Search results for: indigenous trauma

Authors: Saloni Khanderia

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The World Trade Organisation’s (WTO) Information Technology Agreement (ITA), was concluded at the Singapore Ministerial Conference in 1996. The ITA is considered to be one of the biggest tariff-cutting deals because it eliminates all customs-related duties on the exportation of specific categories of information technology products to the territory of any other signatory to the Agreement. Over time, innovations in the information and communication technology (ICT) sector mandated the consideration of expanding the list of products covered by the ITA, which took place in the form of ITA-II negotiations during the WTO’s Nairobi Ministerial Conference. India, which was an original Member of the ITA-I, however, decided to opt-out of the negotiations to expand the list of products covered by the agreement. Instead, it preferred to give priority to its national policy initiative, namely the ‘Make-in-India’ programme [the MiI programme], which embarks upon fostering the domestic production of, inter alia, the ICT sector. India claims to have abstained from the ITA-II negotiations by stating that the zero-tariff regime created by the ITA-I debilitated its electronics-manufacturing sectors and on the contrary resulted in an over-reliance on imported electronic inputs. The author undertakes doctrinal research to examine India’s decision to opt-out of ITA-II negotiations, against the backdrop of the MiI Programme, which endeavours to improve productivity across-the-board. This paper accordingly scrutinises the tariff-cutting strategies of India to weigh the better alternative for India. Apropos, it examines whether initiatives like the MiI programme could plausibly resuscitate the ailing domestic electronics-manufacturing sector. The author opines that the country’s present decision to opt-out of ITA-II negotiations should be perceived as a welcome step. Thus, market-oriented reforms such as the MiI Programme, which focuses on indigenous innovation to improve domestic manufacturing in the ICT sector, should instead, in the present circumstances gain priority. Consequently, the MiI Programme would aid in moulding the country’s current tariff policy in a manner that will concurrently assist the promotion and sustenance of domestic manufacturing in the IT sector.

Keywords: electronics-manufacturing sector, information technology agreement, make in india programme, world trade organisation

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Authors: Oluwafemi Samuel Oyamakin

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The forest in Nigeria is currently estimated to extend to around 9.6 million hectares, but used to expand over central and southern Nigeria decades ago. The forest estate is shrinking due to long-term human exploitation for agricultural development, fuel wood demand, uncontrolled forest harvesting and urbanization, amongst other factors, compounded by population growth in rural areas. Nigeria has lost more than 50% of its forest cover since 1990 and currently less than 10% of the country is forested. The current deforestation rate is estimated at 3.7%, which is one of the highest in the world. Reducing Emissions from Deforestation and forest Degradation plus conservation, sustainable management of forests and enhancement of forest carbon stocks constituted what is referred to as REDD+. This study evaluated some of the existing way of computing carbon stocks using eight indigenous tree species like Mansonia, Shorea, Bombax, Terminalia superba, Khaya grandifolia, Khaya senegalenses, Pines and Gmelina arborea. While these components are the essential elements of REDD+ programme, they can be brought under a broader framework of systems analysis designed to arrive at optimal solutions for future predictions through statistical distribution pattern of carbon sequestrated by various species of tree. Available data on height and diameter of trees in Ibadan were studied and their respective potentials of carbon sequestration level were assessed and subjected to tests so as to determine the best statistical distribution that would describe the carbon sequestration pattern of trees. The result of this study suggests a reasonable statistical distribution for carbons sequestered in simulation studies and hence, allow planners and government in determining resources forecast for sustainable development especially where experiments with real-life systems are infeasible. Sustainable management of forest can then be achieved by projecting future condition of forests under different management regimes thereby supporting conservation and REDD+ programmes in Nigeria.

Keywords: REDD+, carbon, climate change, height and diameter

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Authors: Po-Sheng Kuo, Che-Wei Lu, Ssu-Ching Chen

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Chlorinated ethenes (CEs) constitute a predominant contaminant in Taiwan's native polluted sites, particularly in groundwater inundated with sulfate salts that substantially impede remediation efforts. The reduction of sulfate by sulfate-reducing bacteria (SRB) impairs the dechlorination efficiency of Dehalococcoides by generating hydrogen sulfide (H₂S), resulting in incomplete chloride degradation and thereby leading to the failure of bioremediation. In order to elucidate interactions between sulfate reduction and dechlorination, this study aims to establish a co-culture system of Dehalococcoides and SRB, overcoming H₂S inhibition by employing the synthesis of ferrous sulfide (FeS), which is commonly utilized in chemical remediation due to its high reduction potential. Initially, the study demonstrates that the addition of ferrous chloride (FeCl₂) effectively removed H₂S production from SRB and enhanced the degradation of trichloroethylene to ethene. This process overcomes the inhibition caused by H₂S produced by SRB in high sulfate environments. Compared to different concentrations of ferrous dosages for the biogenic generation of FeS, the efficiency was optimized by adding FeCl₂ at an equal ratio to the concentration of sulfate in the environment. This was more effective in removing H₂S and crystal particles under 10 times smaller than those synthesized under excessive FeCl₂ dosages, addressing clogging issues in situ remediation. Finally, utilizing Taiwan's indigenous dechlorinating consortium in a simulated high sulfate-contaminated environment, the biodiversity of microbial species was analyzed to reveal a higher species richness within the FeS group, conducive to ecological stability. This study validates the potential of the co-culture system in generating biogenic FeS under sulfate and CEs co-contamination, removing sulfate-reducing products, and improving CE remediation through integrated chemical and biological remediations.

Keywords: biogenic ferrous sulfide, chlorinated ethenes, Dehalococcoides, sulfate-reducing bacteria, sulfide inhibition

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Authors: J. B. J. Njalam’mano, E. M. N. Chirwa

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In low resource settings in Africa and other developing regions, pit latrines remain the dominant basic minimum acceptable form of sanitation. However, unpleasant smells-malodours emitted from faecal sludge in the pit latrines, which elicit disgusting or repulsive response, are one of the factors that thwart people to use latrines and instead opt for open defecation as an alternative. This provides an important but often overlooked major impediment, dissuading people from adopting and using the pit latrines hence affecting successful, effective sanitation promotion. The malodours are primarily attributed to four odorants: butanoic acid (C₄H₈O₂), dimethyl trisulphide (C₂H₆S₃), indole (C₈H₇N) and para-cresol (C₇H₈O). Several pit latrine deodorisation methods such as addition of carbonous materials, use of ventilation systems and urine separation are available, and they continue to occupy their niche, but social, economic, environmental and technological shortfalls remain. Bioremediation has been gaining popularity because it is inexpensive, simple to operate and environmentally friendly. Recently, the biodegradation of butanoic acid as individual odorant has been studied. However, to the best of our knowledge, there have been no kinetic studies of the butanoic acid in the presence of other key odorous compounds. In this study, a series of experiments were conducted to investigate the effects of indole on the removal of butanoic acid under aerobic conditions using indigenous bacteria strains, Pseudomonas aeruginosa, and Serratia marcescens isolated from faecal sludge as pure cultures as well as mixed cultures. In this purpose, butanoic acid removal was performed in a batch reactor containing the bacterial strains in mineral salt medium (MSM) amended with 3000 ppm of butanoic acid at the temperature of 30°C, under continuous stirring rate of 150 rpm and the concentration of indole was varied from 50-200 ppm. The initial pH of the solution was in the range of 6.0-7.2. Overall, there were significant differences in the bacterial growth rate and total butanoic acid removal dependent on the concentration of indole in the solution.

Keywords: biodegradation, butanoic acid, indole, pit latrine

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Authors: Hakan Akgul

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Purpose: The use of firecrackers (i.e., Ramadan Cannon) during the month of Ramadan is a traditional way of indicating that the fasting period is over in Muslim countries. Here, we report the rehabilitation of a case of hand injury with pluridigital fractures due to premature explosion of a Ramadan cannon. Materials and Methods: A 48-year old man admitted to the Emergency Department due to left hand injury as a result of a premature explosion of a Ramadan cannon. The patient was immediately taken to operation room because of the multiple fractures, tendon loss, and soft tissue loss in the left hand. Range of motion (ROM) of joints was measured with goniometer, pain and oedema were measured and splinting was performed. Results: Rehabilitation team took over the patient at postoperative 9th week. During the 3 month rehabilitation, range of motion increased, oedema was taken under control, pain was reduced, the colour of the skin turned to the normal tone. According to the visual analog scale (VAS), pain decreased from 9 to 4. Oedema, around the metacarpofalangeal (MCP) joints, decreased from 27,5 cm to 23,5 cm. Total active range of motion of the wrist increased from 5 degrees to 50 degrees.Total active range of motion of supination and pronation increased from 55 degrees to 70 degrees. Discussion: The rehabilitation of multiple hand injury is quite difficult. Different aspects of trauma should be taken into consideration when rehabilitation is planned. Factors such as waiting for the bone union, wound healing, and use of external fixators may delay rehabilitation process. Joint mobilization, massage for reducing oedema and preventing scar tissue, exercise within the range of motion are efficient measures. Poor patient compliance to treatment may lead to poor outcome. First of all, oedema and scar formation must be taken under control. Removing fixators should not be delayed depending on the bone union, and exercise within the range of motion should be started.

Keywords: explosion, fracture, hand, injury

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Authors: Kristin Lewis, Howard Steele, Anne Murphy, Miriam Steele, Karen Bonuck, Paul Meissner

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The present study examines data collected during the randomized control trial (RCT) of the Group Attachment-Based Intervention (GABI©), a trauma-informed, attachment-based intervention aimed at promoting healthy parent-child relationships that support child development. Families received treatment at Treatment Center and were randomly assigned to either the GABI condition or the treatment as usual condition, a parenting class called Systematic Training for Effective Parenting (STEP). Significant improvements in the parent-child relationship have been reported for families participating in GABI, but not in the STEP control group relying on Coding Interactive Behavior (CIB) as applied to 5-minute video-films of mothers and their toddlers in a free play context. This report considers five additional attachment-relevant 'clinical codes' that were also applied to the 5-minute free play sessions. Seventy-two parent-child dyads (38 in GABI and 34 in STEP) were compared to one another at intake and end-of-treatment, on these five-point dimensions: two-parent codes—the dissociation and ignoring; two child codes—simultaneous display of contradictory behavior and fear; and one parent-child code, i.e., role reversal. Overall, scores were low for these clinical codes; thus, a binary measure was computed contrasting no evidence with some evidence of each clinical code. Crosstab analyses indicate that child fear at end-of-treatment was significantly lower among children who participated in GABI (7% or 3 children) as compared to those whose mothers participated in STEP (29% or 10 children) Chi Sq= 6.57 (1), p < .01. Discussion focuses on the potential for GABI to reduce childhood fearfulness and so enhance the child's health.

Keywords: coding interactive behavior, clinical codes, group attachment based intervention, GABI, attachment, fear

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Authors: Yvonne A. Unrau

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Social work education is a competency-based curriculum that relies mostly on cognitive frameworks and problem-solving models. Absent from the curriculum is knowledge and skills that draw from an embodiment perspective, especially somatic practice methods. Embodiment broadly encompasses the understanding that biological, political, historical, and social factors impact human development via changes to the nervous system. In the past 20 years, research has well-established that unresolved traumatic events, especially during childhood, negatively impacts long-term health and well-being. Furthermore, traumatic stress compromises cognitive processing and activates reflexive action such as ‘fight’ or ‘flight,’ which are the focus of somatic methods. The main objective of this paper is to show how embodiment perspectives and somatic methods can enhance social work practice overall. Using an exploratory approach, the author shares a decade-long journey that involved creating an education-support program for college students who exited the state foster care system. Personal experience, program outcomes and case study narratives revealed that ‘classical’ social work methods were insufficient to fully address the complex needs of college students who were living with complex traumatic stressors. The paper chronicles select case study scenarios and key program development milestones over a 10-year period to show the benefit of incorporating embodiment perspectives in social work practice. The lessons reveal that there is an immediate need for social work curriculum to include embodiment perspectives so that social workers may be equipped to respond competently to their many clients who live with unresolved trauma.

Keywords: social work practice, social work curriculum, embodiment, traumatic stress

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Authors: Prathama Guha Chaudhuri, Arunima Datta, Ashis Mukhopadhyay

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Background: Visualization (guided imagery) is a set of techniques which induce relaxation and help people create positive mental images in order to reduce stress.It is relatively inexpensive and can even be practised by bed bound people. Studies have shown visualization to be an effective tool to improve cancer patients’ anxiety, depression and quality of life. The common images used with cancer patients in the developed world are those involving the individual’s body and its strengths. Since breast cancer patients in India are more family oriented and often their main concerns are the stigma of having cancer and subsequent isolation of their families, including their children, we figured that positive images involving acceptance and integration within family and society would be more effective for them. Method: Data was collected from 119 breast cancer patients on chemotherapy willing to undergo psychotherapy, with no history of past psychiatric illness. Their baseline stress, anxiety, depression and quality of life were assessed using validated tools. The participants were then randomly divided into three groups: a) those who received visualization therapy with standard imageries involving the body and its strengths (sVT), b) those who received visualization therapy using indigenous family oriented imageries (mVT) and c) a control group who received supportive therapy. There were six sessions spread over two months for each group. The psychological outcome variables were measured post intervention. Appropriate statistical analyses were done. Results:Both forms of visualization therapy were more effective than supportive therapy alone in reducing patients’ depression, anxiety and quality of life.Modified VT proved to be significantly more effective in improving patients’ anxiety and quality of life. Conclusion: Visualization is a valuable therapeutic option for reduction of psychological distress and improving quality of life of breast cancer patients.In order to be more effective, the images used need to be modified according to the sociocultural background and individual needs of the patients.

Keywords: breast cancer, visualization therapy, quality of life, anxiety, depression

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Authors: Maria Do Carmo Baracho De Alencar, Marciene Campos Fialho, Maria Do Carmo Vitório Ramos

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The subjects affected by Repetitive Strain Injury/Work Related Musculoskeletal Disorder (RSI/WRMSD) face an everyday life marked by pain, feelings of worthlessness and incapacity caused by the disease, and aggravated often because of discrimination society. Aim: To investigate the experiences and feelings of workers affected by RSI/WRMSD in removal from work situations and to understand the repercussions on mental health. Methods: Clinical records of workers were consulted, opened from July 1, 2014, to July 1, 2015, at the Reference Center for Worker's Health, in Santos city-SP. Selection of workers affected by RSI /WRMSD and who had experienced the removal from work situation due to the disease, and invitation to participate in the study. Semi-structured and individual interviews were carried out based on a pre-elaborated script, and for thematic content analysis. Results: Of a total of 502 medical records, 157 were selected, and of these, 18 workers participated in the interviews, both gender, most of them with low education level, aged between 35 and 56 years, and from different professions. Diseases affected several physical body regions and some workers had more than one body region affected by chronic pain. In the testimonies emerged the psychic suffering by the process of illness at work, fear of dismissal, invisibility of pain, in medical expertise attendance, by the incapacity to perform tasks that were easily achievable, with feelings of uselessness, revolt, and injustice, among others. Conclusion: The workers need to be readapted to new life situations, and the study promotes reflections on the need for more interdisciplinary actions and of the Psychology to the workers affected by RSI/ WRMSD.

Keywords: repetitive strain injury, cumulative trauma disorder, absence from work, mental health, occupational health

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Authors: Constance Chivengwa, Tinashe Mandimutsira, Jephris Gere, Charles Magogo, Irene Chikanza, Jerneja Vidmar, Walter Chingwaru

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The use of traditional methods in the management of diarrhoea has remained a common practice among the indigenous African tribes of Southern Africa. Despite the widespread use of traditional medicines in Zimbabwe, very little research validating the activities of phytomedicines against diarrhoea, as claimed by the Shona people of Zimbabwe, has been reported. This study sought to determine the efficacies of the plants that are frequently used to treat stomach complaints, namely Dicoma anomala, Cassia abbreviata, Lannea edulis and Peltophorum africanum against Escherichia coli (an indicator of faecal contamination of water, and whose strains such as EHEC (O157), ETEC and EPEC, are responsible for a number of outbreaks of diarrhoea) and Salmonella spp. Ethanol and aqueous extracts from these plants were obtained, evaporated, dried and stored. The dried extracts were reconstituted and diluted 10-fold in nutrient broth (from 100 to 0.1 microgram/mL) and tested for inhibition against the bacteria. L. edulis exhibited the best antimicrobial effect (minimum inhibition concentration = 10 microgram/mL for both extracts and microorganisms). Runners up to L. edulis were C. abbreviata (20 microgram/mL for both microorganisms) and P. africanum (20 and 30 microgram/mL respectively). Interestingly, D. anomala, which is widely considered panacea in African medicinal practices, showed low antimicrobial activity (60 and 100 microgram/mL respectively). The high antimicrobial activity of L. edulis can be explained by its content of flavonoids, tannins, alkylphenols (cardonol 7 and cardonol 13) and dihydroalkylhexenones. The antimicrobial activities of C. abbreviata can be linked to its content of anthraquinones and triterpenoids. P. africanum is known to contain benzenoids, flavanols, flavonols, terpenes, xanthone and coumarins. This study therefore demonstrated that, among the plants that are used against diarrhoea in African traditional medicine, L. edulis is a clear winner against E. coli and Salmonella spp. Activity guided extraction is encouraged to establish the complement of compounds that have antimicrobial activities.

Keywords: diarrhoea, Escherichia coli, Salmonella, phytomedicine, MIC, Zimbabwe

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Authors: Aruna Ramani Grover

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In 1857, the British army in Bengal rose in mutiny. The outcome of a yearlong stifle was the abolition of the East India Company and the establishment of Crown rule in 1958. Despite being a political democracy back home, with the declaration of Queen Victoria as Empress of India, the British established themselves as imperialistic successors to the Mughals in India. With the institution of the Crown's role in the sub-continent, there was a serious endeavor for systematic governance. This led to infrastructure development and the creation of institutions as well. The outcome was many public buildings like courts, railway- stations and headquarters, senates, post offices, banks, libraries, memorial halls, museums, memorials, theatres, government colleges, residential schools and clock towers. These were built in the old and emerging urban settlements of the sub-continent. In the realm of architecture, like all political masters of the past, the British architects, too, encountered the living tradition of the sub-continent. A bewildering plethora of buildings in various climatic zones, using local materials and crafted with tools and techniques of the region by local craftsmen, had to be understood and assimilated. The 19th-century British architects who built in India designed institutional buildings that were functional and responded to the needs of the user. In visual terms, however, it was a completely different story. Using the manifest elements of the complex and layered indigenous tradition, they fashioned buildings to create an architecture of reconciliation. Treating the traditional architecture as a pattern book, finished buildings were served up to the local population colored by their understanding of tradition. This paper will discuss a series of building some of which are the Senate House and Law Courts at Madras, the Municipal Building and Gateway of India in Bombay, the Muir College in Allahabad, Mayo College Ajmer, the Mubarak Mahal in Jaipur, demonstrate how a visual language of reconciliation was created.

Keywords: infrastructure, British architects, tradition, pattern book, reconciliation

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Authors: Simona Capossela, Ramona Schaniel, Singer Franziska, Aquino Fournier Catharine, Daniel Stekhoven, Jivko Stoyanov

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A spinal cord injury (SCI) is a traumatic life event that often results in ageing associated health conditions such as muscle mass decline, adipose tissue increase, decline in immune function, frailty, systemic chronic inflammation, and psychological distress and depression. Psychological, oxidative, and metabolic stressors may facilitate accelerated ageing in the SCI population with reduced life expectancy. Research designs using biomarkers of aging and stress are needed to elucidate the role of psychological distress in accelerated aging. The aim of this project is a feasibility pilot study to observe changes in stress biomarkers and correlate them with aging markers in SCI patients during their first rehabilitation (longitudinal cohort study). Biological samples were collected in the SwiSCI (Swiss Spinal Cord Injury Cohort Study) Biobank in Nottwil at 4 weeks±12 days after the injury (T1) and at the end of the first rehabilitation (discharge, T4). The "distress thermometer" is used as a selfassessment tool for psychological distress. Stress biomarkers, as cortisol and protein carbonyl content (PCC), and markers of cellular aging, such as telomere lengths, will be measured. 2 Preliminary results showed that SCI patients (N= 129) are still generally distressed at end of rehabilitation, however we found a statistically significant (p< 0.001) median decrease in distress from 6 (T1) to 5 (T4) during the rehabilitation. In addition, an explorative transcriptomics will be conducted on N=50 SCI patients to compare groups of persons with SCI who have different trajectories of selfreported distress at the beginning and end of the first rehabilitation after the trauma. We identified 4 groups: very high chronic stress (stress thermometer values above 7 at T1 and T4; n=14); transient stress (high to low; n=14), low stress (values below 5 at T1 and T4; n=14), increasing stress (low to high; n=8). The study will attempt to identify and address issues that may occur in relation to the design and conceptualization of future study on stress and aging in the SCI population.

Keywords: stress, aging, spinal cord injury, biomarkers

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Authors: Kerry Hull, Mark Wright

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This paper brings light to ethnobotanical medicines used by the Maya of Belize to treat snake bites. The varying ecological zones of Belize boast over fifty species of snakes, nine of which are poisonous and dangerous to humans. Two distinct Maya groups occupy neighboring regions of Belize, the Q’eqchi’ and the Mopan. With Western medical care often far from their villages, what traditional methods are used to treat poisonous snake bites? Based primarily on data gathered with native consultants during the authors’ fieldwork with both groups, this paper details the ethnobotanical resources used by the Q’eqchi’ and Mopan traditional healers. The Q’eqchi’ and Mopan most commonly rely on traditional ‘bush doctors’ (ilmaj in Mopan), both male and female, and specialized ‘snake doctors’ to heal bites from venomous snakes. First, this paper presents each plant employed by healers for bites for the nine poisonous snakes in Belize along with the specific botanical recipes and methods of application for each remedy. Individual chemical and therapeutic qualities of some of those plants are investigated in an effort to explain their possible medicinal value for different toxins or the symptoms caused by those toxins. In addition, this paper explores mythological associations with certain snakes that inform local understanding regarding which plants are considered efficacious in each case, arguing that numerous oral traditions (recorded by the authors) help to link botanical medicines to episodes within their mythic traditions. Finally, the use of plants to counteract snakebites brought about through sorcery is discussed inasmuch as some snakes are seen as ‘helpers’ of sorcerers. Snake bites given under these circumstances can only be cured by those who know both the proper corresponding plant(s) and ritual prayer(s). This paper provides detailed documentation of traditional ethnomedicines and practices from the dying art of traditional Maya healers and argues for multi-faceted diagnostic techniques to determine toxin severity, the presence or absence of sorcery, and the appropriate botanical remedy.

Keywords: ethnobotany, Maya, medicine, snake bites

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Authors: Johanna Bapela, Heino Heyman, Marion Meyer

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Regardless of the significant advances accomplished in reducing the burden of malaria and other tropical diseases in recent years, malaria remains a major cause of mortality in endemic countries. This is especially the case in sub-Saharan Africa where 99% of the estimated global malaria deaths occurs on an annual basis. The emergence of resistant Plasmodium species and the lack of diversified chemotherapeutic agents provide the rationale for bioprospecting for antiplasmodial scaffolds. Crude extracts from twenty indigenous antimalarial plant species were screened for antimalarial activity and then subjected to 1H NMR-based metabolomic analysis. Ten plant extracts exhibited significant in vitro antiplasmodial activity (IC50 ≤ 5 µg/ml). The Principal Component Analysis (PCA) of the acquired 1H NMR spectra could not separate the analyzed plant extracts according to the detected antiplasmodial bioactivity. Application of supervised Orthogonal Projections to Latent Structures–Discriminant Analysis (OPLS-DA) to the 1H NMR profiles resulted in a discrimination pattern that could be correlated to bioactivity. A contribution plot generated from the OPLS-DA scoring plot illustrated the classes of compounds responsible for the observed grouping. Given the preliminary in vitro results, Tabernaemontana elegans Stapf. (Apocynaceae) and Vangueria infausta Burch. subsp. infausta (Rubiaceae) were subjected to further phytochemical investigations. Two indole alkaloids, dregamine and tabernaemontanine possessing antiplasmodial activity were isolated from T. elegans. Two compounds were isolated from V. infausta subsp. infausta and identified as friedelin (IC50 = 3.01 µg/ml) and morindolide (IC50 = 18.5 µg/ml). While these compounds have been previously identified, this is the first account of their occurrence in the genus Vangueria and their antiplasmodial activity. Based on the results of the study, metabolomics can be used to globally identify classes of plant secondary metabolites that are responsible for antiplasmodial activity.

Keywords: ethnopharmacology, Malaria, medicinal plants, metabolomics

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Authors: Monique Du Plessis, Anina Coetzee, Colleen L. Seymour, Claire N. Spottiswoode

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Artificial nectar feeders are used to attract nectarivorous birds to gardens and are increasing in popularity. The costs and benefits of these feeders remain controversial, however. Nectar feeders may have positive effects by attracting nectarivorous birds towards suburbia, facilitating their urban adaptation, and supplementing bird diets when floral resources are scarce. However, this may come at the cost of luring them away from the plants they pollinate in neighboring indigenous vegetation. This study investigated the effect of nectar feeders on an African pollinator-plant mutualism. Given that birds are important pollinators to many fynbos plant species, this study was conducted in gardens and natural vegetation along the urban edge of the Cape Peninsula. Feeding experiments were carried out to compare relative bird abundance and local distribution patterns for nectarivorous birds (i.e., sunbirds and sugarbirds) between feeder and control treatments. Resultant changes in their visitation rates to Erica flowers in the natural vegetation were tested by inspection of their anther ring status. Nectar feeders attracted higher densities of nectarivores to gardens relative to natural vegetation and decreased their densities in the neighboring fynbos, even when floral abundance in the neighboring vegetation was high. The consequent changes to their distribution patterns and foraging behavior decreased their visitation to at least Erica plukenetii flowers (but not to Erica abietina). This study provides evidence that nectar feeders may have positive effects for birds themselves by reducing their urban sensitivity but also highlights the unintended negative effects feeders may have on the surrounding fynbos ecosystem. Given that nectar feeders appear to compete with the flowers of Erica plukenetii, and perhaps those of other Erica species, artificial feeding may inadvertently threaten bird-plant pollination networks.

Keywords: avian nectarivores, bird feeders, bird pollination, indirect effects in human-wildlife interactions, sugar water feeders, supplementary feeding

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Authors: Natalie Delia

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This academic paper investigates the transformative potential of incorporating alternative ways of knowing within the framework of Critical Studies departments. Traditional academic paradigms often prioritize empirical evidence and established methodologies, potentially limiting the scope of critical inquiry. In response to this, our research seeks to illuminate the benefits and challenges associated with integrating alternative epistemologies, such as indigenous knowledge systems, artistic expressions, and experiential narratives. Drawing upon a comprehensive review of literature and case studies, we examine how alternative ways of knowing can enrich and diversify the intellectual landscape of Critical Studies departments. By embracing perspectives that extend beyond conventional boundaries, departments may foster a more inclusive and holistic understanding of critical issues. Additionally, we explore the potential impact on pedagogical approaches, suggesting that alternative ways of knowing can stimulate alternative way of teaching methods and enhance student engagement. Our investigation also delves into the institutional and cultural shifts necessary to support the integration of alternative epistemologies within academic settings. We address concerns related to validation, legitimacy, and the potential clash with established norms, offering insights into fostering an environment that encourages intellectual pluralism. Furthermore, the paper considers the implications for interdisciplinary collaboration and the potential for cultivating a more responsive and socially engaged scholarship. By encouraging a synthesis of diverse perspectives, Critical Studies departments may be better equipped to address the complexities of contemporary issues, encouraging a dynamic and evolving field of study. In conclusion, this paper advocates for a paradigm shift within Critical Studies departments towards a more inclusive and expansive approach to knowledge production. By embracing alternative ways of knowing, departments have the opportunity to not only diversify their intellectual landscape but also to contribute meaningfully to broader societal dialogues, addressing pressing issues with renewed depth and insight.

Keywords: critical studies, alternative ways of knowing, academic department, Wallerstein

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Authors: A. Juhász, M. Fogarasi

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Those causing fatal traffic accidents are traumatized, which negatively influences their cognitive functions and their personality. In order to clarify how much the trauma of causing a fatal accident effects their driving skills and personality traits, the results of a psychological aptitude and a personality test of drivers carelessly causing fatal accidents and of drivers not causing any accidents were compared separately. The sample (N = 354) consists of randomly selected drivers from the Transportation Aptitude and Examination Centre database who caused fatal accidents (Fatal group, n = 177) or did not cause accidents (Control group, n = 177). The aptitude tests were taken between 2014 and 2019. The comparison of the 2 groups was done according to 3 aspects: 1. Categories of aptitude (suitable, restricted, unsuited); 2. Categories of causes (ability, personality, ability and personality) within the restricted or unsuited (altogether: non-suitable subgroups); 3. Categories of ability and personality within the non-suitable subgroups regardless of the cause-category. Within ability deficiency, the two groups include those, whose ability factor is impaired or limited. This is also true in case of personality failure. Compared to the control group, the number of restricted drivers causing fatal accidents is significantly higher (p < .000) and the number of unsuited drivers is higher on a tendency-level (p = .06). Compared to the control group in the fatal non-suitable subgroup, the ratio of restricted suitability and the unsuitability due to ability factors is exclusively significantly lower (p < .000). The restricted suitability and the unsuitability due to personality factors are more significant in the fatal non-suitable subgroup (p < .000). Incapacity due to combination of ability and personality is also significantly higher in the fatal group (p = .002). Compared to the control group both ability and personality factors are also significantly higher in the fatal non-suitable subgroup (p < .000). Overall, the control group is more eligible for driving than drivers who have caused fatalities. The ability and personality factors are significantly higher in the case of fatal accident causers who are non-suitable for driving. Moreover the concomitance of ability and personality factors occur almost exclusively to drivers who caused fatal accidents. Further investigation is needed to understand the causes and how the aptitude test results for the fatal group could improve over time.

Keywords: aptitude, unsuited, fatal accident, ability, personality

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Authors: Hasanzadeh Tahraband F., Kheirkhah M.

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The trauma resulting from abortion causes fear, frustration, inability, lack of self-confidence, and psychological distress in women. The present study was conducted to determine the effect of midwifery counseling based on the Gamble approach on coping strategies of women with abortion. This randomized controlled clinical trial was conducted on women with abortions in April–October 2021, Karaj, Iran. Ninety-six eligible women were randomly assigned to two 48-member groups with 4, 6, and 8 blocks. The women in the intervention group participated in two 45-75-minute Gamble counseling programs. They were asked to fill out the demographic and fertility information questionnaire before the intervention and the cope operations preference inquiry questionnaire before, immediately (in the 4-6th week of the study), and three months after the intervention. The analysis of the data was done through Chi-square, independent sample t-test. The significance level was considered P<0.05. The results showed that the differences between the two groups before the intervention were not statistically significant in terms of demographic and fertility variables (P>0.05). However, the total mean score of the problem-focused dimension in 3-month post-abortion (97/34±8/69) and the emotion-focused dimension in 4-6 weeks and 3-month post-abortion (34/14±3/48 and 32/41±3/41) in the intervention group was significantly different from the control group (P<0.001). According to the results of the repeated measures ANOVA, the level of coping and its dimensions significantly changed in the intervention group over time (P<0.001). The results of the present study showed that Gamble counseling promoted the problem-focused dimension score and reduced the emotion-focused dimension score in women with abortion. It is recommended that Gamble counseling should be used as midwife-led counseling to increase coping strategies and reduce the psychological distress of women who have experienced abortion.

Keywords: midwife-led counseling, coping strategies, post-abortion, psychological distress, Iran

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Authors: Fleura Shkëmbi, Sevim Mustafa, Naim Fanaj

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Hypnosis, often known as cognitive therapy, is a sort of mind-body psychotherapy. A professional and certified hypnotist or hypnotherapist guides the patient into this extreme level of focus and relaxation during the session by utilizing verbal cues, repetition, and imagery. In recent years, hypnotherapy has gained popularity in the treatment of a variety of disorders, including anxiety and particular phobias. The term "phobia" is commonly used to define fear of a certain trigger. When faced with potentially hazardous situations, the brain naturally experiences dread. While a little dread here and there may keep us safe, phobias can drastically reduce our quality of life. In summary, persons who suffer from anxiety are considered to see particular environmental situations as dangerous, but those who do not suffer from anxiety do not. Hypnosis is essential in the treatment of anxiety disorders. Hypnosis can help patients minimize their anxiety symptoms. This broad concept has aided in the development of models and therapies for anxiety disorders such as generalized anxiety disorder, panic attacks, hypochondria, and obsessional disorders. Hypnosis techniques are supposed to be attentive and mental pictures, which is conceivable; this is why they're associated with improved working memory and visuospatial abilities. In this sense, the purpose of this study is to determine how effectively specific therapeutic methods perform in treating persons with anxiety and phobias. In addition to cognitive-behavioral therapy and other therapies, the approaches emphasized the use of therapeutic hypnosis. This study looks at the use of hypnosis and related psychotherapy procedures in the treatment of anxiety disorders. Following a discussion of the evolution of hypnosis as a therapeutic tool, neurobiological research is used to demonstrate the influence of hypnosis on the change of perception in the brain. The use of hypnosis in the treatment of phobias, stressful situations, and posttraumatic stress disorder is examined, as well as similarities between the hypnotic state and dissociative reactions to trauma. Through an extensive literature evaluation, this study will introduce hypnotherapy procedures that result in more successful anxiety and phobia treatment.

Keywords: anxiety, hypnosis, hypnotherapy, phobia, technique, state

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Authors: Chew Zhao Hong

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Since the transition of power in 2018, the Malaysian political landscape has experienced substantial shifts and complexities. The decline of the longstanding ruling party, United Malays National Organization (UMNO), following the party rotation, has given rise to splinter parties such as the Indigenous Unity Party (Bersatu), along with the enduring presence of the Pan-Malaysian Islamic Party (PAS) in the northern region of the Malay Peninsula. However, the "Sheraton Move" in 2020 led to the fall of the Pakatan Harapan government and the emergence of Perikatan Nasional, signifying the ascent of a third political force. The 2022 general elections marked Malaysia's entry into a hung parliament, culminating in an intricate negotiation that resulted in a coalition government formed by Pakatan Harapan, Barisan Nasional, and the Sarawak parties alliance (GPS), collectively governing the Malaysian federal administration. During the 2023 state elections, Pakatan Harapan and Barisan Nasional formed an unprecedented alliance, yet the media framing benefited Perikatan Nasional, even securing substantial support from UMNO's traditional constituencies. In the era of converging new media, Malaysia’s democratization faces new challenges: first, political leaders leveraging media to cultivate unfiltered personas risk inducing populism; second, under the influence of agenda-setting and two-step flow theories, media contributes to polarization; lastly, Malaysia's multi-party system is no longer effectively moderate extreme ideologies into the political center. This study examines the role of media framing and its impact on the democratization process within Malaysia's consociational democracy under a multi-party system and analyzes media discourse before and after the 2023 Malaysian state elections to explore how different parties shape public opinion and political discourse, and how political messages may be amplified or distorted in the process.

Keywords: multi-party system, democratization, elections, political polarization, Malaysia, media framing

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Authors: Rhodine Hickman, Craig Wylie, Michael G. McCaul

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Introduction: The World Health Organisation has called on governments around the world to recognise emergency conditions as a global public health problem and respond with appropriate steps for effective preventative strategies. However, to understand the magnitude of the problem, good quality epidemiological data is required. This is especially challenging in low and middle-income countries, where routine data is scarce, specifically within the prehospital setting. Methods: We conducted a retrospective cross-sectional study of a national prehospital private sector EMS database. The database being the property of ER24 (private Emergency Medical Services (EMS) company in South Africa) contains claims submitted by the majority of ambulance services in South Africa during the period between 1 January 2008 to 28 March 2017. We used descriptive statistics and control charts to describe the data using STATA 14. Results: 299,257 calls were included in the analysis. The top clinical conditions requiring ambulance transport were transport accidents (10% of total call volume) and ischaemic heart disease (4.4%). The number of transport accidents consistently increased between 2009 and 2014 and reached beyond the limit for normal variation in 2015. Victims of transport accidents required basic life support services 60% of the time with 80% of injuries being minor to moderate. The frequency of ischaemic heart disease had a steady incline from 2011 to 2016. Advanced life support services were required about 50% of the time, with 60% of patients needing urgent care. Conclusion: Transport accidents, followed by ischaemic heart disease, are the most prevalent conditions in South African private EMS. There is a potential to address these conditions by developing the capacity of low and mid-level providers in trauma and advanced EMS providers in ischaemic heart disease.

Keywords: emergency care, emergency medicine, prehospital providers, South Africa

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Authors: Mahmoud A. Amin, Essam Taman, Ahmed Omran, Mahmoud Shawky, Ahmed Mekawy, Abdallah M. Kotkat, Saber Younes, Nehad N. Ghonemy, Amin Saad, Ezz-Aleslam, Abdullah M. Elosh

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Introduction: TMJ is a one-of-a-kind, complicated synovial joint that helps with masticatory function by allowing the mandible to open and close the mouth. True ankylosis is a situation in which condylar movement is limited by a mechanical defect in the joint, whereas false ankylosis is a condition in which there is a restriction in mandibular movement due to muscular spasm myositis ossificans, and coronoid process hyperplasia. Ankylosis is characterized by the inability to open the mouth due to fusion of the TMJ condyle to the base of the skull as a result of trauma, infection, or systemic diseases such as rheumatoid arthritis (the most common) and psoraisis. Ankylosis causes facial asymmetry and affects the patient psychologically as well as speech, difficult mastication, poor oral hygiene, malocclusion, and other factors. TMJ is a technically challenging joint; hence TMJ ankylosis management is complicated. Case presentation: this case is a male patient 25 years old reported to our maxillofacial clinic in Damietta faculty of medicine, Al-Azhar University with the inability to open the mouth at all, with a history of difficulty of mouth breathing and eating foods, there was a history of falling from height at 2006, and the patient underwent corrective surgery before with no improvement because the ankylosis was relapsed short period after the previous operations with that done out of our hospital inter-incisor distant ZERO so, this condition need mandatory management. Clinical examination and radiological investigations were done after complete approval from the patient and his brother; tracheostomy was done for our patient before the operation. The patient entered the operation in our hospital and drastic improvement in mouth opening was noticed, helping to restore the physical psychological health of the patient.

Keywords: temporomandibular joint, TMJ, Ankylosis, mouth opening, physiotherapy, condylar plate

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Authors: Ririn Marinasari, S. Pi

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Hampal (Hampala macrolepidota) is one of Citarum river indigenous fishes that still find in Jatiluhur dam. IUCN at 2013 said that hampal listed on redlist species category, this species was rare in Jatiluhur dam. This species more and more decreasing because change of habitats characteristic such as water quality and fishing effort. This study aims to determine and identify the influence of fishing effort and the quality of water on the productivity of fish resources hampal (Hampala macrolepidota) in Jatiluhur. The study was conducted from October to November 2013. Zones of research include lacustrine zone, transition and Riverin. Hampal fish productivity value computed by Hampal’s CPUE values. The results showed that fish MSY hampal obtained from surplus production model of Schaefer is equal to 0.2045 tons / quarterly. In the years 2011-2012 have occurred over fishing in 2013 while still under fishing. Total catches have exceeded the MSY during the year 2011 and the third quarterly of 2012 tons of fish that exceed 0.2045 hampal. The rate of utilization of fish resources hampal is equal to 80% of MSY or equal to the allowable catch (Total Allowable Catch) for fish in Jatiluhur hampal based Schaefer surplus production theory. Fishing effort, water quality parameters such as DO, turbidity and negatively correlated sulfide as H2S, while the temperature and pH positively correlated to productivity or unit catches fish hampal efforts in quarterly time series in the period 2011-2013. Shows that the higher fishing effort, DO, turbidity and sulfide in H2S and diminishing the temperature and pH of the productivity decreases. Variables that affect the productivity of fishing hampal only H2S only factor beta coefficient -0.834 which indicates a negative effect. It can be caused by H2S levels are toxic and have already exceeded the quality standard, while for other water quality parameters are still below the maximum standards allowed in the waters. Result of the study can be a reference of fishing regulation for hampal conservation in Jatiluhur dam.

Keywords: effort, hampal, productivity, water quality

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Authors: Daniela Lamaison Sepulveda

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Critical media literacy teaches people to think analytically about the information they receive through the media. It is heavily influenced by Paulo Freire’s critical pedagogy and the necessity of becoming conscious of one’s reality in order to transform it. This qualitative research examines the case of Bolivia, which experienced dramatic political change after the first indigenous president, Evo Morales, was elected in 2006. In 2010, the government passed an education reform — the Avelino Siñani Elizardo Pérez (ASEP) —that draws heavily on decolonial thought and the Freirean notion of critical consciousness. The extent to which these theories were implemented in practice is evaluated in context of a media literacy project, run by an NGO, that trains secondary school teachers from public schools across Bolivia through yearly workshops ranging from producing media to identifying fake news. This context is examined against the backdrop of the highly contested general elections in October 2019. While there is plenty of literature that outlines the benefits of teaching media literacy in the classroom and different ways to apply it, little research has been done analysing implementation at an institutional level and how to best enable teachers who are motivated to teach the subject. Through semi-structured interviews, document analysis and naturalistic observations, this study aims to identify the struggles faced by teachers who are dedicated to teaching critical media literacy in their classrooms and how they navigate educational spaces while being subject to a demanding national curriculum that supposedly also seeks to promote critical thinking. The interplay between the aspirations of teachers and NGOs in contrast to the top-down discourse and policy of governmental institutions provides for a very enlightening case. By exploring these institutional, cultural, sociopolitical and economic barriers the teachers face, this research attempts to contribute to the debate in media literacy theories concerned with implementing the practice in schools.

Keywords: media literacy, critical pedagogy, teacher agency, misinformation, education reform, Bolivia

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Authors: Cheryl-Ann Sarita Boodram

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Historically, the movement of people has been the subject of socio-political and economic regulatory policies which congeal to regulate human mobility and establish geopolitical and spatial identities and borderlands. As migratory practices evolved, so too has the problematization associated with movement, migration and citizenship. The emerging trends have led to active development of immigration technology governing human mobility and the naming of migratory practices. One such named phenomenon is ‘deportation’ or the forced removal of individuals from their adopted country. Deportation, has gained much attention within the human mobility landscape in the past twenty years following the September 2001 terrorist attack on the World Trade Centre in New York. In a reactionary move, several metropolitan countries, including Canada and the United Kingdom enacted or reviewed immigration laws which further enabled the removal of foreign born criminals to the land of their birth in the global south. Existing studies fall short of understanding the multiple textures of the forced returned migration experiences and the social injustices resulting from deportation displacement. This study brings together indigenous research methodologies through the use of participatory action research and social work with returned migrants in Trinidad and Tobago to uncover the experiences of displacement of deported nationals. The study explores the experiences of negotiating life as a ‘stranger’ and how return has influenced the construction of identities of returned nationals. Findings from this study reveal that deportation has led to inequalities and facilitated ‘othering’ of this group within their own country of birth. The study further highlighted that deportation leads to circuits of dispossession, and perpetuates inequalities. This study provides original insights into the way returned migrants negotiate, map and embody ‘strangeness’ and manage their return to a soil they consider unfamiliar and alien.

Keywords: stranger, alien geographies, displacement, deportation, negotiating strangeness, identity, otherness, alien landscapes

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Authors: Eli Buchbinder

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Introduction. Language is the basis to our experience as human being. We use language in describing our experiences and construct meaning and narratives from experiences. Metaphors are a valuable linguistic tool commonly use. Metaphors link two domains that are ordinarily not related. Metaphors achieve simultaneously multi-level integration: abstract and concrete, rational and imaginative, familiar and the unfamiliar, conscious and preconscious/unconscious. As such, metaphors epistemological and ontological tool that are important in social work in every field and domain. Goals and Methods The presentation’s aim is to validate the value of metaphors through the first psychiatric breakdown is a traumatic for families. The presentation is based on two pooled qualitative studies. The first study focused on 12 spouses: 7 women and 5 men, between the ages of 22 and 57, regarding their experiences and meanings of the first psychiatric hospitalization of their partners diagnosed with affective disorders. The second study focused on 10 parents, between the ages of 47 and 62, regarding their experiences and meanings following their child's first psychotic breakdown during young adulthood. Results Two types of major metaphors evolved from the interviews in farming the trauma of the first mental breakdown. The first mode - orientation (spatial) metaphors, reflect symbolic expression of the loss of a secure base, represented in the physical environment, e.g., describing hospitalization as "falling into an abyss." The second mode- ontological metaphors, reflect how parents and spouses present their traumatic experiences of hospitalization in terms of discrete, powerful and coherent entities, e.g., describing the first hospitalization as "swimming against the tide." The two metaphors modes reflect the embodiment of the unpredictability, being mired in distress, shock, intense pain and the experience the collapse of continuity on the life course and cuts off the experience of control. Conclusions Metaphors are important and powerful guide in assessing individuals and families’ phenomenological reality. As such, metaphors are useful for understanding and orientated therapeutic intervening, in the studies above, with the first psychiatric hospitalization experienced, as well as in others social workers’ interventions.

Keywords: first mental breakdown, metaphors, family perspective, qualitative research

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Authors: Reena Aggarwal

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Wall art is a manifestation of the human mind and an absorbing form of cultural expression. Solapur wall hanging making art reflects cultural values, regional sensibilities, beliefs, and identity and helps to preserve the many different communities. The tango of warp and weft in many ways than one tells the story of civilization itself. Solapur wall hanging is a poem in multicolor, written with the warp and weft having long, rich, and complex history with indigenous design vocabularies made by the Padmasali communities. The wall-hanging weaving of Solapur has remained unaltered for years, from being very basic and monochrome having landscapes and portraits catering only to the local market, thereby becoming a potential family income generation tool. The study focuses on the need for contemporization of the Solapur wall hanging and also deliberates on the fact that wherever the culture of native people has been aided by intervention, in nearly every case, the quality of their craft has began to be enhanced. The study also found the underlying reason for diminishing sales to a declining market, low sales, lack of innovation in design, and product development. Keeping in mind that the artisans of Solapur have heroically always hold on to their ancient beliefs and practices, which give them strength and identity, and a sense of pride, an intervention program was developed with an objective of widening the market and help artisans have a sustaining income which include urban consumers and create designs suitable for the urban market. The process of defining and measuring the advantages of design intervention was achieved by using qualitative research methods. An ethnographic research methodology was adopted, which includes six months of close interface with artisans from ten families engaged in making of wall hanging in Solapur. Design solutions were proposed in terms of product diversification and design extensions of the existing product line for increased variety. A collection of contemporary wall arts (wall decor) and room dividers were designed and developed.

Keywords: wall hanging, Solapur, contemporization, traditional, sustainable

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Authors: Maiko Kiyohara, Toshiki Ito

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In this study, we used a psychotherapy process for patient with dissociative disorder and the graphic Rorschach (Digital version) (GRD). A dissociative disorder is a type of dissociation characterized by multiple alternating personalities (also called alternate identity or another identity). "dissociation" is a state in which consciousness, memory, thinking, emotion, perception, behavior, body image, and so on are divided and experienced. Dissociation symptoms, such as lack of memory, are seen, and the repetition of blanks in daily events causes serious problems in life. Although the pathological mechanism of dissociation has not yet been fully elucidated, it is said that it is caused by childhood abuse or shocking trauma. In case of Japan, no reliable data has been reported on the number of patients and prevalence of dissociative disorders, no drug is compatible with dissociation symptoms, and no clear treatment has been established. GRD is a method that the author revised in 2017 to a Graphic Rorschach, which is a special technique for subjects to draw language responses when enforce Rorschach. GRD reduces the burden on both the subject and the examiner, reduces the complexity of organizing data, improves the simplicity of organizing data, and improves the accuracy of interpretation by introducing a tablet computer during the drawing reaction. We are conducting research for the purpose. The patient in this case is a woman in her 50s, and has multiple personalities since childhood. At present, there are about 10 personalities whose main personality is just grasped. The patients is raising her junior high school sons as single parent, but personal changes often occur at home, which makes the home environment inferior and economically oppressive, and has severely hindered daily life. In psychotherapy, while a personality different from the main personality has appeared, I have also conducted psychotherapy with her son. In this case, the psychotherapy process and the GRD were performed to understand the personality characteristics, and the possibility of therapeutic significance to personality integration is reported.

Keywords: GRD, dissociative disorder, a case study of psychotherapy process, dissociation

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Authors: Angkrit Phitchayangkoon, Ar-Aishah Dadeh

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Background: A key aim of triage is to identify the patients with high risk of cardiac arrest because they require intensive monitoring, resuscitation facilities, and early intervention. We aimed to identify the predicting factors such as initial vital signs, serum pH, serum lactate level, initial capillary blood glucose, and Modified Early Warning Score (MEWS) which affect the occurrence of cardiac arrest in an emergency department (ED). Methods: We conducted a retrospective data review of ED patients in an emergency department (ED) from 1 August 2014 to 31 July 2016. Significant variables in univariate analysis were used to create a multivariate analysis. Differentiation of predicting factors between cardiac arrest patient and non-cardiac arrest patients for occurrence of cardiac arrest in an emergency department (ED) was the primary outcome. Results: The data of 527 non-trauma patients with Emergency Severity Index (ESI) 1-3 were collected. The factors found to have a significant association (P < 0.05) in the non-cardiac arrest group versus the cardiac arrest group at the ED were systolic BP (mean [IQR] 135 [114,158] vs 120 [90,140] mmHg), oxygen saturation (mean [IQR] 97 [89,98] vs 82.5 [78,95]%), GCS (mean [IQR] 15 [15,15] vs 11.5 [8.815]), normal sinus rhythm (mean 59.8 vs 30%), sinus tachycardia (mean 46.7 vs 21.7%), pH (mean [IQR] 7.4 [7.3,7.4] vs 7.2 [7,7.3]), serum lactate (mean [IQR] 2 [1.1,4.2] vs 7 [5,10.8]), and MEWS score (mean [IQR] 3 [2,5] vs 5 [3,6]). A multivariate analysis was then performed. After adjusting for multiple factors, ESI level 2 patients were more likely to have cardiac arrest in the ER compared with ESI 1 (odds ratio [OR], 1.66; P < 0.001). Furthermore, ESI 2 patients were more likely than ESI 1 patients to have cardiovascular disease (OR, 1.89; P = 0.01), heart rate < 55 (OR, 6.83; P = 0.18), SBP < 90 (OR, 3.41; P = 0.006), SpO2 < 94 (OR, 4.76; P = 0.012), sinus tachycardia (OR, 4.32; P = 0.002), lactate > 4 (OR, 10.66; P = < 0.001), and MEWS > 4 (OR, 4.86; P = 0.028). These factors remained predictive of cardiac arrest at the ED. Conclusion: The factors related to cardiac arrest in the ED are ESI 1 patients, ESI 2 patients, patients diagnosed with cardiovascular disease, SpO2 < 94, lactate > 4, and a MEWS > 4. These factors can be used as markers in the event of simultaneous arrival of many patients and can help as a pre-state for patients who have a tendency to develop cardiac arrest. The hemodynamic status and vital signs of these patients should be closely monitored. Early detection of potentially critical conditions to prevent critical medical intervention is mandatory.

Keywords: cardiac arrest, predicting factor, emergency department, emergency patient

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Authors: Reham Barakat

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Over the last few decades, the influence of International Financial Institutions (IFIs), especially the World Bank (WB), has significantly increased. Since the early 1980s, IFIs have assumed greater role, especially in developing countries; their total lending has dramatically increased, affecting billions of people in their Borrower States. Though the purpose of the development assistance provided by IFIs is to alleviate poverty and promote economic and social development in their member countries, IFIs have been subject to massive criticism by civil society institutions, international NGOs and local communities for the harmful environmental, social and economic impacts resulting from their development interventions in borrower countries, such as deforestation, displacement of indigenous peoples, and unemployment. While the role of IFIs has expanded over time, affecting billions of people, their accountability mechanisms remained behind and were criticized for lacking sufficient independency and enforceability. The serious adverse environmental impacts of the World Bank’s funded projects, along with their weak accountability mechanisms, raises the question of 'To what extent IFIs should be held internationally responsible for the harmful environmental consequences arising from their development interventions?'. This paper argues that IFIs are legally responsible for the harmful environmental consequences arising from their development interventions. The study (i) identifies the applicable laws and relevant primary rules from which the international environmental obligations of IFIs towards their borrower countries are derived (ii) assesses the World Bank’s compliance to the principles of the International Environmental Law including the precautionary principle, the polluter pays principle, and the principle of Good-Neighborliness, (iii) assesses the World Bank’s current internal accountability mechanisms for harmful environmental impacts resulting from the World Bank’s funded projects, and finally (iv) identifies the appropriate dispute settlement mechanisms to which states and non-state actors could raise their claims against IFIs for harmful environmental consequences arising from their interventions.

Keywords: international environmental law, international financial institutions, international responsibility, world bank, environmental and social safeguards

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