Search results for: ethical progression

Authors: Geliashvili T. M., Tyulyandina A. S., Valiev A. K., Kononets P. V., Kharatishvili T. K., Salkov A. G., Pronin A. I., Gadzhieva E. H., Parnas A. V., Ilyakov V. S.

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Aim/Introduction: Metastasis (Mts) to the sternum, while extremely rare in differentiated thyroid cancer (DTC) (1), requires a personalized, multidisciplinary treatment approach. In aggressively growing Mts to the sternum, which rapidly become unresectable, a comprehensive therapeutic and diagnostic approach is particularly important. Materials and methods: We present a clinical case of solitary Mts to the sternum as first manifestation of a papillary thyroid microcarcinoma in a 55-year-old man. Results: 18F-FDG PET/CT after thyroidectomy confirmed the solitary Mts to the sternum with extremely high FDG uptake (SUVmax=71,1), which predicted its radioiodine-refractory (RIR). Due to close attachment to the mediastinum and rapid growth, Mts was considered unresectable. During the next three months, the patient received targeted therapy with the tyrosine kinase inhibitor (TKI) Lenvatinib 24 mg per day. 1st course of radioiodine therapy (RIT) 6 GBq was also performed, the results of which confirmed the RIR of the tumor process. As a result of systemic therapy (targeted therapy combined with RIT and suppressive hormone therapy with L-thyroxine), there was a significant biochemical response (decrease of serum thyroglobulin level from 50,000 ng/ml to 550 ng/ml) and a partial response with decrease of tumor size (from 80x69x123 mm to 65x50x112 mm) and decrease of FDG accumulation (SUVmax from 71.1 to 63). All of this made possible to perform surgical treatment of Mts - sternal extirpation with its replacement by an individual titanium implant. At the control examination, the stimulated thyroglobulin level was only 134 ng/ml, and PET/CT revealed postoperative areas of 18F-FDG metabolism in the removed sternal Mts. Also, 18F-FDG PET/CT in the early (metabolic) stage revealed two new bone Mts (in the area of L3 SUVmax=17,32 and right iliac bone SUVmax=13,73), which, as well as the removed sternal Mts, appeared to be RIRs at the 2nd course of RIT 6 GBq. Subsequently, on 02.2022, external beam radiation therapy (EBRT) was performed on the newly identified oligometastatic bone foci. At present, the patient is under dynamic monitoring and in the process of suppressive hormone therapy with L-thyroxine. Conclusion: Thus, only due to the early prescription of targeted TKI therapy was it possible to perform surgical resection of Mts to the sternum, thereby improve the patient's quality of life and preserve the possibility of radical treatment in case of oligometastatic disease progression.

Keywords: differentiated thyroid cancer, metastasis to the sternum, radioiodine therapy, radioiodine-refractory cancer, targeted therapy, lenvatinib

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Authors: Lee Rui, Rajeev Ramachandran

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The approach to recurrent fevers in the paediatric or adolescent age group is not a straightforward one. Causes range from infectious diseases to rheumatological conditions to endocrinopathies, and are usually accompanied by weight loss rather than weight gain. We present an interesting case of a 16-year-old girl brought by her mother to the General Pediatrics Clinic for concerns of recurrent fever paired with significant weight gain over 1.5 years, with no identifiable cause found despite extensive work-up by specialists ranging from Rheumatologists to Oncologists. This case provides a learning opportunity on the approach to weight gain paired with persistent fevers in a paediatric population, one which is not commonly encountered and prompts further evaluation and consideration of less common diagnoses. In a span of 2 years, the girl’s weight had increased from 55 kg at 13 years old (75th centile) to 73.9 kg at 16 years old (>97th centile). About 1 year into her rapid weight gain, she started developing recurrent fevers of documented temperatures > 37.5 – 38.6 every 2-3 days, resulting in school absenteeism when she was sent home after temperature-taking in school found her to be febrile. The rapid onset of weight gain paired with unexplained fevers prompted the treating physician to consider the diagnosis of ROHHAD syndrome. Rapid onset obesity with hypoventilation, hypothalamic dysfunction and autonomic dysregulation (ROHHAD) syndrome is a rare disorder first described in 2007. It is characterized by dysfunction of the autonomic and endocrine system, characterized by hyperphagia and rapid-onset weight gain. This rapid weight gain is classically followed by hypothalamic manifestations with neuroendocrine deficiencies, hypo-ventilatory breathing abnormalities, and autonomic dysregulation. ROHHAD is challenging to diagnose with and diagnosis is made based mostly on clinical judgement. However if truly diagnosed, the condition is characterized by high morbidity and mortality rates. Early recognition of sleep disorders breathing and targeted therapeutic interventions helps limit morbidity and mortality associated with ROHHAD syndrome. This case poses an interesting diagnostic challenge and a diagnosis of ROHHAD has to be considered, given the serious complications that can come with disease progression while conditions such as Munchausen’s or drug fever remain as diagnoses of exclusion until we have exhausted all other possible conditions.

Keywords: pediatrics, endocrine, weight gain, recurrent fever, adolescent

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Authors: Pirakorn Sukonthaman, Paphitchaya Temphattharachok, Warangkana Thammasanya, Kraichart Tantrakarnarpa, Tanongson Tientavorn

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Agriculture is the main occupation in Thailand. Excessive amount of pesticides are used to increase the products but are toxic to human body. In 2009, Bureau of Epidemiology received 1,691 cases reported with pesticides toxicity (2.66:100,000) which 10.61 % of them is caused by Organophosphate. The purposes are to find factors associated with pesticides used and plasma cholinesterase level and other emerging issues that previous studies did not explain among agricultural workers in Baan Na Yao, Chachoengsao, Thailand. This research was an exploratory mixed method study. Qualitative interviews and quantitative questionnaires were used together in order to gather information from the agricultural workers (mainly cassava and rice farming) directly exposed to pesticides within 2 months simultaneously. Qualitative participants were selected by purposive sampling and a total survey for quantitative ones. The quantitative data was statistically analyzed by using multiple logistic regression model. Qualitative data was transcribed verbatim and thematically analyzed. For qualitative study, 15 participants were interviewed and 300/323 participants (92.88%) were given questionnaires, of which were 175 male and 125 female and 113 among them were spraymen. The prevalence of abnormal plasma cholinesterase level was 92.28% (Safe 7.72% Risky 49.33% and Unsafe 42.95%). Participants with inappropriate behaviors during spraying had a significant association with plasma cholinesterase level (95%CI=1.399-14.858) but other factors such as age, gender, education, attitude and knowledge had no association. They also had encountered various symptoms from pesticides such as fatigue (61%), vertigo (59.67%) and headache (58.86%), etc. Although they had high knowledge and attitude they still had poor behaviors. Moreover, our qualitative component showed that though they had worn the personal protective equipment (PPE) regularly, their PPE was not standard. Not only substandard PPE, but also there were obstacles of wearing such as the hot climate and inconvenience. They misunderstood their symptoms from using pesticides as allergy. Therefore, they did not seek for proper medical check-ups and treatment. This research revealed almost all of the participants have abnormal levels of plasma cholinesterase related especially those with poor behaviors. They also wore PPE but inadequately and misunderstood the symptoms produced by organophosphate use as allergy. Therefore, they did not seek for medical treatment. Occupation health education, modification of PPE and periodic medical checking are ways to make agricultural workers concern and know if there is any progression in a long term.

Keywords: pesticides, plasma cholinesterase level, spraymen, agricultural workers

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Authors: Habib Noorbhai

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History of Cricket: Cricket has a known history spanning from the 16th century till present, with international matches having been played since 1844. The game of cricket arrived in Australia as soon as colonization began in 1788. Cricketers started playing on turf wickets in the late 1800’s and dimensions for both the boundary and pitch later became assimilated. As the years evolved, cricket bats and balls, protective equipment, playing surfaces and the three formats of the game adapted to the playing conditions and laws of cricket. Business of Cricket: During the late 1900's, the shorter version of the game (T20) was introduced in order to attract the crowds to stadiums and television viewers for broadcasting rights. One could argue if this was merely a business venture or a platform for enhancing the performance of cricketers. Between the 16th and 20th century, cricket was a common sport played for passion and pure enjoyment. Industries saw a potential in diversified business ventures in the game (as well as other sports played globally) and cricket subsequently became a career for players, administrators and coaches, the media, health professionals, managers and the corporate world. Pros and Cons of Cricket Developments: At present, the game has significantly gained from the use of technology, sports sciences and varied mechanisms to optimize the performances and forecast frameworks for injury prevention in cricket players. Unfortunately, these had not been utilized in the earlier times of cricket and it would prove interesting to observe how the greats of the game would have benefited with such developments. Cricketers in the 21st century are faced with many overwhelming commitments. One of these is playing cricket for 11 months in a year, making it more than 250 days away from home and their families. As the demand of player contracts increase, the supply of commitment and performances from players increase. Way Forward and Future Implications: The questions are: Are such disadvantages contributing to the overload and injury risks of players? How far have we really come in the cricketing world or has everything since the game’s inception become institutionalized with a business model? These are the fundamental questions which need to be addressed and legislation, policies and ethical considerations need to be drafted and implemented. These will ensure that there is equilibrium of effective transitions and management of not only the players, but also the credibility of the wonderful game.

Keywords: enterprising business of cricket, technology, legislation, credibility

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Authors: Enes Caliskan, Hatice Camgoz Akdag

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There is no doubt that humanity needs to realize the sustainability problems in the world and take serious action regarding that. All members of the United Nations adopted the 2030 Agenda for Sustainable Development, the most comprehensive study on sustainability internationally, in 2015. The summary of the study is 17 sustainable development goals. It covers everything about sustainability, such as environment, society and governance. The use of Information and Communication Technology (ICT), such as the Internet, mobile phones, and satellites, is essential for tackling the main issues facing sustainable development. Hence, the contributions of 3 major ICT companies to the sustainable development goals are assessed in this study. Quality Function Deployment (QFD) is utilized as a methodology for this study. Since QFD is an excellent instrument for comparing businesses on relevant subjects, a House of Quality must be established to complete the QFD application. In order to develop a House of Quality, the demanded qualities (voice of the customer) and quality characteristics (technical requirements) must first be determined. UN SDGs are used as demanded qualities. Quality characteristics are derived from annual sustainability and corporate social responsibility reports of ICT companies. The companies' efforts, as indicated by the QFD results, are concentrated on the use of recycled raw materials and recycling, reducing GHG emissions through energy saving and improved connectivity, decarbonizing the value chain, protecting the environment and water resources by collaborating with businesses that have completed CDP water assessments and paying attention to reducing water consumption, ethical business practices, and reducing inequality. The evaluations of the three businesses are found to be very similar when they are compared. The small differences between the companies are usually about the region they serve. Efforts made by the companies mostly concentrate on responsible consumption and production, life below water, climate action, and sustainable cities and community goals. These efforts include improving connectivity in needed areas for providing access to information, education and healthcare.

Keywords: multi-criteria decision-making, sustainable supply chain risk, supply chain agility, quality function deployment, Sustainable development goals

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Authors: E. T. Svahn

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Knowledge about the factors that influence the exchange between research and society is of the utmost importance for developing collaboration between different actors, especially in future science policy development and the creation of support structures for researchers. Among other things, how researchers look at the surrounding open science policy environment and what conditions and attitudes they have for interacting with it. This paper examines the Finnish researchers' attitudes towards open science policies in 2020. Open science is an integrated part of researchers' daily lives and supports not only the effectiveness of research outputs but also the quality of research. Open science policy in ideal situation is seen as a supporting structure that enables the exchange between research and society, but in other situation, it can end up being red tape generating obstacles and hindering possibilities of making science in an efficient way. Results of this study were carried out through focus group interviews. This qualitative research method was selected because it aims to understand the phenomenon under study. In addition, focus group interviews produce diverse and rich material that would not be available with other research methods. Focus group interviews have well-established applications in social science, especially in understanding the perspectives and experiences of research subjects. In this study, focus groups were used in studying the mindset and actions of researchers. Each group's size was between 4-10 people, and the aim was to bring out different perspectives on the subject. The interviewer enabled the presentation of different perceptions and opinions, and the focus group interviews were recorded and written as text. The material was analysed using grounded theory method. The results are presented as thematic areas, theoretical model, and as direct quotations. Attitudes towards open science policy can vary greatly depending on the research area. This study shows that the open science policy demands in medicine, technology, and natural sciences compared to social sciences, educational sciences, and the humanities, varies somewhat. The variation in attitudes between different research areas can thus be largely explained by the fact that the research output and ethical code vary significantly between certain subjects. This study aims to increase understanding of the nuances to what extent open science policies should be tailored for different disciplines and research areas.

Keywords: focus group interview, grounded theory, open science policy, science policy

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Authors: Reuben Mugisha, Stella Bakibinga

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The cervical cancer burden is a global threat, but more so in low income settings where more than 85% of mortality cases occur due to lack of sufficient screening programs. There is consequently a lack of early detection of cancer and precancerous cells among women. Studies show that 3% to 35% of deaths could have been avoided through early screening depending on prognosis, disease progression, environmental and lifestyle factors. In this study, a systematic literature review is undertaken to understand potential barriers and facilitators as documented in previous studies that focus on the application of telehealth in cervical cancer screening programs for early detection of cancer and precancerous cells. The study informs future studies especially those from low income settings about lessons learned from previous studies and how to be best prepared while planning to implement telehealth for cervical cancer screening. It further identifies the knowledge gaps in the research area and makes recommendations. Using a specified selection criterion, 15 different articles are analyzed based on the study’s aim, theory or conceptual framework used, method applied, study findings and conclusion. Results are then tabulated and presented thematically to better inform readers about emerging facts on barriers and facilitators to telehealth implementation as documented in the reviewed articles, and how they consequently lead to evidence informed conclusions that are relevant to telehealth implementation for cervical cancer screening. Preliminary findings of this study underscore that use of low cost mobile colposcope is an appealing option in cervical cancer screening, particularly when coupled with onsite treatment of suspicious lesions. These tools relay cervical images to the online databases for storage and retrieval, they permit integration of connected devices at the point of care to rapidly collect clinical data for further analysis of the prevalence of cervical dysplasia and cervical cancer. Results however reveal the need for population sensitization prior to use of mobile colposcopies among patients, standardization of mobile colposcopy programs across screening partners, sufficient logistics and good connectivity, experienced experts to review image cases at the point-of-care as important facilitators to the implementation of mobile colposcope as a telehealth cervical cancer screening mechanism.

Keywords: cervical cancer screening, digital technology, hand-held colposcopy, knowledge-sharing

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Authors: Madeleine Cox

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Objective: discussion of diagnosis of vernix caseosa peritonitis, recovery and subsequent caesarean seciton Case: 30 year old G4P1 presented in labour at 40 weeks, planning a vaginal birth afterprevious caesarean section. She underwent an emergency caesarean section due to concerns for fetal wellbeing on CTG. She was found to have a thin lower segment with a very small area of dehiscence centrally. The operation was uncomplicated, and she recovered and went home 2 days later. She then represented to the emergency department day 6 post partum feeling very unwell, with significant abdominal pain, tachycardia as well as urinary retention. Raised white cell count of 13.7 with neutrophils of 11.64, CRP of 153. An abdominal ultrasound was poorly tolerated by the patient and did not aide in the diagnosis. Chest and abdominal xray were normal. She underwent a CT chest and abdomen, which found a small volume of free fluid with no apparent collection. Given no obvious cause of her symptoms were found and the patient did not improve, she had a repeat CT 2 days later, which showed progression of free fluid. A diagnostic laparoscopy was performed with general surgeons, which reveled turbid fluid, an inflamed appendix which was removed. The patient improved remarkably post operatively. The histology showed periappendicitis with acute appendicitis with marked serosal inflammatory reaction to vernix caseosa. Following this, the patient went on to recover well. 4 years later, the patient was booked for an elective caesarean section, on entry into the abdomen, there were very minimal adhesions, and the surgery and her subsequent recovery was uncomplicated. Discussion: this case represents the diagnostic dilemma of a patient who presents unwell without a clear cause. In this circumstance, multiple modes of imaging did not aide in her diagnosis, and so she underwent diagnostic surgery. It is important to evaluate if a patient is or is not responding to the typical causes of post operative pain and adjust management accordingly. A multiteam approach can help to provide a diagnosis for these patients. Conclusion: Vernix caseosa peritonitis is a rare cause of acute abdomen post partum. There are few reports in the literature of the initial presentation and no reports on the possible effects on future pregnancies. This patient did not have any complications in her following pregnancy or delivery secondary to her diagnosis of vernix caseosa peritonitis. This may assist in counselling other women who have had this uncommon diagnosis.

Keywords: peritonitis, obstetrics, caesarean section, pain

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Authors: Karen Boaz, C. R. Charan

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Background: The infiltration of tumour stroma by eosinophils, Tumor-Associated Tissue Eosinophilia (TATE), is known to modulate the progression of Oral Squamous Cell Carcinoma (OSCC). Eosinophils have direct tumoricidal activity by release of cytotoxic proteins and indirectly they enhance permeability into tumor cells enabling penetration of tumoricidal cytokines. Also, eosinophils may promote tumor angiogenesis by production of several angiogenic factors. Identification of eosinophils in the inflammatory stroma has been proven to be an important prognosticator in cancers of mouth, oesophagus, larynx, pharynx, breast, lung, and intestine. Therefore, the study aimed to correlate TATE with clinical and histopathological variables, and blood eosinophil count to assess the role of TATE as a prognosticator in Oral Squamous Cell Carcinoma (OSCC). Methods: Seventy two biopsy-proven cases of OSCC formed the study cohort. Blood eosinophil counts and TNM stage were obtained from the medical records. Tissue sections (5µm thick) were stained with Haematoxylin and Eosin. The eosinophils were quantified at invasive tumour front (ITF) in 10HPF (40x magnification) with an ocular grid. Bryne’s grading of ITF was also performed. A subset of thirty cases was also assessed for association of TATE with recurrence, involvement of lymph nodes and surgical margins. Results: 1) No statistically significant correlation was found between TATE and TNM stage, blood eosinophil counts and most parameters of Bryne’s grading system. 2) Statistically significant relation of intense degree of TATE was associated with the absence of distant metastasis, increased lympho-plasmacytic response and increased survival (diseasefree and overall) of OSCC patients. 3) In the subset of 30 cases, tissue eosinophil counts were higher in cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. Conclusion: While the role of eosinophils in mediating immune responses seems ambiguous as eosinophils support cell-mediated tumour immunity in early stages while inhibiting the same in advanced stages, TATE may be used as a surrogate marker for determination of prognosis in oral squamous cell carcinoma.

Keywords: tumour-associated tissue eosinophilia, oral squamous cell carcinoma, prognosticator, tumoral immunity

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Authors: George Leventakis, George Kokkinis, Nikos Moustakidis, George Papalexandratos, Ioanna Vasiliadou

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Enhancing the feeling of public safety and crime prevention are tasks customarily assigned to the Police. Police departments have, however, recognized that traditional ways of policing methods are becoming obsolete; Community Policing (CP) philosophy; however, when applied appropriately, leads to seamless collaboration between various stakeholders like the Police, NGOs and the general public and provides the opportunity to identify risks, assist in solving problems of crime, disorder, safety and crucially contribute to improving the quality of life for everyone in a community. Social Media, on the other hand, due to its high level of infiltration in modern life, constitutes a powerful mechanism which offers additional and direct communication channels to reach individuals or communities. These channels can be utilized to improve the citizens’ perception of the Police and to capture individual and community needs, when their feedback is taken into account by Law Enforcement Agencies (LEAs) in a structured and coordinated manner. This paper presents research conducted under INSPEC²T (Inspiring CitizeNS Participation for Enhanced Community PoliCing AcTions), a project funded by the European Commission’s research agenda to bridge the gap between CP as a philosophy and as an organizational strategy, capitalizing on the use of Social Media. The project aims to increase transparency, trust, police accountability, and the role of civil society. It aspires to build strong, trusting relationships between LEAs and the public, supporting two-way, contemporary communication while at the same time respecting anonymity of all affected parties. Results presented herein summarize the outcomes of four online multilingual surveys, focus group interviews, desktop research and interviews with experts in the field of CP practices. The above research activities were conducted in various EU countries aiming to capture requirements of end users from diverse backgrounds (social, cultural, legal and ethical) and determine public expectations regarding CP, community safety and crime prevention.

Keywords: community partnerships, next generation community policing, social media, public safety

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Authors: Debora Caetano Dahas

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In ‘Ethics’ and in ‘A Political Treatise’ Spinoza presents his very influential take on natural law and the principles that guide his philosophical work and observations. Spinoza’s ideas about rationalization, God, and ethical behavior are undeniably relevant to many debates in the field of legal theory. In addition, it is important to note that Spinoza's takes on body, mind, and imagination played an important role in building a certain way of understanding the female figure in western societies and of their differences in regards to the male figure. It is important to emphasize that the constant and insistent presentation of women as inferior and irrational beings corroborates the institutionalization of discriminatory public policies and practices legitimized by the legal system that cooperates with the aggravation of gender inequalities. Therefore, his arguments in relation to women and their nature have been highly criticized, especially by feminist theorists during the second half of the 21st century. The questioning of this traditional philosophy –often phallocentric– and its way of describing women as irrational and less capable than men, as well as the attempt to reformulate postulates and concepts, takes place in such a way as to create a deconstruction of classical concepts. Some of the arguments developed by Spinoza, however, can serve as a basis for elucidating in what way and to what extent the social and political construction of the feminine identity served as a basis for gender inequality. Thus, based on to the observations elaborated by Moira Gantes, the present research addresses the relationship between Spinoza and the feminist demands in the juridical and political spheres, elaborating arguments that corroborate the convergence between his philosophy and feminist critical theory. Finally, this research aims to discuss how the feminists' critics of Spinoza’s writings have deconstructed and rehabilitated his principles and, in doing so, can further help to illustrate the importance of his philosophy –and, consequently, of his notes on Natural Law– in understanding gender equality as a vital part of the effective implementation of democratic debate and inclusive political participation and representation. In doing so, philosophical and legal arguments based on the feminist re-reading of Spinoza’s principles are presented and then used to explain the controversial political reform in Brazil, especially in regards to the applicability of the legislative act known as Law n. 9.504/1997 which establishes that at least 30% of legislative seats must be occupied by women.

Keywords: natural law, feminism, politics, gender equality

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Authors: Silvia Platania, Martina Morando, Giuseppe Santisi

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Introduction: In the last thirty years, there is constant talk of sustainable consumption and a "transition" of consumer lifestyles towards greater awareness of consumer choices (United Nation, 1992). The 2019 coronavirus (COVID-19) epidemic that has hit the world population since 2020 has had significant consequences in all areas of people's lives; individuals have been forced to change their behaviors, to redefine their owngoals, priorities, practices, and lifestyles, to rebuild themselves in the new situation dictated by the pandemic. Method(Participants and procedure ): The data were collected through an online survey; moreover, we used convenience sampling from the general population. The participants were 669 Italians consumers (Female= 514, 76.8%; Male=155, 23.2%) that choice sustainability brands, aged between 18 and 65 years (Mₐ𝓰ₑ = 35.45; Standard Deviation, SD = 9.51).(Measure ): The following measures were used: The Muncy–Vitell Consumer Ethics Scale; Attitude Toward Business Scale; Perceived Consumer Effectiveness Scale; Consumers Perception on Sustainable Brand Attitudes. Results: Preliminary analyses were conducted to test our model. Pearson's bivariate correlation between variables shows that all variables of our model correlate significantly and positively, PCE with CPSBA (r = .56, p <.001). Furthermore, a CFA, according to Harman's single-factor test, was used to diagnose the extent to which common-method variance was a problem. A comparison between the hypothesised model and a model with one factor (with all items loading on a unique factor) revealed that the former provided a better fit for the data in all the CFA fit measures [χ² [6, n = 669] = 7.228, p = 0.024, χ² / df = 1.20, RMSEA = 0.07 (CI = 0.051-0.067), CFI = 0.95, GFI = 0.95, SRMR = 0.04, AIC = 66.501; BIC = 132,150). Next, amulti mediation was conducted to test our hypotheses. The results show that there is a direct effect of PCE on ethical consumption behavior (β = .38) and on ATB (β = .23); furthermore, there is a direct effect on the CPSBA outcome (β = .34). In addition, there is a mediating effect by ATB (C.I. =. 022-.119, 95% interval confidence) and by CES (C.I. =. 136-.328, 95% interval confidence). Conclusion: The spread of the COVID-19 pandemic has affected consumer consumption styles and has led to an increase in online shopping and purchases of sustainable products. Several theoretical and practical considerations emerge from the results of the study.

Keywords: decision making, sustainability, pandemic, multimediation model

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Authors: Mohammed Mutala Surazu

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The origin of Islam is traced back to the time of Prophet Mohammed (SAW), 571 AD, who thought the six main articles of faith and the five pillars of the region. Today, Islam is regarded as one of the fastest growing religions in the world, another peaceful one and very accommodating to other religions. Politics dominates in Islam and, as a result, divisions into various groupings, including the Ahmadiyah, Tijania, Suni and many others. Despite all believing the Qur’an as the only holy book used, they are all affiliated with different types of hadiths, including the al-Nawawi’s. These divisions are the reasons for tension in Islam, and it is necessary to conduct this research to investigate political situations in Islam within the society. Over the past three or two decades, there have been diverse and divided opinions about politics and religion (Islam). Many believe that politics and religion are inherently subjective and should be accepted as such, and the further argument for a relativistic approach is that individuals' and communities’ beliefs and values should be acknowledged and respected since no single political or religious ideology can claim absolute truth and superiority over the other. The perspective view is that emphasis is placed on tolerance and coexistence between different political and religious views; moreover, society is comprised of individuals with different backgrounds, opinions and interests, so it is necessary to find common ground and create space where diverse ideas can peacefully coexist in order to promote dialogue, understanding and mutual respect to maintain social harmony and peaceful relation in the society. Also, some individuals in society argue about the universalism of certain moral principles, which should be certain and agreed upon by all. For example, the Jewish people believe that eating pork is wrong, and if someone of another religion is asked if they agree with that, objectively, the non-Jewish would be comfortable with that. Others still argue that a continuous relativistic approach to politics and religion can lead to a breakdown of shared moral standards, loss of ethical principles, doubting faith or loyalty and uprising against agencies of politics and religion. And within the political groupings, they believe in the same ideologies to propagate their message, likewise the religious belongings (Christianity, Islam, Judaism and others) who also ensure that their religious perspectives or beliefs are deeply rooted in the society. This forms the basis for research about the perspective of politics and religious relativism in this modern era to respond to the questions and the challenges of religious politics in Islam.

Keywords: relativism, religion, universality, politics

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Authors: Gabriel Sunday Ayayia

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Food waste remains a critical global challenge with significant environmental, economic, and ethical implications. In an era where food waste and food insecurity coexist, innovative technology-driven solutions have emerged, aiming to bridge the gap between surplus food and those in need. Simultaneously, disparities in food access persist, exacerbating issues of hunger and malnutrition. Emerging food-sharing apps offer a promising avenue to mitigate these problems but require further examination within the context of the Ubuntu sharing economy. This study seeks to understand the impact of food-sharing apps, guided by the principles of Ubuntu, on reducing food waste and enhancing food access. The study examines how specific food-sharing apps within the Ubuntu sharing economy could contribute to fostering community resilience and reducing food waste. Ubuntu underscores the idea that we are all responsible for the well-being of our community members. In the context of food waste, this means that individuals and businesses have a collective responsibility to ensure that surplus food is shared rather than wasted. Food-sharing apps align with this principle by facilitating the sharing of excess food with those in need, transforming waste into a communal resource. This research employs a mixed-methods approach of both quantitative analysis and qualitative inquiry. Large-scale surveys will be conducted to assess user behavior, attitudes, and experiences with food-sharing apps, focusing on the frequency of use, motivations, and perceived impacts. Qualitative interviews with app users, community organizers, and stakeholders will explore the Ubuntu-inspired aspects of food-sharing apps and their influence on reducing food waste and improving food access. Quantitative data will be analyzed using statistical techniques, while qualitative data will undergo thematic analysis to identify key patterns and insights. This research addresses a critical gap in the literature by examining the role of food-sharing apps in reducing food waste and enhancing food access, particularly within the Ubuntu sharing economy framework. Findings will offer valuable insights for policymakers, technology developers, and communities seeking to leverage technology to create a more just and sustainable food system.

Keywords: sharing economy, food waste reduction, technology, community- based approach

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Authors: Tirimisiyu Olaide Gbadamosi

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Individuals go into business for the sake of obtaining regular income, becoming self-employed. Although, there different kinds of business enterprises that female and male can go into, often times, some businesses are regarded more suitable for a particular sex and not the other. This means that there is some gender discrimination in the choice of business one goes into and by extension in entrepreneurship development. Apparently, gender attitudes and behaviors will have positive or negative effects on entrepreneurship development in a society or economy. This research work therefore intends to take a critical look at gender discrimination as they affect entrepreneurship development with particular reference to northern Nigeria in general, using Exceptional Production Services Limited Kaduna, Kaduna North Local Government area as a case study, and also to suggest the possible solution to unidentified problems and give recommendation where necessary. Statement of research problem: Entrepreneurship has generally been recognised as a good medium or strategy for economic development of an individual, a community and a nation. It is also a known a known fact that some gender discrimination are often used in the choice of business or even the decision to go into business. For example, some businesses are regarded as more suitable to men than women. The question here is, is this the right approach to economic development through entrepreneurship? Of what effect is this approach to entrepreneurship development? These and the other questions are what this research intends to find answers to and if possible make recommendations. Significance of the study: The findings of this study will provide a guide for anyone for the establishment of a business in Nigeria. The study will help any prospective entrepreneur to make the right decision of which business to go into and how to contend with gender related issues that might influence its success in business. Furthermore, it is hoped that the study will assist the government and her agencies in the process in developing entrepreneurship development programs. Conclusion: There has been growing recognition that various types of discrimination do not always affect women and men in the same way. Moreover, gender discrimination may be intensified and facilitated by all other forms of discrimination. It has been increasingly recognized that without gender analysis of all forms of discrimination in business, including multiple forms of discrimination, and, in particular, in this context, related intolerance, violations of the human rights of women might escape detection and remedies to address racism may also fail to meet the needs of women and girls. It is also important that efforts to address gender discrimination incorporate approaches to the elimination of all forms of discrimination. Recommendation: Campaigning and raising awareness among young men and women, parents, teachers and employers about gender stereotypical attitudes towards academic performances and the likely consequences of overall educational choices for employment and entrepreneurship opportunities, career progression and earnings.

Keywords: entrepreneurship, economic development, small medium enterprises, gender discrimination

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Authors: L. Hoade, O. O. Onafowokan, K. Anderson, G. E. Bartlett, E. D. Fern, M. R. Norton, R. G. Middleton

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Aims: Femoroacetabular impingement (FAI) was first recognised as a potential driver for hip pain at the turn of the last millennium. While there is an increasing trend towards surgical management of FAI by arthroscopic means, open surgical hip dislocation and debridement (SHD) remains the Gold Standard of care in terms of reported outcome measures. (1) Long-term functional and survivorship outcomes of SHD as a treatment for FAI are yet to be sufficiently reported in the literature. This study sets out to help address this imbalance. Methods: We undertook a retrospective review of our institutional database for all patients who underwent SHD for FAI between January 2003 and December 2008. A total of 223 patients (241 hips) were identified and underwent a ten year review with a standardised radiograph and patient-reported outcome measures questionnaire. The primary outcome measure of interest was survivorship, defined as progression to total hip arthroplasty (THA). Negative predictive factors were analysed. Secondary outcome measures of interest were survivorship to further (non-arthroplasty) surgery, functional outcomes as reflected by patient reported outcome measure scores (PROMS) scores, and whether a learning curve could be identified. Results: The final cohort consisted of 131 females and 110 males, with a mean age of 34 years. There was an overall native hip joint survival rate of 85.4% at ten years. Those who underwent a THA were significantly older at initial surgery, had radiographic evidence of preoperative osteoarthritis and pre- and post-operative acetabular undercoverage. In those whom had not progressed to THA, the average Non-arthritic Hip Score and Oxford Hip Score at ten year follow-up were 72.3% and 36/48, respectively, and 84% still deemed their surgery worthwhile. A learning curve was found to exist that was predicated on case selection rather than surgical technique. Conclusion: This is only the second study to evaluate the long-term outcomes (beyond ten years) of SHD for FAI and the first outside the originating centre. Our results suggest that, with correct patient selection, this remains an operation with worthwhile outcomes at ten years. How the results of open surgery compared to those of arthroscopy remains to be answered. While these results precede the advent of collison software modelling tools, this data helps set a benchmark for future comparison of other techniques effectiveness at the ten year mark.

Keywords: femoroacetabular impingement, hip pain, surgical hip dislocation, hip debridement

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Authors: Anuruddhi Edirisinghe, Anusha Edirisinghe, Maithree Wicramasinghe, Sagarika Kannangara, Annista Wijayanayake

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SGBV which refer to acts of inflicting physical, mental or sexual harm or sufferings that deprive a person’s liberty based on one’s gender or sexuality is known to occur in various forms. Ragging in educational institutions can often be one such form of SGBV. Ragging related SGBV is a growing problem despite various legal, policy and programme initiatives introduced over the years. While the punishment of perpetrators through the criminal justice system is expected to bring a deterrent effect, other strategies such as awareness-raising, attitudinal changes, and the empowerment of students to say no to ragging and SGBV will lead to enlightened attitudes about the practice in universities. Thus, effective regular prevention programmes are the need of the hour. The objectives of the paper are to engage with the case of a female fresher subjected to verbal abuse, physical assault and sexual harassment due to events which started as a result of wearing a trouser to the university during the ragging season. The case came to the limelight since a complaint was made to the police and 10 students were arrested under the anti-ragging act. This led to dividend opinions among the student population and a backlash from the student union. Simultaneously, this resulted in the society demanding the stricter implementation of laws and the punishment of perpetrators. The university authority appointed a task force comprising of academics, non-academics, parents, community leaders, stakeholders and students to draw up an action plan to respond to the immediate situation as well as future prevention. The paper will also discuss the implementation of task force plan. The paper is based on interviews with those involved with the issue and the experiences of the task force members and is expected to provide an in-depth understanding of the intricacies and complications associated with dealing with a contentious problem such as ragging. Given the political and ethical issues involved with insider research as well as the sensationalism of the topic, maximum care will be taken to safeguard the interests of those concerned.

Keywords: fresher, sexual and gender based violence (SGBV), sexual harassment, ragging

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Authors: M. M. Essa, S. Subash, M. Akbar, S. Al-Adawi, A. Al-Asmi, G. J. Guillemein

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Objective: Transgenic (tg) mice which contain an amyloid precursor protein (APP) gene mutation, develop extracellular amyloid beta (Aβ) deposition in the brain, and severe memory and behavioural deficits with age. These mice serve as an important animal model for testing the efficacy of novel drug candidates for the treatment and management of symptoms of Alzheimer's disease (AD). Several reports have suggested that oxidative stress is the underlying cause of Aβ neurotoxicity in AD. Pomegranates contain very high levels of antioxidants and several medicinal properties that may be useful for improving the quality of life in AD patients. In this study, we investigated the effect of dietary supplementation of Omani pomegranate extract on the memory, anxiety and learning skills along with inflammation in an AD mouse model containing the double Swedish APP mutation (APPsw/Tg2576). Methods: The experimental groups of APP-transgenic mice from the age of 4 months were fed custom-mix diets (pellets) containing 4% pomegranate. We assessed spatial memory and learning ability, psychomotor coordination, and anxiety-related behavior in Tg and wild-type mice at the age of 4-5 months and 18-19 months using the Morris water maze test, rota rod test, elevated plus maze test, and open field test. Further, inflammatory parameters also analysed. Results: APPsw/Tg2576 mice that were fed a standard chow diet without pomegranates showed significant memory deficits, increased anxiety-related behavior, and severe impairment in spatial learning ability, position discrimination learning ability and motor coordination along with increased inflammation compared to the wild type mice on the same diet, at the age of 18-19 months In contrast, APPsw/Tg2576 mice that were fed a diet containing 4% pomegranates showed a significant improvements in memory, learning, locomotor function, and anxiety with reduced inflammatory markers compared to APPsw/Tg2576 mice fed the standard chow diet. Conclusion: Our results suggest that dietary supplementation with pomegranates may slow the progression of cognitive and behavioural impairments in AD. The exact mechanism is still unclear and further extensive research needed.

Keywords: Alzheimer's disease, pomegranates, oman, cognitive decline, memory loss, anxiety, inflammation

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Authors: Aulanni’am Aulanni’am

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Incidence of Diabetes Mellitus (DM) progressively increasing it became a serious problem in Indonesia and it is a disease that government is priority to be addressed. The longer a person is suffering from diabetes the more likely to develop complications particularly diabetic patients who are not well maintained. Therefore, Incidence of Diabetes Mellitus needs to be done in the early diagnosis of pre-phase of the disease. In this pre-phase disease, already happening destruction of pancreatic beta cells and declining in beta cell function and the sign autoimmunity reactions associated with beta cell destruction. Type 1 DM is a multifactorial disease triggered by genetic and environmental factors, which leads to the destruction of pancreatic beta cells. Early marker of "beta cell autoreactivity" is the synthesis of autoantibodies against 65-kDa protein, which can be a molecule that can be detected early in the disease pathomechanism. The importance of early diagnosis of diabetic patients held in the phase of pre-disease is to determine the progression towards the onset of pancreatic beta cell destruction and take precautions. However, the price for this examination is very expensive ($ 150/ test), the anti-GAD65 abs examination cannot be carried out routinely in most or even in all laboratories in Indonesia. Therefore, production-based Rapid Test Recombinant Human Protein GAD65 with "Reverse Flow Immunchromatography Technique" in Indonesia is believed to reduce costs and improve the quality of care of patients with diabetes in Indonesia. Rapid Test Product innovation is very simple and suitable for screening and routine inspection of GAD65 autoantibodies. In the blood serum of patients with diabetes caused by autoimmunity, autoantibody-GAD65 is a major serologic marker to detect autoimmune reaction because their concentration level of stability.GAD65 autoantibodies can be found 10 years before clinical symptoms of diabetes. Early diagnosis is more focused to detect the presence autontibodi-GAD65 given specification and high sensitivity. Autoantibodies- GAD65 that circulates in the blood is a major indicator of the destruction of the islet cells of the pancreas. Results of research in collaboration with Biofarma has produced GAD65 autoantibodies based Rapid Test had conducted the soft launch of products and has been tested with the results of a sensitivity of 100 percent and a specificity between 90 and 96% compared with the gold standard (import product) which worked based on ELISA method.

Keywords: diabetes mellitus, GAD65 autoantibodies, rapid test, sensitivity, specificity

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Authors: K. P. Valdés García, E. I. Rodríguez Fonseca, L. G. Juárez Cantú

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Suicide is a global, multidimensional and dynamic problem of mental health, which requires a constant study for its understanding and prevention. When research of this phenomenon is done, it is necessary to consider the different characteristics it may have because of the individual and sociocultural variables, the importance of this consideration is related to the generation of effective treatments and interventions. Adolescents are a vulnerable population due to the characteristics of the development stage. The investigation was carried out with the objective of identifying and describing the conceptualization of adolescents of suicide, and in this process, we find possible differences between men and women. The study was carried out in Saltillo, Coahuila, Mexico. The sample was composed of 418 volunteer students aged between 11 and 18 years. The ethical aspects of the research were reviewed and considered in all the processes of the investigation with the participants, their parents and the schools to which they belonged, psychological attention was offered to the participants and preventive workshops were carried in the educational institutions. Natural semantic networks were the instrument used, since this hybrid method allows to find and analyze the social concept of a phenomenon; in this case, the word suicide was used as an evocative stimulus and participants were asked to evoke at least five words and a maximum 10 that they thought were related to suicide, and then hierarchize them according to the closeness with the construct. The subsequent analysis was carried with Excel, yielding the semantic weights, affective loads and the distances between each of the semantic fields established according to the words reported by the subjects. The results showed similarities in the conceptualization of suicide in adolescents, men and women. Seven semantic fields were generated; the words were related in the discourse analysis: 1) death, 2) possible triggering factors, 3) associated moods, 4) methods used to carry it out, 5) psychological symptomatology that could affect, 6) words associated with a rejection of suicide, and finally, 7) specific objects to carry it out. One of the necessary aspects to consider in the investigations of complex issues such as suicide is to have a diversity of instruments and techniques that adjust to the characteristics of the population and that allow to understand the phenomena from the social constructs and not only theoretical. The constant study of suicide is a pressing need, the loss of a life from emotional difficulties that can be solved through psychiatry and psychological methods requires governments and professionals to pay attention and work with the risk population.

Keywords: adolescents, psychological construct, semantic networks, suicide

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Authors: Paloma Mendes Saldanha

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Access to information is a prerequisite for democracy while also guiding the material construction of fundamental rights. The exercise of citizenship requires knowing, understanding, questioning, advocating for, and securing rights and responsibilities. In other words, it goes beyond mere active electoral participation and materializes through awareness and the struggle for rights and responsibilities in the various spaces occupied by the population in their daily lives. In times of hyper-cultural connectivity, active citizenship is shaped through ethical trust processes, most often established between humans and algorithms. Automated decisions, so prevalent in various everyday situations, such as purchase preference predictions, virtual voice assistants, reduction of accidents in autonomous vehicles, content removal, resume selection, etc., have already found their place as a normalized discourse that sometimes does not reveal or make clear what violations of fundamental rights may occur when algorithmic explainability is lacking. In other words, technological and market development promotes a normalization for the use of automated decisions while silencing possible restrictions and/or breaches of rights through a culturally modeled, unethical, and unexplained trust process, which hinders the possibility of the right to a healthy, transparent, and complete exercise of citizenship. In this context, the article aims to identify the violations caused by the absence of algorithmic explainability in the exercise of citizenship through the construction of an unethical and silent trust process between humans and algorithms in automated decisions. As a result, it is expected to find violations of constitutionally protected rights such as privacy, data protection, and transparency, as well as the stipulation of algorithmic explainability as a fundamental right in the exercise of Brazilian citizenship in the era of virtualization, facing a threefold foundation called trust: culture, rules, and systems. To do so, the author will use a bibliographic review in the legal and information technology fields, as well as the analysis of legal and official documents, including national documents such as the Brazilian Federal Constitution, as well as international guidelines and resolutions that address the topic in a specific and necessary manner for appropriate regulation based on a sustainable trust process for a hyperconnected world.

Keywords: artificial intelligence, ethics, citizenship, trust

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Authors: Syed Asif Hassan, Tabrej Khan

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Multiple sclerosis (MS) is a chronic demyelinating autoimmune disorder, of the central nervous system (CNS). In the present scenario, the current therapies either do not halt the progression of the disease or have side effects which limit the usage of current Disease Modifying Therapies (DMTs) for a longer period of time. Therefore, keeping the current treatment failure schema, we are focusing on screening novel analogues of the available DMTs that specifically bind and inhibit the Sphingosine1-phosphate receptor1 (S1PR1) thereby hindering the lymphocyte propagation toward CNS. The novel drug-like analogs molecule will decrease the frequency of relapses (recurrence of the symptoms associated with MS) with higher efficacy and lower toxicity to human system. In this study, an integrated approach involving ligand-based virtual screening protocol (Ultrafast Shape Recognition with CREDO Atom Types (USRCAT)) to identify the non-toxic drug like analogs of the approved DMTs were employed. The potency of the drug-like analog molecules to cross the Blood Brain Barrier (BBB) was estimated. Besides, molecular docking and simulation using Auto Dock Vina 1.1.2 and GOLD 3.01 were performed using the X-ray crystal structure of Mtb LprG protein to calculate the affinity and specificity of the analogs with the given LprG protein. The docking results were further confirmed by DSX (DrugScore eXtented), a robust program to evaluate the binding energy of ligands bound to the ligand binding domain of the Mtb LprG lipoprotein. The ligand, which has a higher hypothetical affinity, also has greater negative value. Further, the non-specific ligands were screened out using the structural filter proposed by Baell and Holloway. Based on the USRCAT, Lipinski’s values, toxicity and BBB analysis, the drug-like analogs of fingolimod and BG-12 showed that RTL and CHEMBL1771640, respectively are non-toxic and permeable to BBB. The successful docking and DSX analysis showed that RTL and CHEMBL1771640 could bind to the binding pocket of S1PR1 receptor protein of human with greater affinity than as compared to their parent compound (Fingolimod). In this study, we also found that all the drug-like analogs of the standard MS drugs passed the Bell and Holloway filter.

Keywords: antagonist, binding affinity, chemotherapeutics, drug-like, multiple sclerosis, S1PR1 receptor protein

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Authors: Sera Ratu, Jane Chivers, Jessica Botfield

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Objectives: The Reproductive and Family Health Association of Fiji (RFHAF) and Family Planning Australia are working together to introduce quality comprehensive sexuality education into Special Schools - which are schools for students with disability. Sexual and reproductive health information is needed by students with disability attending Special Schools. Children with special needs go through the same changes as able-bodied children. The Fiji Disability Inclusion project is a three-year project that started in 2015. One of its objectives is to increase exposure to comprehensive sexuality education for primary and secondary school students with disability. Method: A baseline survey was undertaken with 72 students with disability; it included questions about puberty, sexual health, and relationships. 34 teachers also completed a survey about their views of sexuality education and confidence in delivering it. Consent was facilitated by running information sessions with teachers and parents. The process of gaining consent and completing the surveys was designed to be accessible to students with disability. Given the sensitive nature of reproductive and sexual health, and the potential vulnerability of young people with disability, ethical considerations were important in the design and implementation of the surveys, and ethics approval was obtained. Results: Findings from the surveys suggest that students have mixed knowledge and awareness of sexual health issues. Most teachers reported a need for their students to learn about sexuality and relationships. A positive outcome of conducting the surveys was that RFHAF staff reported they have developed skills and confidence in communicating with young people with a range of disabilities. They have a greater understanding of what students want to learn, and what teachers feel is important. Conclusions: These survey findings will assist RFHAF in developing comprehensive sexuality education programs that are relevant and accessible to students in Special Schools, and to develop an appropriate professional development program for teachers. Findings may also be applicable to other Special Schools when developing sexuality education programs. The education programs developed for students as part of this project, and the professional development programs for teachers, may be relevant to other countries.

Keywords: comprehensive sexuality education, delivery, sexual and reproductive health and rights, special schools

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Authors: Abisha Isaac Mohanlal

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Amidst all suspicions and cynicism raised by the legal fraternity, Artificial Intelligence has found its way into the legal system and has revolutionized the conventional forms of legal services delivery. Be it legal argumentation and research or resolution of complex legal disputes; artificial intelligence has crept into all legs of modern day legal services. Its impact has been largely felt by way of big data, legal expert systems, prediction tools, e-lawyering, automated mediation, etc., and lawyers around the world are forced to upgrade themselves and their firms to stay in line with the growth of technology in law. Researchers predict that the future of legal services would belong to artificial intelligence and that the age of human lawyers will soon rust. But as far as the Judiciary is concerned, even in the developed countries, the system has not fully drifted away from the orthodoxy of preferring Natural Intelligence over Artificial Intelligence. Since Judicial decision-making involves a lot of unstructured and rather unprecedented situations which have no single correct answer, and looming questions of legal interpretation arise in most of the cases, discretion and Emotional Intelligence play an unavoidable role. Added to that, there are several ethical, moral and policy issues to be confronted before permitting the intrusion of Artificial Intelligence into the judicial system. As of today, the human judge is the unrivalled master of most of the judicial systems around the globe. Yet, scientists of Artificial Intelligence claim that robot judges can replace human judges irrespective of how daunting the complexity of issues is and how sophisticated the cognitive competence required is. They go on to contend that even if the system is too rigid to allow robot judges to substitute human judges in the recent future, Artificial Intelligence may still aid in other judicial tasks such as drafting judicial documents, intelligent document assembly, case retrieval, etc., and also promote overall flexibility, efficiency, and accuracy in the disposal of cases. By deconstructing the major challenges that Artificial Intelligence has to overcome in order to successfully invade the human- dominated judicial sphere, and critically evaluating the potential differences it would make in the system of justice delivery, the author tries to argue that penetration of Artificial Intelligence into the Judiciary could surely be enhancive and reparative, if not fully transformative.

Keywords: artificial intelligence, judicial decision making, judicial systems, legal services delivery

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Authors: Poonam Goswami

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Background: The diagnosis of a serious illness like cancer can have an impact on a patient’s emotional well-being and may result in psychological symptoms, anxiety, depression, and loss of control. Advance care planning discussions ensure patients’ values and goals of care, including patients’ freedom to choose their place of death, are respected. Unfortunately, these discussions are often delayed and are not initiated early in patients’ cancer trajectory. As a result, patients’ wishes often remains unknown until the last phase of their life. Evidence suggests that many patients inappropriately receive aggressive treatment near the end of life, which does lead to higher resource utilization, decreased quality of life, and increased cost. Additionally, the novel coronavirus disease 2019 (COVID-19) pandemic challenged the health care systems worldwide and raised important ethical issues, especially regarding the potential need for rationing health care in the context of scarce resources and crisis capacity. The importance of goal concordant care is now even substantially important and is heightened in the context of this pandemic. Problem: Although there is growing evidence on the effects of the ACP on the completion of advanced directives, improved patient and family concordance for preferences for medical care, and receipt of care, there is still a lack of standardized ACP conversation strategies for patients with cancer. Methods: The Key concepts of ACP include (1) assessing patient and family readiness, (2) identifying a surrogate decision maker ( medical power of attorney), (3) exploring patient and family understanding of the disease and treatment options,(4) discussing the values and goals of care, and options for end-of-life care, (5) documenting patient preferences in the medical record, and (6) revisiting the discussions at every change in the treatment plan and /or change in clinical status, including at every hospitalization. Conclusion/Implication for practice: Advance Care Planning (ACP) and end-of-life (EOL) discussions are important for patients, families, and health care providers. Adopting the verbal and nonverbal communication strategies can help overcome the barriers to effective communication on these difficult discussions. ACP with goals of care discussions should not be delayed until the patient is hospitalized.

Keywords: advance care planning, end of life, cancer, global, pandemic

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Authors: Marissa Dallara, Amalia Ardeljan, Lexi Frankel, Nadia Obaed, Naureen Rashid, Omar Rashid

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Human Cytomegalovirus (HCMV) is a ubiquitous virus that remains latent in approximately 60% of individuals in developed countries. Viral load is kept at a minimum due to a robust immune response that is produced in most individuals who remain asymptomatic. HCMV has been recently implicated in cancer research because it may impose oncomodulatory effects on tumor cells of which it infects, which could have an impact on the progression of cancer. HCMV has been implicated in increased pathogenicity of certain cancers such as gliomas, but in contrast, it can also exhibit anti-tumor activity. HCMV seropositivity has been recorded in tumor cells, but this may also have implications in decreased pathogenesis of certain forms of cancer such as leukemia as well as increased pathogenesis in others. This study aimed to investigate the correlation between cytomegalovirus and the incidence of breast cancer. Methods The data used in this project was extracted from a Health Insurance Portability and Accountability Act (HIPAA) compliant national database to analyze the patients infected versus patients not infection with cytomegalovirus using ICD-10, ICD-9 codes. Permission to utilize the database was given by Holy Cross Health, Fort Lauderdale, for the purpose of academic research. Data analysis was conducted using standard statistical methods. Results The query was analyzed for dates ranging from January 2010 to December 2019, which resulted in 14,309 patients in both the infected and control groups, respectively. The two groups were matched by age range and CCI score. The incidence of breast cancer was 1.642% and 235 patients in the cytomegalovirus group compared to 4.752% and 680 patients in the control group. The difference was statistically significant by a p-value of less than 2.2x 10^-16 with an odds ratio of 0.43 (0.4 to 0.48) with a 95% confidence interval. Investigation into the effects of HCMV treatment modalities, including Valganciclovir, Cidofovir, and Foscarnet, on breast cancer in both groups was conducted, but the numbers were insufficient to yield any statistically significant correlations. Conclusion This study demonstrates a statistically significant correlation between cytomegalovirus and a reduced incidence of breast cancer. If HCMV can exert anti-tumor effects on breast cancer and inhibit growth, it could potentially be used to formulate immunotherapy that targets various types of breast cancer. Further evaluation is warranted to assess the implications of cytomegalovirus in reducing the incidence of breast cancer.

Keywords: human cytomegalovirus, breast cancer, immunotherapy, anti-tumor

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Authors: Yuri V. Bykov, V. A. Baturin

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Aim of the study: The aim of the study was to perform a comparative analysis of the levels of autoantibodies (AAB) to the S-100 protein as well as to the dopamine and NMDA receptors in children with type 1 diabetes mellitus (DM) in therapeutic remission. Materials and methods: Blood serum obtained from 42 children ages 4 to 17 years (20 boys and 22 girls) was analyzed. Twenty-one of these children had a diagnosis of type 1 DM and were in therapeutic remission (study group). The mean duration of disease in children with type 1 DM was 9.6±0.36 years. Children without DM were included in a group of "apparently healthy children" (21 children, comparison group). AAB to the S-100 protein, the dopamine, and NMDA receptors were measured by ELISA. The normal range of IgG AAB was specified as up to 10 µg/mL. In order to compare the central parameters of the groups, the following parametric and non-parametric methods were used: Student's t-test or Mann-Whitney U test. The level of significance for inter-group comparisons was set at p<0.05. Results: The mean levels of AAB to the S-100B protein were significantly higher (p=0.0045) in children with DM (16.84±1.54 µg/mL) when compared with "apparently healthy children" (2.09±0.05 µg/mL). The detected elevated levels of AAB to NMDA receptors may indicate that in children with type 1 DM, there is a change in the activity of the glutamatergic system, which in its turn suggests the presence of excitotoxicity. The mean levels of AAB to dopamine receptors were higher (p=0.0082) in patients comprising the study group than in the children of the comparison group (40.47±2.31 µg/mL and 3.91±0.09 µg/mL). The detected elevated levels of AAB to dopamine receptors suggest an altered activity of the dopaminergic system in children with DM. This can also be viewed as indirect evidence of altered activity of the brain's glutamatergic system. The mean levels of AAB to NMDA receptors were higher in patients with type 1 DM compared with the "apparently healthy children," at 13.16±2.07 µg/mL and 1.304±0.05 µg/mL, respectively (p=0.0021). The elevated mean levels of AAB to the S-100B protein may indicate damage to brain tissue in children with type 1 DM. A difference was also detected between the mean values of the measured AABs, and this difference depended on the duration of the disease: mean AAB values were significantly higher in patients whose disease had lasted more than five years. Conclusions: The elevated mean levels of AAB to the S-100B protein may indicate damage to brain tissue in the setting of excitotoxicity in children with type 1 DM. The discovered elevation of the levels of AAB to NMDA and dopamine receptors may indicate the activation of the glutamatergic and dopaminergic systems. The observed abnormalities indicate the presence of central nervous system damage in children with type 1 DM, with a tendency towards the elevation of the levels of the studied AABs with disease progression.

Keywords: autoantibodies, brain damage, children, diabetes mellitus

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Authors: Alina M. Udall, Judith de Groot, Simon de Jong, Avi Shankar

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There are many ways in which environmentally significant behavior can be explained. Dominant psychological theories, namely, the theory of planned behavior, the norm-activation theory, its extension, the value-belief-norm theory, and the theory of habit do not explain large parts of environmentally significant behaviors. A new and rapidly growing approach is to focus on how consumer’s identities predict environmentally significant behavior. Identity may be relevant because consumers have many identities that are assumed to guide their behavior. Therefore, we assume that many identities will guide environmentally significant behavior. Many identities can be relevant for environmentally significant behavior. In reviewing the literature, over 200 identities have been studied making it difficult to establish the key identities for explaining environmentally significant behavior. Therefore, this paper first aims to establish the key identities previously used for explaining environmentally significant behavior. Second, the aim is to test which key identities explain environmentally significant behavior. To address the aims, an online survey study (n = 578) is conducted. First, the exploratory factor analysis reveals 15 identity factors. The identity factors are namely, environmentally concerned identity, anti-environmental self-identity, environmental place identity, connectedness with nature identity, green space visitor identity, active ethical identity, carbon off-setter identity, thoughtful self-identity, close community identity, anti-carbon off-setter identity, environmental group member identity, national identity, identification with developed countries, cyclist identity, and thoughtful organisation identity. Furthermore, to help researchers understand and operationalize the identities, the article provides theoretical definitions for each of the identities, in line with identity theory, social identity theory, and place identity theory. Second, the hierarchical regression shows only 10 factors significantly uniquely explain the variance in environmentally significant behavior. In order of predictive power the identities are namely, environmentally concerned identity, anti-environmental self-identity, thoughtful self-identity, environmental group member identity, anti-carbon off-setter identity, carbon off-setter identity, connectedness with nature identity, national identity, and green space visitor identity. The identities explain over 60% of the variance in environmentally significant behavior, a large effect size. Based on this finding, the article reveals a new, theoretical framework showing the key identities explaining environmentally significant behavior, to help improve and align the field.

Keywords: environmentally significant behavior, factor analysis, place identity, social identity

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Authors: Madeleine Cox

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Objective: Discussion of diagnosis and management options for myometrial ectopic pregnancy Case: A 30 yo G1P0 presented to the emergency department with vaginal bleeding for the last 4 days. She had a positive home urine pregnancy test, confirmed with a serum HCG. When she presented for an ultrasound, there was no intrauterine pregnancy, no evidence of adnexal pregnancy, however, the anterior myometrium of the uterus was noted to be markedly abnormal. When she presented to the emergency department of a busy tertiary hospital in Queensland, she had a small amount of vaginal bleeding, was anxious but well, observations normal. Repeat blood testes demonstrated a serum HCG of 9246 IU/L, haemoglobin of 143g/L. The patient had an interesting history of a right oophorectomy and open myomectomy in another country. A repeat ultrasound again showed an abnormality within the myometrium of the uterus, which was initially reported as concerning for an AVM, or potentially invasive gestational trophoblastic disease. An MRI was organised 2 days later, which demonstrated a intramural/subserosal irregularity in the right lateral body measuring 35x38x42mm with peripheral enhancement and central cystic components, favouring a myometrial ectopic most likely at the site of previous myomectomy. Alternative diagnosis of AVM, GTD were considered less likely. After discussion with the patient, IV methotrexate was administered as an in patient 4 days after her initial presentation to emergency. After this, her HCG fell to 1236 IU/L on day 6 post treatment. Weekly reviews showed stable ultrasound appearances with a steadily dropping HCG level. A repeat MRI was performed 3 weeks after methotrexate administration which confirmed involution of the myometrial ectopic, however, showed ongoing progression of vascularity surrounding the site. Despite resolution of HCG, the patient persisted to have ongoing bleeding associated with this and went to have uterine artery embolisation. Follow up ultrasound showed resolution of abnormal vascularity and negative HCG levels. Conclusion: Myometrial ectopic pregnancies are a rare occurrence and require a multidisciplinary approach to achieve timely management for these patients. This patient was in a very well resourced setting with excellent access to Interventional Radiology and specialist Radiologists who could work together with the Obstetrics, Gynaecology, and Maternal Fetal Medicine team to provide multiple options of management which preserved her fertility. This case has a very good outcome, with the patient being referred back to our service 12 months later with an early intrauterine pregnancy.

Keywords: ectopic, pregnancy, miscarriage, gynaecology

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Authors: Laura Rueda-Gensini, Jader Rodríguez, Juan C. Cruz, Carolina Munoz-Camargo

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There is an emerging interest in botanicals and plant extracts for medicinal practices due to their widely reported health benefits. A large variety of phytochemicals found in plants have been correlated with antioxidant, immunomodulatory, and analgesic properties, which makes plant-derived products promising candidates for modulating the progression and treatment of numerous diseases. Non-centrifugal cane sugar (NCS), in particular, has been known for its high antioxidant and nutritional value, but composition-wise variability due to changing environmental and processing conditions have considerably limited its use in the nutraceutical and biomedical fields. This work is therefore aimed at assessing the effect of thermal exposure during NCS production over its bioactive composition and, in turn, its therapeutic value. Accordingly, two modified dehydration methods are proposed that employ: (i) vacuum-aided evaporation, which reduces the necessary temperatures to dehydrate the sample, and (ii) window refractance evaporation, which reduces thermal exposure time. The biochemical composition of NCS produced under these two methods was compared to traditionally-produced NCS by estimating their total polyphenolic and protein content with Folin-Ciocalteu and Bradford assays, as well as identifying the major phenolic compounds in each sample via HPLC-coupled mass spectrometry. Their antioxidant activities were also compared as measured by their scavenging potential of ABTS and DPPH radicals. Results show that the two modified production methods enhance polyphenolic and protein yield in resulting NCS samples when compared to traditional production methods. In particular, reducing employed temperatures with vacuum-aided evaporation demonstrated to be superior at preserving polyphenolic compounds, as evidenced both in the total and individual polyphenol concentrations. However, antioxidant activities were not significantly different between these. Although additional studies should be performed to determine if the observed compositional differences affect other therapeutic activities (e.g., anti-inflammatory, analgesic, and immunoprotective), these results suggest that reducing thermal exposure holds great promise for the production of natural products with enhanced nutritional value.

Keywords: non-centrifugal cane sugar, polyphenolic compounds, thermal processing, antioxidant activity

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