Search results for: self-help and family support group

Authors: Basma Hussein Abdelaziz Hassan, Kareem Kamel, Philobater Bahgat Adly Awad, Karim Fahmy

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Background: Laparoscopic adjustable gastric band was one of the most applied and common bariatric procedures in the last 8 years. However; the failure rate was very high, reaching approximately 60% of the patients not achieving the desired weight loss. Most patients sought another revisional surgery. In which, we compared two of the most common weight loss surgeries performed nowadays: the laparoscopic sleeve gastrectomy and laparoscopic one- anastomosis gastric bypass. Objective: To compare the weight loss and postoperative outcomes among patients undergoing conversion laparoscopic one-anastomosis gastric bypass (cOAGB) and laparoscopic sleeve gastrectomy (cSG) after a failed laparoscopic adjustable gastric band (LAGB). Patients and Methods: A prospective cohort study was conducted from June 2020 to June 2022 at a single medical center, which included 77 patients undergoing single-stage conversion to (cOAGB) vs (cSG). Patients were reassessed for weight loss, comorbidities remission, and post-operative complications at 6, 12, and 18 months. Results: There were 77 patients with failed LAGB in our study. Group (I) was 43 patients who underwent cOAGB and Group (II) was 34 patients who underwent cSG. The mean age of the cOAGB group was 38.58. While in the cSG group, the mean age was 39.47 (p=0.389). Of the 77 patients, 10 (12.99%) were males and 67 (87.01%) were females. Regarding Body mass index (BMI), in the cOAGB group the mean BMI was 41.06 and in the cSG group the mean BMI was 40.5 (p=0.042). The two groups were compared postoperative in relation to EBWL%, BMI, and the co-morbidities remission within 18 months follow-up. The BMI was calculated post-operative at three visits. After 6 months of follow-up, the mean BMI in the cOAGB group was 34.34, and the cSG group was 35.47 (p=0.229). In 12-month follow-up, the mean BMI in the cOAGB group was 32.69 and the cSG group was 33.79 (p=0.2). Finally, the mean BMI after 18 months of follow-up in the cOAGB group was 30.02, and in the cSG group was 31.79 (p=0.001). Both groups had no statistically significant values at 6 and 12 months follow-up with p-values of 0.229, and 0.2 respectively. However, patients who underwent cOAGB after 18 months of follow-up achieved lower BMI than those who underwent cSG with a statistically significant p-value of 0.005. Regarding EBWL% there was a statistically significant difference between the two groups. After 6 months of follow-up, the mean EBWL% in the cOAGB group was 35.9% and the cSG group was 33.14%. In the 12-month follow-up, the EBWL % mean in the cOAGB group was 52.35 and the cSG group was 48.76 (p=0.045). Finally, the mean EBWL % after 18 months of follow-up in the cOAGB group was 62.06 ±8.68 and in the cSG group was 55.58 ±10.87 (p=0.005). Regarding comorbidities remission; Diabetes mellitus remission was found in 22 (88%) patients in the cOAGB group and 10 (71.4%) patients in the cSG group with (p= 0.225). Hypertension remission was found in 20 (80%) patients in the cOAGB group and 14 (82.4%) patients in the cSG group with (p=1). In addition, dyslipidemia remission was found in 27(87%) patients in cOAGB group and 17(70%) patients in the cSG group with (p=0.18). Finally, GERD remission was found in about 15 (88.2%) patients in the cOAGB group and 6 (60%) patients in the cSG group with (p=0.47). There are no statistically significant differences between the two groups in the post-operative data outcomes. Conclusion: This study suggests that the conversion of LAGB to either cOAGB or cSG could be feasibly performed in a single-stage operation. cOAGB had a significant difference as regards the weight loss results than cSG among the mid-term follow-up. However, there is no significant difference in the postoperative complications and the resolution of the co-morbidities. Therefore, cOAGB could provide a reliable alternative but needs to be substantiated in future long-term studies.

Keywords: laparoscopic, gastric banding, one-anastomosis gastric bypass, Sleeve gastrectomy, revisional surgery, weight loss

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Authors: Goldie Lynn Diaz, Ma. Teresa Tricia G. Bautista, Elisabeth Engeljakob, Mary Glaze Rosal

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Introduction: Residents are expected to convey unfavorable news, discuss prognoses, and relieve suffering, and address do-not-resuscitate orders, yet some report a lack of competence in providing this type of care. Recognizing this need, Family Medicine residency programs are incorporating end-of-life care from symptom and pain control, counseling, and humanistic qualities as core proficiencies in training. Objective: This study determined the competency of Family Medicine Residents from various institutions in Metro Manila on rendering care for the dying. Materials and Methods: Trainees completed a Palliative Care Evaluation tool to assess their degree of confidence in patient and family interactions, patient management, and attitudes towards hospice care. Results: Remarkably, only a small fraction of participants were confident in performing independent management of terminal delirium and dyspnea. Fewer than 30% of residents can do the following without supervision: discuss medication effects and patient wishes after death, coping with pain, vomiting and constipation, and reacting to limited patient decision-making capacity. Half of the respondents had confidence in supporting the patient or family member when they become upset. Majority expressed confidence in many end-of-life care skills if supervision, coaching and consultation will be provided. Most trainees believed that pain medication should be given as needed to terminally ill patients. There was also uncertainty as to the most appropriate person to make end-of-life decisions. These attitudes may be influenced by personal beliefs rooted in cultural upbringing as well as by personal experiences with death in the family, which may also affect their participation and confidence in caring for the dying. Conclusion: Enhancing the quality and quantity of end-of-life care experiences during residency with sufficient supervision and role modeling may lead to knowledge and skill improvement to ensure quality of care. Fostering bedside learning opportunities during residency is an appropriate venue for teaching interventions in end-of-life care education.

Keywords: end of life care, geriatrics, palliative care, residency training skill

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Authors: Suzy Pereira, Alberto Rocha, Ana Almeida, Catarina Figueiredo, Helena Fonseca, Leonor Moreira, Carla Blum Vestena, Cristina Costa-Lobo

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The socio-educational support to parents, through parental education intervention programs, is part of European social policies, aiming to respond to the needs of education, promotion of well-being and development of children and young people. The purpose of this research is to evaluate the impact of the Positive Parenting Program on the subjective well-being of the parents of gifted children. The Positive Parenting Program is authored and is conducted by the National Association of Study and Intervention in Giftedness, Portuguese Association. The central question to be explored in this research is: Does the promotion of positive parenting in parents of gifted children have a positive impact on the subjective well-being? The sample consisted of 30 parents, non-probabilistic sampling of convenience, of which 15 parents belong to the intervention group and the rest to the control group. One dimension will be evaluated - subjective well-being, through the PANAS questionnaire - before and after the sessions of this program. The aim is to contribute to the understanding of the process and results of the positive parenting program in parents of gifted children.

Keywords: positive parenting, subjective well-being, giftedness, parental education intervention programs

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Authors: Bi Xiao Fang, Tan Bao Zhen

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Soft skills, core competencies, and generic competencies are exchangeable terminologies often used to represent a similar concept. In the Singapore context, such skills are currently being referred to as Critical Core Skills (CCS). In 2019, SkillsFuture Singapore (SSG) reviewed the Generic Skills and Competencies (GSC) framework that was first introduced in 2016, culminating in the development of the Critical Core Skills (CCS) framework comprising 16 soft skills classified into three clusters. The CCS framework is part of the Skills Framework, and whose stated purpose is to create a common skills language for individuals, employers and training providers. It is also developed with the objectives of building deep skills for a lean workforce, enhance business competitiveness and support employment and employability. This further helps to facilitate skills recognition and support the design of training programs for skills and career development. According to SSG, every job role requires a set of technical skills and a set of Critical Core Skills to perform well at work, whereby technical skills refer to skills required to perform key tasks of the job. There has been an increasing emphasis on soft skills for the future of work. A recent study involving approximately 80 organizations across 28 sectors in Singapore revealed that more enterprises are beginning to recognize that soft skills support their employees’ performance and business competitiveness. Though CCS is of high importance for the development of the workforce’s employability, there is little attention paid to the CCS use and profiling across occupations. A better understanding of how CCS is distributed across the economy will thus significantly enhance SSG’s career guidance services as well as training providers’ services to graduates and workers and guide organizations in their hiring for soft skills. This CCS profiling study sought to understand how CCS is demanded in different occupations. To achieve its research objectives, this study adopted a quantitative method to measure CCS use across different occupations in the Singaporean workforce. Based on the CCS framework developed by SSG, the research team adopted a formative approach to developing the CCS profiling tool to measure the importance of and self-efficacy in the use of CCS among the Singaporean workforce. Drawing on the survey results from 2500 participants, this study managed to profile them into seven occupation groups based on the different patterns of importance and confidence levels of the use of CCS. Each occupation group is labeled according to the most salient and demanded CCS. In the meantime, the CCS in each occupation group, which may need some further strengthening, were also identified. The profiling of CCS use has significant implications for different stakeholders, e.g., employers could leverage the profiling results to hire the staff with the soft skills demanded by the job.

Keywords: employability, skills profiling, skills measurement, soft skills

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Authors: Hsiao-Lin Fang

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Every life is precious, and comprehensive care should be provided to individuals who are in the final stages of their lives. Hospice-shared care aims to provide optimal symptom control and palliative care to terminal (cancer) patients through the implementation of shared care, and to support patients and their families in making various physical and psychological adjustments in the face of death. This report examines a 10-year-boy diagnosed with Out-of-Hospital Cardiac Arrest (OHCA). The individual fainted when swimming at school and underwent 31 minutes of cardiopulmonary resuscitation (CPR). While receiving treatment at the hospital, the individual received extracorporeal membrane oxygenation(ECMO) due to unstable hemodynamics. Urgent cardiac catheterization found: Suspect acute fulminant myocarditis or underlying cardiomyopathy with acute decompensation, After the active rescue by the medical team, hemodynamics still showed only mean pressure value. With respect to the patient, interdepartmental hospice-shared care was implemented and a do-not-resuscitate (DNR) order was signed after family discussions were conducted. Assistance and instructions were provided as part of the comfort care process. A farewell gathering attended by the patient’s relatives, friends, teachers, and classmates was organized in an intensive care unit (ICU) in order to look back on the patient’s life and the beautiful memories that were created, as well as to alleviate the sorrow felt by family members, including the patient’s father and sister. For example, the patient was presented with drawings and accompanied to a garden to pick flowers. In this manner, the patient was able to say goodbye before death. Finally, the patient’s grandmother and father participated in the clinical hospice care and post-mortem care processes. A hospice-shared care clinician conducted regular follow-ups and provided care to the family of the deceased, supporting family members through the sorrowful period. Birth, old age, sickness, and death are the natural phases of human life. In recent years, growing attention has been paid to human-centered hospice care. Hospice care is individual holistic care provided by a professional team and it involves the provision of comprehensive care to a terminal patient. Hospice care aims to satisfy the physical, psychological, mental, and social needs of patients and their families. It does not involve the cessation of treatment but rather avoids the exacerbation or extension of the suffering endured by patients, thereby preserving the dignity and quality of life during the end-of-life period. Patients enjoy the company of others as they complete the last phase of their lives, and their families also receive guidance on how they can move on with their own lives after the patient’s death.

Keywords: hospice-shared care, extracorporeal membrane oxygenation (ECMO), hospice-shared care, child patient

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Authors: Jong Yeop Kim, Jong Bum Choi, Hyun Jeong Kwak, Sook Young Lee

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Background: Each supraglottic airway requires different anesthetic depth because it has a specific structure and different compressive force in the oropharyngeal cavity. We designed the study to investigate remifentanil effect-site concentration (Ce) in 50% of patients (EC50) for successful insertion of i- gel, and to compare it with that for laryngeal mask airway (LMA) insertion during propofol target-controlled infusion (TCI). Methods: Forty-one female patients were randomized to the i-gel group (n=20) or the LMA group (n=21). Anesthesia induction was performed using propofol Ce of 5 μg/ml and the predetermined remifentanil Ce, and i-gel or LMA insertion was attempted 5 min later. The remifentanil Ce was estimated by modified Dixon's up-and-down method (initial concentration: 3.0 ng/ml, step size: 0.5 ng/ml). The patient’s response to device insertion was classified as either ‘success (no movement)’ or ‘failure (movement)’. Results: Using the Dixon’s up and down method, EC50 of remifentanil Ce for i-gel (1.58 ± 0.41 ng/ml) was significantly lower than that for LMA (2.25 ± 0.55 ng/ml) (p=0.038). Using isotonic regression, EC50 (83% CI) of remifentanil in the i-gel group [1.50 (1.37-1.80) ng/ml] was statistically lower than that in the LMA group [2.00 (1.82-2.34) ng/ml]. EC95 (95% CI) of remifentanil in the i-gel group [2.38 (1.48-2.50) ng/ml] was statistically lower than that in the LMA group [3.35 (2.58-3.48) ng/ml]. Conclusion: We found that EC50 of remifentanil Ce for i-gel insertion (1.58 ng/ml) was significantly lower than that for LMA insertion (2.25 ng/ml), in female patients during propofol TCI without neuromuscular blockade.

Keywords: i-gel, laryngeal mask airway, propofol, remifentanil

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Authors: G. Alex Ambrose, Melissa Paulsen, Abrar Fitwi, Masud Akbari

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In 2016, a U.S. business college was awarded a sub grant to work with FHI360, a nonprofit human development organization, to support a university in Afghanistan funded by the State Department’s U.S. Agency for International Development (USAID). A newly designed Master’s Degree in Finance and Accounting is being implemented to support Afghanistan’s goal of 20% females in higher education and industry by 2020 and to use finance and accounting international standards to attract capital investment for economic development. This paper will present a case study to describe the co-construction of an approach to an International Flipped Faculty Development Model grounded in blended learning theory. Like education in general, faculty development is also evolving from the traditional face to face environment and interactions to the fully online and now to a best of both blends. Flipped faculty development is both a means and a model for careful integration of the strengths of the synchronous and asynchronous dynamics and technologies with the combination of intentional sequencing to pre-online interactions that prepares and enhances the face to face faculty development and mentorship residencies with follow-up post-online support. Initial benefits from this model include giving the Afghan faculty an opportunity to experience and apply modern teaching and learning strategies with technology in their own classroom. Furthermore, beyond the technological and pedagogical affordances, the reciprocal benefits gained from the mentor-mentee, face-to-face relationship will be explored. Evidence to support this model includes: empirical findings from pre- and post-Faculty Mentor/ Mentee survey results, Faculty Mentorship group debriefs, Faculty Mentorship contact logs, and student early/end of semester feedback. In addition to presenting and evaluating this model, practical challenges and recommendations for replicating international flipped faculty development partnerships will be provided.

Keywords: educational development, faculty development, international development, flipped learning

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Authors: K. P. v. R. de Silva, R. W. Senevirathna, M. M. A. J. Kumara, J. P. M. Kumarasinghe, R. L. Gunawardana, S. M. Uluwitiya, G. C. P. Jayawickrama, W. K. T. I. Madushani

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Introduction: The limited literature supporting the utilization of mechanical bowel preparation (MBP) for patients undergoing laparoscopic anterior resection (LAR) remains a notable issue. This study was conducted to examine the clinical consequences of anastomosis in colorectal surgery with MBP compared to cases where MBP was not utilized (no-MBP) in the context of LAR. Methods: This was a retrospective comparative study conducted in the professorial surgical wards of the teaching hospital karapitiya (THK). Colorectal cancer patients(n=306) participated in the study, including 151 MBP patients and 155 no-MBP patients, where the postoperative complications and mortality rates were compared. Results: The anastomotic leakage rate was 2.6%(n=4) in the no-MBP group and 6.0%(n=9) in the MBP group (p=0.143). The postoperative paralytic ileus rate was 18.5%(n=28) and 5.8%(n=9) in the MBP group and no-MBP group, respectively, displaying a statistically significant difference (p=0.001). Wound infection, pneumonia, urinary tract infection, and cardiac complication rates also were higher in the MBP group. The overall mortality rate was 1.3%(n=3) in the no-MBP group and 2.0%(n=2) in the MBP group. Conclusions: The evidence concludes that MBP increases post-operative complications. Therefore, prophylactic MBP in LAR has not been proven to benefit patients. However, further research is necessary to understand the comparative effects of MBP versus no preparation comprehensively.

Keywords: MBP, anastomosis, LAR, paralytic ileus

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Authors: Lily Beaumont-Griffin, Philip Reynolds, Helen Pote, Pinder Kaur

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Siblings are a key part of the family unit, which Multisystemic Therapy (MST) intervenes, with the aim of reducing antisocial behavior and keeping families together. However, despite operating in multiple countries, including the United States of America, Europe, parts of South America, and the Western Hemisphere, there are only few previous studies on siblings within MST. According to best of authors knowledge neither of these seeks to understand the siblings' experience of the intervention nor their perception of the outcomes. This study utilized semi-structured interviews to understand the experience of seven siblings of children and adolescents who were closed to MST within the last year (2023-2024). Using reflexive thematic analysis, three themes were identified: sibling inclusion by the therapist, sharing responsibility for change, and fostering a safe and supportive environment at home. These themes express that siblings need to have a basic understanding of an intervention to be able to perceive benefits, siblings need help understanding responsibility across the whole family, and that safety is both physical and emotional. Clinical implications, including encouragement of therapists to integrate the siblings in the intervention more, and future research directions around integrating these findings into the development of iterations of MST standard are discussed.

Keywords: siblings, multisystemic therapy, family therapy, experience

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Authors: Sizhu Wang, Cuisong Tang, Lin Zhang, Guangyu Tang

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Objective: We aimed to detect the composition of bone marrow fatty acids early after ovariectomized (OVX) surgery and explore the potential mechanism. Methods: Thirty-two female Sprague-Dawley (SD) rats (12 weeks) were randomly divided into OVX group and Sham group (N=16/group), and received ovariectomy or sham surgery respectively. After 3 and 28 days, eight rats in each group were sacrificed to detect the composition of bone marrow fatty acids by gas chromatography–mass spectrometry (GC–MS) and evaluate the trabecular bone microarchitecture by micro-CT. Significant different fatty acids in the early stage of post-menopausal osteoporosis were selected by OPLS-DA and t test. Then selected fatty acids were further studied in the process of osteogenic differentiation through RT-PCR and Alizarin Red S staining. Results: An apparent sample clustering and group separation were observed between OVX group and sham group three days after surgery, which suggested the role of bone marrow fatty acids in the early stage of postmenopausal osteoporosis. Specifically, myristate, palmitoleate and arachidonate were found to play an important role in classification between OVX group and sham group. We further investigated the effect of palmitoleate and arachidonate on osteogenic differentiation and found that palmitoleate promoted the osteogenic differentiation of MC3T3-E1 cells while arachidonate inhibited this process. Conclusion: Profound bone marrow fatty acids changes have taken place in the early stage of post-menopausal osteoporosis. Bone marrow fatty acids may begin to affect osteogenic differentiation shortly after deficiency of estrogen.

Keywords: bone marrow fatty acids, GC-MS, osteoblast, osteoporosis, post-menopausal

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Authors: Xitong Liu, Yutong Huang, Shu-Ching Yang

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The phenomena of hypergamous and hypogamous marriages have become popular due to the imbalanced sex ratio caused by Chinese social preference for sons. Our research explores the spillover effect of husbands' lifestyles on their wives' marital satisfaction in China. Both personal and spouse lifestyle elements are utilized to develop regression models to study husbands' spillover effects on women's marital satisfaction. With data from China Family Panel Study and Stata for analysis, we tested our hypothesis that both smoking and substance use by a spouse will negatively impact women's marital satisfaction. Our empirical findings suggest that substance use has negative implications on marriage satisfaction. In particular, husbands' substance use is more critical to wives' marriage satisfaction than wives' behaviours. Conversely, another behavior indicating bad habits, the number of times the spouse drank alcohol, had no significant effect on the wife's marital satisfaction. We concluded our investigation and provided future implications for scholars in the family economics field.

Keywords: Asian/Pacific Islander families, family economics, housework/division of labor, spillover

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Authors: Helen Nelly Naiga, Christopher Garimoi Orach

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Introduction: Long-acting reversible contraceptive (LARC) methods are highly effective. However, LARC use in Uganda is low (13%). We assessed the factors associated with the use of long-acting reversible contraceptives among women of reproductive age (15-49 yrs) in Jinja District. Methods: We conducted a facility-based cross-sectional study. A total of 314 women aged 15–49 years attending public health facilities (1 hospital and 3 health center IV) in Jinja district, were randomly selected. A total of 6 key informants and 6 in-depth interviews were conducted. Logistic regression analysis was conducted using Stata version 14. Qualitative data were analysed using thematic analysis. Results: The study found that 40.45% of the respondents had ever used LARC. The commonest LARC method used was implanting (38.22%). The factors significantly associated with use of LARC were employment (AOR =2.91; 95% CI (1.05-8.08), access to LARC methods (AOR =4.48; 95% CI (1.24-16.21), husband support (AOR =4.90; 95% CI (1.56-15.41), and experience of no side effects (AOR =3.48; 95% CI (1.00-12.19). Conclusion and recommendations: The study showed that 4 in 10 women of reproductive age in Jinja District were using LARC. The factors associated with LARC use were employment, husband support, access to LARC methods, and the lack of side effects. There is a need to strengthen client education, improve accessibility to LARC methods at all levels of health centers, improve male partner’s decision-making in LARC use and manage the side effects effectively.

Keywords: family planning, implants, intrauterine device, long-acting reversible contraceptives (LARC)

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Authors: Shikha Gupta, Suneet Kathuria, Supriya Sampley, Sunil Katyal

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Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anesthesia. The aim of this prospective, randomized, double‑blind study is to compare the effects of adding sufentanil or fentanyl to low dose bupivacaine in spinal anesthesia for endoscopic urological procedures. A total of 90 elective endoscopic urological surgery patients, 40‑80 years old, received spinal anesthesia with 7.5 mg hyperbaric bupivacaine 0.5% (Group A) or by adding sufentanil 10 μg (Group B) or fentanyl 25 μg (Group C) to 5 mg hyperbaric bupivacaine 0.5%. These groups were compared in terms of the quality of spinal anesthesia as well as analgesia. Analysis of variance and Chi‑square test were used for Statistical analysis. The onset of sensory and motor blockade was significantly rapid in Group A as compared with Groups B and C. The maximum upper level of sensory block was higher in Group A patients than Groups B and C patients. Quality of analgesia was significantly better and prolonged in sufentanil group as compared with other two groups. Motor block was more intense and prolonged in Group A as compared with Groups B and C patients. Request for post‑operative analgesic was significantly delayed in Group B patients. Hence in conclusions, spinal anesthesia for endoscopic urological procedures in elderly patients using low dose bupivacaine (5 mg) combined with 10 μg sufentanil is associated with a lower incidence of hemodynamic instability, better quality and prolonged duration as compared to that by adding 25 μg fentanyl.

Keywords: adjuvants, bupivacaine, fentanyl, intrathecal, low dose spinal, sufentanil

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Authors: Reham H. Diab, Amira A. A. Abdallah, Eman A. Embaby

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Background: The effectiveness of bracing on preventing spino-pelvic alignment deterioration in idiopathic scoliosis has been extensively studied especially in the frontal plane. Yet, there is lack of knowledge regarding the effect of soft braces on spino-pelvic alignment in the sagittal plane. Achieving harmonious sagittal plane spino-pelvic balance is critical for the preservation of physiologic posture and spinal health. Purpose: This study examined the kyphotic angle, lordotic angle and pelvic inclination in the sagittal plane and trunk imbalance in the frontal plane before and after a six-month rehabilitation period. Methods: Nineteen patients with idiopathic scoliosis participated in the study. They were divided into two groups; experimental and control. The experimental group (group I) used the SpineCor brace in addition to a rehabilitation exercise program while the control group (group II) had the exercise program only. The mean ±SD age, weight and height were 16.89±2.15 vs. 15.3±2.5 years; 59.78±6.85 vs. 62.5±8.33 Kg and 162.78±5.76 vs. 159±5.72 cm for group I vs. group II. Data were collected using for metric Π system. Results: Mixed design MANOVA showed that there were significant (p < 0.05) decreases in all the tested variables after the six-month period compared with “before” in both groups. Moreover, there was a significant decrease in the kyphotic angle in group I compared with group II after the six-month period. Interpretation and conclusion: SpineCor brace is beneficial in reducing spino-pelvic alignment deterioration in both sagittal and frontal planes.

Keywords: adolescent idiopathic scoliosis, SpineCor, spino-pelvic alignment, biomechanics

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Authors: Rajendra Kanojia

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Femoral components with inbuilt rotation require thicker flexion resection of the lateral femoral condyle and could potential risk to damage the popliteus tendon especially in the smaller Asian knees. We prospectively evaluated 10 patients with bilateral varus osteoarthritis knee to size the cuts and their location in relation to the popliteus tendon. Two different types of implant were used on either side, one side requires resection in 3° external rotation (group A) and other side femoral component with inbuilt external roation (group B). We had popliteus tendon injury in 3 knees all from group B. Risk of damaging the popliteus tendon was found higher in group B.

Keywords: popliteaus tendon injury, TKA, orthopaedic surgery, biomechanics and clinical applications

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Authors: K. M. Shahunja, Peter D. Sly, Tahmina Begum, Tuhin Biswas, Abdullah Mamun

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Background: Various associations between different environmental exposures and asthma have been reported in different countries and populations. We aimed to investigate the associations between family, neighbourhood, and psychosocial environmental factors and asthma in Australia by conducting a systematic review and meta-analysis. Methods: We analysed the primary research studies conducted in Australia across multiple databases, including PubMed, EMBASE, and Scopus, and published between 2000 and 2020. The reviews and analyses focused on the overall association of different environmental exposures with the development or exacerbation of asthma symptoms or asthma-related hospital visits. Quality-effect meta-analysis was done to estimate the pooled odds ratio for different environmental exposures for asthma symptoms. Findings: Among the 4,799 unique published articles found, 46 were included here for systematic review and 28 for meta-analysis. Our review found that psychosocial factors, including low socioeconomic condition, maternal depression, mental stress, ethnicity, and discrimination, are associated with asthma symptoms. Pooled analysis was conducted on family and neighbourhood environmental factors and revealed that environmental tobacco smoking (ETS) (OR 1·69, 95% CI 1·19–2.38), synthetic bedding (OR 1·91, 95% CI 1·48–2·47) and gas heaters (OR 1·40, 95% CI 1·12–1·76) had significant overall associations with asthma-symptoms in Australia. Conclusion: Although the studies were heterogeneous, both systematic review and meta-analysis found several psychosocial and family environmental exposures to be significantly associated with asthma symptoms. Further study to identify their causal relationship and modification may reduce asthma symptoms in the Australian population.

Keywords: asthma, Australia, environment, systematic review

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Authors: Kejal Joshi Reddy, Sirimavo Nair

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Micronutrient malnutrition affects pregnant women and children extremely with reference to growth manifestations in gestation as well as after birth. Early fetal development affected by iodine and iron deficiency leads to poor life quality. Various researchers have found interesting interrelations between iron and iodine. A few studies on impact assessment of DFS supplementation during pregnancy have been reported in India. Aim To provide meaningful contribution by assessing the efficacy of DFS supplementation on iodine and iron status of pregnant women. Design An interventional study. Setting A semi government hospital of urban Vadodara. Subjects Pregnant women (n=150) enrolled during first trimester (< 12 weeks) and followed up till the end of gestation, n=75 were divided in experimental (DFS supplemented) and control (Non supplemented) group. Results Impact on iron and iodine status was assessed by Hb concentration and UIE respectively. Mean Hb improved significantly (p < 0.001) (+0.42 g/dl) in experimental group and reduced non significantly (-0.20 g/dl) in control group at the end, since DFS provided additional 93 mg of iron within 6 months. Median UIE improved non significantly (278.6 to 299.01µg/L) in experimental group and decreased significantly (p < 0.05) (376.59 to 288.66 µg/L) in control group. Conclusion DFS could improve iron and iodine status of experimental group compared to control group. It is an effective measure to control two essential micronutrient deficiencies together.

Keywords: DFS supplementation, anemia, pregnancy, iodine deficiency, iron

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Authors: Christiane H. Kellner, Sarah Reker

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The UN-Convention on the Rights of Persons with Disabilities, which Germany also ratified, postulates the necessity of user-centred design, especially when it comes to evaluating the individual needs and wishes of all citizens. Therefore, a multidimensional approach is required. Based on this insight, the structure of the town-like centre in Schönbrunn - a large residential complex and service provider for persons with disabilities in the outskirts of Munich - will be remodelled to open up the community to all people as well as transform social space. This strategy should lead to more equal opportunities and open the way for a much more diverse community. The research project “Index for participation development and quality of life for persons with disabilities” (TeLe-Index, 2014-2016), which is anchored at the Technische Universität München in Munich and at the Franziskuswerk Schönbrunn supports this transformation process called “Vision 2030”. In this context, we have provided academic supervision and support for three projects (the construction of a new school, inclusive housing for children and teenagers with disabilities and the professionalization of employees using person-centred planning). Since we cannot present all the issues of the umbrella-project within the conference framework, we will be focusing on one sub-project more in-depth, namely “The Person-Centred Think Tank” [Arbeitskreis Personenzentriertes Denken; PZD]. In the context of person-centred thinking (PCT), persons with disabilities are encouraged to (re)gain or retain control of their lives through the development of new choice options and the validation of individual lifestyles. PCT should thus foster and support both participation and quality of life. The project aims to establish PCT as a fundamental approach for both employees and persons with disabilities in the institution through in-house training for the staff and, subsequently, training for users. Hence, for the academic support and supervision team, the questions arising from this venture can be summed up as follows: (1) has PCT already gained a foothold at the Franziskuswerk Schönbrunn? And (2) how does it affect the interaction with persons with disabilities and how does it influence the latter’s everyday life? According to the holistic approach described above, the target groups for this study are both the staff and the users of the institution. Initially, we planned to implement the group discussion method for both target-groups. However, in the course of a pretest with persons with intellectual disabilities, it became clear that this type of interview, with hardly any external structuring, provided only limited feedback. In contrast, when the discussions were moderated, there was more interaction and dialogue between the interlocutors. Therefore, for this target-group, we introduced structured group interviews. The insights we have obtained until now will enable us to present the intermediary results of our evaluation. We analysed and evaluated the group interviews and discussions with the help of qualitative content analysis according to Mayring in order to obtain information about users’ quality of life. We sorted out the statements relating to quality of life obtained during the group interviews into three dimensions: subjective wellbeing, self-determination and participation. Nevertheless, the majority of statements were related to subjective wellbeing and self-determination. Thus, especially the limited feedback on participation clearly demonstrates that the lives of most users do not take place beyond the confines of the institution. A number of statements highlighted the fact that PCT is anchored in the everyday interactions within the groups. However, the implementation and fostering of PCT on a broader level could not be detected and thus remain further aims of the project. The additional interviews we have planned should validate the results obtained until now and open up new perspectives.

Keywords: person-centered thinking, research with persons with disabilities, residential complex and service provider, participation, self-determination.

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

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

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

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Authors: Bayu Rizky Pratama, Hardiansyah Nur Sahaya

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Riau Province is the worst emitter for forest burning which causes the huge scale of externality such as declining of forest habitat, health disease, and climate change impact. Indonesia forum of budget transparency for Riau Province (FITRA) reported the length of forest burning reached about 186.069 hectares which is 7,13% of total national forest burning disaster, consisted of 107.000 hectares of peatland and the rest 79.069 hectares of mineral land. Anti-fire group, a voluntary group next to the forest, to help in protecting the forest burning and heavily smoke residual has been established but unfortunately the implementation still far from expectation. This research will emphasize on (1) how the anti-fire group contribute to fire hazard tackling; (2) the identification of SWOT analysis to enhance the group benefit; and (3) government policy implication to maximize the role of Anti-fire group and reduce the case of forest burning as well as heavily smoke which can raise climate change impact. As the observation found some weakness from SWOT identification such as (1) lack of education and training; (2) facility in extinguishing the fire damage; (3) law for economic incentive; (4) communication and field experience; (5) also the reporting the fire case.

Keywords: anti-fire group, forest burning impact, SWOT, climate change mitigation

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Authors: Tanya Keni

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Efforts to link culture and self, have been the focus, initially of Anthropology and later of Psychology in the first half of the 20th century. In doing so, cross-cultural researchers have endeavored to identify factors valuable for classifying cultures. One such central classification is that of individualism and collectivism which remains prominent. However, it overlooks certain other cultural dimensions that can be of interest and need attention. The current paper tries to move beyond this classic distinction, to cultures that are termed to be honor and dignity oriented. Both honor and dignity, refer to the worth of a person but bear different connotations and psychological consequences. While dignity is an independent concept of self-worth whose locus lies deep within the individual, honor is an interdependent concept that needs both personal as well as societal acknowledgment. This research takes an exploratory and qualitative approach to draw the individual, structural and contextual understanding of personal honor and dignity in broad cultures that are conceptualized as honor and dignity aimed. The aim is to understand the cultural influence on an individual’s self-worth, considering gender. 12 Focus group discussions were conducted across North India and Germany with four participants each. The research process was inspired by the approaches of social constructivism and critical realism. These discussions were transcribed and further analyzed using thematic analysis and the results have revealed differential themes for the concepts of honor and dignity. Certain dimensional similarities were also observed for both the cultural groups, however with differential usage of language. In particular, the North Indian group was seen using phrases that were oriented towards safeguarding against loss of honor or dignity. While the phrases of the German group were aligned towards worth-enhancement. The research also gives an illustration of how honor and dignity translate into behavioral practice that can exert an influence on important life decisions, especially about self and family for both males and females. In addition to these, the study also contributes to the literature on self-worth by developing the concept of ‘dignity’ for which there exists a dearth of research.

Keywords: culture, dignity, honor, self, self-worth

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Authors: F. Guspi, E. García

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This exploratory study gives an overview of the evolution of the main financial and performance indicators of the Academic Spin-Off’s and High Growth Academic Spin-Off’s in year 3 and year 6 after its creation in the region of Catalonia in Spain. The study compares and evaluates results of these different measures of performance and the degree of success of these companies for each University. We found that the average Catalonian Academic Spin-Off is small and have not achieved the sustainability stage at year 6. On the contrary, a small group of High Growth Academic Spin-Off’s exhibit robust performance with high profits in year 6. Our results support the need to increase selectivity and support for these companies especially near year 3, because are the ones that will bring wealth and employment. University role as an investor has rigid norms and habits that impede an efficient economic return from their ASO investment. Universities with high performance on sales and employment in year 3 not always could sustain this growth in year 6 because their ASO’s are not profitable. On the contrary, profitable ASO exhibit superior performance in all measurement indicators in year 6. We advocate the need of a balanced growth (with profits) as a way to obtain subsequent continuous growth.

Keywords: Academic Spin-Off (ASO), university entrepreneurship, entrepreneurial university, high growth, New Technology Based Companies (NTBC), University Spin-Off

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Authors: David Tresner-Kirsch

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Reconciling patient medication lists from multiple sources is a critical task supporting the safe delivery of patient care. Manual reconciliation is a time-consuming and error-prone process, and recently attempts have been made to develop efficiency- and safety-oriented automated support for professionals performing the task. An important capability of any such support system is automated alignment – finding which medications from a list correspond to which medications from a different source, regardless of misspellings, naming differences (e.g. brand name vs. generic), or changes in treatment (e.g. switching a patient from one antidepressant class to another). This work describes a new algorithmic solution to this alignment task, using a greedy matching approach based on string similarity, edit distances, concept extraction and normalization, and synonym search derived from the RxNorm nomenclature. The accuracy of this algorithm was evaluated against a gold-standard corpus of 681 medication records; this evaluation found that the algorithm predicted alignments with 99% precision and 91% recall. This performance is sufficient to support decision support applications for medication reconciliation.

Keywords: clinical decision support, medication reconciliation, natural language processing, RxNorm

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Authors: Allison Streutker, Josephine Tan

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Universities across Canada have experienced unprecedented growth in international student enrollment from across the world. As cultural diversity in Canada and other countries increases, understanding the social support needs of all students is important for providing them with the assistance they need to thrive psychologically and academically. Those from individualistic cultural orientations tend to seek explicit social support, which involves expressly asking for assistance in times of stress. However, those from collectivistic cultural orientations are more likely to seek implicit social support, where encouragement is obtained from spending time among valued social groups without explicitly talking about problems. This study explored whether the relationship between the type of social support needs (implicit or explicit) and psychological and academic functioning might be moderated by cultural orientations (individualistic, collectivistic) among university students. Participants were 110 university students (70 women, 40 men; mean age = 24.8 years, SD = 6.6). They completed the Individualism and Collectivism Scale (ICS), Perceived Stress Scale (PSS), Interpersonal Support Evaluation List (ISEL) which assesses implicit and explicit social support, Satisfaction with Life Scale (SWLS), Scale of Positive and Negative Experience (SPANE) which yields positive and negative experience scores, Flourishing Scale (FS), and reported their grade point average (GPA) as a measure of academic performance. Moderated regression analysis demonstrated that, for those scoring lower on individualism, reporting lower level of implicit support predicted higher levels of perceived stress. For those scoring higher on individualism, lower levels of explicit social support predicted higher levels of perceived stress and a greater number of negative experiences. Generally, higher levels of implicit support were associated with greater satisfaction with life for all students, with the association becoming stronger among students with higher collectivism scores. No other significant findings were found. The results point to the value of considering the cultural orientations of students when designing programs to maintain and improve their sense of well-being.

Keywords: cultural orientation, social support, university students, well-being

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Authors: Sadaf Kalhori

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Introduction: Doxorubicin (DOX)-induced cardiotoxicity is widely known as the most severe complication of anthracycline-based chemotherapy in patients with cancer. It is unknown whether Deferiprone (DFP), could reduce the severity of DOX-induced cardiotoxicity by inhibiting free radical reactions. Thus, this study was performed to assess the protective effect of Deferiprone on DOX-induced cardiotoxicity in a rat model. Methods: The rats were divided into five groups. Group one was a control group. Group 2 was DOX (2 mg/kg/day, every other day for 12 days), and Group three to five which receiving DOX as in group 2 and DFP 75,100 and 150 mg/kg/day, for 19 days, respectively. DFP was starting 5 days prior to the first DOX injection and two days after the last DOX injection throughout the study. Electrocardiographic and hemodynamic studies, along with histopathological examination, were conducted. In addition, serum sample was taken and total cholesterol, Malone dialdehyde, triglyceride, albumin, AST, ALT, total protein, lactate dehydrogenase, total anti-oxidant and creatine kinase were assessed. Result: Our results showed the normal structure of endocardial, myocardial and pericardial in the control group. Pathologic data such as edema, hyperemia, bleeding, endocarditis, myocarditis and pericarditis, hyaline degeneration, cardiomyocyte necrosis, myofilament degeneration and nuclear chromatin changes were assessed in all groups. In the DOX group, all pathologic data was seen with mean grade of 2±1.25. In the DFP group with a dose of 75 and 100 mg, the mean grade was 1.41± 0.31 and 1±.23, respectively. In DFP group with a dose of 150, the pathologic data showed a milder change in comparison with other groups with e mean grade of 0.45 ±0.19. Most pathologic data in DFP groups showed significant changes in comparison with the DOX group (p < 0.001). Discussion: The results also showed that DFP treatment significantly improved DOX-induced heart damage, structural changes in the myocardium, and ventricular function. Our data confirm that DFP is protective against cardiovascular-related disorders induced by DOX. Clinical studies are needed to be involved to examine these findings in humans.

Keywords: cardiomyopathy, deferiprone, doxorubicin, rat

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Authors: Mulligan T., Barker-Collo S., Gobson K., Jones K.

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There is a relatively scarce body of literature regarding adolescent experiences of traumatic brain injury (TBI). This qualitative study explored how sustaining a TBI at this unique stage of development might impact a young person as they navigate the challenges of adolescence and transition to adulthood, and what might support recovery. Thirteen young adults who sustained a mild-moderate TBI as an adolescent (aged 13 – 17 years), approximately 7.7 years (range = 6.7 – 8.0 years) prior, participated in the research. Semi-structured individual interviews were conducted to explore participants’ experiences surrounding and following their TBIs. Thematic analysis of interview data produced five key categories of findings: (1) Following their TBIs, many participants experienced problems with cognitive (e.g., forgetfulness, concentration difficulties), physical (e.g., migraines, fatigue) and emotional (e.g., depression, anxiety) functioning, which were often endured into adulthood. (2) TBI-related problems often adversely affected important areas of life for the participant, including school, work and friendships. (3) Changes following TBI commonly impacted identity formation. (4) Recovery processes evolved over time as the participants coped initially by just ‘getting on with it’, before learning to accept new limitations and, ultimately, growing from their TBI experiences. (5) While the presence of friends and family assisted recovery, struggles were often exacerbated by a lack of emotional support from others, in addition to the absence of any assistance or information-provision from professionals regarding what to expect following TBI. The findings suggest that even mild TBI sustained during adolescence can have consequences for an individual’s functioning, engagement in life and identity development, whilst also giving rise to post-traumatic growth. Recovery following adolescent TBI might be maximised by facilitating greater understanding of the injury and acknowledging its impacts on important areas of life, as well as the provision of emotional support and facilitating self-reflection and meaning-making.

Keywords: adolescent, brain Injury, qualitative, post-traumatic growth

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Authors: Wen Liang Chang, Mei Wei Wang, Ruey Huei Yeh

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This paper studies the comparisons of individual and group replacement policies for a series connection system with two machines. Suppose that manufacturer’s production system is a series connection system which is combined by two machines. For two machines, when machines fail within the operating time, minimal repair is performed for machines by the manufacturer. The manufacturer plans to a preventive replacement for machines at a pre-specified time to maintain system normal operation. Under these maintenance policies, the maintenance cost rate models of individual and group replacement for a series connection system with two machines is derived and further, optimal preventive replacement time is obtained such that the expected total maintenance cost rate is minimized. Finally, some numerical examples are given to illustrate the influences of individual and group replacement policies to the maintenance cost rate.

Keywords: individual replacement, group replacement, replacement time, two machines, series connection system

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Authors: Hassan Shahmiri Barzoki

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Background: Posttraumatic stress disorder (PTSD) is an abnormal physiologic and psychological reaction in person with severe traumatic history. In recent studies, the relationship between PTSD and some other disease apparently unrelated to psychological situations, such as cardiovascular diseases, diabetes, and metabolic syndrome, has been revealed. Thus, the aim of this study was to survey the prevalence of metabolic syndrome and mental health in PTSD patients. Methods: The research design was retrospective cohort study. Subjects were consisted of 142 Iran-Iraq war veterans with PTSD (age: 40-60 years), and the control group was consisted of 153 veterans without PTSD. Data was collected using questionnaires, physical exams and laboratory tests. Results: Prevalence of metabolic syndrome was 45.1%in PTSD group and 17% in control group. In addition, blood pressure, triglyceride and fasting blood sugar in PTSD group were significantly higher than control group (p<0.05). Also, PTSD patients had significant high rates of psychiatric disorders. Conclusion: PTSD patients are more prone to metabolic syndrome and psychiatric disorders than control group.

Keywords: mental health, metabolic syndrome, post traumatic stress disorder, patient

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Authors: Mohammed M. Mahdy Tawfeek

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Objective: The aim of this work is to compare the outcome of photoactivated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) alone with combined PACK-CXL WA and standard anti-microbial therapy (SAT) for the treatment of infectious keratitis. Patients and Methods: This is a randomized prospective comparative clinical trial. Thirty eyes with clinically suspected infectious keratitis were randomly assigned into two equal groups of 15 eyes each: Group (A) was treated by PACK-CXL WA alone and group (B) was treated by PACK-CXL WA combined with SAT. Identification of organisms was made by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethics committee of the Faculty of Medicine, Zagazig University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) were observed in 10 eyes (66.7%) of a group (A) and 14 eyes (93.3%) of group (B) and failure was observed in 5 eyes (33.3%) of a group (A) and one eye (6.67%) of group (B). They were statistically significant (P =0.042 and 0.003) in a comparison between both groups regarding success and failure of treatment, respectively. Complete corneal healing was reported in the third month postoperatively in 10 eyes (66.7%) of group (A) and 14 eyes (93.3%) of group (B). Complications were absent in 12 patients (80%) in group (A) and 14 patients (93.3%) of group (B); however, perforation and impending perforation were found in 3 patients of group (A) and only one patient of group (B). Conclusion: PACK-CXL is a promising, non-invasive treatment option for infectious keratitis, especially when performed with the window absorption (WA) technique, either alone or combined with SAT. It has a synergistic effect with a standard antimicrobial treatment that gives good outcome results in the treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

Keywords: corneal cross linking, infectious keratitis, PACK-CXL, window absorption

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Authors: Leen Al Kassab, Sarah Johns, Helen Noble, Nawal Nour, Elizabeth Janiak, Sarrah Shahawy

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Introduction: Immigrant and refugee women experience disparities in sexual and reproductive health (SRH) outcomes, partially as a result of barriers to SRH literacy and to regular healthcare access and engagement. Despite the existing data highlighting growing needs for culturally relevant and structurally competent care, interventions are scarce and not well-documented. Methods: In this IRB-approved study, we used a community-based participatory research approach, with the assistance of a community advisory board, to conduct a qualitative needs assessment of SRH knowledge and service engagement with immigrant and refugee women from Africa or the Middle East and currently residing in Boston. We conducted a total of nine focus group discussions (FGDs) in partnership with medical, community, and religious centers, in six languages: Arabic, English, French, Somali, Pashtu, and Dari. A total of 44 individuals participated. We explored migrant and refugee women’s current and evolving SRH care needs and gaps, specifically related to the development of interventions and clinical best practices targeting SRH literacy, healthcare engagement, and informed decision-making. Recordings of the FGDs were transcribed verbatim and translated by interpreter services. We used open coding with multiple coders who resolved discrepancies through consensus and iteratively refined our codebook while coding data in batches using Dedoose software. Results: Participants reported immigrant adaptation experiences, discrimination, and feelings of trust, autonomy, privacy, and connectedness to family, community, and the healthcare system as factors surrounding SRH knowledge and needs. The context of previously learned SRH knowledge was commonly noted to be in schools, at menstruation, before marriage, from family members, partners, friends, and online search engines. Common themes included empowering strength drawn from religious and cultural communities, difficulties bridging educational gaps with their US- born daughters, and a desire for more SRH education from multiple sources, including family, health care providers, and religious experts & communities. Regarding further SRH education, participants’ preferences varied regarding ideal platform (virtual vs. in-person), location (in religious and community centers or not), smaller group sizes, and the involvement of men. Conclusions: Based on these results, empowering SRH initiatives should include both community and religious center-based, as well as clinic-based, interventions. Interventions should be composed of frequent educational workshops in small groups involving age-grouped women, daughters, and (sometimes) men, tailored SRH messaging, and the promotion of culturally, religiously, and linguistically competent care.

Keywords: community, immigrant, religion, sexual & reproductive health, women's health

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