members had high information needs through the whole process of treatment, not only the first diagnosis but also after completion of treatment. Hospitals provided basic information on chemo therapy, medication, and various examinations. However, they were more likely to rely on information from other patients and families by word of mouth. Participants’ information needs were different according to their treatment stage (e.g., first admitted patients versus cancer survivors returning to their social life). Even newly diagnosed patients worried about social adjustment after completion of all treatment, such as return to school and diet and physical activity at home. Most family members had unpleasant experiences while they were admitted in hospitals and concerned about healthcare system issues, such as medical error and patient safety. Conclusions: In conclusion, pediatric cancer patients and their family members wanted information source which can provide tailored information based on their needs. Different information needs with patients and their family members based on their diagnosis, progress, stage of treatment were identified. Findings from this study will be used to develop a patient-centered online health intervention program for pediatric cancer patients. Pediatric cancer patients and their family members had variety fields of education needs and soak the information from various sources. Web-based health intervention program for them is required to satisfy their inquiries to provide reliable information.

Keywords: focus group interview, family caregivers, pediatric cancer patients, qualitative content analysis

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Authors: Sigal Barkai

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'Ironic Historiography' is a hybrid notion combining criticism of historical narratives concerning the Israeli state with ironic artistic expression. The paper will deal with questions of identities of native Israeli visual artists who chose to live out of the country, or to move back and forth to and from it. It will examine the ways these wanderings are reflected in their work. The paper discusses the work of 4 contemporary artists who produce artworks in diverse techniques and media, such as video, performance and installation art. Yael Bartana, Erez Israeli and Tamir Zadok are artists who constantly deal with Israeli nationality and history in their artwork, using ironic components. In comparison, the paper will review the works of Mika Rottenberg, who is now a New York based artist. She is concerned with global social issues and neglected specific national identity altogether. All of them use visual irony as a means of reflecting and criticizing society. The analysis was done in awareness of the life stories of the artists, in an attempt to trace the ways they establish their identities through their art. It was pre-supposed that these identities will be shaped in the in-between space of being an Israeli citizen and a citizen of the world. The study asks how ironic expression appears in their work, what kind of irony do they use and in what ways does it serves them. The methodology combined visual analysis, interviews with the artists, and analyzation of secondary discourses in the media. As theoretical background various fields of knowledge were used, such as literature and language studies, Sociology, and Visual Culture studies. The findings point out that visual and artistic irony has many different goals in the use of historiographic fiction. It can bind an artist to his homeland and native society, or it can help her to detach. It helps healing breaches in the in-between space, or it can be used as a means to completely detach from any identification with a native origin.

Keywords: visual art, irony, identities, Israel

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Authors: Sristi Silwal

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South Asian rivers support ecosystems and sustain well-being of thousands of riparian communities. Rivers however are also sources of conflict between countries and one of the contested issues between governments of the region. Governments have signed treaties to harness some of the rivers but their provisions have not been successful in improving the quality of life of those who depend on water as common property resources. This paper will present a case of the study of the status of the water commons along the lower command areas of Koshi, Gandka and Mahakali rivers. Nepal and India have signed treaties for development and management of these rivers in 1928, 1954 and 1966. The study investigated perceptions of the local community on climate-induced disasters, provision of the treaties such as water for irrigation, participation in decision-making and specific impact of women. It looked at how the local community coped with adversities. The study showed that the common pool resources are gradually getting degraded, flood events increasing while community blame ‘other state’ and state administration for exacerbating these ills. The level of awareness about provisions of existing treatise is poor. Ongoing approach to trans-boundary water management has taken inadequate cognizance of these realities as the dominant narrative perpetuates cooperation between the governments. The paper argues that on-going discourses on trans-boundary water development and management need to use a new metrics of taking cognizance of the condition of the commons and that of the people depended on them for sustenance. In absence of such narratives, the scale of degradation would increase making those already marginalized more vulnerable to impacts of global climate change.

Keywords: climate change vulnerability, conflict, cooperation, water commons

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Authors: Samhita Bharadwaj

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This is an empirical study of classifiers in Assamese and Bodo, two genetically unrelated languages of India. The objective of the paper is to address the language contact between Assamese and Bodo as reflected in classifiers. The data has been collected through fieldwork in Bodo recording narratives and folk tales and eliciting specific data from the speakers. The data for Assamese is self-produced as native speaker of the language. Assamese is the easternmost New-Indo-Aryan (henceforth NIA) language mainly spoken in the Brahmaputra valley of Assam and some other north-eastern states of India. It is the lingua franca of Assam and is creolised in the neighbouring state of Nagaland. Bodo, on the other hand, is a Tibeto-Burman (henceforth TB) language of the Bodo-Garo group. It has the highest number of speakers among the TB languages of Assam. However, compared to Assamese, it is still a lesser documented language and due to the prestige of Assamese, all the Bodo speakers are fluent bi-lingual in Assamese, though the opposite isn’t the case. With this context, classifiers, a characteristic phenomenon of TB languages, but not so much of NIA languages, presents an interesting case study on language contact caused by bilingualism. Assamese, as a result of its language contact with the TB languages which are rich in classifiers; has developed the richest classifier system among the IA languages in India. Yet, as a part of rampant borrowing of Assamese words and patterns into Bodo; Bodo is seen to borrow even Assamese classifiers into its system. This paper analyses the borrowed classifiers of Bodo and finds the route of this borrowing phenomenon in the number system of the languages. As the Bodo speakers start replacing the higher numbers from five with Assamese ones, they also choose the Assamese classifiers to attach to these numbers. Thus, the partial loss of number in Bodo as a result of language contact and bilingualism in Assamese is found to be the reason behind the borrowing of classifiers in Bodo. The significance of the study lies in exploring an interesting aspect of language contact in Assam. It is hoped that this will attract further research on bilingualism and classifiers in Assam.

Keywords: Assamese, bi-lingual, Bodo, borrowing, classifier, language contact

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Authors: Ilham Zaidi, P. Sankara Sarma, Quazi Taufique Ahmed, V. Raman Kutty, Khalid Umer Khayyam, Gurpreet Singh, Abhishek Royal

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Introduction: Tuberculosis is a global public health emergency, but it is particularly acute in India, which has the world's highest tuberculosis burden. Due to overpopulation, lack of sanitation, malnutrition, low living standards, and poor socioeconomic status, among other factors, it is India's most common infectious disease. The long period of treatment is one of the main reasons for considering it as a public health emergency. Consequently, there is an increase in patient noncompliance, which leads to treatment failure, adverse treatment outcomes, and deaths. This could lead to the growth of anti-TB drug resistance. According to the WHO, approximately 558 thousand new cases of Multi-Drug Resistance Tuberculosis were diagnosed worldwide, with 8.5 percent developed Extensively Drug Resistance Tuberculosis. Methodology: This study is a program-based cross-sectional descriptive survey of adult tuberculosis patients enrolled in the Delhi-based Revised National Tuberculosis Program. The study setting was 27 NTEP districts of Delhi. (N=65,893) and Sample size- was 200; the sampling method which is used in the study was the systemic random sampling method. Results: Most of the demographic factors (age, gender, residence, and family type) were not significantly associated with adherence; marital status was found statistically significant with the treatment compliance. Hesitation while telling people about the disease and motivation to strictly follow drug schedule by healthcare workers were other factors where a significant association with drug adherence was observed. The study findings also suggest that provision of food, minimal financial and other moral support from family, counseling, discussion and politeness by healthcare providers might also facilitate adherence. Discussion and Conclusions: For TB treatment, adherence, age, sex, socioeconomic status, types of accommodations, malnutrition, and personal hygiene should all be considered; similar results were observed in previous studies. In the care of TB patients, DOTS services, health workers, and family support play a significant role. According to the country's National Strategic Plan, the Indian government has set a goal of eliminating tuberculosis by 2025 and patients' compliance with TB care and treatment adherence is very crucial to achieve this aim. A cohort study will be able to give a better understanding of factors associated with adherence since this study may have missed some defaulters who were absconding and could not be reached. Important Terms: RNTCP, NTEP, DOTS, DS-TB, DR-TB, RR-TB, MDR-TB, XDR-TB, Treatment failure, Treatment relapse, Treatment adherence.

Keywords: treatment adherence, treatment relapse, treatment failure, drug resistance tuberculosis

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Authors: Ju-Chun Chien

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Rapid aging and depopulation could lead to serious problems, including workforce shortages and health expenditure costs. The current and predicted future LTC workforce shortages could be a real threat to Taiwan’s society. By means of comparison of data from 144 nursing aide trainees and 727 general public, the main purpose of the present study was to determine whether there were any notable differences between the two groups toward engaging in LTC services. Moreover, this study focused on recognizing the attributes of the general public who had the willingness to take LTC jobs but continue to ride the fence. A self-developed questionnaire was designed based on Ajzen’s Theory of Planned Behavior model. After conducting exploratory factor analysis (EFA) and reliability analysis, the questionnaire was a reliable and valid instrument for both nursing aide trainees and the general public. The main results were as follows: Firstly, nearly 70% of nursing aide trainees showed interest in LTC jobs. Most of them were middle-aged female (M = 46.85, SD = 9.31), had a high school diploma or lower, had unrelated work experience in healthcare, and were mostly unemployed. The most common reason for attending the LTC training program was to gain skills in a particular field. The second most common reason was to obtain the license. The third and fourth reasons were to be interested in caring for people and to increase income. The three major reasons that might push them to leave LTC jobs were physical exhaustion, payment is bad, and being looked down on. Secondly, the variables that best-predicted nursing aide trainees’ intention to engage in LTC services were having personal willingness, perceived behavior control, with high school diploma or lower, and supported from family and friends. Finally, only 11.80% of the general public reported having interest in LTC jobs (the disapproval rating was 50% for the general public). In comparison to nursing aide trainees who showed interest in LTC settings, 64.8% of the new workforce for LTC among the general public was male and had an associate degree, 54.8% had relevant healthcare experience, 67.1% was currently employed, and they were younger (M = 32.19, SD = 13.19) and unmarried (66.3%). Furthermore, the most commonly reason for the new workforce to engage in LTC jobs were to gain skills in a particular field. The second priority was to be interested in caring for people. The third and fourth most reasons were to give back to society and to increase income, respectively. The top five most commonly reasons for the new workforce to quitting LTC jobs were listed as follows: physical exhaustion, being looked down on, excessive working hours, payment is bad, and excessive job stress.

Keywords: long-term care services, nursing aide trainees, Taiwanese people, theory of planned behavior

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Authors: Sela Adjei

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This research delves into the nuanced representations of queerness in Ghana, presented through photographs, illustrations, film and music videos on social media and streaming platforms. The study focuses on the works of five Ghanaian artists (Va-Bene Elikem Fiatsi, Angel Maxine, Josephine Kuuire, Bright Ackwerh and Philip Nee Whang) within the context of Ghana's evolving media landscape. Of primary concern is a need to uncover the various aspects of queerness captured within the distinct artistic expressions of these five creatives. This study adopts a qualitative approach by analyzing artistic expressions of queerness in Ghana’s digital media spaces. Content analysis and visual semiotics served as the guiding tools to discuss and decipher the nuanced messages embedded in their works, considering both the visual and narrative aspects. This dual approach takes into account both the visual aesthetics and narrative elements, enhancing our understanding of the complex interplay between queerness and gender representation in the media. This study's contribution is twofold. First, it enriches the discourse surrounding queerness as portrayed by artists within Ghana's vibrant media landscape and situates their works within the broader discourse of global gender identities. Secondly, analyzing the creative output of these five Ghanaian artists broadens our understanding of gender minorities and the various challenges they face in Ghana (currently debating in parliament to pass an anti-LGBTQ+ bill that criminalizes activities related to gender minority groups). While focusing on the intersection of queerness, art, and gender identities, the reflections in this study challenge existing narratives and offer fresh insights into how these artists navigate and challenge societal norms through their creative expressions.

Keywords: queer, film, representation, streaming, media, gender

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Authors: Kira Gulko Morse

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Choosing one’s primary language may not be as common as choosing an additional foreign language to study or use during travel. In some instances, however, it becomes a matter of internal personal struggle, as language is tied not only to specific circumstances but also to human background and identity. This phenomenological qualitative study focuses on the factors affecting the decision of a person to undergo a language shift. Specifically, it considers how these factors relate to identity negotiation and expression. The data for the study include the analysis of published autobiographical narratives and personal interviews conducted using the Responsive Interviewing model. While research participants come from a variety of geographical locations and have used different reasons for undergoing their individual language shift, the study identifies a number of common features shared by all the participants. Specifically, while all the participants have been able to maintain their first language to varying degrees of proficiency, they have all completed the shift to establish a primary language different from their first. Additionally, the process of self-identification is found to be directly connected to the phenomenon of language choice for each of the participants. The findings of the study further tie the phenomenon of individual language shift to a more comprehensive issue of individual life choices – ethnic revival, immigration, and inter-cultural marriage among others. The study discusses varying language roles and the data indicate that language shift may occur whether it is a symbolic driving force or a secondary means in fulfilling a set life goal. The concept of language addition is suggested as an alternative to the arbitrariness of language shift. Thus, instead of focusing on subtractive bilingualism or language loss, the emphasis becomes the integration of languages within the individual. The study emphasizes the importance of the construct of personal choice in its connection to individual language shift. It places the focus from society onto an individual and the ability of an individual to make decisions in matters of linguistic identification.

Keywords: choice theory, identity negotiation, language shift, psycholinguistics

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Authors: Shazia Salam

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This paper focuses on studying the literary reactions of selected Muslim women writers to the event of Partition of India in the north western region. It aims to explore how Muslim women experienced the Partition and how that experience was articulated through their writing. There is a serious dearth of research on the experience of Muslim women who had to witness the momentous event of the subcontinent. Since scholars have often questioned the silence around the historiography related to the experiences of Muslim women, this paper aims to explore if literature could provide insights that may be less readily available in other modes of narration. Using literature as an archival source, it aims to delve into the arenas of history that have been cloistered and closed. Muslim women have been silent about their experiences of Partition which at the cost of essentializing could be attributed to patriarchal constraints, and taboos, on speaking of intimate matters. These silences have consigned the question of their experience to a realm of anonymity. The lack of ethnographic research has in a way been compensated in the realm of literature, mainly poetry and fiction. Besides reportage, literature remains an important source of social history about Partition and how Muslim women lived through it. Where traditional history fails to record moments of rupture and dislocation, literature serves the crucial purpose. The central premise in this paper is that there is a need to revise the history of partition owing to the gaps in historiography. It looks into if literature can serve as a ground for developing new approaches to history since the question of the representation always confronts us--between what a text represents and how it represents it since imagination of the writer plays a great role in the construction of any text. With this approach as an entry point, this paper aims to unpack the questions of representation, the coalescing of history /literature and the gendered nature of partition history. It concludes that the gaps in the narratives of Partition and the memory of Partition can be addressed by way of suing literary as a source to fill in the cracks and fissures.

Keywords: gender, history, literature, partition

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Authors: Claudia Pimentel, Nuno Resende, Maria Fatima Lambert

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In the present time, catastrophe seems to be inevitable, and individuals are permanently overwhelmed with challenges that test one’s ability to cope with reality. Undoubtedly, photography surpassed the barrier of efficient communication in a world filled with omnifarious narratives. It wandered an outing shorter than words and younger than other sciences but became, nowadays, imperative in the context of several fields of knowledge, namely Heritage studies. Heritage and photography thus emerge as unapologetically related concepts, a fact that makes them equally relevant in today's society. Political, economic, social and humanitarian challenges alter the way in which the relationship with the past is managed and the way in which identities and ideas for the future are constructed. Ruins and destruction have become part of aesthetics discourse since the 18th century and are an area of interest when we discuss cultural heritage preservation. The image proves to be a unique way of revealing the event details when we refer to a catastrophic situation, whether it be anthropic, social or climatic. Like poetry, which has a challenging connection with silence, image is capable of creating spaces of sound and silence, and it is often these “pseudo-voids” that capture the attention of the spectator, of the one who sees/observes/contacts with the photography. The way we look at the catastrophe, how we describe it, and the images we keep in our memory will determine the record/capture/news of the event. We, thus, have a visual record, a document that will contribute to the creation of individual and collective identity, in a jigsaw puzzle of memories, pseudo memories and post memories. Based on photographic records in the Portuguese press, we intend to rethink the earthquake at Angra do Heroísmo – Azores in 1980, exploring the viewer´s perspective on the catastrophe’s iconography under the perspective of aesthetics and genealogy of the catastrophe.

Keywords: photography, aesthetics, catastrophe, Portugal

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Authors: Yan Wang; Mathis Stock

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The World Heritage Site of Honghe Hani rice terrace, also a marginal rural region in Southern China, is undergoing rapid change because of urbanization and heritage tourism. Influenced by out-migration and changing ways of living in the urbanization process, the place sees a tendency of losing its rice terrace landscape, traditional housings and other forms of cultural traditions. However, heritage tourism tends to keep the past, valorize them for tourism purposes and diversifies rural livelihood strategies. The place stands at this development trajectories, where the same resources are subjected to different uses by different actors. The research seeks to answer the questions of how the site is transformed and co-constructed by different institutions, practices and actors, and the how heritage tourism affects local livelihood. The research aims to describe the transformation of villages, rice terraces, and cultural traditions, analyze the place-making process, and assess the role of heritage tourism in local livelihood transition. The research uses a mixed of methods including direct observation, participant observation, interviews; collects various data of images, words, narratives, and statistics, and analyze them qualitatively and qualitatively. Theoretically, it is hoped that the research would reexamine the concept of heritage, the world heritage practice from UNESCO, reveal the conflicts it entails in development and brings more thoughts from a functional perspective on heritage in relation to rural development. Practically, it is also anticipated that the research could access the linkage between heritage tourism and local livelihood, and generate concrete suggestions on how tourism could engage locals and improve their livelihood.

Keywords: cultural landscape, Hani rice terraces, heritage tourism, livelihood strategy, place making, rural development, transformation

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Authors: A. A. AlRasheed, A. Atkins, R. Campion

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This paper focuses on using knowledge management and visualisation concepts to improve the patients and hospitals employee’s workflow. Hospitals workflow is a complex and complicated process and poor patient flow can put both patients and a hospital’s reputation at risk, and can threaten the facility’s financial sustainability. Healthcare leaders are under increased pressure to reduce costs while maintaining or increasing patient care standards. In this paper, a framework is proposed to help improving patient experience, staff satisfaction, and operational efficiency across hospitals by using knowledge management based visualisation concepts. This framework is using real-time visibility to track and monitor location and status of patients, staff, rooms, and medical equipment.

Keywords: knowledge management, improvements, visualisation, workflow

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Authors: Jo Parsons, Cath Grimley, Debra Bick, Sarah Hillman, Louise Clarke, Helen Atherton

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The problem: Vaccinations are routinely offered to pregnant women in the UK for influenza (flu), pertussis (whooping cough), and COVID-19, yet the uptake of these vaccinations in pregnancy remains low. Pregnant women are at increased risk of hospitalisation, morbidity, and mortality from these preventable illnesses, which can also expose their unborn babies to an increased risk of serious complications, including in utero death. This research aims to explore how pregnant women feel about vaccinations offered during pregnancy (flu, whooping cough, and COVID-19), particularly following the COVID-19 pandemic. It also aims to examine factors influencing women’s decisions about vaccinations during pregnancy and how they feel about their health and vulnerabilities to illness arising from the COVID-19 pandemic. The approach: This is a qualitative study involving semi-structured interviews with pregnant women and midwives in the UK. Interviews with pregnant women explored their views since the COVID-19 pandemic about vaccinations offered during pregnancy and whether the pandemic has influenced perceptions of vulnerability to illness in pregnant women. Interviews with midwives explored vaccination discussions they routinely have with pregnant women and identified some of the barriers to vaccination that pregnant women discuss with them. Pregnant women were recruited via participating hospitals and community groups. Midwives were recruited via participating hospitals and midwife-specific social media groups. All interviews were conducted remotely (using telephone or Microsoft Teams) and analysed using thematic analysis. Findings: 43 pregnant women and 16 midwives were recruited and interviewed. The findings presented will focus on data from pregnant women. Pregnant women reported a wide range of views and vaccination behaviour, and identified several factors influencing their decision whether to accept vaccinations or not. These included internal factors (comprised of beliefs about susceptibility to illness, perceptions of immunity, fear, and feelings of responsibility), other influences (including visibility of illness and external influences such as healthcare professional recommendations), vaccination-related factors (comprised of beliefs about effectiveness and safety of vaccinations, availability and accessibility of vaccinations and preferences for alternative forms of protection to vaccination) and COVID-19 specific factors (including COVID-19 vaccinations and COVID-19 specific influences). Implications: Findings identified some of the factors that affect pregnant women’s decisions when deciding to have a vaccination or not and how these decisions have been influenced by COVID-19. Findings highlight areas where healthcare professional advice needs to focus, such as the provision of information about the increased vulnerability to illnesses during pregnancy and consideration of opportunistic vaccination at hospital appointments to maximise uptake of vaccinations during pregnancy. Findings of this study will inform the development of an intervention to increase vaccination uptake amongst pregnant women.

Keywords: vaccination, pregnancy, qualitative, interviews, COVID-19

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Authors: Kelsi Hagerty, Ami Rosen, Aaliyah Heyward, Nadia Ali, Emily Brown, Erin Demo, Yue Guan, Modele Ogunniyi, Brianna McDaniels, Alanna Morris, Kunal Bhatt

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Hereditary transthyretin amyloidosis (hATTR) is a progressive, multi-systemic, and life-threatening disease caused by a disruption in the TTR protein that delivers thyroxine and retinol to the liver. This disruption causes the protein to misfold into amyloid fibrils, leading to the accumulation of the amyloid fibrils in the heart, nerves, and GI tract. Over 130 variants in the TTR gene are known to cause hATTR. The Val122Ile variant is the most common in the United States and is seen almost exclusively in people of African descent. TTR variants are inherited in an autosomal dominant fashion and have incomplete penetrance and variable expressivity. Individuals with hATTR may exhibit symptoms from as early as 30 years to as late as 80 years of age. hATTR is characterized by a wide range of clinical symptoms such as cardiomyopathy, neuropathy, carpal tunnel syndrome, and GI complications. Without treatment, hATTR leads to progressive disease and can ultimately lead to heart failure. hATTR disproportionately affects individuals of African descent; the estimated prevalence of hATTR among Black individuals in the US is 3.4%. Unfortunately, hATTR is often underdiagnosed and misdiagnosed because many symptoms of the disease overlap with other cardiac conditions. Due to the progressive nature of the disease, multi-systemic manifestations that can lead to a shortened lifespan, and the availability of free genetic testing and promising FDA-approved therapies that enhance treatability, early identification of individuals with a pathogenic hATTR variant is important, as this can significantly impact medical management for patients and their relatives. Furthermore, recent literature suggests that TTR genetic testing should be performed in all patients with suspicion of TTR-related cardiomyopathy, regardless of age, and that follow-up with genetic counseling services is recommended. Relatives of patients with hATTR benefit from genetic testing because testing can identify carriers early and allow relatives to receive regular screening and management. Despite the striking prevalence of hATTR among Black individuals, hATTR remains underdiagnosed in this patient population, and germline genetic testing for hATTR in Black individuals seems to be underrepresented, though the reasons for this have not yet been brought to light. Historically, Black patients experience a number of barriers to seeking healthcare that has been hypothesized to perpetuate the underdiagnosis of hATTR, such as lack of access and mistrust of healthcare professionals. Prior research has described a myriad of factors that shape an individual’s decision about whether to pursue presymptomatic genetic testing for a familial pathogenic variant, such as family closeness and communication, family dynamics, and a desire to inform other family members about potential health risks. This study explores these factors through 10 in-depth interviews with patients with hATTR about what factors may be contributing to the underdiagnosis of hATTR in the Black population. Participants were selected from the Emory University Amyloidosis clinic based on having a molecular diagnosis of hATTR. Interviews were recorded and transcribed verbatim, then coded using MAXQDA software. Thematic analysis was completed to draw commonalities between participants. Upon preliminary analysis, several themes have emerged. Barriers identified include i) Misdiagnosis and a prolonged diagnostic odyssey, ii) Family communication and dynamics surrounding health issues, iii) Perceptions of healthcare and one’s own health risks, and iv) The need for more intimate provider-patient relationships and communication. Overall, this study gleaned valuable insight from members of the Black community about possible factors contributing to the underdiagnosis of hATTR, as well as potential solutions to go about resolving this issue.

Keywords: cardiac amyloidosis, heart failure, TTR, genetic testing

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Authors: Dane Morace-Court

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This paper offers a reflective and reflexive examination of the lived experience of a group of young, white, working-class males engaging in secondary-education in England at a time when this population is widely recognised as the lowest attaining ethnic group within British schools. The focus of the paper is an exploration of the development of identities and aspirations, alongside contemporary demographic and ideological shifts in the British population, in their intersection with neoliberal education policies and the emerging ideological conflict between identity conservatism and liberalism. The construction and performance of intersecting social-class, gender, ethnic and national identities is considered as well as the process through which socially constructed narratives inform identities, values, and aspirations. Evocative autoethnography is then employed to offer reflections on working-class habitus and, in particular, classed and gendered codes that underpin expectations of manhood in post-industrial culture within an education system which seemingly requires the abandonment of aspects of a working-class background. Findings from the study identify the emergence of a culture of hyper-individualisation amongst white, working-class males in schools and a belief in the meritocratic ideologies of the New Right. In particular, the breakdown of the social contract, including notions of political and civic responsibility, coupled with the symbolic violence perpetrated against working-class culture and solidarity in British schools, have all informed the construction of a working-class masculinity which values the individual entrepreneur over the collective, and depoliticizes students to an extent where a focus on the spectacle and performance of success has replaced individual and collective investment in community.

Keywords: education, identity, masculinity, neoliberalism, working-class, intersectionality, autoethnography

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Authors: Maryam Pirdehghan

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During the Ba'ath Party's rule in Iraq, propaganda was utilized to justify and to promote Saddam Hussein's image in the collective memory as the greatest Arab leader. Consequently, urban walls were routinely covered with images of Saddam. Relying on these images, the regime aimed to provide a basis for evoking meanings in the public opinion, which would supposedly strengthen Saddam’s power and reconstruct facts to legitimize his political ideology. Nonetheless, Saddam was not always portrayed with common and explicit elements but in certain periods of his rule, the paintings depicted him in an unusual context, where various historical and contemporary elements were combined in a narrative background. Therefore, an understanding of the implied socio-political references of these elements is required to fully elucidate the impact of these images on forming the memory and collective unconscious of the Iraqi people. To obtain such understanding, one needs to address the following questions: a) How Saddam Hussein is portrayed in mural during his rule? b) What of elements and mythical-historical narratives are found in the paintings? c) Which Saddam's political views were subject to the collective memory through mural? Employing visual semiotics, this study reveals that during Saddam Hussein's regime, the paintings were initially simple portraits but gradually transformed into narrative images, characterized by a complex network of historical, mythical and religious elements. These elements demonstrate the transformation of a secular-nationalist politician into a Muslim ruler who tried to instill three major policies in domestic and international relations i.e. the arabization of Iraq, as well as the propagation of pan-arabism ideology (first period), the implementation of anti-Israel policy (second period) and the implementation of anti-American-British policy (last period).

Keywords: Ba'ath Party, Saddam Hussein, mural, Iraq, propaganda, collective memory

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Authors: L. Donelle, S. Regan, R. Booth, M. Kerr, J. McMurray, D. Fitzsimmons

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Palliative home health care provision within the Canadian context is challenged by: (i) a shortage of registered nurses (RN) and RNs with palliative care expertise, (ii) an aging population, (iii) reliance on unpaid family caregivers to sustain home care services with limited support to conduct this ‘care work’, (iv) a model of healthcare that assumes client self-care, and (v) competing economic priorities. In response, an interprofessional team of service provider organizations, a software/technology provider, and health care providers developed and implemented a technology-enabled model of home care, the eShift model of palliative home care (eShift). The eShift model combines communication and documentation technology with non-traditional utilization of health human resources to meet patient needs for palliative care in the home. The purpose of this study was to investigate the structure, processes, and outcomes of the eShift model of care. Methodology: Guided by Donebedian’s evaluation framework for health care, this qualitative-descriptive study investigated the structure, processes, and outcomes care of the eShift model of palliative home care. Interviews and focus groups were conducted with health care providers (n= 45), decision-makers (n=13), technology providers (n=3) and family care givers (n=8). Interviews were recorded, transcribed, and a deductive analysis of transcripts was conducted. Study Findings (1) Structure: The eShift model consists of a remotely-situated RN using technology to direct care provision virtually to patients in their home. The remote RN is connected virtually to a health technician (an unregulated care provider) in the patient’s home using real-time communication. The health technician uses a smartphone modified with the eShift application and communicates with the RN who uses a computer with the eShift application/dashboard. Documentation and communication about patient observations and care activities occur in the eShift portal. The RN is typically accountable for four to six health technicians and patients over an 8-hour shift. The technology provider was identified as an important member of the healthcare team. Other members of the team include family members, care coordinators, nurse practitioners, physicians, and allied health. (2) Processes: Conventionally, patient needs are the focus of care; however within eShift, the patient and the family caregiver were the focus of care. Enhanced medication administration was seen as one of the most important processes, and family caregivers reported high satisfaction with the care provided. There was perceived enhanced teamwork among health care providers. (3) Outcomes: Patients were able to die at home. The eShift model enabled consistency and continuity of care, and effective management of patient symptoms and caregiver respite. Conclusion: More than a technology solution, the eShift model of care was viewed as transforming home care practice and an innovative way to resolve the shortage of palliative care nurses within home care.

Keywords: palliative home care, health information technology, patient-centred care, interprofessional health care team

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Authors: Armenio Lopes, Carlos Ferreira

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In the specific context of the Iberian Union between 1580 and 1640, characteristics emerged in Portuguese architecture that stood out from the main architectural production of the period. Recognised and identified aspects that had begun making their appearance decades before (1521) became significantly more marked during the Hapsburg-Spanish occupation. Distinctive even from the imperialist language of Spain, this trend would endure even after the restoration of independence (1706), continuing through to the start of the age of absolutism. Or perhaps not. This trend, recognised as Plain Style (Kubler), associated with a certain scarcity of resources, involved a certain formal and decorative simplification, as well as a particular set of conventions that would subsequently mark the landscape. This expression could also be seen as a means of asserting a certain spirit of independence as the Iberian Union breathed its last. The image of a simple, bare-bones architecture with purer design lines is associated by various authors –most notably Kubler– with the narratives of modernism, to whose principles it is similar, in a context-specific to the period. There is a contrast with some of the exuberance of the baroque or its expression in the Manueline period, in a similar fashion to modernism's responses to nineteenth-century eclecticism. This assertion and practice of simple architecture, drafted from the interpretation of the treaties, and highlighting a certain classical inspiration, was to become a benchmark in the theory of architecture, spanning the Baroque and Mannerism, until achieving contemporary recognition within certain originality and modernity. At a time when the baroque and its scenography became generally very widespread, it is important also to recognise the role played by plain style architecture in the construction of a rather complex and contradictory waterfront landscape, featuring promises of exuberance and more discrete practices.

Keywords: Carlos Mardel, Lisbon's waterfront, plain style, urban image on the waterfront

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Authors: Tianqi Yin

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Following the establishment of the state of Israel, how to harmonize the relationship between Palestinians and Jews in Israel has always been an intractable problem. As the number of Palestinian Arabs in Israel has increased to over two million, the issue has become more severe. Due to a variety of factors, Israeli Palestinians and Israeli Jews often find it hard to interact with each other, let alone form a relationship. Multiple authors and directors have produced cultural works to touch on the issue, exposing the reasons for the irreconcilable relation between the two ethnic groups. This paper analyzes the representation scenes of the Palestinian-Jewish relationship in three prominent cultural works, each from a distinct perspective, to examine the intrinsic challenges from the Israeli side that curb the two ethnicities from interacting successfully. The first scene is from the Jewish perspective in Amos Oz’s memoir A Tale of Love and Darkness, in which young Oz, a Jewish boy, attempts to interact with Aisha, a young Israeli-Arab girl, but eventually failed because of an accident. The second scene is from a short Israeli film Bus Station which, from an outsider perspective, depicted a brief encounter between an Arab woman and a Jewish woman in Jerusalem. The third scene is the initially successful yet eventually failed relationship between Eyad, a Palestinian boy, and Naomi, a Jewish girl, in an elite Israeli high school from the 2014 film A Borrowed Identity, which is depicted through Eyad’s Arab perspective. Through the analysis of these three narratives, this paper argues that the burden of national responsibility, family influences, and Israeli government’s discriminatory policies are the three main factors on the Jewish side, in ascender order of importance, that make Arab-Jewish interaction hard in Israel.

Keywords: arab-Jewish interaction, ethnographic conflicts, israel, Jewish narrative, narrative styles

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Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah

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Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.

Keywords: healthcare associated infections, incidence, intensive care unit, risk factors

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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: Jurijs Salijevs, Katrina Bolocko

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The integration of artificial intelligence and neural networks has significantly changed full-body imaging and high-resolution 3D mapping systems, and this paper reviews research in these areas. With an emphasis on their use in the early identification of melanoma and other disorders, the goal is to give a wide perspective on the current status and potential future of these medical imaging technologies. Authors also examine methodologies such as machine learning and deep learning, seeking to identify efficient procedures that enhance diagnostic capabilities through the analysis of 3D body scans. This work aims to encourage further research and technological development to harness the full potential of AI in disease diagnosis.

Keywords: artificial intelligence, neural networks, 3D scan, body scan, 3D mapping system, healthcare

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Authors: Dessy Arumsari, Ais Assana Athqiya, Mulyaminingrum

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Healthcare in remote areas is one of the major concerns in Indonesia. Building hospitals in a nation of 18.000 islands with a larger-than-life bureaucracy and problems with corruption, a critical shortage of qualified medical professionals and well-heeled patients resigned to traveling abroad for health care is a hard feat to accomplish. To assuring that all populations have access to appropriate and cost-effective care, a new solution to tackle this problem is with the presence of RV Car Clinic. This car has a concept such as a walking hospital that provides health facilities inside it. All of the health professionals who work in RV Car Clinic will do the rotation for a year in order to the equitable distribution of health workers. We need to advocate the policy makers to help realize RV Car Clinic in remote areas. Health services can be disseminated by the present of RV Car Clinic. Summarily, the local communities can get cost effectively because RV Car Clinic will come to their place and serve the health services.

Keywords: health policy, health professional, remote areas, RV Car Clinic

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Authors: Naseem M. Twaissi

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Medical professionals play an important role in society, and in general, they care more about their patients than about their personal well-being. They need to take a professional approach to maintain a work-life balance. Through a collection of primary data from 1020 medical professionals and the application of relevant statistical tools, this paper explores the pressures on medical professionals with reference to their work-life balance. This study highlights how hospital management, in addition to economic reasons, needs to identify variables to enhance the work-life balance of medical professionals so that quality healthcare facilities may be provided to the citizens of Jordan. Results indicate that formulation and implementation of policies for enhancing work-life balance together with career and retention plans for medical professionals would enhance the performance of hospitals and the quality of health care in Jordan, leading to greater societal well-being.

Keywords: work life balance, job environment, job satisfaction, employee well-being, stress, hospital industry

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Authors: Zahra BehboodiI-Moghadam, Zohre Khalajinia, Ali Reza Nikbakht Nasrabadi, Minoo Mohraz

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The purpose of our study was to explore and describe the experiences of pregnant women with HIV in Iran. A qualitative exploratory study with conventional content analysis was used. Twelve pregnant women with HIV who referred to perinatal care at the Imam Khomeini Hospital Behavioral Diseases Consultation: Center in Tehran were recruited to participate in in-depth interviews. The average age of the participants was 32.5 years. Four main themes were extracted from the data: “fear and hope, “stigma and discrimination, “marital life stability” and “trust”. The findings reveal the pregnant women living with HIV are vulnerable and need professional support. Improving the knowledge of healthcare professionals especially midwifes on pregnancy complications for women with HIV is crucial in order to provide high-quality care to pregnant women with HIV-positive.

Keywords: HIV, pregnancy, content analysis, experiences, Iran, qualitative research

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Authors: K. Mellou, G. Anastopoulos, T. Zakinthinos, C. Botsi, A. Terzidis

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‘PHILOS – Emergency health response to refugee crisis’ is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP). The programme is funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. With the EU Member States accepting, the last period, accelerating migration flows, Greece inevitably occupies a prominent position in the migratory map due to this geographical location. The main objectives of the programme are a) reinforcement of the capacity of the public health system and enhancement of the epidemiological surveillance in order to cover refugees/migrant population, b) provision of on-site primary health care and psychological support services, and c) strengthening of national health care system task-force. The basic methods for achieving the aforementioned goals are: a) implementation of syndromic surveillance system at camps and enhancement of public health response with the use of mobile medical units (Sub-action A), b) enhancement of health care services inside the camps via increasing human resources and implementing standard operating procedures (Sub-action B), and c) reinforcement of the national health care system (primary healthcare units, hospitals, and emergency care spots) of affected regions with personnel (Sub-action C). As a result, 58 health professionals were recruited under sub-action 2 and 10 mobile unit teams (one or two at each health region) were formed. The main actions taken so far by the mobile units are the evaluation, of syndromic surveillance, of living conditions at camps and medical services. Also, vaccination coverage of children population was assessed, and more than 600 catch-up vaccinations were performed by the end of June 2017. Mobile units supported transportation of refugees/migrants from camps to medical services reducing the load of the National Center for Emergency Care (more than 350 transportations performed). The total number of health professionals (MD, nurses, etc.) placed at camps was 104. Common practices were implemented in the recording and collection of psychological and medical history forms at the camps. Protocols regarding maternity care, gender based violence and handling of violent incidents were produced and distributed at personnel working at camps. Finally, 290 health care professionals were placed at primary healthcare units, public hospitals and the National Center for Emergency Care at affected regions. The program has, also, supported training activities inside the camps and resulted to better coordination of offered services on site.

Keywords: migrants, refugees, public health, syndromic surveillance, national health care system, primary care, emergency health response

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Authors: Kwaku Damoah

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This study presents a comprehensive data-driven analysis to understand the evolution of adverse events (AEs) in pharmacovigilance. Utilizing data from the FDA Adverse Event Reporting System (FAERS), we employed three analytical methods: rank-based, frequency-based, and percentage change analyses. These methods assessed temporal trends and patterns in AE reporting, focusing on various drug-active ingredients and patient demographics. Our findings reveal significant trends in AE occurrences, with both increasing and decreasing patterns from 2000 to 2023. This research highlights the importance of continuous monitoring and advanced analysis in pharmacovigilance, offering valuable insights for healthcare professionals and policymakers to enhance drug safety.

Keywords: event analysis, FDA adverse event reporting system, pharmacovigilance, temporal trend analysis

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