Search results for: medical practice

Authors: Mir Afzal Tajik

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The 'Strengthening Teacher Education in Pakistan' (STEP) is an innovative programme jointly funded by the Government of Canada and the Aga Khan Foundation Canada and implemented by the Aga Khan University - Institute for Educational Development (AKU-IED) in partnership with the local governments, education departments and communities in the provinces of Balochistan, Sindh and Gilgit-Baltistan in Pakistan. One of the key components of the programme is professional development of teachers, head teachers and teacher educators through a variety of teacher education programmes including a two-year Masters of Education (MEd) Programme offered by AKU-IED. A number of teachers, head teachers and teacher educators from these provinces have been developed through the MEd Programme. This paper discusses a qualitative research study conducted to explore the nature, relevance, rigor and richness of the experiences of the MEd graduates, and how these experiences have fostered their own professional development and their ability to bring about positive changes in their schools. The findings of the study provide useful insights into the graduates’ self-actualization, transformation of their professional beliefs and practices, the difference they have made in their schools, and the challenges they face. The study also provides evidences of how the implementation of this multi-stakeholders and multi-partners STEP programme has led to the development of ‘communities of practice’ in schools. The study then makes a number of recommendations for policy and practice related to teacher education programmes as well as for partnerships in education.

Keywords: STEP, change agents, Pakistan, Canada, teacher education, MEd

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Authors: Lisa Bennett, Cynthia Walters, Cynthia Argani, Andy Satin, Geeta Sood, Kerri Huber, Lisa Grubb, Woodrow Noble, Melissa Eichelberger, Darlene Zinalabedini, Eric Ausby, Jeffrey Snyder, Kevin Kirchoff

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Background: Surgical site infections (SSIs) within the obstetric population pose a variety of complications, creating clinical and personal challenges for the new mother and her neonate during the postpartum period. Our journey to achieve compliance with the SSI core measure for cesarean sections revealed many opportunities to improve these outcomes. Objective: Achieve and sustain core measure compliance keeping surgical site infection rates below the national benchmark pooled mean of 1.8% in post-operative patients, who delivered via cesarean section at the Johns Hopkins Bayview Medical Center. Methods: A root cause analysis was performed and revealed several environmental, pharmacologic, and clinical practice opportunities for improvement. A multidisciplinary approach led by the OB Safety Nurse, OB Medical Director, and Infectious Disease Department resulted in the implementation of fourteen interventions over a twenty-month period. Interventions included: post-operative dressing changes, standardizing operating room attire, broadening pre-operative antibiotics, initiating vaginal preps, improving operating room terminal cleaning, testing air quality, and re-educating scrub technicians on technique. Results: Prior to the implementation of our interventions, the SSI quarterly rate in Obstetrics peaked at 6.10%. Although no single intervention resulted in dramatic improvement, after implementation of all fourteen interventions, the quarterly SSI rate has subsequently ranged from to 0.0% to 2.70%. Significance: Taking an introspective look at current practices can reveal opportunities for improvement which previously were not considered. Collectively the benefit of these interventions has shown a significant decrease in surgical site infection rates. The impact of this quality improvement project highlights the synergy created when members of the multidisciplinary team work in collaboration to improve patient safety, and achieve a high quality of care.

Keywords: cesarean section, surgical site infection, collaboration and teamwork, patient safety, quality improvement

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Authors: Rara Wulan Anggareni, Narita Putri, Riski Septianing Astuti

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Breastfeeding is a key to prevent mortality and morbidity in children. It is also the second highest risk responsible for Disability Adjusted Life Years (DALYs) among children below five years old. UNICEF estimates that during 1995 – 2003, there are only about 38% infants in developing countries who get to be exclusively breastfed during the first six months of their lives. According to Demography and Health Survey in Indonesia 2007, breastfeed practice rate still considered as low which is about 41%. One of the factors causing the low breastfeed practice rate in Indonesia is the anxiety and postpartum depression, and also the weanling dilemma in which mother feels that her breastmilk cannot suffice infant needs. Those factors finally resulting into low or even stopped production of breastmilk. Breastmilk production can be enhanced by consuming food containing phytosterol and lactogoga effect. Food with the highest phytosterol level is Sauropus androgynus (L.) Merr leaf (merr leaf). In this study, we made alternative food which named Chocomerr for breastfeeding mothers. Chocomerr consists of merr leaves which have lactogoga effect and chocolate for relaxation. Based on organoleptic tests conducted towards 2 age groups, which are 18 – 21 and 25 – 40 years old, this product gets good acceptance in taste, texture, and colour categories. Chocomerr can be used as an alternative way for increasing breastmilk production to aim for the decreasing number of DALYs among children aged under 5 years old.

Keywords: breastfeeding, increasing, chocolate, merr leaves

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Authors: Jesvin Puay-Hwa Yeo, Laavanya Kathiravelu, Sa’Eda Binte Buang

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In the early days, myths and taboos were used by our ancestors to give explanations to the existence of nature and man, as well as to propitiate fortunes and to avoid unluckiness and harm. Myths and taboos are deeply rooted in our cultures and environment, and they form certain characteristics of any society, even in modern societies. With decades of the three main ethnic communities in Singapore – Malay, Indian and Chinese – living together, there has been intermingling and intermixing of traditions and practices. This may mean that what we think is a ‘Malay’ practice is actually one that is a hybrid of the Chinese and Malay. A good example would be the practice of covering all mirrors in a house of mourning. Therefore, the proposed seeks to explore and understand the underlying social influences of Singapore’s oral tradition. As part of a bigger cultural research project: Designing Cultures, the proposed paper focused on using secondary data to contribute to the overall cultural understanding of the integral connections between oral traditions, people and landscapes. The proposed paper will discuss in details the initials findings of the research project, including the two manners that contributed to the intermixing of myths and taboos. The first is the presence of social institutions such as religions, and the second is the presence of cross-cultural minorities such as the Straits Chinese. As well as other observations included the use and influence of Chinese oral traditions such as folklore among the early Chinese immigrants through social institutions.

Keywords: cultural belief, multiracial society, myths, oral tradition

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Authors: Nelson Igaba, C. Onaga, S. Hlongwane

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Background: Medical Male Circumcision (MMC) is part of a comprehensive HIV prevention strategy. The quality of MMC done at Right To Care (RtC) sites is maintained by Continuous Quality Improvement (CQI) based on findings of assessments by internal and independent external assessors who evaluate such parameters as the quality of the surgical procedure, infection control, etc. There are 12 RtC MMC teams in Mpumalanga, two of which are headed by Medical Officers and 10 by Clinical Associates (Clin A). Objectives: To compare the quality (i) of care rendered at doctor headed sites (DHS) versus Clin A headed sites (CHS); (ii) of CQI assessments (external versus internal). Methodology: A retrospective review of data from RightMax™ (a novel RtC data management system) and CQI reports (external and internal) was done. CQI assessment scores of October 2015 and October 2016 were taken as the baseline and latest respectively. Four sites with 745-810 circumcisions per annum were purposively selected; the two DHS (group A) and two CHS (group B). Statistical analyses were conducted using R (2017 version). Results: There were no significant difference in latest CQI scores between the two groups (DHS and CHS) (Anova, F = 1.97, df = 1, P = 0.165); between internal and external CQI assessment scores (Anova, F = 2.251, df = 1, P = 0.139) or among the individual sites (Anova, F = 1.095, df = 2, P = 0.341). Of the total of 16 adverse events reported by the four sites in the 12 months reviewed (all were infections), there was no statistical evidence that the documented severity of the infection was different for DHS and CHS (Fisher’s exact test, p-value = 0.269). Conclusion: At RtC VMMC sites in Mpumalanga, internal and external/independent CQI assessments are comparable, and quality of care of VMMC is standardized with the performance of well-supervised clinical associates comparing well with those of medical officers.

Keywords: adverse events, Right to Care, male medical circumcision, continuous quality improvement

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Authors: Kreso Ivandic, Filip Dodigovic, Damir Stuhec

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The paper deals with the proposed 'Material' and 'Action-resistance factor' design methods in designing the embedded retaining walls. The parametric analysis of evaluating the differences of the output values mutually and compared with classic approach computation was performed. There is a challenge with the criteria for choosing the proposed calculation design methods in Eurocode 7 with respect to current technical regulations and regular engineering practice. The basic criterion for applying a particular design method is to ensure minimum an equal degree of reliability in relation to the current practice. The procedure of combining the relevant partial coefficients according to design methods was carried out. The use of mentioned partial coefficients should result in the same level of safety, regardless of load combinations, material characteristics and problem geometry. This proposed approach of the partial coefficients related to the material and/or action-resistance should aimed at building a bridge between calculations used so far and pure probability analysis. The measure to compare the results was to determine an equivalent safety factor for each analysis. The results show a visible wide span of equivalent values of the classic safety factors.

Keywords: action-resistance factor design, classic approach, embedded retaining wall, Eurocode 7, limit states, material factor design

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Authors: Etaf Alkhlaifat

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This study drew conceptually on Communication Accommodation Theory to describe and analyze conversations between doctors and patients to examine the extent to which patients’ level of literacy represents one of the linguistic obstacles that may adversely influence the quality of healthcare services in Jordan. A thematic qualitative approach was employed to interpret the phenomena under study, which required direct observation and interviews with doctors (n=6) and patients (n=15) in natural Jordanian medical settings. This generated a comprehensive corpus of audio and videotaped data, which revealed that most doctors expressed dissatisfaction with patients’ ability to express themselves and comprehend them as a result of a lack of medical awareness and limited health education. The significance of this study rests on its detailed investigation of the impact of health literacy on patients’ health outcomes and while providing unique insights into how low health literacy could contribute to misunderstanding and potential ill-health.

Keywords: doctor-patient communication, health literacy, medical knowledge, communication accommodation theory, qualitative research

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Authors: Hsiao-Chuan Huang, King-Lung Kuo, Mei-Hsin Lo, Hsiao-Yun Chou, Yusen Lin

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The most robust and economical method for laboratory diagnosis of TB is to identify mycobacterial bacilli (AFB) under acid-fast staining despite its disadvantages of low sensitivity and labor-intensive. Though digital pathology becomes popular in medicine, an automated microscopic system for microbiology is still not available. A new AI-assisted automated microscopic system, consisting of a microscopic scanner and recognition program powered by big data and deep learning, may significantly increase the sensitivity of TB smear microscopy. Thus, the objective is to evaluate such an automatic system for the identification of AFB. A total of 5,930 smears was enrolled for this study. An intelligent microscope system (TB-Scan, Wellgen Medical, Taiwan) was used for microscopic image scanning and AFB detection. 272 AFB smears were used for transfer learning to increase the accuracy. Referee medical technicians were used as Gold Standard for result discrepancy. Results showed that, under a total of 1726 AFB smears, the automated system's accuracy, sensitivity and specificity were 95.6% (1,650/1,726), 87.7% (57/65), and 95.9% (1,593/1,661), respectively. Compared to culture, the sensitivity for human technicians was only 33.8% (38/142); however, the automated system can achieve 74.6% (106/142), which is significantly higher than human technicians, and this is the first of such an automated microscope system for TB smear testing in a controlled trial. This automated system could achieve higher TB smear sensitivity and laboratory efficiency and may complement molecular methods (eg. GeneXpert) to reduce the total cost for TB control. Furthermore, such an automated system is capable of remote access by the internet and can be deployed in the area with limited medical resources.

Keywords: TB smears, automated microscope, artificial intelligence, medical imaging

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Authors: Yen Ling Liu, Shu-Fen Wu, Chen-Fuh Lam, I-Ling Tsai, Chia-Yu Chen

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Purpose: Nurse anesthetists are confronting extraordinarily high job stress in their daily practice, deriving from the fast-track anesthesia care, risk of perioperative complications, routine rotating shifts, teaching programs and interactions with the surgical team in the operating room. This study investigated the influence of work stress on the burnout and turnover intention of nurse anesthetists in a regional general hospital in Southern Taiwan. Methods: This was a descriptive correlational study carried out in 66 full-time nurse anesthetists. Data was collected from March 2017 to June 2017 by in-person interview, and a self-administered structured questionnaire was completed by the interviewee. Outcome measurements included the Practice Environment Scale of the Nursing Work Index (PES-NWI), Maslach Burnout Inventory (MBI) and nursing staff turnover intention. Numerical data were analyzed by descriptive statistics, independent t test, or one-way ANOVA. Categorical data were compared using the chi-square test (x²). Datasets were computed with Pearson product-moment correlation and linear regression. Data were analyzed by using SPSS 20.0 software. Results: The average score for job burnout was 68.7916.67 (out of 100). The three major components of burnout, including emotional depletion (mean score of 26.32), depersonalization (mean score of 13.65), and personal(mean score of 24.48). These average scores suggested that these nurse anesthetists were at high risk of burnout and inversely correlated with turnover intention (t = -4.048, P < 0.05). Using linear regression model, emotional exhaustion and depersonalization were the two independent factors that predicted turnover intention in the nurse anesthetists (19.1% in total variance). Conclusion/Implications for Practice: The study identifies that the high risk of job burnout in the nurse anesthetists is not simply derived from physical overload, but most likely resulted from the additional emotional and psychological stress. The occurrence of job burnout may affect the quality of nursing work, and also influence family harmony, in turn, may increase the turnover rate. Multimodal approach is warranted to reduce work stress and job burnout in nurse anesthetists to enhance their willingness to contribute in anesthesia care.

Keywords: anesthesia nurses, burnout, job, turnover intention

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Authors: Nurten Tasdemir, Busra Baloglu, Zeynep Cingoz, Can Demirel, Zeki Gezer, Barıs Efe

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Student nurses are increasingly exposed to technology in the workplace after graduation with the growing numbers of electric health records (EHRs), handheld computers, barcode scanner medication dispensing systems, and automatic capture of patient data such as vital signs. Internationally, electronic health records (EHRs) systems are being implemented and evaluated. Students will inevitably encounter EHRs in the clinical learning environment and their professional practice. Nursing students must develop competency in the use of EHR. Aim: The study aimed to examine nursing students’ experiences of learning to use electronic health records (EHR) in clinical placements. Method: This study adopted a descriptive approach. The study population consisted of second and third-year nursing students at the Zonguldak School of Health in the West Black Sea Region of Turkey; the study was conducted during the 2015–2016 academic year. The sample consisted of 315 (74.1% of 425 students) nursing students who volunteered to participate. The students, who were involved in clinical practice, were invited to participate in the study Data were collected by a questionnaire designed by the researchers based on the relevant literature. Data were analyzed descriptively using the Statistical Package for Social Sciences (SPSS) for Windows version 16.0. The data are presented as means, standard deviations, and percentages. Approval for the study was obtained from the Ethical Committee of the University (Reg. Number: 29/03/2016/112) and the director of Nursing Department. Findings: A total of 315 students enrolled in this study, for a response rate of 74.1%. The mean age of the sample was 22.24 ± 1.37 (min: 19, max: 32) years, and most participants (79.7%) were female. Most of the nursing students (82.3%) stated that they use information technologies in clinical practice. Nearly half of the students (42.5%) reported that they have not accessed to EHR system. In addition, 61.6% of the students reported that insufficient computers available in clinical placement. Of the students, 84.7% reported that they prefer to have patient information from EHR system, and 63.8% of them found more effective to preparation for the clinical reporting. Conclusion: This survey indicated that nursing students experience to learn about EHR systems in clinical placements. For more effective learning environment nursing education should prepare nursing students for EHR systems in their educational life.

Keywords: electronic health record, clinical placement, nursing student, nursing education

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Authors: Abdullah I. Alkraiji, Thomas W. Jackson, Ian Murray

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The proliferation of health data standards today is somewhat overlapping and conflicting, resulting in market confusion and leading to increasing proprietary interests. The government role and support in standardization for health data are thought to be crucial in order to establish credible standards for the next decade, to maximize interoperability across the health sector, and to decrease the risks associated with the implementation of non-standard systems. The normative literature missed out the exploration of the different steps required to be undertaken by the government towards the development of national health data standards. Based on the lessons learned from a qualitative study investigating the different issues to the adoption of health data standards in the major tertiary hospitals in Saudi Arabia and the opinions and feedback from different experts in the areas of data exchange and standards and medical informatics in Saudi Arabia and UK, a list of steps required towards the development of national health data standards was constructed. Main steps are the existence of: a national formal reference for health data standards, an agreed national strategic direction for medical data exchange, a national medical information management plan and a national accreditation body, and more important is the change management at the national and organizational level. The outcome of this study can be used by academics and practitioners to develop the planning of health data standards, and in particular those in developing countries.

Keywords: interoperabilty, medical data exchange, health data standards, case study, Saudi Arabia

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Authors: Shamie Kumar

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Background: Radiologists and radiographers (RR) need to educate themselves and their colleagues to ensure that AI is integrated safely, useful, and in a meaningful way with the direction it always benefits the patients. AI education and training are fundamental to the way RR work and interact with it, such that they feel confident using it as part of their clinical practice in a way they understand it. Methodology: This exploratory research will outline the current educational and training gaps for radiographers and radiologists in AI radiology diagnostics. It will review the status, skills, challenges of educating and teaching. Understanding the use of artificial intelligence within daily clinical practice, why it is fundamental, and justification on why learning about AI is essential for wider adoption. Results: The current knowledge among RR is very sparse, country dependent, and with radiologists being the majority of the end-users for AI, their targeted training and learning AI opportunities surpass the ones available to radiographers. There are many papers that suggest there is a lack of knowledge, understanding, and training of AI in radiology amongst RR, and because of this, they are unable to comprehend exactly how AI works, integrates, benefits of using it, and its limitations. There is an indication they wish to receive specific training; however, both professions need to actively engage in learning about it and develop the skills that enable them to effectively use it. There is expected variability amongst the profession on their degree of commitment to AI as most don’t understand its value; this only adds to the need to train and educate RR. Currently, there is little AI teaching in either undergraduate or postgraduate study programs, and it is not readily available. In addition to this, there are other training programs, courses, workshops, and seminars available; most of these are short and one session rather than a continuation of learning which cover a basic understanding of AI and peripheral topics such as ethics, legal, and potential of AI. There appears to be an obvious gap between the content of what the training program offers and what the RR needs and wants to learn. Due to this, there is a risk of ineffective learning outcomes and attendees feeling a lack of clarity and depth of understanding of the practicality of using AI in a clinical environment. Conclusion: Education, training, and courses need to have defined learning outcomes with relevant concepts, ensuring theory and practice are taught as a continuation of the learning process based on use cases specific to a clinical working environment. Undergraduate and postgraduate courses should be developed robustly, ensuring the delivery of it is with expertise within that field; in addition, training and other programs should be delivered as a way of continued professional development and aligned with accredited institutions for a degree of quality assurance.

Keywords: artificial intelligence, training, radiology, education, learning

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Authors: Gulhan Sen

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Disasters could result in many deaths and injuries. In these difficult times, accessible resources are limited, demand and supply balance is distorted, and there is a need to make urgent interventions. Disproportionateness between accessible resources and intervention capacity makes triage a necessity in every stage of disaster response. Healthcare professionals, who are in charge of triage, have to evaluate swiftly and make ethical decisions about which patients need priority and urgent intervention given the limited available resources. For such critical times in disaster triage, 'doing the greatest good for the greatest number of casualties' is adopted as a code of practice. But there is no guide for healthcare professionals about ethical decision-making during disasters, and this study is expected to use as a source in the preparation of the guide. This study aimed to examine whether the qualities healthcare professionals in Izmir related to disaster triage were adequate and whether these qualities influence their capacity to make ethical decisions. The researcher used a survey developed for data collection. The survey included two parts. In part one, 14 questions solicited information about socio-demographic characteristics and knowledge levels of the respondents on ethical principles of disaster triage and allocation of scarce resources. Part two included four disaster scenarios adopted from existing literature and respondents were asked to make ethical decisions in triage based on the provided scenarios. The survey was completed by 215 healthcare professional working in Emergency-Medical Stations, National Medical Rescue Teams and Search-Rescue-Health Teams in Izmir. The data was analyzed with SPSS software. Chi-Square Test, Mann-Whitney U Test, Kruskal-Wallis Test and Linear Regression Analysis were utilized. According to results, it was determined that 51.2% of the participants had inadequate knowledge level of ethical principles of disaster triage and allocation of scarce resources. It was also found that participants did not tend to make ethical decisions on four disaster scenarios which included ethical dilemmas. They stayed in ethical dilemmas that perform cardio-pulmonary resuscitation, manage limited resources and make decisions to die. Results also showed that participants who had more experience in disaster triage teams, were more likely to make ethical decisions on disaster triage than those with little or no experience in disaster triage teams(p < 0.01). Moreover, as their knowledge level of ethical principles of disaster triage and allocation of scarce resources increased, their tendency to make ethical decisions also increased(p < 0.001). In conclusion, having inadequate knowledge level of ethical principles and being inexperienced affect their ethical decision-making during disasters. So results of this study suggest that more training on disaster triage should be provided on the areas of the pre-impact phase of disaster. In addition, ethical dimension of disaster triage should be included in the syllabi of the ethics classes in the vocational training for healthcare professionals. Drill, simulations, and board exercises can be used to improve ethical decision making abilities of healthcare professionals. Disaster scenarios where ethical dilemmas are faced should be prepared for such applied training programs.

Keywords: disaster triage, medical ethics, ethical principles of disaster triage, ethical decision-making

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Authors: M. A. Rahman, A. T. Ohta, H. V. Trinh, J. Hyvl

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Atmospheric pressure and oxygen (O2) concentration are critical life support parameters for human-occupied aerospace vehicles and habitats. Various medical conditions may require medical O2; for example, the American Medical Association has determined that commercial air travel exposes passengers to altitude-related hypoxia and gas expansion. It may cause some passengers to experience significant symptoms and medical complications during the flight, requiring supplemental medical-grade O2 to maintain adequate tissue oxygenation and prevent hypoxemic complications. Although supplemental medical grade O2 is a successful lifesaver for respiratory and cardiac failure, O2-enriched exhaled air can contain more than 95 % O2, increasing the likelihood of a fire. In an aerospace environment, a localized high concentration O2 bubble forms around a patient being treated for hypoxia, increasing the cabin O2 beyond the safe limit. To address this problem, this work describes a medical O2 delivery system that can reduce the O2 concentration from patient-exhaled O2-rich air to safe levels while maintaining the prescribed O2 administration to the patient. The O2 delivery system is designed to be a part of the medical O2 kit. The system uses cationic multimetallic cobalt complexes to reversibly, selectively, and stoichiometrically chemisorb O2 from the exhaled air. An air-release sub-system monitors the exhaled air, and as soon the O2 percentage falls below 21%, the air is released to the room air. The O2-enriched exhaled air is channeled through a layer of porous, thin-film heaters coated with the cobalt complex. The complex absorbs O2, and when saturated, the complex is heated to 100°C using the thin-film heater. Upon heating, the complex desorbs O2 and is once again ready to absorb or remove the excess O2 from exhaled air. The O2 absorption is a sub-second process, and desorption is a multi-second process. While heating at 0.685 °C/sec, the complex desorbs ~90% O2 in 110 sec. These fast reaction times mean that a simultaneous absorb/desorb process in the O2 delivery system will create a continuous absorption of O2. Moreover, the complex can concentrate O2 by a factor of 160 times that in air and desorb over 90% of the O2 at 100°C. Over 12 cycles of thermogravimetry measurement, less than 0.1% decrease in reversibility in O2 uptake was observed. The 1 kg complex can desorb over 20L of O2, so simultaneous O2 desorption by 0.5 kg of complex and absorption by 0.5 kg of complex can potentially continuously remove 9L/min O2 (~90% desorbed at 100°C) from exhaled air. The complex is synthesized and characterized for reversible O2 absorption and efficacy. The complex changes its color from dark brown to light gray after O2 desorption. In addition to thermogravimetric analysis, the O2 absorption/desorption cycle is characterized using optical imaging, showing stable color changes over ten cycles. The complex was also tested at room temperature in a low O2 environment in its O2 desorbed state, and observed to hold the deoxygenated state under these conditions. The results show the feasibility of using the complex for reversible O2 absorption in the proposed fire safe medical O2 delivery system.

Keywords: fire risk, medical oxygen, oxygen removal, reversible absorption

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Authors: Nicholas Okpe

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The world is no more innocent as previously, as it gets more and more engulfed in both man-made and natural disasters and the call for religious intervention becomes intrinsically louder to the extent that any religious inclination that does not devolve into societal or humanitarian adventures makes no meaning. Issues such as wars, conflicts of different dimensions, natural and man made discomforts in form of environmental disturbances have thrown new challenges hitherto unknown to the doorsteps of religious groups especially faith based organizations. In the last two decades, the above speaks volumes in Nigeria such that Chunua Achebe's "things fallen apart" is real today all over Nigeria. An estimated five million people live in internally displaced camps all over the country as a consequence of various forms of social unrest as well as natural disasters. These incidences have brought to the fore the signifance of religion in societal affairs as many groups who through their interventions have often shown to be the hope of the people. The crux of this paper is to examine the role of religion in not only making people to cope with difficult situations they find themselves in, but also giving hope to the many who otherwise are feeling despondent and at the edge of life. Many religious groups have well developed strategies of interventions in various humanitarian situations. Thus, this paper assesses efforts of religions such as christianity, Islam and the indigenous African religion in this respect. It is discovered that the most potent and effective means of attending to humanitarian crisis today in Nigeria is through the various religious and cultural organizations as governments at various levels have lost credibility in such exercises.

Keywords: humanitarianism, religion, practice, nigeria

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Authors: Mohamad Shamsuri Juhari

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Fathers who positively involve themselves in their children’s lives will have had a constructive influence on the latter’s social, behavioural, and psychological development. This paper will share the preliminary findings of an ongoing research project which investigates Singaporean fathers from the nation’s minority Malay-Muslim community who commit the reverse, that is, it intends to study the reasons behind these fathers’ non-involvement during the period of their children’s developing years be it through absence, disinterest or ignorance. For instance, children from homes with absentee fathers are more likely to develop deficiencies in attitude and conduct. A father’s negative show of parental skills can also cause setbacks in the child’s education, economic instability in the latter’s future family life, as well as the likelihood of an ensuing intergenerational transmission of criminal behaviour. In the context of the minority Singaporean Malay-Muslim community, the need to investigate the challenges faced by fathers from the ethnic group in carrying out their parental roles arose due to the perceptible rise in statistics reflecting delinquency among its youths. This has resulted in other associated issues such as teenage pregnancies (and the subsequent cyclical patterns of divorce and single motherhood), over-representation in the data for drug offences, and under-representation in statistics reflecting academic achievement. While other factors are known to be involved, these negative outcomes have also been attributed to the lack of fatherly guidance in the affected Malay families. This still-ongoing research project is being carried out in two phases: The first by means of secondary research as well as exploratory data collection via roundtable and focus group discussions with fathers from diverse socio-economic backgrounds. This sets the way for the second phase in which a survey will be undertaken, followed by a series of in-depth face-to-face interviews. The research findings will then be translated into intervention initiatives to overcome the identified challenges. Based on the results collated from Phase 1 of the research, this paper will share a ‘first look’ on the challenges to effective parenting faced by Malay-Muslim fathers in Singapore specifically those relating to the socio-cultural domains of attitude, knowledge, and practice.

Keywords: Malay fathers, socio-cultural domains, attitude, knowledge, practice

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Authors: Kuan-Jen Lai, Fang-Yi Lin, Shang-Rong Huang, Yun-Zheng Zeng, Po-Chieh Hsu, Jay Wu

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The normalized glandular dose (DgN) estimates the energy deposition of mammography in clinical practice. The Monte Carlo simulations frequently use uniformly mixed phantom for calculating the conversion factor. However, breast tissues are not uniformly distributed, leading to errors of conversion factor estimation. This study constructed a three-layer phantom to estimated more accurate of normalized glandular dose. In this study, MCNP code (Monte Carlo N-Particles code) was used to create the geometric structure. We simulated three types of target/filter combinations (Mo/Mo, Mo/Rh, Rh/Rh), six voltages (25 ~ 35 kVp), six HVL parameters and nine breast phantom thicknesses (2 ~ 10 cm) for the three-layer mammographic phantom. The conversion factor for 25%, 50% and 75% glandularity was calculated. The error of conversion factors compared with the results of the American College of Radiology (ACR) was within 6%. For Rh/Rh, the difference was within 9%. The difference between the 50% average glandularity and the uniform phantom was 7.1% ~ -6.7% for the Mo/Mo combination, voltage of 27 kVp, half value layer of 0.34 mmAl, and breast thickness of 4 cm. According to the simulation results, the regression analysis found that the three-layer mammographic phantom at 0% ~ 100% glandularity can be used to accurately calculate the conversion factors. The difference in glandular tissue distribution leads to errors of conversion factor calculation. The three-layer mammographic phantom can provide accurate estimates of glandular dose in clinical practice.

Keywords: Monte Carlo simulation, mammography, normalized glandular dose, glandularity

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Authors: Anmol Patel

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Cardiopulmonary resuscitation is medical intervention which should be considered for all inpatients; with a patient centred approach, open communication and accurate documentation of clinical decisions. National enquiries have shown that in a significant number of cases CPR was attempted when it was considered inappropriate. In these circumstances attempting to prevent a natural death and subjecting a patient to trauma at the end of life would deprive them of a dignified death. Anticipatory “do not attempt CPR (DNACPR)” decisions aim to prevent this for those considered appropriate. As a legal document, these forms are required to be completed accurately and thoroughly. The aim of this study was to evaluate the difference in quality of DNACPR forms completed using electronic versus paper formats. A retrospective review of DNACPR forms and related documentation was completed in two District General Hospitals in South-East England, one of which uses electronic forms, while the other uses paper red forms. 50 completed forms from each hospital were analysed to assess for legibility, and quality of completion of all subsections of the form, including communications with family, relatives and the Multidisciplinary team. The hospital using paper forms showed a 40-44% rate of completion of sections relating to communication with patients and family, compared to 70% with the hospital using electronic forms. Similar trends were observed with other sections of the form. Conclusion: This study suggests that the implementation of electronic DNACPR forms significantly improves clinical practice and promotes better open communication with patients, family and the MDT.

Keywords: DNACPR, resuscitation, DNAR, patient communication

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Authors: Chung-Yu Wu, Chia-Chi Chang, Wei-Ming Chen, Pu-Wei Wu, Shih-Fan Chen, Po-Chun Chen

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Electrostimulation medical devices for neural diseases require electroactive and biocompatible materials to transmit signals from electrodes to targeting tissues. Protection of surrounding tissues has become a great challenge for long-term implants. In this study, we designed back-end processes with compatible, efficient, and reliable advantages over the current state-of-the-art. We explored a hermetic packaging process with high quality of adhesion and uniformity as the biocompatible devices for long-term implantation. This approach is able to provide both excellent biocompatibility and protection to the biomedical electronic devices by performing conformal coating of biocompatible materials. We successfully developed a packaging process that is capable of exposing the stimulating electrode and cover all other faces of chip with high quality of protection to prevent leakage of devices and body fluid.

Keywords: biocompatible package, medical microelectronics, surface coating, long-term implantation

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Authors: Sarthak Mishra, Astha Sinha

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There’s no doubt about the convenience of making commercial and business transactions over the Internet under the new business model known as the e-Commerce. The term 'Electronic commerce' or e-Commerce refers to the use of an electronic medium to carry out commercial transactions. E-Commerce is one of the parts of Information Science framework and its uses are gradually becoming popular. Thus, the threat of security issues in Information Science has now become an important subject of discussion amongst the concerned users. These two issues i.e. security and privacy are required to be looked into through social, organizational, technical and economic perspectives. The current paper analyses the effect of these two issues in the arena of e-commerce. Here, no specification has been discussed rather an attempt has been made to provide a general overview. Further, attempts have been made to discuss the security and privacy issues in relation to the E-Commerce financial transactions. We shall also discuss in particular different steps required to be taken before online shopping and also shall discuss the purpose of security and privacy in E-Commerce and why it has currently become the need of the present hour. Lastly, an attempt has been made to discuss the plausible future course of development of this practice and its impact upon the global economy and if any changes should be bought about to ensure a smooth evolution of the practice. This paper has adopted a descriptive methodology to undertake its major area of study, wherein the major source of information has been via the secondary resources. Also, the study is of a comparative nature wherein the position of the various national regimes have compared with regards to the research question.

Keywords: business-business transaction (B2B), business-consumer transaction (B2C), e-commerce, online transaction, privacy and security threats

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Authors: Ramona-Niculina Jurcau, Ioana-Marieta Jurcau, Dong Hun Kwak, Nicolae-Alexandru Colceriu

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Background: Stress management (SM) is a topic of great academic interest and equally a task to accomplish. In addition, it is recognized the beneficial role of unconventional therapies (UCT) in stress modulation. Aims: The aim was to evaluate medical (MS) versus non-medical students’ (NMS) opinions about academic stress management (ASM) using UCT. Methods: MS (n=103, third year males and females) and NMS (n=112, males and females, from humanities faculties, different years of study), out of their academic program, voluntarily answered to a questionnaire concerning: a) Classification of the four most important academic stress factors; b) The extent to which their daily life influences academic stress; c) The most important SM methods they know; d) Which of these methods they are applying; e) the UCT they know or about which they have heard; f) Which of these they know to have stress modulation effects; g) Which of these UCT, participants are using or would like to use for modulating stress; and if participants use UTC for their own choose or following a specialist consultation in those therapies (SCT); h) If they heard about the following UCT and what opinion they have (using visual analogue scale) about their use (following CST) for the ASM: Phytotherapy (PT), apitherapy (AT), homeopathy (H), ayurvedic medicine (AM), traditional Chinese medicine (TCM), music therapy (MT), color therapy (CT), forest therapy (FT). Results: Among the four most important academic stress factors, for MS more than for NMS, are: busy schedule, large amount of information taught; high level of performance required, reduced time for relaxing. The most important methods for SM that MS and NMS know, hierarchically are: listen to music, meeting friends, playing sport, hiking, sleep, regularly breaks, seeing positive side, faith; of which, NMS more than MS, are partially applying to themselves. UCT about which MS and less NMS have heard, are phytotherapy, apitherapy, acupuncture, reiki. Of these UTC, participants know to have stress modulation effects: some plants, bee’s products and music; they use or would like to use for ASM (the majority without SCT) certain teas, honey and music. Most of MS and only some NMS heard about PT, AT, TCM, MT and much less about H, AM, CT, TT. NMS more than MS, would use these UCT, following CST. Conclusions: 1) Academic stress is similarly reflected in MS and NMS opinions. 2) MS and NMS apply similar but very few UCT for stress modulation. 3) Information that MS and NMS have about UCT and their ASM application is reduced. 4) It is remarkable that MS and especially NMS, are open to UCT use for ASM, following an SCT.

Keywords: academic stress, stress management, stress modulation, medical students, non-medical students, unconventional therapies

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Authors: Yen-Sheng Ho

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It is important to actively adjust the legal system of land use in archaeological sites and the reward system to meet the needs of modern society and to solve the dilemma of government management. Under the principle of administration according to law and the principle of the clarity of law, human rights, legal orders and legitimate expectation shall be regulated. The Cultural Heritage Preservation Act has many norms related to archaeological sites in Taiwan. However, in practice, the preservation of archaeological sites still encounters many challenges. For instance, some archaeological sites have ‘management and maintenance plans’. The restrictions of land uses are not clearly defined making it difficult to determine how planting types and cultivation methods will impact the underground relics. In addition, there are questions as follows. How to coordinate the ‘site preservation plan’ with the Regional Planning Act and the Urban Planning Act? How to define preservation of land, preservation area and other uses of land or area? How to define land use in practice? How to control land use? After selecting three sites for the case investigation, this study will analyze the site’s land use status and propose the direction of land use and control methods. This study suggests that the prerequisite to limit the use of land is to determine the public interest in the preservation of the site. Another prerequisite is to establish a mechanism for permitting the use of the site and for setting the site preservation and zoning maintenance practices according to the Regional Planning Act, Urban Planning Act and other relevant rules, such as, land use zoning, land use control, land management, land maintenance, regional development and management and etc.

Keywords: archaeological site, land use and site preservation plan, regional planning, urban planning

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Authors: Rahul Bishnoi

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Theatre, as Ann Ubersfld calls it, is a paradox. At once, it is both a literary work and a physical representation. Theatre as a text is eternal, reproducible, and identical while as a performance, theatre is momentary and never identical to the previous performances. In this dual existence of theatre, who is the author? Is the author the playwright who writes the dramatic text, or the director who orchestrates the performance, or the actor who embodies the text? From the poststructuralist lens of Barthes, the author is dead. Barthes’ argument of discrete temporality, i.e. the author is the before, and the text is the after, does not hold true for theatre. A published literary work is written, edited, printed, distributed and then gets consumed by the reader. On the other hand, theatrical production is immediate; an actor performs and the audience witnesses it instantaneously. Time, so to speak, does not separate the author, the text, and the reader anymore. The question of authorship gets further complicated in Augusto Boal’s “Theatre of the Oppressed” movement where the audience is a direct participant like the actors in the performance. In this research, through an experimental performance, the duality of theatre is explored with the authorship discourse. And the conventional definition of authorship is subjected to additional complexity by erasing the distinction between an actor and the audience. The design/methodology of the experimental performance is as follows: The audience will be asked to produce a text under an anonymous virtual alias. The text, as it is being produced, will be read and performed by the actor. The audience who are also collectively “authoring” the text, will watch this performance and write further until everyone has contributed with one input each. The cycle of writing, reading, performing, witnessing, and writing will continue until the end. The intention is to create a dynamic system of writing/reading with the embodiment of the text through the actor. The actor is giving up the power to the audience to write the spoken word, stage instruction and direction while still keeping the agency of interpreting that input and performing in the chosen manner. This rapid conversation between the actor and the audience also creates a conversion of authorship. The main conclusion of this study is a perspective on the nature of dynamic authorship of theatre containing a critical enquiry of the collaboratively produced text, an individually performed act, and a collectively witnessed event. Using practice as a methodology, this paper contests the poststructuralist notion of the author as merely a ‘scriptor’ and breaks it further by involving the audience in the authorship as well.

Keywords: practice based research, performance studies, post-humanism, Avant-garde art, theatre

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Authors: Rose Hattab

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Women have been an important dynamic in religious context and the state-building process of Arab countries throughout history. During the 1970s as the movement for women’s activism and rights developed, the Iraqi state under the Ba’ath Party began to provide Iraqi women with legal and civil rights. This was done to liberate women from the grasps of social traditions and was a tangible espousing of equality between men and women in the process of nation-building. Whereas women’s rights were stronger and more supported throughout the earliest years of the Ba’ath Regime (1970-1990), the aftermath of the Gulf War and economic sanctions on the conditions of Iraqi society laid the foundation for a division of women’s rights between civil and religious authorities. Personal status codes that were secured in 1959 were being pushed back by amendments made in coordination with religious leaders. Civil laws were present on paper, but religious authority took prominence in practice. The written legal codes were inclusive of women’s rights, but there is not an active or ensured practice of these rights within Iraqi society. This is due to many different factors, such as religious, sectarian, political and conservative reasons that hold back or limit the ability for Iraqi women to have autonomy in aspects such as participation in the workforce, getting married, and ensuring social justice. This paper argues that the Personal Status Code introduced in 1959 – which replaced Sharia-run courts with personal status courts – provided Iraqi women with equality and increased mobility in social and economic dynamics. The statewide crisis felt after the Gulf War and the economic sanctions imposed by the United Nations led to a stark shift in the Ba’ath party’s political ideology. This ideological turn guided the social system to the embracement of social conservatism and religious traditions in the 1990s. The effect of this implementation continued after the establishment of a new Iraqi government during 2003-2005. Consequently, Iraqi women's rights in employment, marriage, and family became divided into paper and practice by religious authorities and civil law from that period to the present day. This paper also contributes to the literature by expanding on the gap between legal codes on paper and in practice, through providing an analysis of Iraqi women’s rights in the Iraqi Constitution of 2005 and Iraq’s Penal Code. The turn to conservative and religious traditions is derived from the multiplicity of identities that make up the Iraqi social fabric. In the aftermath of a totalitarian regime, active wars, and economic sanctions, the Iraqi people attempted to unite together through their different identities to create a sense of security in the midst of violence and chaos. This is not an excuse to diminish the importance of women’s rights, but in the process of building a new nation-state, women were lost from the narrative. Thus, the presence of gender equity is found in the written text but is not practiced and upheld in the social context.

Keywords: civil rights, Iraqi women, nation building, religion and conflict

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Authors: Vilasinee Jintalikhitdee, Saowapa Phaithayawat

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The research on “The Way of Life of the Civil Servant Community under the Bureau of the Royal Household” aims to study 1) the way of life of the people who live in the civil servant community in Tha Wasukri, and 2) the model of community administration of civil servants under the Bureau of the Royal Household. This research is conducted qualitatively and quantitatively by collecting data from interviews, focus group discussion, participant and non-participant observation along with the data from the questionnaire based on age groups which include elder group, working age group and youth group. The result of the research shows that the origin of this community is related to the history during the Rama V’s reign. It has been a harbor for the king to boat in any royal ceremonies; this custom is still maintained until today. The status or position of person who serves the king in terms of working is often inherited from the bureau of the Royal Household based on his/her consanguinity and, hence, further receives the rights to live in the Tha Wasukri area. Therefore, this community has some special characteristics demonstrating the way of living influenced by the regulation of the Bureau of the Royal Household such as respecting elders and interdependence in which there is internal social organization with the practice of bureaucracy in going in and out the community. The person who has rights to live here must be friendly to everybody so that this community will be a safe place for lives and property. The administration based on the model of Bangkok for local administration was used as an external structure only, but the way of living still follows the practice of the Bureau of the Royal Household.

Keywords: way of life, community, Tha Wasukri, Bureau of the Royal Household

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Authors: Tripta Dixit, Smita Sahu, William Selvamurthy, Sadhana Srivastava

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India is battling with the issues of accessibility, affordability and availability of quality health to the masses. Indian medical heritage which dated back to 3000 BC unveils the rich knowledge pool which has undergone a perceptible change over years, such as eradication of many communicable diseases, increasing individual awareness of quality health and import driven medical device market etc. Despite a slew of initiatives the holistic slogan of ‘health for all’ remains elusive and a concern for the nation. The 21st-century projects a myriad of challenges like cultural diversity, large population, demographic dividend and geographical segmentation leading to varied needs of people as per their regional conditions of climate, disease prevalence, nutrition and sanitation. But these challenges are also opportunities for the development of indigenous, low cost and accessible technologies to tackle them. This requires reinforcing the potential of indigenous technologies in coordination with prevailing health issues in various regions of country. This paper emphasis on the strategy for exploring the indigenous technologies with entrusted up-scaling to meet the diverse needs of the people. This review proposes to adopt technology transfer as a strategy to establish a vibrant ecosystem for identifying and up-scaling the indigenous medical technologies with diligent hand-holding for public health.

Keywords: health, indigenous, medical technology, technology transfer

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Authors: Zahra Emami, Mohammad Ebrahim Khamseh, Nahid Hashemi Madani, Iman Kermani

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The aim of the study was to map scientific research on adrenal gland diseases in the Middle East countries through the Web of Science database using scientometric analysis. Data were analyzed with Excel software; and HistCite was used for mapping of the scientific texts. In this study, from a total of 268 retrieved records, 1125 authors from 328 institutions published their texts in 138 journals. Among 17 Middle East countries, Turkey ranked first with 164 documents (61.19%), Israel ranked second with 47 documents (15.53%) and Iran came in the third place with 26 documents. Most of the publications (185 documents, 69.2%) were articles. Among the universities of the Middle East, Istanbul University had the highest science production rate (9.7%). The Journal of Clinical Endocrinology & Metabolism had the highest TGCS (243 citations). In the scientific mapping, 7 clusters were formed based on TLCS (Total Local Citation Score) & TGCS (Total Global Citation Score). considering the study results, establishment of scientific connections and collaboration with other countries and use of publications on adrenal gland diseases from high ranking universities can help in the development of this field and promote the medical practice in this regard. Moreover, investigation of the formed clusters in relation to Congenital Hyperplasia and puberty related disorders can be research priorities for investigators.

Keywords: mapping, scientific research, adrenal gland diseases, scientometric

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Authors: Zainab Alghali Elsaid Muhammed

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Background : IBS is a gastrointestinal disorder characterized by a variety of symptoms that occur concurrently. It is very common and is associated with high levels of psychiatric comorbidities, all of which have a negative impact on the patient's quality of life. Abdominal pain, diarrhea, constipation, excess gas, and bloating are common symptoms of IBS. Objectives : The purpose of this study is to determine the prevalence of IBS among medical students and intern doctors in Sudan, as well as the risk factors associated with it. Study design: This cross-sectional study was carried out in Sudan from April to July 2022. All participants completed a six-part online questionnaire. The ROME IV criteria questionnaire was used to make an IBS diagnosis. Participants completed the hospital anxiety and depression questionnaire in order to be diagnosed with anxiety and depression. Results : 600 participants filled out the questionnaire. The overall prevalence of IBS was found to be 42%, with females being the most affected. Intern doctors had higher IBS rates (30.0%) than medical students, but this was not statistically significant. Single status (p =0.079), good GPAs (p =0.00), had significant associations with IBS occurrence. Other significantly associated habits were sleeping less than 8 hours (p =0.013), two cups or less of coffee per day (p = 0.109), No smoking (p =0.001), and No exercise (p =0.00, IBS participants were also found to have a significant relationship with abnormal anxiety (p =0.00) and borderline depression (p=0.0156). Conclusion : The high prevalence of IBS in this study suggests that medical students and interns are unable to recognize their symptoms. The main IBS predictors in this study were suffering from anxiety or depression, having an insufficient income, sleeping less than 8 hours per day, working/ studying more than 8 hours per day, and not performing any type of exercise.

Keywords: irritable bowel syndrome, sudan, HADS, rome IV, medical students

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Authors: Maryam Tabrizi, Shahrzad Aarup

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Objectives- Understanding the close association between oral health and overall health for older adults at the right time and right place, a person, focus treatment through Project ECHO telementoring. Methodology- Data from monthly ECHO telementoring sessions were provided for three years. Sessions including case presentations, overall health conditions, considering medications, organ functions limitations, including the level of cognition. Contributions- Providing the specialist level of providing care to all elderly regardless of their location and other health conditions and decreasing oral health inequity by increasing workforce via Project ECHO telementoring program worldwide. By 2030, the number of adults in the USA over the age of 65 will increase more than 60% (approx.46 million) and over 22 million (30%) of 74 million older Americans will need specialized geriatrician care. In 2025, a national shortage of medical geriatricians will be close to 27,000. Most individuals 65 and older do not receive oral health care due to lack of access, availability, or affordability. One of the main reasons is a significant shortage of Oral Health (OH) education and resources for the elderly, particularly in rural areas. Poor OH is a social stigma, a thread to quality and safety of overall health of the elderly with physical and cognitive decline. Poor OH conditions may be costly and sometimes life-threatening. Non-traumatic dental-related emergency department use in Texas alone was over $250 M in 2016. Most elderly over the age of 65 present with at least one or multiple chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) are at higher risk to develop gum (periodontal) disease, yet they are less likely to get dental care. In addition, most older adults take both prescription and over-the-counter drugs; according to scientific studies, many of these medications cause dry mouth. Reduced saliva flow due to aging and medications may increase the risk of cavities and other oral conditions. Most dental schools have already increased geriatrics OH in their educational curriculums, but the aging population growth worldwide is faster than growing geriatrics dentists. However, without the use of advanced technology and creating a network between specialists and primary care providers, it is impossible to increase the workforce, provide equitable oral health to the elderly. Project ECHO is a guided practice model that revolutionizes health education and increases the workforce to provide best-practice specialty care and reduce health disparities. Training oral health providers for utilizing the Project ECHO model is a logical response to the shortage and increases oral health access to the elderly. Project ECHO trains general dentists & hygienists to provide specialty care services. This means more elderly can get the care they need, in the right place, at the right time, with better treatment outcomes and reduces costs.

Keywords: geriatric, oral health, project echo, chronic disease, oral health

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Authors: Federica Ceccoli

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Italy is undergoing one of its largest migratory waves, and Italian schools are reporting the highest numbers of multilingual students coming from immigrant families and speaking minority languages. For these pupils, who have not perfectly acquired their mother tongue yet, learning a second language may represent a burden on their linguistic development and may have some repercussions on their school performances and relational skills. These are some of the reasons why they have turned out to be those who have the worst grades and the highest school drop-out rates. However, despite these negative outcomes, it has been demonstrated that multilingual immigrant students frequently act as translators or language brokers for their peers or family members who do not speak Italian fluently. This activity has been defined as Child Language Brokering (hereinafter CLB) and it has become a common practice especially in minority communities as immigrants’ children often learn the host language much more quickly than their parents, thus contributing to their family life by acting as language and cultural mediators. This presentation aims to analyse the data collected by a research carried out during the school year 2014-2015 in the province of Ravenna, in the Northern Italian region of Emilia-Romagna, among 126 immigrant students attending junior high schools. The purpose of the study was to analyse by means of a structured questionnaire whether multilingualism matched with language brokering experiences or not and to examine the perspectives of those students who reported having acted as translators using their linguistic knowledge to help people understand each other. The questionnaire consisted of 34 items roughly divided into 2 sections. The first section required multilingual students to provide personal details like their date and place of birth, as well as details about their families (number of siblings, parents’ jobs). In the second section, they were asked about the languages spoken in their families as well as their language brokering experience. The in-depth questionnaire sought to investigate a wide variety of brokering issues such as frequency and purpose of the activity, where, when and which documents young language brokers translate and how they feel about this practice. The results have demonstrated that CLB is a very common practice among immigrants’ children living in Ravenna and almost all students reported positive feelings when asked about their brokering experience with their families and also at school. In line with previous studies, responses to the questionnaire item regarding the people they brokered for revealed that the category ranking first is parents. Similarly, language-brokering activities tend to occur most often at home and the documents they translate the most (either orally or in writing) are notes from teachers. Such positive feelings towards this activity together with the evidence that it occurs very often in schools have laid the foundation for further projects on how this common practice may be valued and used to strengthen the linguistic skills of these multilingual immigrant students and thus their school performances.

Keywords: immigration, language brokering, multilingualism, students' points of view

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