Search results for: clinical interpretation
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 4536

Search results for: clinical interpretation

3216 Using Synonymy in Translation of Hemingway’s 'A Farewell to Arms' from English into Albanian

Authors: Miranda Enesi, Helena Grillo Mukli

Abstract:

The English word-stock is extremely rich in synonyms which can be largely accounted for by the abundant borrowing. Translation problems encountered by translators in general are usually ‘transfer problems’. They face more difficulties in the interpretation of meaning from the source language text than lexical differences between languages. The aim of the study is to inspect the various strategies used in translating from English into Albanian specific words in the ‘A Farwell to arms’ novel. For this purpose, examples translated from English into Albanian were examined. The Albanian equivalents have shown that various strategies were used in order to overcome the problem of rendering words and expressions into the target language. Employed strategies were synonymy, modulation, transposition, calque and word for word translation. In addition, this paper shows that the strategy of translating using synonymy is mostly used. In this paper, an attempt is made to examine the nature of contextual synonymy in order to investigate its problematic nature regarding translation. Types of synonymy are analyzed and then examples from English and Albanian versions are provided to examine the overlap between them.

Keywords: equivalence, literal translation, paraphrasing, transfer problems, synonymy

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3215 Use of Alternative and Complementary Therapies in Patients with Chronic Pain in a Medical Institution in Medellin, Colombia, 2014

Authors: Lina María Martínez Sánchez, Juliana Molina Valencia, Esteban Vallejo Agudelo, Daniel Gallego González, María Isabel Pérez Palacio, Juan Ricardo Gaviria García, María De Los Ángeles Rodríguez Gázquez, Gloria Inés Martínez Domínguez

Abstract:

Alternative and complementary therapies constitute a vast and complex combination of interventions, philosophies, approaches, and therapies that acquire a holistic healthcare point of view, becoming an alternative for the treatment of patients with chronic pain. Objective: determine the characteristics of the use of alternative and complementary therapies in patients with chronic pain who consulted in a medical institution. Methodology: cross-sectional and descriptive study, with a population of patients that assisted to the outpatient consultation and met the eligibility criteria. Sampling was not conducted. A form was used for the collection of demographic and clinical variables and the Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) was validated. The analysis and processing of information was carried out using the SPSS program vr.19. Results: 220 people with chronic pain were included. The average age was 54.7±16.2 years, 78.2% were women, and 75.5% belonged to the socioeconomic strata 1 to 3. Musculoskeletal pain (77.7%), migraine (15%) and neuralgia (9.1%) were the most frequently types of chronic pain. 33.6% of participants have used some kind of alternative and complementary therapy; the most frequent were: homeopathy (14.5%), phytotherapy (12.7%), and acupuncture (11.4%). The total average HCAMQ score for the study group was 30.2±7.0 points, which shows a moderate attitude toward the use of complementary and alternative medicine. The highest scores according to the type of pain were: neuralgia (32.4±5.8), musculoskeletal pain (30.5±6.7), fibromyalgia (29.6±7.3) and migraine (28.5±8.8). The reliability of the HCAMQ was acceptable (Cronbach's α: 0.6). Conclusion: it was noted that the types of chronic pain and the clinical or therapeutic management of patients correspond to the data available in current literature. Despite the moderate attitude toward the use of these alternative and complementary therapies, one of every three patients uses them.

Keywords: chronic pain, complementary therapies, homeopathy, acupuncture analgesia

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3214 Biochemical Characterization of CTX-M-15 from Enterobacter cloacae and Designing a Novel Non-β-Lactam-β-Lactamase Inhibitor

Authors: Mohammad Faheem, M. Tabish Rehman, Mohd Danishuddin, Asad U. Khan

Abstract:

The worldwide dissemination of CTX-M type β-lactamases is a threat to human health. Previously, we have reported the spread of blaCTX-M-15 gene in different clinical strains of Enterobacteriaceae from the hospital settings of Aligarh in north India. In view of the varying resistance pattern against cephalosporins and other β-lactam antibiotics, we intended to understand the correlation between MICs and catalytic activity of CTX-M-15. In this study, steady-state kinetic parameters and MICs were determined on E. coli DH5α transformed with blaCTX-M-15 gene that was cloned from Enterobacter cloacae (EC-15) strain of clinical background. The effect of conventional β-lactamase inhibitors (clavulanic acid, sulbactam and tazobactam) on CTX-M-15 was also studied. We have found that tazobactam is the best among these inhibitors against CTX-M-15. The inhibition characteristic of tazobactam is defined by its very low IC50 value (6 nM), high affinity (Ki = 0.017 µM) and better acylation efficiency (k+2/K9 = 0.44 µM-1s-1). It forms an acyl-enzyme covalent complex, which is quite stable (k+3 = 0.0057 s-1). Since increasing resistance has been reported against conventional b-lactam antibiotic-inhibitor combinations, we aspire to design a non-b-lactam core containing b-lactamase inhibitor. For this, we screened ZINC database and performed molecular docking to identify a potential non-β-lactam based inhibitor (ZINC03787097). The MICs of cephalosporin antibiotics in combination with this inhibitor gave promising results. Steady-state kinetics and molecular docking studies showed that ZINC03787097 is a reversible inhibitor which binds non-covalently to the active site of the enzyme through hydrogen bonds and hydrophobic interactions. Though, it’s IC50 (180 nM) is much higher than tazobactam, it has good affinity for CTX-M-15 (Ki = 0.388 µM). This study concludes that ZINC03787097 compound can be used as seed molecule to design more efficient non-b-lactam containing b-lactamase inhibitor that could evade pre-existing bacterial resistance mechanisms.

Keywords: ESBL, non-b-lactam-b-lactamase inhibitor, bioinformatics, biomedicine

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3213 Case Report of a Secretory Carcinoma of the Salivary Gland: Clinical Management Following High-Grade Transformation

Authors: Wissam Saliba, Mandy Nicholson

Abstract:

Secretory carcinoma (SC) is a rare type of salivary gland cancer. It was first realized as a distinct type of malignancy in 2010and wasinitially termed “mammary analogue secretory carcinoma” because of similarities with secretory breast cancer. The name was later changed to SC. Most SCs originate in parotid glands, and most harbour a rare gene mutation: ETV6-NTRK3. This mutation is rare in common cancers and common in rare cancers; it is present in most secretory carcinomas. Disease outcomes for SC are usually described as favourable as many cases of SC are lowgrade (LG), and cancer growth is slow. In early stages, localized therapy is usually indicated (surgery and/or radiation). Despitea favourable prognosis, a sub-set of casescan be much more aggressive.These cases tend to be of high-grade(HG).HG casesare associated with a poorer prognosis.Management of such cases can be challenging due to limited evidence for effective systemic therapy options. This case report describes the clinical management of a 46-year-oldmale patient with a unique case of SC. He was initially diagnosed with a low/intermediate grade carcinoma of the left parotid gland in 2009; he was treated with surgery and adjuvant radiation. Surgical pathology favoured primary salivary adenocarcinoma, and 2 lymph nodes were positive for malignancy. SC was not yet realized as a distinct type of cancerat the time of diagnosis, and the pathology reportvalidated this gap by stating that the specimen lacked features of the defined types of salivary carcinoma.Slow-growing pulmonary nodules were identified in 2017. In 2020, approximately 11 years after the initial diagnosis, the patient presented with malignant pleural effusion. Pathology from a pleural biopsy was consistent with metastatic poorly differentiated cancer of likely parotid origin, likely mammary analogue secretory carcinoma. The specimen was sent for Next Generation Sequencing (NGS); ETV6-NTRK3 gene fusion was confirmed, and systemic therapy was initiated.One cycle ofcarboplatin/paclitaxel was given in June 2020. He was switched to Larotrectinib (NTRK inhibitor (NTRKi)) later that month. Larotrectinib continued for approximately 9 months, with discontinuation in March 2021 due to disease progression. A second-generation NTRKi (Selitrectinib) was accessed and prescribedthrough a single patient study. Selitrectinib was well tolerated. The patient experienced a complete radiological response within~4 months. Disease progression occurred once again in October 2021. Progression was slow, and Selitrectinib continuedwhile the medical team performed a thorough search for additional treatment options. In January 2022, a liver lesion biopsy was performed, and NGS showed an NTRKG623R solvent-front resistance mutation. Various treatment pathways were considered. The patient pursuedanother investigational NTRKi through a clinical trial, and Selitrectinib was discontinued in July 2022. Excellent performance status was maintained throughout the entire course of treatment.It can be concluded that NTRK inhibitors provided satisfactory treatment efficacy and tolerance for this patient with high-grade transformation and NTRK gene fusion cancer. In the future, more clinical research is needed on systemic treatment options for high-grade transformations in NTRK gene fusion SCs.

Keywords: secretory carcinoma, high-grade transformations, NTRK gene fusion, NTRK inhibitor

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3212 Preparing Undergraduate Nursing and Midwifery Students for Culturally Competent Health Care: A Qualitative Study

Authors: Olayide Ogunsiji, Glenda McDonald

Abstract:

Engendering cultural competence in nursing and midwifery students is germane to reducing disparities in contemporary health care settings, increasingly patronized by people from diverse background. Professional standards for registration in Australia require nurses and midwives to be culturally competent. Nursing and midwifery academics worldwide are responsible for preparing students for clinical practice, yet limited attention is paid to exploring how students are being prepared to care for a culturally diverse population. This paper provides insight into the perceptions of academics about how they are preparing undergraduate nursing and midwifery students for culturally competent health care. Academics were drawn from a tertiary educational institution in metropolitan Australia. They responded to a generic email indicating their interest in participating in the study. A total of nine academics who have taught undergraduate nursing and midwifery students in a unit that focused on health and illness perspectives for culturally diverse communities; and provided written consent to participate were included. These academics were engaged in a qualitative digitally-recorded semi-structured face-to-face or telephone interviews which lasted for about 45-60 minutes. Interview data were transcribed verbatim. Through constant comparison, three themes emerged: experiences of the teachers, strategies used for preparing students and challenges in preparing students. The participants spoke about their experiences of teaching in the unit and with the students. They faced challenges related to physical and relational space. They utilised a number of didactic approaches in teaching the unit and critiqued the adequacy of the content in preparing students for practice. This study demonstrated that didactic classroom approaches need to be supported with clinical practice and cultural immersion for a meaningful preparation of nursing and midwifery students to care for culturally diverse populations.

Keywords: cultural competence, nursing students, preparation, undergraduate

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3211 Osteoarticular Manifestations and Abnormalities of Bone Metabolism in Celiac Disease

Authors: Soumaya Mrabet, Imen Akkari, Amira Atig, Elhem Ben Jazia

Abstract:

Introduction: Celiac disease (CD) is a chronic autoimmune inflammatory enteropathy caused by gluten. The clinical presentation is very variable. Malabsorption in the MC is responsible for an alteration of the bone metabolism. Our purpose is to study the osteoarticular manifestations related to this condition. Material and methods: It is a retrospective study of 41 cases of CD diagnosed on clinical, immunological, endoscopic and histological arguments, in the Internal Medicine and Gastroenterology Department of Farhat Hached Hospital between September 2005 and January 2016. Results: Osteoarticular manifestations were found in 9 patients (22%) among 41 patients presenting CD. These were 7 women and 2 men with an average age of 35.7 years (25 to 67 years). These manifestations were revelatory of CD in 3 cases. Abdominal pain and diarrhea were present in 6 cases. Inflammatory polyarthralgia of wrists and knees has been reported in 7 patients. Mechanical mono arthralgia was noted in 2 patients. Biological tests revealed microcytic anemia by iron deficiency in 7 cases, hypocalcemia in 5 cases, Hypophosphatemia in 3 cases and elevated alkaline phosphatases in 3 cases. Upper gastrointestinal endoscopy with duodenal biopsy found villous atrophy in all cases. In immunology, Anti-transglutaminase antibodies were positive in all patients, Anti-endomysium in 7 cases. Measurement of bone mineral density (BMD) by biphotonic X-ray absorptiometer with evaluation of the T-score and the Z-score was performed in Twenty patients (48.8%). It was normal in 7 cases (33%) and showed osteopenia in 5 patients (25%) and osteoporosis in 2 patients (10%). All patients were treated with a Gluten-free diet associated with vitamin D and calcium substitution in 5 cases. The evolution was favorable in all cases with reduction of bone pain and normalization of the phosphocalcic balance. Conclusion: The bone impact of CD is frequent but often asymptomatic. Patients with CD should be evaluated by the measurement of bone mineral density and monitored for calcium and vitamin D deficiencies.

Keywords: bone mineral density, celiac disease, osteoarticular manifestations, vitamin D and calcium

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3210 Anti-Obesity Activity of Garcinia xanthochymus: Biochemical Characterization and In vivo Studies in High Fat Diet-Rat Model

Authors: Mahesh M. Patil, K. A. Anu-Appaiah

Abstract:

Overweight and obesity is a serious medical problem, increasing in prevalence, and affecting millions worldwide. Investigators have been trying from decades to articulate the burden of obesity and related risk factors. To answer this problem, we suggest a new therapeutic anti-obesity compounds from Garcinia xanthochymus fruit. However, there is little published scientific information on non-hydroxycitric acid Garcinia species. Our findings include biochemical characterization of the fruit; in vivo toxicity and bio-efficacy study of G. xanthochymus in high fat diet wistar rat model. We observed that Garcinia pericarp is a rich source of organic acids, polyphenols, mono- (40.63%) and poly-unsaturated fatty acids (16.45%; omega-3: 10.02%). Toxicological studies have showed that Garcinia is safe and had no observed adverse effect level up to 400 mg/kg/day. Body weight and food intake was significantly (P<0.05) reduced in oral gavage treated rats (sonicated Garcinia powder) in 13 weeks. Subcutaneous fat was significantly (P<0.05) reduced in Garcinia treated rats. Hepatocytes significantly (p<0.05) overexpressed sterol regulatory element binding protein 2, liver X receptor- α, liver X receptor- β, lipoprotein lipase and monoacylglycerol lipase. Fatty acid binding protein 1 and peroxisome proliferator activated receptor- α were down regulated as assessed by real time qPCR. Currently our research is focused on the adipocyte obesity related gene expressions, effect of Garcinia on 3T3-adipocyte cell lines and high fat diet induced mice model. This in vivo pre-clinical data suggests that G. xanthochymus may have clinical utility for the treatment of obesity. However, further studies are required to establish its potency.

Keywords: Garcinia xanthochymus, anti-obesity, high fat diet, real time qPCR

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3209 Spatial Integrity of Seismic Data for Oil and Gas Exploration

Authors: Afiq Juazer Rizal, Siti Zaleha Misnan, M. Zairi M. Yusof

Abstract:

Seismic data is the fundamental tool utilized by exploration companies to determine potential hydrocarbon. However, the importance of seismic trace data will be undermined unless the geo-spatial component of the data is understood. Deriving a proposed well to be drilled from data that has positional ambiguity will jeopardize business decision and millions of dollars’ investment that every oil and gas company would like to avoid. Spatial integrity QC workflow has been introduced in PETRONAS to ensure positional errors within the seismic data are recognized throughout the exploration’s lifecycle from acquisition, processing, and seismic interpretation. This includes, amongst other tests, quantifying that the data is referenced to the appropriate coordinate reference system, survey configuration validation, and geometry loading verification. The direct outcome of the workflow implementation helps improve reliability and integrity of sub-surface geological model produced by geoscientist and provide important input to potential hazard assessment where positional accuracy is crucial. This workflow’s development initiative is part of a bigger geospatial integrity management effort, whereby nearly eighty percent of the oil and gas data are location-dependent.

Keywords: oil and gas exploration, PETRONAS, seismic data, spatial integrity QC workflow

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3208 Humanitarian Aid and National Sovereignty: The Case of Kosovo

Authors: Nick Papanikolaou

Abstract:

In modern world politics, International relations are very complex not only in their construction but also in their interpretation the ex-Yugoslavian(western Balkans) countries, due to the establishment of independent states, have also risen pending geopolitical and territorial issues such as the Kosovo dispute widely known as an active frozen conflict. Science of anthropology and its subfield of anthropology of conflict can suggest a sustainable plan of communities coexistence and abolishment of fondamentalism. The 1244 Security Council Resolution provides a framework of implementation of a transitional international joint international armed presence for ensuring control and stability in the territory. The changing international relations landscape and the rise of the integration of the Western Balkans in the European Union have brought the question of Kosovo and all the till now internationally controlled system of governance to a dead end. A new solution that will ensure a sustainable future needs to be applied in order to solve this case in a way that rights of both albanians and Serbians will be equally respected and both populations will coexist peacefully. What this presentation aims for is to present a plan for the peaceful coexistence and sovreignty of habitants of Kosovo in a whole new way of governance.

Keywords: sovereignty, Kosovo, Western Balkans, anthropology of conflict

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3207 Selection of Appropriate Classification Technique for Lithological Mapping of Gali Jagir Area, Pakistan

Authors: Khunsa Fatima, Umar K. Khattak, Allah Bakhsh Kausar

Abstract:

Satellite images interpretation and analysis assist geologists by providing valuable information about geology and minerals of an area to be surveyed. A test site in Fatejang of district Attock has been studied using Landsat ETM+ and ASTER satellite images for lithological mapping. Five different supervised image classification techniques namely maximum likelihood, parallelepiped, minimum distance to mean, mahalanobis distance and spectral angle mapper have been performed on both satellite data images to find out the suitable classification technique for lithological mapping in the study area. Results of these five image classification techniques were compared with the geological map produced by Geological Survey of Pakistan. The result of maximum likelihood classification technique applied on ASTER satellite image has the highest correlation of 0.66 with the geological map. Field observations and XRD spectra of field samples also verified the results. A lithological map was then prepared based on the maximum likelihood classification of ASTER satellite image.

Keywords: ASTER, Landsat-ETM+, satellite, image classification

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3206 Application of Additive Manufacturing for Production of Optimum Topologies

Authors: Mahdi Mottahedi, Peter Zahn, Armin Lechler, Alexander Verl

Abstract:

Optimal topology of components leads to the maximum stiffness with the minimum material use. For the generation of these topologies, normally algorithms are employed, which tackle manufacturing limitations, at the cost of the optimal result. The global optimum result with penalty factor one, however, cannot be fabricated with conventional methods. In this article, an additive manufacturing method is introduced, in order to enable the production of global topology optimization results. For a benchmark, topology optimization with higher and lower penalty factors are performed. Different algorithms are employed in order to interpret the results of topology optimization with lower factors in many microstructure layers. These layers are then joined to form the final geometry. The algorithms’ benefits are then compared experimentally and numerically for the best interpretation. The findings demonstrate that by implementation of the selected algorithm, the stiffness of the components produced with this method is higher than what could have been produced by conventional techniques.

Keywords: topology optimization, additive manufacturing, 3D-printer, laminated object manufacturing

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3205 Case Report: Mandibular Area Abscesses in Calves

Authors: Dovilė Bačėninaitė, Karina Džermeikaitė, Justinas Kirvela, Ramūnas Antanaitis

Abstract:

Bacteria are often present in the mouth of cattle. Some of them can cause abscesses. Starting with severe swelling of the mouth, muscle spasm, or locked jaw, it can lead to inability to open its mouth, move the neck, cause pain while eating. While the calf is unable to eat properly, it becomes more susceptible to infectious diseases, lower weight gain can be observed. Abscesses can be considered as a continuum of oral disease, whereby early stages of the lumpy jaw could proceed from gingivitis to periodontal disease. In the event of tissue damage, bacteria can enter the bloodstream, even cause sepsis. The most common lesions occur when animals eat sharp grass, coarse fodder, sharp, piercing foreign bodies (this is especially common for calves when they are trying to eat inedible objects). A crossbred Holstein calf presented with a history of proliferative outgrowth in the mandibular region. On clinical examination, needle aspiration, mandibular swelling revealed sticky, white curd-like fluid containing. Pus bacteriology revealed gram-negative cocci. They were sensitive to amoxicillin, cephalexin, enrofloxacin, ceftiofur. Blood morphology was in physiological ranges. The calf was treated surgically. The growth was excised, the puss drained and the wound was flushed with potassium permanganate solution (0,01%). A week after clinical surgery examination was performed. The swelling was decreased. Superficial bacterial infections are often associated with poor hygiene, which should be improved before treatment is commenced. Clipping away dirty hair and gently washing affected areas of skin daily with solutions such as povidone-iodine, potassium permanganate is effective. Appropriate antibiotic therapy, based on sensitivity testing, may be used where there is evidence of systemic illness.

Keywords: calf, abscess, lumpy jaw, pus, Streptococcus, Staphylococcus, Actinobacillus, infection

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3204 Effectiveness of Using Multiple Non-pharmacological Interventions to Prevent Delirium in the Hospitalized Elderly

Authors: Yi Shan Cheng, Ya Hui Yeh, Hsiao Wen Hsu

Abstract:

Delirium is an acute state of confusion, which is mainly the result of the interaction of many factors, including: age>65 years, comorbidity, cognitive function and visual/auditory impairment, dehydration, pain, sleep disorder, pipeline retention, general anesthesia and major surgery… etc. Researches show the prevalence of delirium in hospitalized elderly patients over 50%. If it doesn't improve in time, may cause cognitive decline or impairment, not only prolong the length of hospital stay but also increase mortality. Some studies have shown that multiple nonpharmacological interventions are the most effective and common strategies, which are reorientation, early mobility, promoting sleep and nutritional support (including water intake), could improve or prevent delirium in the hospitalized elderly. In Taiwan, only one research to compare the delirium incidence of the older patients who have received orthopedic surgery between multi-nonpharmacological interventions and general routine care. Therefore, the purpose of this study is to address the prevention or improvement of delirium incidence density in medical hospitalized elderly, provide clinical nurses as a reference for clinical implementation, and develop follow-up related research. This study is a quasi-experimental design using purposive sampling. Samples are from two wards: the geriatric ward and the general medicine ward at a medical center in central Taiwan. The sample size estimated at least 100, and then the data will be collected through a self-administered structured questionnaire, including: demographic and professional evaluation items. Case recruiting from 5/13/2023. The research results will be analyzed by SPSS for Windows 22.0 software, including descriptive statistics and inferential statistics: logistic regression、Generalized Estimating Equation(GEE)、multivariate analysis of variance(MANOVA).

Keywords: multiple nonpharmacological interventions, hospitalized elderly, delirium incidence, delirium

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3203 PYURF and ZED9 Have a Prominent Role in Association with Molecular Pathways in Bortezomib in Myeloma Cells in Acute Myeloid Leukemia

Authors: Atena Sadat Hosseini, Mohammadhossein Habibi

Abstract:

Acute myeloid leukemia (AML) is the most typically diagnosed leukemia. In older adults, AML imposes a dismal outcome. AML originates with a dominant mutation, then adds collaborative, transformative mutations leading to myeloid transformation and clinical/biological heterogeneity. Several chemotherapeutic drugs are used for this cancer. These drugs are naturally associated with several side effects, and finding a more accurate molecular mechanism of these drugs can have a significant impact on the selection and better candidate of drugs for treatment. In this study, we evaluated bortezomibin myeloma cells using bioinformatics analysis and evaluation of RNA-Seq data. Then investigated the molecular pathways proteins- proteins interactions associated with this chemotherapy drug. A total of 658upregulated genes and 548 downregulated genes were sorted.AUF1 (hnRNP D0) binds and destabilizes mRNA, degradation of GLI2 by the proteasome, the role of GTSE1 in G2/M progression after G2 checkpoint, TCF dependent signaling in response to WNT demonstrated in upregulated genes. Besides insulin resistance, AKT phosphorylates targets in the nucleus, cytosine methylation, Longevity regulating pathway, and Signal Transduction of S1P Receptor were related to low expression genes. With respect to this results, HIST2H2AA3, RP11-96O20.4, ZED9, PRDX1, and DOK2, according to node degrees and betweenness elements candidates from upregulated genes. in the opposite side, PYURF, NRSN1, FGF23, UPK3BL, and STAG3 were a prominent role in downregulated genes. Sum up, Using in silico analysis in the present study, we conducted a precise study ofbortezomib molecular mechanisms in myeloma cells. so that we could take further evaluation to discovermolecular cancer therapy. Naturally, more additional experimental and clinical procedures are needed in this survey.

Keywords: myeloma cells, acute myeloid leukemia, bioinformatics analysis, bortezomib

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3202 Post-modernist Tragi-Comedy: A Study of Tom Stoppard’s “Rosencrantz and Guildenstern Are Dead”

Authors: Azza Taha Zaki

Abstract:

The death of tragedy is probably the most distinctive literary controversy of the twentieth century. There is common critical consent that tragedy in the classical sense of the word is no longer possible. Thinkers, philosophers, and critics such as Nietzsche, Durrenmatt, and George Steiner have all agreed that the decline of the genre in the modern age is due to the total lack of a unified world image and the absence of a shared vision in a fragmented and ideologically diversified world. The production of Rosencrantz and Guildenstern are Dead in 1967 marked the rise of the genre of tragi-comedy as a more appropriate reflection of the spirit of the age. At the hands of such great dramatists as Tom Stoppard (1937- ), the revived genre was not used as an extra comic element to give some comic relief to an otherwise tragic text, but it was given a postmodernist touch to serve the interpretation of the dilemma of man in the postmodernist world. This paper will study features of postmodernist tragi-comedy in Rosencrantz and Guildenstern are Dead as one of the most important plays in modern British theatre and investigate Stoppard’s vision of man and life as influenced by postmodernist thought and philosophy.

Keywords: British, drama, postmodernist, Stoppard, tragi-comedy

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3201 Common Orthodontic Indices and Classification in the United Kingdom

Authors: Ashwini Mohan, Haris Batley

Abstract:

An orthodontic index is used to rate or categorise an individual’s occlusion using a numeric or alphanumeric score. Indexing of malocclusions and their correction is important in epidemiology, diagnosis, communication between clinicians as well as their patients and assessing treatment outcomes. Many useful indices have been put forward, but to the author’s best knowledge, no one method to this day appears to be equally suitable for the use of epidemiologists, public health program planners and clinicians. This article describes the common clinical orthodontic indices and classifications used in United Kingdom.

Keywords: classification, indices, orthodontics, validity

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3200 Neuropsychological Deficits in Drug-Resistant Epilepsy

Authors: Timea Harmath-Tánczos

Abstract:

Drug-resistant epilepsy (DRE) is defined as the persistence of seizures despite at least two syndrome-adapted antiseizure drugs (ASD) used at efficacious daily doses. About a third of patients with epilepsy suffer from drug resistance. Cognitive assessment has a crucial role in the diagnosis and clinical management of epilepsy. Previous studies have addressed the clinical targets and indications for measuring neuropsychological functions; best to our knowledge, no studies have examined it in a Hungarian therapy-resistant population. To fill this gap, we investigated the Hungarian diagnostic protocol between 18 and 65 years of age. This study aimed to describe and analyze neuropsychological functions in patients with drug-resistant epilepsy and identify factors associated with neuropsychology deficits. We perform a prospective case-control study comparing neuropsychological performances in 50 adult patients and 50 healthy individuals between March 2023 and July 2023. Neuropsychological functions were examined in both patients and controls using a full set of specific tests (general performance level, motor functions, attention, executive facts., verbal and visual memory, language, and visual-spatial functions). Potential risk factors for neuropsychological deficit were assessed in the patient group using a multivariate analysis. The two groups did not differ in age, sex, dominant hand and level of education. Compared with the control group, patients with drug-resistant epilepsy showed worse performance on motor functions and visuospatial memory, sustained attention, inhibition and verbal memory. Neuropsychological deficits could therefore be systematically detected in patients with drug-resistant epilepsy in order to provide neuropsychological therapy and improve quality of life. The analysis of the classical and complex indices of the special neuropsychological tasks presented in the presentation can help in the investigation of normal and disrupted memory and executive functions in the DRE.

Keywords: drug-resistant epilepsy, Hungarian diagnostic protocol, memory, executive functions, cognitive neuropsychology

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3199 New Hybrid Method to Model Extreme Rainfalls

Authors: Youness Laaroussi, Zine Elabidine Guennoun, Amine Amar

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Modeling and forecasting dynamics of rainfall occurrences constitute one of the major topics, which have been largely treated by statisticians, hydrologists, climatologists and many other groups of scientists. In the same issue, we propose in the present paper a new hybrid method, which combines Extreme Values and fractal theories. We illustrate the use of our methodology for transformed Emberger Index series, constructed basing on data recorded in Oujda (Morocco). The index is treated at first by Peaks Over Threshold (POT) approach, to identify excess observations over an optimal threshold u. In the second step, we consider the resulting excess as a fractal object included in one dimensional space of time. We identify fractal dimension by the box counting. We discuss the prospect descriptions of rainfall data sets under Generalized Pareto Distribution, assured by Extreme Values Theory (EVT). We show that, despite of the appropriateness of return periods given by POT approach, the introduction of fractal dimension provides accurate interpretation results, which can ameliorate apprehension of rainfall occurrences.

Keywords: extreme values theory, fractals dimensions, peaks Over threshold, rainfall occurrences

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3198 Phenotypical and Genotypical Diagnosis of Cystic Fibrosis in 26 Cases from East and South Algeria

Authors: Yahia Massinissa, Yahia Mouloud

Abstract:

Cystic fibrosis (CF), the most common lethal genetic disease in the Europe population, is caused by mutations in the transmembrane conductance regulator gene (CFTR). It affects most organs including an epithelial tissue, base of hydroelectrolytic transepithelial transport, notably that aerial ways, the pancreas, the biliary ways, the intestine, sweat glands and the genital tractus. The gene whose anomalies are responsible of the cystic fibrosis codes for a protein Cl channel named CFTR (cystic fibrosis transmembrane conductance regulator) that exercises multiple functions in the cell, one of the most important in control of sodium and chlorine through epithelia. The deficient function translates itself notably by an abnormal production of viscous secretion that obstructs the execrator channels of this target organ: one observes then a dilatation, an inflammation and an atrophy of these organs. It also translates itself by an increase of the concentration in sodium and in chloride in sweat, to the basis of the sweat test. In order to do a phenotypical and genotypical diagnosis at a part of the Algerian population, our survey has been carried on 16 patients with evocative symptoms of the cystic fibrosis at that the clinical context has been confirmed by a sweat test. However, anomalies of the CFTR gene have been determined by electrophoresis in gel of polyacrylamide of the PCR products (polymerase chain reaction), after enzymatic digestion, then visualized to the ultraviolet (UV) after action of the ethidium bromide. All mutations detected at the time of our survey have already been identified at patients attained by this pathology in other populations of the world. However, the important number of found mutation with regard to the one of the studied patients testifies that the origin of this big clinical variability that characterizes the illness in the consequences of an enormous diversity of molecular defects of the CFTR gene.

Keywords: cystic fibrosis, CFTR gene, polymorphism, algerian population, sweat test, genotypical diagnosis

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3197 Challenges Faced by Physician Leaders in Teaching Hospitals of Private Medical Schools in the National Capital Region, Philippines

Authors: Policarpio Jr. Joves

Abstract:

Physicians in most teaching hospitals are commonly promoted into managerial roles, yet their training is mostly in clinical and scientific skills but not in leadership competencies. When they shift into roles of physician leadership, the majority hold on to their primary identity of physicians. These conflicting roles affect their identity and eventually their work. The physician leaders also face additional challenges related to academics which include incorporation of new knowledge into the existing curriculum, use of technology in the delivery of teaching, the need to train medical students outside of hospital wards, etc. The study aims to explore how physician leaders in teaching hospitals of private medical schools enact their leadership roles and how they face the challenges as physician leaders. The study setting shall be teaching hospitals of three private medical schools situated in the National Capital Region, Philippines. A multiple case study design shall be adopted in this research. Physicians shall be eligible to participate in the study if they are practicing clinicians limited to the five major clinical specialty: Internal Medicine, Pediatrics, Family Medicine, Surgery, Obstetrics and Gynecology. They must be teaching in the College of Medicine prior to their appointments as physician leaders in both medical school and teaching hospital. Semi-structured face-to-face interviews shall be utilized as a means of data collection, with open-ended questions, enabling physician leaders to present narratives about their identity, role enactment, conflicts, reaction of colleagues, and the challenges encountered in their day-to-day work as physician leaders. Interviews shall be combined with observations and review of records to gain more insights into how the physician leaders are 'doing' management. Within-case analysis shall be done initially followed by a thematic analysis across the cases, referred to as cross–case analysis or cross-case synthesis.

Keywords: academic leaders, academic managers, physician leaders, physician managers

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3196 Platelet Transfusion Thresholds for Pediatrics; A Retrospective Study

Authors: Hessah Alsulami, Majedah Aldosari

Abstract:

Introduction: Platelet threshold of 10x109 /L is recommended for clinically stable thrombocytopenic pediatric patients. Transfusions at a higher level (given the absence of research evidence, as determined by clinical circumstances, generally at threshold of 40x109 /L) may be required for patients with signs of bleeding, high fever, hyper-leukocytosis, rapid fall in platelet count, concomitant coagulation abnormality, critically ill patients, and those with impaired platelet function (including drug induced). Transfusions at a higher level may be also required for patients undergoing invasive procedures. Method: This study is a retrospective observational analysis of platelet transfusion thresholds in a single secondary pediatric hospital in Riyadh. From the blood bank database, the list of the patients who received platelet transfusions in the second half of 2018 was retrieved. Patients were divided into two groups; group A, those belong to the category of high platelet level for transfusion (such as those with bleeding, high fever, rapid fall in platelet count, impaired platelet function or undergoing invasive procedures) and group B, those who were not. Then we looked at the pre and post transfusion platelet levels for each group. The data was analyzed using GraphPad software and the data expressed as Mean ± SD. Result: A total of 112 of transfusion episodes in 61 patients (38% female) were analyzed. The age ranged from 24 days to 8 years. The distribution of platelet transfusion episodes was 64% (n=72) for group A and 36% (n= 40) for group B. The mean pre-transfusion platelet count was 46x103 ± (11x 103) for group A and 28x103 ± (6x103) for group B. the post-transfusion mean platelet count was 61 x 103 ± (14 x 103) and 60 x103 ± (24 x 103) for group A and B respectively. Among the groups the rise in the mean platelet count after transfusion was significant among stable patients (group B) compared to unstable patients (group A) (P < 0.001). Conclusion: The platelet count threshold for transfusion varied with the clinical condition and is higher among unstable patients’ group which is expected. For stable patients the threshold was higher than what it should be which means that the clinicians don’t follow the guidelines in this regard. The rise of platelet count after transfusion was higher among stable patients.

Keywords: platelet, transfusion, threshold, pediatric

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3195 The Predictability of Three Implants to Support a Fixed Prosthesis in the Edentulous Mandible

Authors: M. Hirani, M. Devine, O. Obisesan, C. Bryant

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Introduction: The use of four or more implants to support a fixed prosthesis in the edentulous mandible is well documented, with high levels of clinical outcomes recorded. Despite this, the use of three implant-supported fixed prostheses offers the potential to deliver a more cost-effective method of oral rehabilitation in the lower arch, an important consideration given that edentulism is most prevalent in low-income subpopulations. The purpose of this study aimed to evaluate the implant and prosthetic survival rate, changes in marginal bone level, and patient satisfaction associated with a three-implant-supported fixed prosthesis for rehabilitation of the edentulous mandible over a follow-up period of at least one year. Methods: A comprehensive literature search was performed to evaluate studies that met the selection criteria. The information extracted included the study design and population, participant demographics, observation period, loading protocol, and the number of implants placed together with the required outcome measures. Mean values and standard deviations (SD) were calculated using SPSS® (IBM Corporation, New York, USA), and the level of statistical significance across all comparative studies described was set at P < 0.05. Results: The eligible studies included a total of 1968 implants that were placed in 652 patients. The subjects ranged in age from 33-89 years, with a mean of 63.2 years. The mean cumulative implant and prosthetic survival rates were 95.5% and 96.2%, respectively, over a mean follow-up period of 3.25 years. The mean marginal bone loss recorded was 1.04 mm, and high patient satisfaction rates were reported across the studies. Conclusion: Current evidence suggests that a three implant-supported fixed prosthesis for the edentulous mandible is a successful treatment strategy presenting high implant and prosthetic survival rates over the short-to-medium term. Further well-designed controlled clinical trials are required to evaluate longer-term outcomes, with supplemental data correlating implant dimensions and prosthetic design.

Keywords: implants, mandible, fixed, prosthesis

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3194 Clinical and Etiological Particularities of Infectious Uveitis in HIV+ and HIV- Patients in the Internal Medicine Department

Authors: N. Jait, M. Maamar, H. Khibri, H. Harmouche, N. Mouatssim, W. Ammouri, Z. Tazimezaelek, M. Adnaoui

Abstract:

Introduction: Uveitis presents with inflammation of the uvea, intraocular, of heterogeneous etiology and presentation. The objective of our study is to describe the clinical and therapeutic characteristics of infectious uveitis in HIV+ and HIV- patients. Patients and Methods: This is a retrospective study conducted at the internal medicine department of CHU Ibn Sina in Rabat over a period of 12 years (2010–2021), collecting 42 cases of infectious uveitis. Results: 42 patients were identified. 34% (14 cases) had acquired immunosuppression (9 cases: 22% had HIV infection and 12% were on chemotherapy), and 66% were immunocompetent. The M/F sex ratio was 1.1. The average age was 39 years old. Uveitis revealed HIV in a single case; 8/9 patients have already been followed, their average viral load is 3.4 log and an average CD4 count is 356/mm³. The revealing functional signs were: ocular redness (27%), decreased visual acuity (63%), visual blurring (40%), ocular pain (18%), scotoma (13%), and headaches (4%). The uveitis was site: anterior (30%), intermediate (6%), posterior (32%), and pan-uveitis (32%); unilateral in 80% of patients and bilateral in 20%. The etiologies of uveitis in HIV+ were: 3 cases of CMV, 2 cases of toxoplasmosis, 1 case of tuberculosis, 1 case of HSV, 1 case of VZV, and 1 case of syphilis. Etiologies of immunocompetent patients: tuberculosis (41%), toxoplasmosis (18%), syphilis (15%), CMV infection (4 cases: 10%), HSV infection (4 cases: 10%) , lepromatous uveitis (1 case: 2%), VZV infection (1 case: 2%), a locoregional infectious cause such as dental abscess (1 case: 2%), and one case of borreliosis (3% ). 50% of tuberculous uveitis was of the pan-uveitis type, 75% of the uveitis by toxoplasmosis was of the posterior type. Uveitis was associated with other pathologies in 2 seropositive cases (cerebral vasculitis, multifocal tuberculosis). A specific treatment was prescribed in all patients. The initial evolution was favorable in 67%, including 12% HIV+. 11% presented relapses of the same seat during uveitis of the toxoplasmic, tuberculous and herpetic type. 47% presented complications, of which 4 patients were HIV+: 3 retinal detachments; 7 Retinal hemorrhages. 6 unilateral blindness (including 2 HIV+ patients). Conclusion: In our series, the etiologies of infectious uveitis differ between HIV+ and HIV- patients. In HIV+ patients most often had toxoplasmosis and CMV, while HIV - patients mainly presented with tuberculosis and toxoplasmosis. The association between HIV and uveitis is undetermined, but HIV infection was an independent risk factor for uveitis.

Keywords: uveitis, HIV, immunosuppression, infection

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3193 Gastric Foreign Bodies in Dogs

Authors: Naglaa A. Abd Elkader, Haithem A. Farghali

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The present study carried out on fifteen clinical cases of different species of dogs which admitted to surgical clinic of veterinary medicine with different symptoms (Acute vomiting, hematemesis and anorexia). There was diagnostic march which including plain radiograph and endoscopic examination. Treatment was including surgical interference and endoscopic retrieval followed by medicinal treatment. This study was aimed the detection of different foreign bodies by the most suitable method according to the type of the foreign bodies.

Keywords: stomach, endoscopy, foreign bodies, dogs

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3192 Autistic Traits and Multisensory Integration–Using a Size-Weight Illusion Paradigm

Authors: Man Wai Lei, Charles Mark Zaroff

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Objective: A majority of studies suggest that people with Autism Spectrum Disorder (ASD) have multisensory integration deficits. However, normal and even supranormal multisensory integration abilities have also been reported. Additionally, little of this work has been undertaken utilizing a dimensional conceptualization of ASD; i.e., a broader autism phenotype. Utilizing methodology that controls for common potential confounds, the current study aimed to examine if deficits in multisensory integration are associated with ASD traits in a non-clinical population. The contribution of affective versus non-affective components of sensory hypersensitivity to multisensory integration was also examined. Methods: Participants were 147 undergraduate university students in Macau, a Special Administrative Region of China, of Chinese ethnicity, aged 16 to 21 (Mean age = 19.13; SD = 1.07). Participants completed the Autism-Spectrum Quotient, the Sensory Perception Quotient, and the Adolescent/Adult Sensory Profile, in order to measure ASD traits, non-affective, and affective aspects of sensory/perceptual hypersensitivity, respectively. In order to explore multisensory integration across visual and haptic domains, participants were asked to judge which one of two equally weighted, but different sized cylinders was heavier, as a means of detecting the presence of the size-weight illusion (SWI). Results: ASD trait level was significantly and negatively correlated with susceptibility to the SWI (p < 0.05); this correlation was not associated with either accuracy in weight discrimination or gender. Examining the top decile of the non-normally distributed SWI scores revealed a significant negative association with sensation avoiding, but not other aspects of effective or non-effective sensory hypersensitivity. Conclusion and Implications: Within the normal population, a greater degree of ASD traits is associated with a lower likelihood of multisensory integration; echoing was often found in individuals with a clinical diagnosis of ASD, and providing further evidence for the dimensional nature of this disorder. This tendency appears to be associated with dysphoric emotional reactions to sensory input.

Keywords: Autism Spectrum Disorder, dimensional, multisensory integration, size-weight illusion

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3191 A Motion Dictionary to Real-Time Recognition of Sign Language Alphabet Using Dynamic Time Warping and Artificial Neural Network

Authors: Marcio Leal, Marta Villamil

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Computacional recognition of sign languages aims to allow a greater social and digital inclusion of deaf people through interpretation of their language by computer. This article presents a model of recognition of two of global parameters from sign languages; hand configurations and hand movements. Hand motion is captured through an infrared technology and its joints are built into a virtual three-dimensional space. A Multilayer Perceptron Neural Network (MLP) was used to classify hand configurations and Dynamic Time Warping (DWT) recognizes hand motion. Beyond of the method of sign recognition, we provide a dataset of hand configurations and motion capture built with help of fluent professionals in sign languages. Despite this technology can be used to translate any sign from any signs dictionary, Brazilian Sign Language (Libras) was used as case study. Finally, the model presented in this paper achieved a recognition rate of 80.4%.

Keywords: artificial neural network, computer vision, dynamic time warping, infrared, sign language recognition

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3190 Cup-Cage Construct for Treatment of Severe Acetabular Bone Loss in Revision Total Hip Arthroplasty: Midterm Clinical and Radiographic Outcomes

Authors: Faran Chaudhry, Anser Daud, Doris Braunstein, Oleg Safir, Allan Gross, Paul Kuzyk

Abstract:

Background: Acetabular reconstruction in the context of massive acetabular bone loss is challenging. In rare scenarios where the extent of bone loss precludes shell placement (cup-cage), reconstruction at our center consisted of a cage combined with highly porous metal augments. This study evaluates survivorship, complications, and functional outcomes using this technique. Methods: A total of 131 cup-cage implants (129 patients) were included in our retrospective review of revisions of total hip arthroplasty from January 2003 to January 2022. Among these cases, 100/131 (76.3%) were women, the mean age at surgery time was 68.7 years (range, 29.0 to 92.0; SD, 12.4), and the mean follow-up was 7.7 years (range, 0.02 to 20.3; SD, 5.1). Kaplan-Meier survivorship analysis was conducted with failure defined as revision surgery and/or failure of the cup-cage reconstruction. Results: A total of 30 implants (23%) reached the study endpoint involving all-cause revision. Overall survivorship was 74.8% at 10 years and 69.8% at 15 years. Reasons for revision included infection 12/131 (9.1%), dislocation 10/131 (7.6%), aseptic loosening of cup and/or cage 5/131 (3.8%), and aseptic loosening of the femoral stem 2/131 (1.5%). The mean LLD improved from 12.2 ± 15.9 mm to 3.9 ± 11.8 (p<0.05). The horizontal and vertical hip centres on plain film radiographs were significantly improved (p<0.05). Functionally, there was a decrease in the number of patients requiring the use of gait aids, with fewer patients (34, 25.9%) using a cane, walker, or wheelchair post-operatively compared to pre-operatively (58, 44%). There was a significant increase in the number of independent ambulators from 24 to 47 (36%). Conclusion: The cup-cage construct is a reliable treatment option for the treatment of various acetabular defects. There are favourable survivorship, clinical and radiographic outcomes, with a satisfactory complication rate.

Keywords: revision total hip arthroplasty, acetabular defect, pelvic discontinuity, trabecular metal augment, cup-cage

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3189 A Study of NT-ProBNP and ETCO2 in Patients Presenting with Acute Dyspnoea

Authors: Dipti Chand, Riya Saboo

Abstract:

OBJECTIVES: Early and correct diagnosis may present a significant clinical challenge in diagnosis of patients presenting to Emergency Department with Acute Dyspnoea. The common cause of acute dyspnoea and respiratory distress in Emergency Department are Decompensated Heart Failure (HF), Chronic Obstructive Pulmonary Disease (COPD), Asthma, Pneumonia, Acute Respiratory Distress Syndrome (ARDS), Pulmonary Embolism (PE), and other causes like anaemia. The aim of the study was to measure NT-pro Brain Natriuretic Peptide (BNP) and exhaled End-Tidal Carbon dioxide (ETCO2) in patients presenting with dyspnoea. MATERIAL AND METHODS: This prospective, cross-sectional and observational study was performed at the Government Medical College and Hospital, Nagpur, between October 2019 and October 2021 in patients admitted to the Medicine Intensive Care Unit. Three groups of patients were compared: (1) HFrelated acute dyspnoea group (n = 52), (2) pulmonary (COPD/PE)-related acute dyspnoea group (n = 31) and (3) sepsis with ARDS-related dyspnoea group (n = 13). All patients underwent initial clinical examination with a recording of initial vital parameters along with on-admission ETCO2 measurement, NT-proBNP testing, arterial blood gas analysis, lung ultrasound examination, 2D echocardiography, chest X-rays, and other relevant diagnostic laboratory testing. RESULTS: 96 patients were included in the study. Median NT-proBNP was found to be high for the Heart Failure group (11,480 pg/ml), followed by the sepsis group (780 pg/ml), and pulmonary group had an Nt ProBNP of 231 pg/ml. The mean ETCO2 value was maximum in the pulmonary group (48.610 mmHg) followed by Heart Failure (31.51 mmHg) and the sepsis group (19.46 mmHg). The results were found to be statistically significant (P < 0.05). CONCLUSION: NT-proBNP has high diagnostic accuracy in differentiating acute HF-related dyspnoea from pulmonary (COPD and ARDS)-related acute dyspnoea. The higher levels of ETCO2 help in diagnosing patients with COPD.

Keywords: NT PRO BNP, ETCO2, dyspnoea, lung USG

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3188 DGA Data Interpretation Using Extension Theory for Power Transformer Diagnostics

Authors: O. P. Rahi, Manoj Kumar

Abstract:

Power transformers are essential and expensive equipments in electrical power system. Dissolved gas analysis (DGA) is one of the most useful techniques to detect incipient faults in power transformers. However, the identification of the faulted location by conventional method is not always an easy task due to variability of gas data and operational variables. In this paper, an extension theory based power transformer fault diagnosis method is presented. Extension theory tries to solve contradictions and incompatibility problems. This paper first briefly introduces the basic concept of matter element theory, establishes the matter element models for three-ratio method, and then briefly discusses extension set theory. Detailed analysis is carried out on the extended relation function (ERF) adopted in this paper for transformer fault diagnosis. The detailed diagnosing steps are offered. Simulation proves that the proposed method can overcome the drawbacks of the conventional three-ratio method, such as no matching and failure to diagnose multi-fault. It enhances diagnosing accuracy.

Keywords: DGA, extension theory, ERF, fault diagnosis power transformers, fault diagnosis, fuzzy logic

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3187 Identification and Origins of Multiple Personality: A Criterion from Wiggins

Authors: Brittany L. Kang

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One familiar theory of the origin of multiple personalities focuses on how symptoms of trauma or abuse are central causes, as seen in paradigmatic examples of the condition. The theory states that multiple personalities constitute a congenital condition, as babies all exhibit multiplicity, and that generally alters only remain separated due to trauma. In more typical cases, the alters converge and become a single identity; only in cases of trauma, according to this account, do the alters remain separated. This theory is misleading in many aspects, the most prominent being that not all multiple personality patients are victims of child abuse or trauma, nor are all cases of multiple personality observed in early childhood. The use of this criterion also causes clinical problems, including an inability to identify multiple personalities through the variety of symptoms and traits seen across observed cases. These issues present a need for revision in the currently applied criterion in order to separate the notion of child abuse and to be able to better understand the origins of multiple personalities itself. Identifying multiplicity through the application of identity theories will improve the current criterion, offering a bridge between identifying existing cases and understanding their origins. We begin by applying arguments from Wiggins, who held that each personality within a multiple was not a whole individual, but rather characters who switch off. Wiggins’ theory is supported by observational evidence of how such characters are differentiated. Alters of older ages are seen to require different prescription lens, in addition to having different handwriting. The alters may also display drastically varying styles of clothing, preferences in food, their gender, sexuality, religious beliefs and more. The definitions of terms such as 'personality' or 'persons' also become more distinguished, leading to greater understanding of who is exactly able to be classified as a patient of multiple personalities. While a more common meaning of personality is a designation of specific characteristics which account for the entirety of a person, this paper argues from Wiggins’ theory that each 'personality' is in fact only partial. Clarification of the concept in question will allow for more successful future clinical applications.

Keywords: identification, multiple personalities, origin, Wiggins' theory

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