Search results for: family and systemic psychotherapy

Authors: Josee Charette

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The academic and educational success of migrant students is a current issue in education, especially in western societies such in the province of Quebec, in Canada. For people who immigrate with school-age children, the success of the family’s migratory project is often measured by the benefits drawn by children from the educational institutions of their host society. In order to support the academic achievement of their children, migrant parents try to develop practices that derive from their representations of school and related challenges inspired by the socio-cultural context of their country of origin. These findings lead us to the following question: How does strategies implemented by migrant parents to manage the representational distance between school of their country of origin and school of their host society support or not the academic and educational success of their child? In the context of a qualitative exploratory approach, we have made interviews in the French , English and Spanish languages with 32 newly immigrated parents and 10 of their children. Parents were invited to complete a network of free associations about «School in Quebec» as a premise for the interview. The objective of this paper is to present strategies implemented by migrant parents to manage the distance between their representations of schools in their country of origin and in the host society, and to explore the influence of this management on their child’s academic and educational trajectories. Data analysis led us to develop various types of strategies, such as continuity, adaptation, resources mobilization, compensation and "return to basics" strategies. These strategies seem to be part of a continuum from oppositional-conflict scenario, in which parental strategies act as a risk factor, to conciliator-integrator scenario, in which parental strategies act as a protective factor for migrant students’ academic and educational success. In conclusion, we believe that our research helps in highlighting strategies implemented by migrant parents to support their child’s academic and educational success in the host society and also helps in providing a more efficient support to migrant parents and contributes to develop a wider portrait of migrant students’ academic achievement.

Keywords: academic and educational achievement of immigrant students, family’s migratory project, immigrants parental strategies, representational distance between school of origin and school of host society

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Authors: Abbassi Daloii Asieh, Yazdani Hoda

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Background and Objective: evidence supports systemic inflammation in obesity and insulin resistance. Apelin that is secreted by adipose tissue plays an important role in the inflammation process and appear act as an anti-inflammatory cytokines. The aim of this study was the effect of eight weeks aerobic training and nitro-L-arginine-methyl ester (L-NAME) on plasma apelin in male’s rats. Materials and Methods: For this purpose, 24 male Wistar rats aged 20 months were randomly assigned into four groups: Control, training, training and L-NAME and L-NAME. Training intervention was eight weeks aerobic exercise (5 time/weekly) at 75-80 (%) of maximal oxygen consumption. All rats were killed 72 hours after lasted exercise session; blood samples collected and plasma were stored. Data was analyzed by one way ANOVA and Tucky Test. A p value less than 0.05 was considered statistically signigcant. Results: The results showed that after eight weeks of endurance training exercise Apelin plasma compared to the control group did not change significantly. Also, the results showed that there was significant difference in plasma Apelin between groups(P > 0/05). Also, the results showed no significant difference between the insulin levels and glucose of four groups (P > 0/05). Conclusion: It seems that aerobic exercise plasma Apelin levels in male rats is not affected. On the other hand, nitric oxide inhibitors can reduce levels of plasma Apelin.

Keywords: aerobic training, L-NAME, plasma Apelin, male’s rats

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Authors: Heena Akbar, Winnie Niumata, Danielle Gallegos

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Type 2 diabetes is a significant public health problem for Māori and Pasifika communities in Queensland, who are experiencing a higher burden of morbidity and mortality from the condition. Despite this higher burden, there are few initiatives that are culturally tailored to improve prevention and management. Modification of personal behaviors through women’s wellness programs aimed at early intervention has been shown to reduce the risk of developing complications in established type 2 diabetes and may reduce hospitalization rates from preventable complications related to this disease. The 24-week Pasifika Women’s Diabetes Wellness Program (PWDWP) was culturally co-designed and co-developed with Māori and Pasifika women with type 2 diabetes through a community-academia partnership in Queensland. Underpinned by Social Cognitive Theory and the Indigenous Pacific Health frameworks to include family culture & spirituality and integrating a collectivist and whānau (family) centered approach to self-care, the program takes into consideration the cultural shame associated with acknowledging the disease and tailors the interventions using talanoa (storytelling or conversation in a relational context) as the key strategy to come to a shared meaning for behavior change. The pilot trial is a 12-week intervention followed by a 12-week follow-up period conducted with 50 women with type 2 diabetes, 25 women who will receive the intervention and 25 women who will receive usual care. The pilot program provides in-person and virtual access to culturally supported prevention and self-management of Māori and Pasifika women with type 2 diabetes with the aim to improve healthy lifestyles and reduce late hospital presentations from diabetes-related complications for better diabetes-related outcomes. This study will test and evaluate the effectiveness of the PWDWP pilot trial in partnership with Māori & Pasifika community organizations and key stakeholders for improved glycated hemoglobin (HbA1c) levels associated with poor management of type 2 diabetes.

Keywords: culturally co-designed intervention, Indigenous methodology, Māori and Pasifika communities, type 2 diabetes self-management

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Authors: Cemile Kütmeç Yilmaz, Güler Duru Asiret, Gulcan Bagcivan

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The aim of this study was to evaluate the reliability and validity of the Turkish version of the Carer’s Assessment of Satisfaction Index (CASI-TR). The study was conducted between the dates of June 2016 and September 2017 at the Training and Research Hospital of Aksaray University with the caregiving family members of the inpatients with chronic diseases. For this study, the sample size was calculated as at least 10 individuals for each item (item number (30)X10=300). The study sample included 300 caregiving family members, who provided primer care for at least three months for a patient (who had at least one chronic disease and received inpatient treatment in general internal medicine and palliative care units). Data were collected by using a demographic questionnaire and CASI-TR. Descriptive statistics, and psychometric tests were used for the data analysis. Of those caregivers, 76.7% were female, 86.3% were 65 years old and below, 43.7% were primary school graduates, 87% were married, 86% were not working, 66.3% were housewives, and 60.3% defined their income status as having an income covering one’s expenses. Care recipients often had problems in terms of walking, sleep, balance, feeding and urinary incontinence. The Cronbach Alpha value calculated for the CASI-TR (30 items) was 0,949. Internal consistency coefficients calculated for subscales were: 0.922 for the subscale of ‘caregiver satisfaction related to care recipient’, 0.875 for the subscale of ‘caregiver satisfaction related to themselves’, and 0.723 for the subscale of ‘dynamics of interpersonal relations’. Factor analysis revealed that three factors accounted for 57.67% of the total variance, with an eigenvalue of >1. assessed in terms of significance, we saw that the items came together in a significant manner. The factor load of the items were between 0.311 and 0.874. These results show that the CASI-TR is a valid and reliable scale. The adoption of the translated CASI in Turkey is found reliable and valid to assessing the satisfaction of caregivers. CASI-TR can be used easily in clinics or house visits by nurses and other health professionals for assessing caregiver satisfaction from caregiving.

Keywords: carer’s assessment of satisfaction index, caregiver, validity, reliability

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Authors: Muhammed-Badar Salihu Jibrin, Chibabi Makedono Darlington

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This paper studied Ideational Grammatical Metaphor (IGM) of Narrative History in Chinua Achebe’s There Was a Country. It started with a narrative historical style as a recent genre out of the conventional historical writings. In order to explore the linguistic phenomenon using a particular lexico-grammatical tool of IGM, the theoretical background was examined based on Hallidayan Systemic Functional Linguistics. Furthermore, the study considered the possibility of applying IGM to the Part 4 of Achebe’s historical text with recourse to the concept of congruence in IGM and research questions before formulating a working methodology. The analysis of Achebe’s memoir was, thus, presented in tabular forms to account for the quantitative content analysis with qualitative research technique, as well as the metaphorical and congruent wording through nominalization and process types with samples. The frequencies and percentage were given appropriately with respect to each subheadings of the text. To this end, the findings showed that material and relational types indicated dominance. The discussion and implications were that the findings confirmed earlier study by MAK Halliday and C.I.M.I.M. Matthiessen’s suggestion that IGM should show dominance of material type process. The implication is that IGM can be an effective tool for the analysis of a narrative historical text. In conclusion, it was observed that IGM does not only carry grammatical function but also an ideological role in shaping the historical discourse within the narrative mode between writers and readers.

Keywords: ideational grammatical metaphor, nominalization, narrative history, memoire, dominance

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Authors: G. Nadirova, B. Aktaulova

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The main question of the research is- how did the Kazakhs manage to keep their religious thinking in the period of active propaganda of Soviet atheism, for seventy years of struggle against religion with the involvement of the scientific worldview as the primary means of proving the absence of the divine nature and materiality of the world? Our hypothesis is that In case of Kazakhstan the conservative female religious consciousness seems to have been a factor that helped to preserve the “everyday” religiousness of Kazakhs, which was far from deep theological contents of Islam, but able to revive in a short time after the decennia of proclaimed atheism.

Keywords: woman, religious thinking, Kazakhstan, soviet ideology, rituals, family

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Authors: Atul Srivastava, D. V. Gowda

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Enterotoxigenic Escherichia coli (ETEC) infection is one of the major causes contributing to the development of diarrhoea in adults and children in developing countries. To date, no preventive/treatment strategy showed promising results, which could be due to the lack of potent vaccines, and/or due to the development of resistance of ETEC to antibiotics. Therefore, in the present investigation, a novel porous Sodium Alginate (SA) tablet formulation loaded with F4 fimbriae antigen was developed and tested for efficacy against ETEC infections in piglet models. Pre-compression parameters of the powder mixes and post compression parameters of tablets have been evaluated and results were found to be satisfactory. Loading of F4 fimbrial antigens in to the tablets was achieved by inducing pores in the tablets via the sublimation of camphor followed by incubation with purified F4 fimbriae. The loaded tablets have been coated with Eudragit L100 to protect the F4 fimbriae from (a) highly acidic gastric environment; (b) proteolytic cleavage by pepsin; and (c) to promote subsequent release in the intestine. Evaluation of developed F4 fimbrial tablets in a Pig model demonstrated induction of mucosal immunity, and a significant reduction of F4+ E. coli in faeces. Therefore, F4 fimbriae loaded porous tablets could be a novel oral vaccination candidate to induce mucosal and systemic immunity against ETEC infections.

Keywords: porous tablets, sublimation, f4 fimbriae, eudragit l100, vaccination

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Authors: Ashleigh Dawn Moeller

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This is a comparative case study which examines the language attitudes and behaviors of descendants of Volga German immigrants in North America and how these attitudes combined with surrounding social conditions have caused their heritage language to develop differently within each community. Of particular interest for this study are the accounts of second- and third-generation descendants in Oregon, Kansas, and North Dakota regarding their parents’ and grandparents’ attitudes toward their language and how this correlates with the current sentiment as well as visibility of their heritage language and culture. This study discusses the point at which cultural identity could diverge from language identity and what elements play a role in this development, establishing the potential for environments (linguistic landscapes) which uphold their heritage yet have detached from the language itself. Emigrating from Germany in the 1700s, these families settled for over a hundred years along the Volga Region of Imperial Russia. Subsequently, many descendants of these settlers immigrated to the Americas in the 1800-1900s. Identifying neither as German nor Russian, they called themselves Wolgadeutche (Volga Germans). During their time in Russia, the German language was maintained relatively homogenously, yet the use and status of their heritage language diverged considerably upon settlement across the Americas. Data shows that specific conditions, such as community isolation, size, religion, location as well as language policy established prior to and following the Volga German immigration to North America have had a substantial impact on the maintenance of their heritage language—causing complete loss in some areas and peripheral use or even full rebirth in others. These past conditions combined with the family accounts correlate directly with the general attitudes and ideologies of the descendants toward their heritage language. Data also shows that in many locations, despite a strong presence of German within the linguistic landscape, minimal to no German is spoken nor understood; the attitude toward the language is indifferent while a staunch holding to the heritage is maintained and boasted. Data for this study was gathered from historical accounts, archived records and newspapers, and published biographies as well as from formal interviews with second- and third-generation descendants of Volga German immigrants conducted in Oregon and Kansas. Through the interviews, members of the community have shared and provided their family genealogies as well as biographies published by family members. These have helped to trace their relatives back to specific locations, thus allowing for comparisons within the same families residing in distinctly different areas of North America. This study is part of a larger ongoing project which researches the immigration of Volga and Black Sea Germans to North America and diachronically examines the over-arching sociological factors which have directly impacted the maintenance, loss, or rebirth of their heritage language. This project follows specific families who settled in areas of Colorado, Kansas, Nebraska, Illinois, Minnesota, North and South Dakota, Saskatchewan, and Manitoba, and who later had relatives move west to areas of Oregon and Washington State. Interviews for the larger project will continue into the following year.

Keywords: heritage language, immigrant language, language change, language contact, linguistic landscape, Volga Germans, Wolgadeutsche

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Authors: Riina I. Bray, Yifan Wang, Nikolas Argiropoulos, Stephanie Robins, John Molot, Kelly Tragash, Lynn M. Marshall, Margaret E. Sears, Marie-Andrée Pigeon, Michel Gaudet, Pierre Auger, Emily Bélanger, Rohini Peris

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Multiple chemical sensitivity (MCS) is a chronic medical condition characterized by intolerances to chemical substances. Since the arrival of the COVID-19 pandemic and associated health measures, people experiencing MCS (PEMCS) are at a heightened risk of environmental exposures associated with cleaners, disinfectants, and sanitizers. Little attention has been paid to the well-being of PEMCS in the context of the COVID-19 pandemic. Objective: This study assesses the lived experiences of Canadian adults with MCS in relation to their living environment, access to healthcare, and levels of perceived social support before and during the pandemic. Methods: A total of 119 PEMCS completed an online questionnaire. McNemar Chi-Squared and Wilcoxon Signed Rank tests were used to evaluate if there were statistically significant changes in participants’ perception of their living environment, access to healthcare, and levels of social support before and after March 11, 2020. Results: Both positive and negative outcomes were noted. Participants reported an increase in exposure to disinfectants/sanitizers that entered their living environment (p<.001). There was a reported decrease in access to a family doctor during the pandemic (p<0.001). Although PEMCS experienced increased social isolation (p<0.001), they also reported an increase in understanding from family (p<0.029) and a decrease in stigma for wearing personal protective equipment (p<0.001). Conclusion: PEMCS reported experiencing: increased exposure to disinfectants or sanitizers, a loss of social support, and barriers in accessing healthcare during the pandemic. However, COVID-19 provided an opportunity to normalize the living conditions of PEMCS, such as wearing masks and social isolation. These findings can guide decision-makers on the importance of implementing nontoxic alternatives for cleaning and disinfection, as well as improving accommodation measures for PEMCS.

Keywords: covid-19, multiple chemical sensitivity, MCS, quality of life, social isolation, physical environment, healthcare

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Authors: Temitope Ogungbemi

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Jama'atu Ahlis Sunna Lidda'awati wal-Jihad (also called Boko Haram) in the North-East of Nigeria has facilitated ideological binarity in discourses on the crisis. Since its proliferation, media representation of the crisis has facilitated identity contamination and ideological struggle through which other critical issues, such as religious intolerance, ethnic diversity and other forms of class conflict in the Nigerian state, are brought to public notice. Though Boko Haram insurgency is ideological laden, the manifestation of the inherent ideologies requires extensive scholarly attention in order deconstruct the veiled ideologies. Therefore, the thrust of this study is to critically investigate identity (mis)representation as a basis for ideological mapping in discourses on Boko Haram in Nigeria, adopting critical discourse analytical tools supported with insights from systemic functional linguistics and critical discourse analysis. The data for this study consist of articles on Boko Haram in Nigerian newspapers published in English. The data selection is purposive and aimed at responding to challenges that are inherent in Nigeria's multifaithism and multiculturalism, and their effects on the construction of narratives on Boko Haram. The study reveals that identity manipulation is a constructive device for ideological mapping, realised through labeling, agency activation, and transitivity. Identity representation in discourses on Boko Haram depicted four dichotomous binarities using exclusion, generalisation, contrasting and attribution.

Keywords: identity representation, ideology, Boko Haram, newspapers

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Authors: Waganesh Zeleke, Abebaw Minaye

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This study examined the act, means, and purpose of human trafficking in the case of Ethiopian migrant returnees from the Middle East and South Africa. Using a questionnaire survey data was gathered from 1078 returnees. Twelve focus group discussions were used to solicit detailed experience of returnee about the process of their 'unsafe' immigration. Both quantitative and qualitative analysis results revealed that against the mainstream thinking of human trafficking means such as forcing, coercing, abducting or threatening, traffickers used 'victims’ free will' means by providing false promises to and capitalizing on the vulnerability of migrants. The migrants’ living condition including unemployment, ambitious view to change their life, and low level of risk perception were found to be risk factors which made them vulnerable and target of the brokers and smugglers who served as a catalyst in the process of their 'unsafe' migration. Equal to the traffickers/brokers/agency, the migrants’ family, friends and Ethiopian embassies contributed to the deplorable situation of migrant workers. 64.4% of the returnees reported that their migration is self-initiated, and 20% reported peer pressure and 13.8 percent reported family pressure, and it is only 1.8% who reported having been pushed by brokers. The findings revealed that 69.5% of the returnees do not know about the lifestyle and culture of the host community before their leave. In a similar vein, 50.9% of the returnees reported that they do not know about the nature of the work they are to do and their responsibilities. Further, 81% of the returnees indicated that the pre-migration training they received was not enough in equipping them with the required skill. Despite the returnees experiences of various forms of abuse and exploitation in the journey and at the destination they still have a positive attitude for migration (t=9.7 mean of 18.85 with a test value of 15). The returnees evaluated the support provided by sending agencies and Ethiopian embassies in the destination to be poor. 51.8% of the migrants do not know the details of the contract they signed during migration. Close to 70% of the returnees expressed that they had not got any legal support from stakeholders when they faced problems. What is more is that despite all these 27.9% of the returnees indicated re-immigrating as their plan. Based on these findings on the context and experience of Ethiopian migrant returnees, implications for training, policy, research, and intervention are discussed.

Keywords: trafficking, migrant, returnee, Ethiopia, experience, reconceptualizing

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Authors: Jiri Beranovsky, Jaroslav Knapek, Tomas Kralik, Kamila Vavrova

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The paper deals with the results of research focused on the complex aspects of the use of intentionally grown biomass on agricultural land for the production of solid biofuels as an alternative for individual household heating. . The study primarily deals with the analysis of CO2 emissions of the logistics cycle of biomass for the production of energy pellets. Growing, harvesting, transport and storage are evaluated in the pellet production cycle. The aim is also to take into account the consumption profile during the year in terms of heating of common family houses, which are typical end-market segment for these fuels. It is assumed that in family houses, bio-pellets are able to substitute typical fossil fuels, such as brown coal and old wood burning heating devices and also electric boilers. One of the competing technology with the pellets are heat pumps. The results show the CO2 emissions related with considered fuels and technologies for their utilization. Comparative analysis is aimed biopellets from intentionally grown biomass, brown coal, natural gas and electricity used in electric boilers and heat pumps. Analysis combines CO2 emissions related with individual fuels utilization with costs of these fuels utilization. Cost of biopellets from intentionally grown biomass is derived from the economic models of individual energy crop plantations. At the same time, the restrictions imposed by EU legislation on Ecodesign's fuel and combustion equipment requirements and NOx emissions are discussed. Preliminary results of analyzes show that to achieve the competitiveness of pellets produced from specifically grown biomass, it would be necessary to either significantly ecological tax on coal (from about 0.3 to 3-3.5 EUR/GJ), or to multiply the agricultural subsidy per area. In addition to the Czech Republic, the results are also relevant for other countries, such as Bulgaria and Poland, which also have a high proportion of solid fuels for household heating.

Keywords: CO2 emissions, heating costs, energy crop, pellets, brown coal, heat pumps, economical evaluation

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Authors: M. F. Amado, A. Amado, F. Poggi, J. Correia de Freitas

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Today it is widely understood that global energy consumption patterns are directly related to the ongoing urban expansion and development process. This expansion is based on the natural growth of human activities and has left most urban areas totally dependent on fossil fuel derived external energy inputs. This status-quo of production, transportation, storage and consumption of energy has become inefficient and is set to become even more so when the continuous increases in energy demand are factored in. The territorial management of land use and related activities is a central component in the search for more efficient models of energy use, models that can meet current and future regional, national and European goals. In this paper, a methodology is developed and discussed with the aim of improving energy efficiency at the municipal level. The development of this methodology is based on the monitoring of energy consumption and its use patterns resulting from the natural dynamism of human activities in the territory and can be utilized to assess sustainability at the local scale. A set of parameters and indicators are defined with the objective of constructing a systemic model based on the optimization, adaptation and innovation of the current energy framework and the associated energy consumption patterns. The use of the model will enable local governments to strike the necessary balance between human activities, economic development, and the local and global environment while safeguarding fairness in the energy sector.

Keywords: solar urban planning, solar smart city, urban development, energy efficiency

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Authors: Patrick Downey

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The political problem besetting all nations, tribes, and families, as illuminated by Plato in the fifth book of his Republic, is the problem of our own private body with its own particular pleasures and pains. This problem we might label the “irrational love of one’s own.” The reasonable philosopher loves reality just because it is, but we love things only if we can convince ourselves that they are “ours” or an imaginative extension of “ours.” The resulting problem, that can only be medicated, but not cured, is that the “body private,” whether our own, our family, tribe, or nation, always lies underneath any level of “body politic” and threatens the bloodshed and disintegration of civil war. This is also the political problem the Bible deals with throughout, beginning with Adam and Eve’s fall from rationally shareable bodies (“the two were one flesh”) into unshareable bodies whose now shameful “privacy” must be hid behind a bloody rather than bloodless veil. The blood is the sign of always threatening civil war, whether murder between brothers, feuds within tribes, or later, war between nations. The scarlet thread of blood tying the entire Bible together, Old and New Testament, reminds us that however far our loves are pushed out beyond our private body to family, tribe or nation, they remain irrational because unshareable. Only by loving the creator God who first loved us, can we rationally love anything of our own, but it must be loved as gift rather than as a possession. Such a love renders all bodies and nations truly shareable, and achieving this shareability is the paradoxical plot of the Bible, wherein the Word becomes flesh in a particular body amidst a particular people and nation. Yet even with His own nation and His own Son, this Lord is not “partial” and demands justice towards widows, orphans, and sojourners, because the irrational love of only our own can become rational solely through the resurrection of this particular body, king of this particular nation and these particular people. His body, along with all other bodies, can thus now retain their particular wounds and history, while yet remaining shareable. Likewise, all nations will share in the nation of Israel, in the same way all distinct languages will share an understanding through the inner rational word that we see illustrated in Pentecost. Without the resurrection, however, this shareability of bodies and nations remains merely a useful fiction, as Plato saw, and the equally fictitious “rationality” of some sort of deductive universalism will not go away. Reading Scripture in terms of Plato’s “irrational love of one’s own” therefore raises questions for both a Protestant and Catholic understanding of nations, questions that neither can answer adequately without this philosophical and exegetical attention.

Keywords: body private, nations, shareability, body politic

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Authors: Anna Sanczyk

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Diverse students may experience different forms of discrimination. Some of the oppression students experience in schools are racism, sexism, classism, or homophobia that may affect their achievement, and teachers need to make sure they create inclusive, equitable classroom environments. The broader literature on social change in education shows that teachers who challenge oppression and want to promote equitable and transformative education face institutional, social, and political constraints. This paper discusses research on teachers’ work to create socially just and culturally inclusive classrooms and schools. The practical contribution of this literature review is that it provides a comprehensive compilation of the studies presenting teachers’ roles and efforts in affecting social change. The examination of the research on social change in education points to the urgency of teachers addressing the needs of marginalized students and resisting systemic oppression in schools. The implications of this literature review relate to the concerns that schools should provide greater advocacy for marginalized students in diverse learning contexts, and teacher education programs should prepare teachers to be active advocates for diverse students. The literature review has the potential to inform educators to enhance educational equity and improve the learning environment. This literature review illustrates teachers as agents of change in diverse classrooms and contributes to understanding various ways of taking action towards fostering more equitable and transformative education in today’s schools.

Keywords: agents of change, diversity, opression, social change

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Authors: Ni'mal Baroya, Andrei Ramani, Irma Prasetyowati

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The access to reproduction health services, including with safe and effective contraception were human rights regardless of social stratum and residence. In addition to individual factors, family and contextual factors were also believed to be the cause in the use of contraceptive methods. This study aimed to assess the determinants of long-term contraceptive methods (LTCM) by considering all the factors at either the individual level or contextual level. Thereby, this study could provide basic information for program development of prevalence enhancement of MKJP in East Java. The research, which used cross-sectional design, utilized Riskesdas 2013 data, particularly in East Java Province for further analysis about multilevel modeling of MKJP application. The sample of this study consisted of 20.601 married women who were not in pregnant that were drawn by using probability sampling following the sampling technique of Riskesdas 2013. Variables in this study were including the independent variables at the individual level that consisted of education, age, occupation, access to family planning services (KB), economic status and residence. As independent variables in district level were the Human Development Index (HDI, henceforth as IPM) in each districts of East Java Province, the ratio of field officers, the ratio of midwives, the ratio of community health centers and the ratio of doctors. As for the dependent variable was the use of Long-Term Contraceptive Method (LTCM or MKJP). The data were analyzed by using chi-square test and Pearson product moment correlation. The multivariable analysis was using multilevel logistic regression with 95% of Confidence Interval (CI) at the significance level of p < 0.05 and 80% of strength test. The results showed a low CPR LTCM was concentrated in districts in Madura Island and the north coast. The women which were 25 to 35 or more than 35 years old, at least high school education, working, and middle-class social status were more likely to use LTCM or MKJP. The IPM and low PLKB ratio had implications for poor CPR LTCM / MKJP.

Keywords: multilevel, long-term contraceptive methods, east java, contextual factor

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Authors: N. Rambabu, H. Gururaj, Reynold Washington, Oommen George

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Motivation: Under the USAID Strengthening Health Outcomes through Private Sector (SHOPS-TB) initiative, Karnataka Health Promotion Trust (KHPT) with technical support of Abt associates is implementing a TB prevention and care model in Karnataka State, South India. KHPT is the interface agency between the public and private sectors, and providers and the target community facilitating early TB case detection and enhancing treatment compliance through private health care providers (pHCP) engagement in RNTCP. The project coverage is 0.84 million urban poor from 663 slums in 12 districts of Karnataka. Problem Statement: India with the highest burden of global TB (26%) and two million cases annually, accounts for approximately one fifth of the global incidence. WHO estimates 300,000 people die from TB annually in India. India expanded the coverage of Directly Observed Treatment, Short-course chemotherapy (DOTS) to the entire country as early as 2006. However, the performance of RNTCP has not been uniform across states. While the national annual new smear-positive (NSP) case notification rate is 53, it is much lower at 47 in Karnataka. A third of TB patients in India reside in urban slums. Approach: Under SHOPS, KHPT actively engages with communities through key opinion leaders and community structures. Interpersonal communication, by Outreach workers through house-to-house visits and at aggregation points, is the primary method used for communication about TB and its management and to increase demand for sputum examination and DOTS. pHCP are mapped, trained and mentored by KHPT. ORWs also provide patient and family counseling on TB treatment, side effects and adherence, screen close contacts of index patients especially children under 6 years of age and screen co-morbidities including HIV, diabetes and malnutrition and risk factors including alcoholism, tobacco use, occupational hazards making appropriate accompanied or documented referrals. A treatment ‘buddy’ system for the patients involving close friends or family members, ICT-based support, DOTS Prerana (inspiration) groups of TB patients, family members and community, DOTS Mitra (friend) helpline services are also used for care and support services. Results: The intervention educated 39988 slum dwellers, referred 1731 chest symptomatics, tested 1061 patients and initiated 248 patients on anti-TB treatment within three months of intervention through continuous community engagement. Conclusions: The intervention’s potential to increase access to preferred health care providers, reduce patient and health system delays in diagnosis and initiation of treatment, improve health seeking behaviour and enhance compliance of pHCPs to standard treatment protocols is being monitored. Initial results are promising.

Keywords: DOTS, KHPT, health outcomes, public and private sector

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Authors: S. Ataei, F. Sarrafzadeh Javadi, K. Gilani, E. Moazeni

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Drug delivery systems using colloidal particulate carriers such as niosomes or liposomes have distinct advantages over conventional dosage forms because the particles can act as drug-containing reservoirs. These carriers play an increasingly important role in drug delivery. Niosomes are vesicular delivery systems which result from the self-assembly of hydrated surfactant. Niosomes are now widely studied as an attractive to liposomes because they alleviate the disadvantages associated with liposomes, such as chemical instability, variable purity of phospholipids and high cost. The encapsulation of drugs in niosomes can decrease drug toxicity, increase the stability of drug and increase the penetrability of drug in the location of application, and may reduce the dose and systemic side effect. Nowadays, Niosomes are used by the pharmaceutical industry in manufacturing skin medications, eye medication, in cosmetic formulas and these vesicular systems can be used to deliver aspiratory drugs. One way of improving dispersion in the water phase and solubility of the hydrophobic drug is to formulate in into niosomes. Itraconazole (ITZ) was chosen as a model hydrophobic drug. This drug is water insoluble (solubility ~ 1 ng/ml at neutral pH), is a broad-spectrum triazole antifungal agent and is used to treat various fungal disease. This study aims to investigate the capability of forming itraconazole niosomes with Spans, Tweens, Brijs as non-ionic surfactants. To this end, various formulations of niosomes have been studied with regard to parameters such as the degree of containment and particle size.

Keywords: physicochemical, non-ionic surfactant vesicles, itraconazole

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Authors: Spencer Jay Knafelc

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Some mental health practitioners and theorists have suggested that we approach remedying psychological problems by centering and intervening upon patients’ narrations. Such theorists and their corresponding therapeutic approaches see persons as narrators of their lives, where the stories they tell constitute and reflect their sense-making of the world. Psychological problems, according to these approaches to therapy, are often the result of problematic narratives. The solution is the construction of more salubrious narratives through therapy. There is trouble lurking within the history of these narrative approaches. These thinkers tend to denigrate the importance of truth, insisting that narratives are not to be thought of as aiming at truth, and thus the truth of our self-narratives is not important. There are multiple motivations for the tendency to eschew truth’s importance within the tradition of narrative approaches to therapy. The most plausible and interesting motivation comes from the observation that, in general, all dominant approaches to therapy are equally effective. The theoretical commitments of each approach are quite different and are often ostensibly incompatible (psychodynamic therapists see psychological problems as resulting from unconscious conflict and repressed desires, Cognitive-Behavioral approaches see them as resulting from distorted cognitions). This strongly suggests that there must be some cases in which therapeutic efficacy does not depend on truth and that insisting that patient’s therapeutic narratives be true in all instances is a mistake. Lewis’ solution is to suggest that narratives are metaphors. Lewis’ account appreciates that there are many ways to tell a story and that many different approaches to mental health treatment can be appropriate without committing us to any contradictions, providing us with an ostensibly coherent way to treat narratives as non-literal, instead of seeing them as tools that can be more or less apt. Here, it is argued that Lewis’ metaphor approach fails. Narratives do not have the right kind of structure to be metaphors. Still, another way to understand Lewis’ view might be that self-narratives, especially when articulated in the language of any specific approach, should not be taken literally. This is an idea at the core of the narrative theorists’ tendency to eschew the importance of the ordinary understanding of truth. This very tendency will be critiqued. The view defended in this paper more accurately captures the nature of self-narratives. The truth of one’s self-narrative is important. Not only do people care about having the right conception of their abilities, who they are, and the way the world is, but self-narratives are composed of beliefs, and the nature of belief is to aim at truth. This view also allows the recognition of the importance of developing accurate representations of oneself and reality for one’s psychological well-being. It is also argued that in many cases, truth factors in as a mechanism of change over the course of therapy. Therapeutic benefit can be achieved by coming to have a better understanding of the nature of oneself and the world. Finally, the view defended here allows for the recognition of the nature of the tension between values: truth and efficacy. It is better to recognize this tension and develop strategies to navigate it as opposed to insisting that it doesn’t exist.

Keywords: philosophy, narrative, psychotherapy, truth

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Authors: Enva Doda

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Recent statistical analyses within the European Union (EU) underscore the enduring significance of the Gender Pay Gap in amplifying the Gender Pension Gap, a phenomenon resisting proportional reduction over time. This study meticulously calculates the Pension Gap, scrutinizing contributing variables within diverse pension systems. Furthermore, it investigates whether the "unexplained" segment of the Gender Gap correlates with political institutions, economic systems, historical events, or discrimination, utilizing quantitative methods and the Blinder-Oaxaca Decomposition Method to pinpoint potential discriminatory factors. The descriptive analysis reveals a conspicuous Gender Pension Gap across European nations, displaying notable variation. While an overall reduction in the Gender Gap is observed, the degree of improvement varies among countries. Subsequent analyses will delve into the specific reasons or variables influencing distinct Gender Gap percentages, forming the basis for nuanced policy recommendations. This comprehensive research enriches the ongoing discourse on gender equality and economic equity. By focusing on the root causes of the Pension Gap, the study has the potential to instigate policy adjustments, urging policymakers to reassess systemic structures and contribute to informed decision-making. Emphasizing gender equality as essential for a flourishing and resilient economy, the research aspires to drive positive change on academic and policy fronts.

Keywords: blinder Oaxaca decomposition method, discrimination, gender pension gap, quantitative methods, unexplained gender gap

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Authors: Hassan Malami Alkanchi

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Acquiring the knowledge of Islamic business ethics nowadays for the conduct of business activities and other business transactions has become one of the best strategies for promoting lawful business as well as a successful business for economic development. The idea of infusing the significance of Islamic business ethics into the minds of Muslim individuals has spurred much enthusiasm in the last few decades. Putting this idea into practice posed significant impacts on the life of Muslim individuals for the development of business. The main objective of this paper is to explore the significant role of Muslim families' awareness in promoting Islamic business ethics for successful business economic development. The methodology adopted for the conduct of this study is qualitative research. The study employed a purposive sampling technique and considered it the most suitable method for data collection. The data collection techniques employed for this study were interviews and focus group discussions. The study used semi-structured interviews and focus group discussions for the data collection. The standard used for selecting the participants was strictly based on professionalism, relevance, expertise and the willingness of the participants to participate in the study. The participants interviewed include Muslim family experts, Islamic scholars, and media workers, comprising five (5) participants for each research subject. Twelve (15) participants were sampled for the study. The method of data analysis used is thematic and theoretical explanations. This paper analytically discusses the new and emerging ethical issues in relation to business activities as well as new strategies for the development of successful businesses for economic prosperity, growth, and development. The study findings revealed that the awareness of Muslim families in promoting Islamic business ethics has significantly contributed to changing the negative attitudes of some Muslim individuals' in relation to their business. Furthermore, findings of unveiled Muslim individuals immensely benefited towards understanding and having knowledge in relation to ethical business guidelines enshrined by the sharia in the conduct of pure business as well as strengthening Islamic business ethics through the teachings of the noble Quran and Sunnah.

Keywords: Muslim family, awareness, business ethics, economic development

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Authors: Katarzyna Pasternak

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Experiencing the meaning of life is widely recognised as a vital element of well-being and central human motivation. Studies have shown that a higher meaning of life is associated, among other things, with a higher quality of life, higher levels of happiness and better declared health. The subject of the study is the meaning in life measured with The Meaning in Life Questionnaire and the presence of such emotions as nostalgia, awe and hope, and the content of imaginations measured after temporal mental simulations in Americans and Poles. The respondents had to imagine themselves in future, in 40 years and describe two events that would take place at that time. Next, participants assessed the importance of the events described by them, recognised whether during their journey through time they felt awe, hope and nostalgia, and answered the questionnaire examining the meaning in life. 204 (102 from Poland 102 from the USA ) people aged 21 to 60 participated in the study. The study checked whether there were differences in the content of the imaginations of the respondents from Poland and USA, and whether there were statistically significant difference between the declared sense of meaning in life among participants from both countries. The result of the study hane shown that there were no differences in the overall result obtained by the participants in The Meaning in Life Questionnaire , while there were statistically significant differences among the subscales of the questionnaire. It turned out that Americans have a higher presence of meaning in life than Poles, but they obtained lower results in searching of meaning in life. Studies have also shown that there was a statistically significant difference between Poles and Americans in feeling awe after a mental simulation. Poles felt higher level of awe. Images about the future differed between Poles and Americans. Poles judged that the events they described were very important to them. Interestingly, the content of American participants’ imaginations was dominated by topics related to the future of the world, ecology and world peace. There were also ideas about nice moments spent with friends and family. Among Poles, ideas related to professional career and development as well as family events dominated. Research shows that despite the lack of differences in the general meaning in life, Poles are more focused on searching for meaning in life than Americans. The study shows interesting differences between the two cultures.

Keywords: meaning in life, mental simulations, imaginations, temporal mental simulations, future, cultural differences

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Authors: Fatna Benmessaoud, Mohammed Cheikh, Vencent Velay, Vanessa Vedal, Farhad Rezai-Aria, Christine Boher

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The global mechanical behavior of materials is strongly linked to their microstructure, especially their crystallographic texture and their grains morphology. These material aspects determine the mechanical fields character (heterogeneous or homogeneous), thus, they give to the global behavior a degree of anisotropy according the initial microstructure. For these reasons, the prediction of global behavior of materials in relationship with the microstructure must be performed with a multi-scale approach. Therefore, multi-scale modeling in the context of crystal plasticity is widely used. In this present contribution, a phenomenological elasto-viscoplastic model developed in the crystal plasticity context and finite element method are used to investigate the effects of crystallographic texture and grains sizes on global behavior of a polycrystalline equiaxed Ti-6Al-4V alloy. The constitutive equations of this model are written on local scale for each slip system within each grain while the strain and stress mechanical fields are investigated at the global scale via finite element scale transition. The beta phase of Ti-6Al-4V alloy modeled is negligible; its percent is less than 10%. Three families of slip systems of alpha phase are considered: basal and prismatic families with a burgers vector and pyramidal family with a burgers vector. The twinning mechanism of plastic strain is not observed in Ti-6Al-4V, therefore, it is not considered in the present modeling. Nine representative elementary volumes (REV) are generated with Voronoi tessellations. For each individual equiaxed grain, the own crystallographic orientation vis-à-vis the loading is taken into account. The meshing strategy is optimized in a way to eliminate the meshing effects and at the same time to allow calculating the individual grain size. The stress and strain fields are determined in each Gauss point of the mesh element. A post-treatment is used to calculate the local behavior (in each grain) and then by appropriate homogenization, the macroscopic behavior is calculated. The developed model is validated by comparing the numerical simulation results with an experimental data reported in the literature. It is observed that the present model is able to predict the global mechanical behavior of Ti-6Al-4V alloy and investigate the microstructural parameters' effects. According to the simulations performed on the generated volumes (REV), the macroscopic mechanical behavior of Ti-6Al-4V is strongly linked to the active slip systems family (prismatic, basal or pyramidal). The crystallographic texture determines which family of slip systems can be activated; therefore it gives to the plastic strain a heterogeneous character thus an anisotropic macroscopic mechanical behavior. The average grains size influences also the Ti-6Al-4V mechanical proprieties, especially the yield stress; by decreasing of the average grains size, the yield strength increases according to Hall-Petch relationship. The grains sizes' distribution gives to the strain fields considerable heterogeneity. By increasing grain sizes, the scattering in the localization of plastic strain is observed, thus, in certain areas the stress concentrations are stronger than other regions.

Keywords: microstructural parameters, multi-scale modeling, crystal plasticity, Ti-6Al-4V alloy

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Authors: Clement Ndoricimpa

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The expression of stance is highly expected in writing at tertiary level. Through a selection of linguistic and rhetorical elements, writers express commitment, critical distance and build a critically discerning reader in texts. Despite many studies on patterns of stance in students’ academic writing, little may not be known about how English as a Foreign Language students learns to build a critically discerning reader in their texts. Therefore, this study examines patterns of stance in essays written by students majoring in business administration at English-medium University in Burundi as part of classroom assignments. It draws on systemic functional linguistics to analyze qualitatively and quantitatively the data. The quantitative analysis is used to identify the differences in frequency of stance patterns in the essays. The results show a significant difference in the use of boosters by lower- and upper-level students. Lower-level students’ writing contains more boosters and many idiosyncratic sentence structures than do upper-level students’ writing, and upper-level students’ essays contain more hedging and few grammatical mistakes than do lower-level students’ essays. No significant difference in the use of attitude markers and concessive and contrastive expressions. Students in lower- and upper-level do not use attitude markers and disclaimer markers appropriately and accurately. These findings suggest that students should be taught the use of stance patterns in academic writing.

Keywords: academic writing, metadiscourse, stance, student corpora

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Authors: Sherif Sabri, Nael Samir, Mohamed Ali, Ahmed ElSakhawy

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Introduction: There is growing evidence to support the hypothesis that serum matrix metalloproteinase -9 in could be an early predictor of mortality in septic patients. Aim of the work: Study the relationship of matrix metalloproteinase 9 in patients with SIRS in comparison to septic patients in day 0 and day 2. Patients and Methods: This is a prospective observational study conducted on 40 adult critically ill patients staying more than 24 hours in ICU either surgical or medical department, El Fayoum General Hospital in the period from November 2014 to March 2015. Patients met at least two of the criteria for severe inflammatory response syndrome (SIRS). Diagnostic criteria include several clinical and laboratory findings of sepsis induced tissue hypoperfusion or organ dysfunction. Samples were grouped as drawn either at admission, or at day 2 after admission. Results: Patients were divided into two groups: The non-sepsis (SIRS) group, which included 15 (37.5%) patients with no later evidence of sepsis were enrolled as controls. The Sepsis group, which included 25 patients diagnosed to have SIRS with later evidence of sepsis with positive culture. Exploring serum level of MMP-9 in non-survivors and survivors, there was significant increase in non-survivors if compared to survivors at admission p-value 0.001 (mean value in survivors 4.4mg/dl±4.1mg/dl at admission versus mean value in non-survivors 11.9mg/dl±5.8mg/dl) and after two days of admission was also significant increase p-value 0.001 (mean value in survivors 10.9mg/dl ±9.4mg/dl versus mean value in non-survivors 22.6mg/dl±10.4). Conclusion: MMP-9 levels in septic patients have a beneficial role in ICU for high-risk stratification as it is an independent marker of mortality in severe sepsis.

Keywords: matrix metalloproteinase (MMP-9), sepsis, septic shock, systemic inflamatory response syndrome

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Authors: Olusegun F. Adebowale

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Research has confirmed that the emergence of information technology is significantly reflected in the field of psychology and its related disciplines due to its widespread use at reasonable price and its user-friendliness. It is consequently affecting ordinary life in many areas like shopping, advertising, corresponding and educating. Specifically the innovations of computer technology led to several new forms of communication, all with implications and applicability for counselling and psychotherapy practices. This is premise on which online counselling is based. Most institutions of higher learning in Nigeria have established their presence on the Internet and have deployed a variety of applications through ICT. Some are currently attempting to include counselling services in such applications with the belief that many counselling needs of students are likely to be met. This study therefore explored different challenges and preferences students present in online counselling interaction in a given Nigerian university with the view to guide new universities that may want to invest into these areas as to necessary preparations and referral requirements. The study is a mixed method research incorporating qualitative and quantitative methodologies to sample the preferences and concerns students express in online interaction. The sample comprised all the 876 students who visited the university online counselling platform either voluntarily, by invitation or by referral. The instrument for data collection was the online counselling platform of the university 'OAU Online counsellors'. The period of data collection spanned between January 2011 and October 2012. Data were analysed quantitatively (using percentages and Mann-Whitney U test) and qualitatively (using Interpretative Phenomenological Analysis (IPA)). The results showed that the students seem to prefer real-time chatting as their online medium of communicating with the online counsellor. The majority of students resorted to e-mail when their effort to use real-time chatting were becoming thwarted. Also, students preferred to enter into online counselling relationships voluntarily to other modes of entry. The results further showed that the prevalent counselling needs presented by students during online counselling sessions were mainly in the areas of social interaction and academic/educational concerns. Academic concerns were found to be prevalent, in form of course offerings, studentship matters and academic finance matters. The personal/social concerns were in form of students’ welfare, career related concerns and relationship matters. The study concludes students’ preferences include voluntary entry into online counselling, communication by real-time chatting and a specific focus on their academic concerns. It also recommends that all efforts should be made to encourage students’ voluntary entry into online counselling through reliable and stable internet infrastructure that will be able to support real-time chatting.

Keywords: online, counselling, needs, preferences

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Authors: Josée Charette

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The academic and educational success of immigrant students is a current issue in education, especially in western societies such in the province of Quebec, in Canada. For people who immigrate with school-age children, the success of the family’s migratory project is often measured by the benefits drawn by children from the educational institutions of their host society. In order to support the academic achievement of their children, immigrant parents try to develop practices that derive from their representations of school and related challenges inspired by the socio-cultural context of their country of origin. These findings lead us to the following question: How does strategies implemented by immigrant parents to manage the representational distance between school of their country of origin and school of the host society support or not the academic and educational success of their child? In the context of a qualitative exploratory approach, we have made interviews in the French-, English- and Spanish-languages with 32 newly immigrated parents and 10 of their children. Parents were invited to complete a network of free associations about «School in Quebec» as a premise for the interview. The objective of this communication is to present strategies implemented by immigrant parents to manage the distance between their representations of schools in their country of origin and in the host society, and to explore the influence of this management on their child’s academic and educational trajectories. Data analysis led us to develop various types of strategies, such as continuity, adaptation, resources mobilization, compensation and "return to basics" strategies. These strategies seem to be part of a continuum from oppositional-conflict scenario, in which parental strategies act as a risk factor, to conciliator-integrator scenario, in which parental strategies act as a protective factor for immigrant students’ academic and educational success. In conclusion, we believe that our research helps in providing a more efficient support to immigrant parents and contributes to develop a wider portrait of immigrant students’ academic achievement. In addition, we think that by improving the experience of immigrant families in Quebec schools, a greater number of migratory projects will be effective.

Keywords: immigrant students, family’s migratory project, school of origin and school of host society, immigrants parental strategies

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Authors: Md. Ashikur Rahman

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Optimal breastfeeding practice is essential to reducing childhood morbidity and mortality and helps to achieve Millennium Development Goal (MDG). A cross-sectional study was conducted in a rural area in Dhaka district to explore the barrier to optimal breastfeeding practices. The population of this study constitutes all nursing mothers having children aged 0-6 months, and they were selected purposively. The study adopted a structured and in-depth interview procedure consisting of open and closed-ended questions. Four hundred rural nursing mothers constituted the sample of the structured interview, while 15 were involved in the in-depth interview. Among the respondent's majority (67%) were in the age group 17-25 years, with a mean age of 24.44 years. Most (39.5%) of the mothers were housewives with a secondary level of education (46.5%). About 32% of mothers started breastfeeding within one hour after birth. But delayed initiation was reported in 31.5% of mothers, whereas 36.8% of mothers forgot the exact time of initiation of breastfeeding. The main reason not to practice colostrum was mothers tried to breastfeed, but there was no milk, stated 13.8% of mothers. In addition, about one-third (34.3%) of the respondents practiced pre-lacteal feeding, and among them, 12.8% introduced sugar with water. Reasons given by the mothers for bottle-feeding was that baby was not satisfied with breast milk only; 22.0% of mothers indicated this cause. The main influence to take formula milk by their mother and mothers-in-law was stated by 18.8% of mothers. Some mothers stated that major constraints to EBF were the perception of not having enough milk (25.5 %) and babies crying seems to be hungry (8.8%). One-third of the mothers (31.5%) felt uncomfortable during breastfeeding. Access to antenatal and postnatal counseling in the study area also was a key obstacle to optimal breastfeeding practices. In a qualitative survey, some mothers believed that there was no difference between breast milk and formula milk. Colostrum feeding, pre-lacteal feeding, early initiation of breastfeeding, and exclusive breastfeeding were strongly associated with family type, family member, birth order, religion, husbands' occupation, delivery attendants and delivery type, postnatal care, and health care facilities. To reduce the barriers to the successful practice of exclusive breastfeeding, there is a need for a grass-roots approach to educating and counseling nursing mothers with identifying factors influencing or discouraging the optimal practice.

Keywords: exclusive, breast feeding, practices, Bangladesh

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Authors: Naveed Ahmad Fazili

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More than 20 human diseases involve the fibrillation of a specific protein/peptide which forms pathological deposits at various sites. Hereditary lysozyme amyloidosis is a systemic disorder which mostly affects liver, spleen and kidney. This conformational disorder is featured by lysozyme fibril formation. In vivo lysozyme fibrillation was simulated under in vitro conditions using a strong denaturant GdHCl at 3M concentration. Sharp decline in the ANS fluorescence intensity compared to the partially unfolded states, almost 20 fold increase in ThT fluorescence intensity, increase in absorbance at 450 nm suggesting turbidity, negative ellipticity peak in the far-UVCD at 217 nm, red shift of 50 nm compared to the native state in congo red assay and appearance of a network of long rope like fibrils in TEM analysis suggested HEWL fibrillation. Anti-fibrillation potency of baicalein against the preformed fibrils of HEWL was investigated following ThT assay in which there was a dose dependent decrease in ThT fluorescence intensity compared to the fibrillar state of HEWL with the maximum effect observed at 150 μM baicalein concentration, loss of negative ellipticity peak in the far-UVCD region, dip in the Rayleigh scattering intensity and absorbance at 350 nm and 450 nm respectively together with a reduction in the density of fibrillar structure in TEM imaging. Thus, it could be suggested that baicalein could prove to be a positive therapeutics for hereditary human lysozyme amyloidosis.

Keywords: amyloid fibrils, baicalein, congo red, negative ellipticity, therapeutics

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Authors: Awais Naeem, Osama Shakeel, Faizan Ullah, Abdul Wahid Anwer

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Introduction: To study the clinic-pathological factors, diagnostic factors and survival of extra-pulmonary small cell carcinoma. Methodology: From 1995 to 2017 all patients with a diagnosis of extra-pulmonary small cell carcinoma were included in the study. Demographic variables and clinic-pathological factors were collected. Management of disease was recorded. Short and long term oncological outcomes were recorded. All data was entered and analyzed in SPSS version 21. Results: A total of 14 patients were included in the study. Median age was 53.42 +/- 16.1 years. There were 5 male and 9 female patients. Most common presentation was dysphagia in 16 patient among esophageal small cell carcinoma and while other patient had pain in abdomen. Mean duration of symptoms was 4.23+/-2.91 months .Most common site is esophagus (n=6) followed by gall bladder(n=3). Almost all of the patients received chemo-radiotherapy. Majority of the patient presented with extensive disease. Five patients (35.7%) died during the follow up period, two (14.3%) were alive and rest of the patients were lost to follow up. Mean follow up period was 22.92 months and median follow up was 15 months. Conclusion: Extra-pulmonary small cell carcinoma is rare and needs to be managed aggressively. All patients should be treated with both systemic and local therapies.

Keywords: small cell carcinoma of esophagus, extrapulmonary small cell carcinoma, small cell carcinoma of gall bladder, small cell carcinoma of rectum, small cell carcinoma of stomach

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