Search results for: early mobilisation in intensive care (ICU)

Authors: Mohammad Naeem Lakanwall, Jamshid Abdul-Ghafar

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Background: Endocrinopathies are a commonly occurring entity, particularly those of the thyroid gland; however, there is a lack of scientific literature from Afghanistan, a country with very limited health care facilities and resources. To our best knowledge, this is the first study aimed to describe the frequency of occurrence and factors associated with thyroid dysfunction in the Afghan population. The aim of this study is to estimate the frequency and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Methods: A cross-sectional study was conducted from July to Sep 2018 at the Department of Clinical Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan. Blood samples were obtained, serum TSH levels were analyzed, and the patients were divided into three diagnostic categories according to their serum TSH concentrations: 1) hypothyroidism, 2) hyperthyroidism, 3) normal. Results: A total of 127 individuals were included in the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction. 74% of the participants in the study had normal TSH levels classified as normal thyroid function, (14%) had lower TSH levels, and (12%) higher TSH levels, classified as hyper and hypothyroid, respectively. Conclusions: The findings of the current study showed a high frequency of thyroid dysfunctions from a single center. Further large-scale studies are needed to find out the prevalence and document this entity for better health outcomes in the country.

Keywords: Afghanistan, factors, frequency, hypothyroid, hyperthyroid, thyroid, thyroid stimulating hormone

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Authors: Mahmoud Reza Hosseini

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The universe is in a continuous expansion process, resulting in the reduction of its density and temperature. Also, by extrapolating back from its current state, the universe at its early times is studied, known as the big bang theory. According to this theory, moments after creation, the universe was an extremely hot and dense environment. However, its rapid expansion due to nuclear fusion led to a reduction in its temperature and density. This is evidenced through the cosmic microwave background and the universe structure at a large scale. However, extrapolating back further from this early state reaches singularity, which cannot be explained by modern physics, and the big bang theory is no longer valid. In addition, one can expect a nonuniform energy distribution across the universe from a sudden expansion. However, highly accurate measurements reveal an equal temperature mapping across the universe, which is contradictory to the big bang principles. To resolve this issue, it is believed that cosmic inflation occurred at the very early stages of the birth of the universe. According to the cosmic inflation theory, the elements which formed the universe underwent a phase of exponential growth due to the existence of a large cosmological constant. The inflation phase allows the uniform distribution of energy so that an equal maximum temperature can be achieved across the early universe. Also, the evidence of quantum fluctuations of this stage provides a means for studying the types of imperfections the universe would begin with. Although well-established theories such as cosmic inflation and the big bang together provide a comprehensive picture of the early universe and how it evolved into its current state, they are unable to address the singularity paradox at the time of universe creation. Therefore, a practical model capable of describing how the universe was initiated is needed. This research series aims at addressing the singularity issue by introducing a state of energy called a "neutral state," possessing an energy level that is referred to as the "base energy." The governing principles of base energy are discussed in detail in our second paper in the series "A Conceptual Study for Addressing the Singularity of the Emerging Universe," which is discussed in detail. To establish a complete picture, the origin of the base energy should be identified and studied. In this research paper, the mechanism which led to the emergence of this natural state and its corresponding base energy is proposed. In addition, the effect of the base energy in the space-time fabric is discussed. Finally, the possible role of the base energy in quantization and energy exchange is investigated. Therefore, the proposed concept in this research series provides a road map for enhancing our understating of the universe's creation from nothing and its evolution and discusses the possibility of base energy as one of the main building blocks of this universe.

Keywords: big bang, cosmic inflation, birth of universe, energy creation, universe evolution

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Authors: D. Velayadum, P. Sthandiwe , N. Maharaj, T. Munien, S. Ndamase, G. Zulu, S. Xulu, F. Oosthuizen

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Introduction and aims of the study: It is the responsibility of the pharmacist to manage drug-related problems in order to ensure the greatest benefit to the patient. In order to prevent drug-related morbidity, pharmacists should be aware of medicines that may contribute to certain drug-related problems due to their pharmacological action. In an attempt to assist healthcare practitioners to prevent drug-related morbidity (PDRM), indicators for prevention have been designed. There are currently no indicators available for primary health care in developing countries like South Africa, where the majority of the population access primary health care. There is, therefore, a need to develop such indicators, specifically with the aim of assisting healthcare practitioners in primary health care. Methods: A literature study was conducted to compile a comprehensive list of PDRM indicators as developed internationally using the search engines Google Scholar and PubMed. MESH term used to retrieve suitable articles was 'preventable drug-related morbidity indicators'. The comprehensive list of PDRM indicators obtained from the literature study was further evaluated for face validity. Face validity was done in duplicate by 2 sets of independent researchers to ensure 1) no duplication of indicators when compiling a single list, 2) inclusion of only medication available in primary healthcare, and 3) inclusion of medication currently available in South Africa. Results: The list of indicators, compiled from PDRM indicators in the USA, UK, Portugal, Australia, India, and Canada contained 324 PDRM. 184 of these indicators were found to be duplicates, and the duplications were omitted, leaving a final list of 140. The 140 PDRM indicators were evaluated for face-validity, and 97 were accepted as relevant to primary health care in South Africa. 43 indicators did not comply with the criteria and were omitted from the final list. Conclusion: This study is a first step in compiling a list of PDRM indicators for South Africa. It is important to take cognizance to the fact the health systems differ vastly internationally, and it is, therefore, important to develop country-specific indicators.

Keywords: drug-related morbidity, primary healthcare, South Africa, developing countries

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Authors: Glenda Wrenn, Juliet Muzere, Meldra Hall, Allyson Belton, Kisha Holden, Chanita Hughes-Halbert, Martha Kent, Bekh Bradley

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Understanding the help seeking decision making process and experiences of health disparity populations with posttraumatic stress disorder (PTSD) is central to development of trauma-informed, culturally centered, and patient focused services. Yet, little is known about the decision making process among adult Black women who are non-treatment seekers as they are, by definition, not engaged in services. Methods: Audiotaped interviews were conducted with 30 African American adult women with clinically significant PTSD symptoms who were engaged in primary care, but not in treatment for PTSD despite symptom burden. A qualitative interview guide was used to elucidate key themes. Independent coding of themes mapped to theory and identification of emergent themes were conducted using qualitative methods. An existing quantitative dataset was analyzed to contextualize responses and provide a descriptive summary of the sample. Results: Emergent themes revealed that active mental avoidance, the intermittent nature of distress, ambivalence, and self-identified resilience as undermining to help seeking decisions. Participants were stuck within the help-seeking phase of ‘recognition’ of illness and retained a sense of “it is my decision” despite endorsing significant social and environmental negative influencers. Participants distinguished ‘help acceptance’ from ‘help seeking’ with greater willingness to accept help and importance placed on being of help to others. Conclusions: Elucidation of the decision-making process from the perspective of non-treatment seekers has implications for outreach and treatment within models of integrated and specialty systems care. The salience of responses to trauma symptoms and stagnation in the help seeking recognition phase are findings relevant to integrated care service design and community engagement.

Keywords: culture, help-seeking, integrated care, PTSD

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Authors: Diego Carrasco, Catarina Freitas, Hugo Rio Tinto, Ricardo Rio Tinto, Nuno Couto, Joaquim Gago, Carlos Carvalho

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Introduction: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) to drain the gallbladder can be a palliative care procedure for non-surgical oncologic patients with cholelithiasis and cholangitis process. Case description: A 59-years old Caucasian male diagnosed with extrahepatic cholangiocarcinoma with multiple liver, lung and peritoneum metastasis, unresponsive to treatment with gemcitabine/cisplatin, presented in the institution with fever, hypotension, and severe upper right abdominal pain secondary to cholelithiasis and cholangitis process. The patient was admitted and started on large spectrum antibiotics plus fluid-challenge. Afterward, a percutaneous transhepatic biliary drainage (PTBD) was performed to drain the gallbladder. This procedure temporarily stabilized the patient. However, the definitive solution required gallbladder removal. Since the patient exhibited an advanced oncologic disease and poor response to the chemotherapy, he was not a candidate for surgical intervention. Diagnostic Pathways: A self-expanding metal stent was placed from the duodenum into the bile duct by endoscopic ultrasound-guided. The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure. Conclusion and Discussion: The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure and successfully reversed the cholangitis process. EUS-CD is an effective and safe technique and can be used as a palliative care procedure for non-surgical oncologic patients.

Keywords: palliative care, cholangiocarcinoma, choledochoduodenostomy, endoscopic ultrasound-guided

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Authors: Yun-Tsuen Chen, Shih-Ting Huang, Pi-Fen Cheng, Yu-Ting Su, Joffrey Hsu, Hui-Zhu Chen

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Acute intestinal obstruction is one of the differentials of acute abdomen and requires timely alleviation of intestinal distention and abdominal pain to avoid perforation, intra-abdominal infection, and peritonitis. Investigation to identify the cause of obstruction will direct treatment planning and allow for more effective management. In this study, we present a 71-year-old female presenting with symptoms of acute intestinal obstruction for five days. After extensive history taking, physical exam, medical imaging, and pathology, the patient was diagnosed with colon cancer with lung metastasis and acute intestinal obstruction. The patient was placed on nil per os status with intravenous fluid support, intravenous antibiotics, and a decompression nasogastric tube was placed. The patient received decompression with colostomy creation surgery. After assessing the patient’s clinical condition and tumor staging, a multidisciplinary healthcare team created an individualized treatment plan, which included plans to prepare the patient for home self-care and maintain good mental health with regular monitoring in the clinic setting. This case demonstrates the importance of early diagnosis, effective treatment, and a multidisciplinary approach to the management of acute intestinal obstruction secondary to colon cancer.

Keywords: acute intestinal obstruction, colostomy surgery, metastatic colon cancer, multidisciplinary healthcare team

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Authors: Antonio Lopez-Villegas, Rafael Bautista-Mesa, Emilio Robles-Musso, Daniel Catalan-Matamoros, Cesar Leal-Costa

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Objectives: The purpose of this trial was to evaluate the burden borne by and the costs to informal caregivers of users with telemonitoring of pacemakers. Methods: This is a controlled, non-randomised clinical trial, with data collected from informal caregivers, five years after implantation of pacemakers. The Spanish version of the Survey on Disabilities, Personal Autonomy, and Dependency Situations was used to get information on clinical and social characteristics, levels of professionalism, duration and types of care, difficulties in providing care, health status, economic and job aspects, impact on the family or leisure due to informal caregiving for patients with pacemakers. Results: After five years of follow-up, 55 users with pacemakers finished the study. Of which, 50 were helped by a caregiver, 18 were included in the telemonitoring group (TM) and 32 in the conventional follow-up group (HM). Overall, females represented 96.0% of the informal caregivers (88.89% in TM and 100.0% in HM group). The mean ages were 63.17 ± 15.92 and 63.13 ± 14.56 years, respectively (p = 0.83) in the groups. The majority (88.0%) of the caregivers declared that they had to provide their services between 6 and 7 days per week (83.33% in TM group versus 90.63% in HM group), without significant differences between both groups. The costs related to care provided by the informal caregivers were 47.04% higher in the conventional follow-up group than in the TM group. Conclusions: The results of this trial confirm that there were no significant differences between the informal caregivers regarding to baseline characteristics, workload and time worked in both groups of follow-up. The costs incurred by the informal caregivers providing care for users with pacemakers included in telemonitoring group are significantly lower than those in the conventional follow-up group. Trial registration: ClinicalTrials.gov NCT02234245. Funding: The PONIENTE study, has been funded by the General Secretariat for Research, Development and Innovation, Regional Government of Andalusia (Spain), project reference number PI/0256/2017, under the research call 'Development and Innovation Projects in the Field of Biomedicine and Health Sciences', 2017.

Keywords: costs, disease burden, informal caregiving, pacemaker follow-up, remote monitoring, telemedicine

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Authors: M. Shahana

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Introduction: Leprosy (Hansens) is one of the major health problems in the developing countries. Sixty percent of the world leprosy cases are in India. According to the 2006 census India has about 54% of the total new cases detected globally. The National Leprosy Elimination Programme in 2012 has reported 9.7% of childhood leprosy. There are only few studies related to paediatric leprosy. Aim: To study the epidemiology and various clinical presentations of leprosy in the paediatric age group. Material and Methods: A 4-year prospective study was done in the out-patient department of dermatology in a tertiary care hospital. All the patients were screened for leprosy and children with a confirmed diagnosis of leprosy were taken up for the study. Results: Total of 321 cases of Hansens were recorded during this period out of which 41 were children. The male to female ratio was 2.72:1. A positive family history was found in 18%. Most of them presented with single hypopigmented hypoanesthetic patch. Conclusions: Children presented with more of Borderline tuberculoid type and reactions or deformities were less common.

Keywords: Hansens, hypoaneasthetic patch, leprosy, reactions

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Authors: Gracie Tredget, Raymond McGrath, Karen Ang, Julie Williams, Nick Sevdalis, Fiona Gaughran, Jorge Aria de la Torre, Ioannis Bakolis, Andy Healey, Zarnie Khadjesari, Euan Sadler, Natalia Stepan

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Background: Preventable physical health problems have been found to increase morbidity rates amongst adults living with serious mental illness (SMI). Community mental health clinicians have a role in identifying, and preventing physical health problems worsening, and supporting primary care services to administer routine physical health checks for their patients. However, little is known about how mental health staff perceive and approach their role when providing physical healthcare amongst patients with SMI, or the impact these attitudes have on routine practice. Methods: The present study involves a prospective service evaluation specific to Adult Community Mental Health Services at South London and Maudsley NHS Foundation Trust (SLaM). A qualitative methodology will use semi-structured interviews, focus groups and observations to explore attitudes, perceptions and experiences of staff, patients, and carers (n=64) towards physical healthcare, and barriers or facilitators that impact upon it. 1South London and Maudsley NHS Foundation Trust, London, SE5 8AZ, UK 2 Centre for Implementation Science, King’s College London, London, SE5 8AF, UK 3 Psychosis Studies, King's College London, London, SE5 8AF, UK 4 Department of Biostatistics and Health Informatics, King’s College London, London, SE5 8AF, UK 5 Kings Health Economics, King's College London, London, SE5 8AF, UK 6 Behavioural and Implementation Science (BIS) research group, University of East Anglia, Norwich, UK 7 Department of Nursing, Midwifery and Health, University of Southampton, Southampton, UK 8 Mind and Body Programme, King’s Health Partners, Guy’s Hospital, London, SE1 9RT *[email protected] Analysis: Data from across qualitative tasks will be synthesised using Framework Analysis methodologies. Staff, patients, and carers will be invited to participate in co-development of recommendations that can improve routine physical healthcare within Adult Community Mental Health Teams at SLaM. Results: Data collection is underway at present. At the time of the conference, early findings will be available to discuss. Conclusions: An integrated approach to mind and body care is needed to reduce preventable deaths amongst people with SMI. This evaluation will seek to provide a framework that better equips staff to approach physical healthcare within a mental health setting.

Keywords: severe mental illness, physical healthcare, adult community mental health, nursing

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Authors: Asma Ahmed, Farah Khalid, Sahlah Sohail, Saira Banusokwalla, Sabiha Banu, Inaara Akbar, Safia Awan, Syed Iqbal Azam

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Background and Objectives: The level of knowledge regarding obesity as a disease condition and health-seeking behavior regarding its management is grossly lacking. We present data from our multidisciplinary obesity clinic at the large tertiary care facility in Karachi, Pakistan, to provide baseline profiles and outcomes of patients attending these clinics. Methods: 260 who attended the obesity clinic between June 2018 to March 2020 were enrolled in this study. The analysis included descriptive and ROC analysis to identify the best cut-offs of theanthropometric measurements to diagnose obesity-related comorbid conditions. Results: The majority of the studied population were women (72.3%) and employed(43.7%) with a mean age of 35.5 years. Mean BMIwas 37.4, waist circumference was 112.4 cm, visceral fat was 11.7%, and HbA1C was 6.9%. The most common comorbidities were HTN & D.M (33 &31%, respectively). The prevalence of MetS was 16.3% in patients and was slightly higher in males. Visceral fat was the main factor in predicting D.M (0.750; 95% CI: 0.665, 0.836) and MetS (0.709; 95% CI: 0.590, 0.838) compared to total body fat, waist circumference, and BMI. The risk of predicting DM &MetS for the visceral fat above 9.5% in women had the highest sensitivity (80% for D.M & 79% for MetS) and an NPV (92.75% for D.M & 95% for MetS). Conclusions: This study describes and establishes characteristics of these obese individuals, which can help inform clinical practices. These practices may involve using visceral fat for earlier identification and counseling-based interventions to prevent more severe surgical interventions down the line.

Keywords: obesity, metabolic syndrome, tertiary care facility, BMI, waist circumference, visceral fat

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Authors: Tess Howard, Lily Owens, Maneesha De Silva, Russell Hodgson

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Purpose: This study aims to evaluate the cost-effectiveness of laparoscopic common bile duct exploration (CBDE) compared to endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy for the emergency management of common bile duct (CBD) stones. Methodology: A retrospective case note review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE, or ERCP and cholecystectomy at a single centre between January 2014-October 2014. Data on admission and procedural costs, length of hospital stay, postoperative complications and further stone related interventions were analysed. Results: A total of 350 patients were analysed. Among them, 299 patients underwent CBDE at the time of cholecystectomy, while the remaining 51 underwent ERCP either pre-, intra- or post cholecystectomy. CBDE was associated with lower overall costs compared to ERCP with an average hospital stay cost of $13,093 vs $22,930 respectively. This was largely attributed to shorter hospital stays (6.5 vs 10.3 days), decreased need for intensive care unit admission and fewer postoperative interventions within the CBDE group. Notably, single procedure laparoscopic cholecystectomy with CBDE demonstrated decreased operative costs compared to laparoscopic cholecystectomy combined with ERCP pre-/intra- or post-operatively ($3,747 vs. $4,641). Conclusion: Emergent CBDE is a cost-effective alternative to ERCP for managing CBD stones when combined with cholecystectomy. The upfront investment in equipment for CBDE and increased cholecystectomy procedural time is counterbalanced by reduced hospital stay, fewer procedures and subsequent cost savings. Economic considerations, in conjunction with clinical outcomes, should inform the selection of the optimal approach for CBD stone management in emergency settings.

Keywords: choledocolithiasis, management, cost-effectiveness, endoscopic retrograde cholangiopancreatography, ERCP, CBDE, common bile duct exploration

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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: Haaris Khan, Farhad Udwadia

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South Asians are the fastest-growing immigrant population in Canada and are 3-4 times more likely to develop diabetes. In a primary care setting, language barriers continue to persist as a prominent obstacle when delivering crucial health information. Given the abundance of languages in the South Asian community and the varying levels of English fluency, there is compelling evidence that these language barriers can adversely impact health outcomes. The microvascular and macrovascular complications of poor diabetic management are well established and universally recognized. However, these are often difficult concepts to grasp for even individuals fluent in English. In order to lessen the burden of language barriers, we developed a comprehensive guide in various languages that discuss the complications and screening guidelines for diabetic and prediabetic patients. The guide is presented in the form of a pamphlet, with an electronic version being constructed as well, that provides basic information on diabetic retinopathy, neuropathy and nephropathy as well as the screening recommendations. We also conducted a review of the literature around the topic and incorporated our findings into our project. Our goal is for primary care physicians to have this resource and to be able to provide the link or pamphlet to patients in need. Our presentation also provides a comprehensive overview of some of the other barriers that individuals in the South Asian community face when seeking care. Given the staggering number of individuals in the South Asian community with diabetes and the morbidity and mortality associated with diabetes and its complications, effective community-specific strategies are needed to mitigate the potential consequences of poor diabetes management.

Keywords: diabetes, patient education, ophthalmology, vascular surgery

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Authors: Dolly Kumari, H. Lhungdim

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Maternal health is one of the crucial health indicators for any country. 5th goal of Millennium Development Goals is also emphasising on improvement of maternal health. Soon after Independence government of India realizing the importance of maternal and child health care services, and took steps to strengthen in 1st and 2nd five year plans. In past decade the other health indicator which is life expectancy at birth has been observed remarkable improvement. But still maternal mortality is high in India and in some states it is observe much higher than national average. Government of India pour lots of fund and initiate National Rural Health Mission (NRHM) in 2005 to improve maternal health in country by providing affordable and accessible health care services. Accredited Social Heath Activist (ASHA) is one of the key components of the NRHM. Mainly ASHAs are selected female aged 25-45 years from village itself and accountable for the monitoring of maternal health care for the same village. ASHA are trained to works as an interface between the community and public health system. This study tries to assess the role of ASHA in utilizing maternal health care services and to see the level of awareness about benefits given under JSY scheme and utilization of those benefits by eligible women. For the study concurrent evaluation data from National Rural health Mission (NRHM), initiated by government of India in 2005 has been used. This study is based on 78205 currently married women from 70 different districts of India. Descriptive statistics, chi2 test and binary logistic regression have been used for analysis. The probability of institutional delivery increases by 2.03 times (p<0.001) while if ASHA arranged or helped in arranging transport facility the probability of institutional delivery is increased by 1.67 times (p<0.01) than if she is not arranging transport facility. Further if ASHA facilitated to get JSY card to the pregnant women probability of going for full ANC is increases by 1.36 times (p<0.05) than reference. However if ASHA discuses about institutional delivery and approaches to get register than probability of getting TT injection is 1.88 and 1.64 times (p<0.01) higher than that if she did not discus. Further, Probability of benefits from JSY schemes is 1.25 times (p<0.001) higher among women who get married after 18 years. The probability of benefits from JSY schemes is 1.25 times (p<0.001) higher among women who get married after 18 year of age than before 18 years, it is also 1.28 times (p<0.001) and 1.32 times (p<0.001) higher among women have 1 to 8 year of schooling and with 9 and above years of schooling respectively than the women who never attended school. Those women who are working have 1.13 times (p<0.001) higher probability of getting benefits from JSY scheme than not working women. Surprisingly women belongs to wealthiest quintile are .53times (P<0.001) less aware about JSY scheme. Results conclude that work done by ASHA has great influence on maternal health care utilization in India. But results also show that still substantial numbers of needed population are far from utilization of these services. Place of delivery is significantly influenced by referral and transport facility arranged by ASHA.

Keywords: institutional delivery, JSY beneficiaries, referral faculty, public health

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Authors: A. Papachristou, A. Ntikoudi, L. Makris, V. Saridakis

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Introduction: More than 10 million people are imprisoned or detained worldwide. Figures from 2011-12 show that prison inmates are more likely than the general population to suffer from chronic or infectious diseases, while most inmates are overweight or obese, and more than a quarter have high blood pressure. In 2011/12, the proportion of prisoners reporting diabetes or hyperglycemia was 899 per 10,000 prisoners, almost double the 2004 figure (483 per 10,000). It is important to ensure that this population has access to the same standard of care as people outside prisons, as access to services should be need-based. Diabetes is a public health problem associated with increased morbidity and mortality worldwide. According to the International Diabetes Federation (IDF) in 2017, approximately 425 million people worldwide had diabetes. This number is expected to increase to 629 million by 2045. Poor management of diabetes in prisons can lead to poor blood sugar control and increase the risk of complications. Aim: The aim of this review was to systematically evaluate all the available literature on diabetes care in custodial settings. Methods: An extensive literature search was conducted through electronic databases (PubMed, Scopus and CINAHL) with the terms ‘custody’, ‘diabetes Mellitus, ‘detention centers and ‘chronic disease’. Articles published in English until September 2022, were included; no other criteria on publication dates were set. Results: Most of the studies mentioned a diabetes prevalence of approximately 10%, among other common chronic. Hypertension, obesity, smoking, sedentary lifestyle were the most common comorbidities associated with diabetes. Conclusion: Good glycemic control is fundamental to managing diabetes, and while many prisoners enter prison poorly, access to regular medication and meals, as well as exercise, offers the potential for improvement. Not being able to get help as quickly as in the past can be extremely stressful, and some prisoners may deliberately raise their blood sugar levels to avoid the risk of developing hypoglycemia, especially if they know they have had previous episodes of nocturnal hypoglycemia. Thus, appropriate training and resources are critical to providing quality care to incarcerated people with diabetes.

Keywords: custody, diabetes mellitus, detention centers, chronic disease

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Authors: Sun-Mi Park, Ji-Hyun Jung, Min-Jung Kang

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Software (SW) education is scheduled to be included in the National curriculum in South Korea by 2018. However, Korean national kindergarten curriculum has been excepted from the revision of the entire Korean national school curriculum including software education. Even though the SW education has not been considered a part of current national kindergarten curriculum, there is a growing interest of adopting software education into the ECE practice. Teachers might be a key element in introducing and implementing new educational change such as SW education. In preparation for the adoption of SW education in ECE, it might be necessary to figure out ECE teachers’ perception and attitudes toward early childhood software education. For this study, 219 ECE teachers’ concern level in SW education was surveyed by using the Stages of Concern Questionnaire (SoCQ). As a result, the teachers' concern level in SW education is the highest at stage 0-Unconcerned and is high level in stage 1-informational, stage 2-personal, and stage 3-management concern. Thus, a non-user pattern was mostly indicated. However, compared to a typical non-user pattern, the personal and informative concern level is slightly high. The 'tailing up' phenomenon toward stage 6-refocusing was shown. Therefore, the pattern aspect close to critical non-user ever appeared to some extent. In addition, a significant difference in concern level was shown at all stages depending on the awareness of necessity. Teachers with SW training experience showed higher intensity only at stage 0. There was statistically significant difference in stage 0 and 6 depending on the future implementation decision. These results will be utilized as a resource in building ECE teachers’ support system according to his or her concern level of SW education.

Keywords: concerns-based adoption model (CBAM), early childhood education teachers, software education, Stages of Concern (SoC)

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Authors: Maria Vargas Hernandez, Jose Rojas Suarez, Carmelo Dueñas Castell, Sandra Contreras, Camilo Bello, Diana Borre, Walter Anichiarico, Harold Vasquez, Eduard Perez, Jose Santacruz

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In the last two decades, there have been outbreaks of emerging infectious diseases, with an impact on both the general population and the obstetric population. These infections, which affect the general population, pose a high risk for adverse maternal and perinatal outcomes, taking into account that physiological and immunological changes that occur during pregnancy can increase their risk or severity. Among these, the pandemics of viral infections, Influenza A/H1N1 and SARS-CoV-2/COVID-19, stand out. In 2009, Influenza A/H1N1 infection (H1N1 2009pdm) affected approximately 3,110 obstetric patients, with data reported from 29 countries, including 1,625 (52.3%) cases that were hospitalized, 378 (23.3%) admissions to ICU and 130 (8%) deaths; and since the end of 2019, the Severe Acute Respiratory Syndrome - 2 (SARS-CoV-2) has been identified, causing the COVID-19 pandemic, with global mortality that is around 2-4% for the general population, and higher mortality in patients requiring admission to the intensive care unit. Its impact on the obstetric population is still unknown. Objectives: To evaluate the impact on maternal and perinatal outcomes of COVID-19 infection in reference to influenza A/H1N1 infection in the obstetric population. Methodology: Systematic review of the literature and meta-analysis. Results: Mortality from maternal infection with influenza A/H1N1 appears to be higher (8%) than mortality due to maternal infection with COVID-19 (3%). The rates of ICU admission, hospitalization, the requirement for invasive mechanical ventilation, and fetal death also appear to be higher in the maternal population with A/H1N1 infection, in reference to the maternal population with COVID-19 infection. Within perinatal outcomes, the admission to the neonatal ICU appears to be higher in the infants born to mothers with COVID-19 infection (28% vs. 15% for COVID-19 and A/H1N1, respectively). Conclusion: A/H1N1 infection in the obstetric population seems to be associated with a higher proportion of adverse outcomes in relation to COVID-19 infection. The actual impact of maternal influenza A/H1N1 infection on perinatal outcomes is unknown. More COVID-19 studies are needed to understand the impact of maternal infection on perinatal outcomes in this population.

Keywords: A/H1N1, COVID-19, maternal outcomes, perinatal outcomes

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Authors: Aikaterini Tsalampouni

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The European Union has long been the most developed model of economic and political integration that has brought a common market, a common currency and a standardization of national policies in certain areas in consistent with EU values and principles. To this direction, there is a parallel process of social integration that effect public policy decisions of member states. Even though social policy, i.e. social protection and moreover healthcare policy, still remains in state's responsibility to develop, EU applies different mechanisms in order to influence health policy systems, since from a more federalist point of view, EU ought to expand its regulatory and legislative roles in as many policy areas as possible. Recently, the pandemic has become a turning point for health care provision and at the same time has also highlighted the need to strengthen the EU’s role in coordinating health care. This paper analyses the EU health policy in general, as well as the response to COVID-19 pandemic with an attempt to identify indications of interaction between EU policies and the promotion of sustainable and resilient health systems. More analytically, the paper investigates the EU binding legal instruments, non-binding legal instruments, monitoring and assessment instruments and instruments for co-financing concerning health care provision in member states and records the evolution of health policies before and during the COVID-19 pandemic. The paper concludes by articulating some remarks regarding the improvement of health policy in EU. Since the ability to deal with a pandemic depends on continuous and increased investment in health systems, the involvement of the EU can lead to a policy convergence, necessary for the resilience of the systems, maintaining at the same time, a strong health policy framework in Europe.

Keywords: EU health policy, EU response to COVID-19, European Health Union, health systems in Europe

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Authors: Cheyenne Johnson, Samantha Robinson, Christina Chant, Ann M. Mitchell, Carol Price, Carmel Clancy, Adam Searby, Deborah S. Finnell

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Introduction: Substance use along the continuum from at-risk use to a substance use disorder (SUD) contributes substantially to the burden of disease and related harms worldwide. There is a growing body of literature that highlights the lack of substance use related content in nursing curricula. Furthermore, there is also a lack of consensus on key competencies necessary for entry-level nurses. Globally, there is a lack of established nursing competencies related to prevention, health promotion, harm reduction and treatment of at-risk substance use and SUDs. At a critical time in public health, this gap in nursing curricula contributes to a lack of preparation for entry-level nurses to support people along the continuum of substance use. Thus, in practice, early opportunities for screening, support, and interventions may be missed. To address this gap, an international committee was convened to develop international entry-level nursing competencies specifying the knowledge, skills, and abilities that all nurses should possess in order to address the continuum of substance use. Methodology: An international steering committee, including representation from Canada, United States, United Kingdom, and Australia was established to lead this work over a one-year time period. The steering committee conducted a scoping review, undertaken to examine nursing competency frameworks, and to inform a competency structure that would guide this work. The next steps were to outline key competency areas and establish leaders for working groups to develop the competencies. In addition, a larger international committee was gathered to contribute to competency working groups, review the collective work and concur on the final document. Findings: A comprehensive framework was developed with competencies covering a wide spectrum of substance use across the lifespan and in the context of prevention, health promotion, harm reduction and treatment, including special populations. The development of this competency-based framework meets an identified need to provide guidance for universities, health authorities, policy makers, nursing regulators and other organizations that provide and support nursing education which focuses on care for patients and families with at-risk substance use and SUDs. Conclusion: Utilizing these global competencies as expected outcomes of an educational and skill building curricula for entry-level nurses holds great promise for incorporating evidence-informed training in the care and management of people across the continuum of substance use.

Keywords: addiction nursing, addiction nursing curriculum, competencies, substance use

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Authors: Eran Viezel

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Critical biblical scholarship emerged in the early modern period, yet scholars frequently search for precursors to it among medieval commentators who adopted critical positions—and many mention Abraham Ibn Ezra (Spain–England, 1089–1164/7) in this context. Indeed, in several places, Ibn Ezra claims that there are verses in the Torah that were added to it after the time of Moses; and some major thinkers and scholars in the early modern period (for example, Baruch Spinoza) were aware of these remarks and influenced by them. However, Ibn Ezra’s belief that the Torah includes verses added at a later time is not based on the considerations that led the founders of critical biblical scholarship to their conclusion that Moses did not write the Torah. Ibn Ezra’s positions on the question of the Torah’s authorship are an example of the fact that similarity in conclusions and even in interpretive methodology should not obscure the different interpretive and attitudinal points of departure that distinguish traditional biblical interpretation from a critical biblical scholarship. Ultimately, a chasm exists between the views of Ibn Ezra and those of critical thinkers such as Spinoza.

Keywords: hebrew bible, Abraham Ibn Ezra, exegesis, biblical scholarship

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Authors: Moksha Singh

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The proponents of deinstitutionalization, including Goffman and others, in their works, have regarded institutions (orphanages to be specific) as regulated social arrangements that negatively impinge upon a resident’s development. They, therefore, propose alternative forms of care. However, even after five decades of this critique institutionalization remains the only hope for children with social, physical and mental disabilities in larger parts of the developing world such as the conflict affected state of Jammu and Kashmir in India. This paper is based on the experiences of children who lost their parents to insurgency and counter-insurgency operations and the rehabilitation process. This study is qualitative in nature and adopts descriptive-cum-exploratory research design. Using theoretical sampling, six orphanages and thirty one child residents who lost their parent(s) in the course of the armed conflict in the state of Jammu and Kashmir in India were studied in the year 2009-2010. It included interviews, observation, life histories and introspective accounts of the orphans and the management. The results were drawn through the qualitative examination, understanding, and interpretation of the primary and secondary data. The findings suggested that rehabilitation of these conflict-affected children is taking place mainly through residential child care facilities run by non-governmental bodies. Alternative forms of rehabilitation are not functional in the state because of various geopolitical and socio-cultural complexities. Even after five years of arriving at these conclusions and more, the state of Jammu and Kashmir still lacks a comprehensive rehabilitation plan for these children. This has further encouraged a mushroomed growth of legal and illegal institutions. Some of these institutions compromise the standard norms of functioning and yet remain the only hope for thousands rendered orphan. These institutions, therefore, are there to stay as other alternative forms of care are not available in the state. A comprehensive intervention policy is needed based on the cultural specifics of the state and incorporation of views of institutions offering aid, the state and the children. The paper introduces Small Group Residential Care Model through which it is expected that the restoration process can be made smooth and effective.

Keywords: armed conflict, children's rights, institutionalization, orphanages, rehabilitation

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Authors: Rushi Naaz, Diksha Suchdeva

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Background: Temperament is a very important aspect of functioning that needs to be understood in children of patients suffering from schizophrenia. The children of parents with mental disorder have substantially increased risk of psychiatric illness in them and may exhibit a range of problems from minor variations in temperament and adjustment to manifest psychiatric disorder. Method: A case control study was conducted to study the temperament characteristics and psychopathology in children of patients suffering from schizophrenia as compared to those of healthy controls. Both the groups were evaluated on Temperament Measurement Schedule and Childhood Psychopathology Measurement Schedule. Results: The results showed that children of patients suffering from schizophrenia were withdrawing, less adaptable, less sociable and had lower activity level than children of healthy parents. However, on the measure of psychopathology, no significant difference was found. Conclusion: Since temperament can be identified at an early age, children at risk for the disorder later on could be identified early enough for possible primary intervention.

Keywords: children, childhood psychopathology, parental psychopathology, psychiatric disorders, schizophrenia, temperament

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Authors: Bindu S., Malavika Anakkathil Anil, Jayashree S. Bhat

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The dyadic interaction between the parent and child during story narration facilitates the emergence of early literacy skills. Early shared reading experiences positively predict better reading and language outcomes in children who experience rich communicative and effective interactions during shared book reading. However, research is yet to systematically explore mother’s perspective towards story narration and how employment may influence their perspectives. The study analysed the perspectives of employed and unemployed mothers of typically developing children between the age ranges of 2 to 5 years through a questionnaire which covered domains on story narration exposure and parental attitudes & beliefs. The results indicate no statistical difference between employed mothers (M=8.5, SD=3.4) and unemployed mothers (M=10.1, SD=1.06). Whereas, post-hoc comparisons using the scheffe test, revealed a significant difference in scores. An increasing score was obtained as the age of the child increased. This change could be attributed due to the integration of children in preschools which could have contributed to the change of perception towards story narration. Older children’s mother perceive story narration to be an important part of their curriculum, which could facilitate rich vocabulary and language output. Younger children’s parents are however not realising the significance of story narration and its impact on the emergent literacy skills. Parent-child interaction is a significant contributor to a healthy social and cultural development. The study emphasises on the need of mothers to engage in preliteracy based activities which contribute to better academic performance in later stages.

Keywords: early literacy skill, employment, language development, mother’s perspective, story narration

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Authors: Ohud Alharbi, Emily Baines

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The animation industry is one of the creative industries that have attracted recent historiographical attention. However, there has been very limited research on Saudi Arabian and wider Arabian animation industries, while there are a large number of studies that have covered this issue for North America, Europe and East Asia. The existing studies show that developed countries such as USA, Japan and the UK have reached the Maturity stage in their animation industry life-cycle. On the other hand, developing countries that are still in the Introduction phase of the industry life-cycle face challenges to improve their industry. Saudi Arabia is one of the countries whose animation industry is still in its infancy. Thus, the aim of this paper is to address the main barriers that hinder the evolution of the industry life-cycle for Saudi animation – challenges that are also relevant to many other early stage industries in developing countries. These barriers have been analysed using the early mobility barriers defined by Porter, to provide a conceptual structure for defining recommendations to enable the transition to a strong Growth phase industry. This study utilized qualitative methods to collect data, which involved in-depth interviews, document analysis and observations. It also undertook a comparative case study approach to investigate the animation industry life-cycle, with three selected case studies that have a more developed industry than Saudi animation. Case studies include: the United Kingdom, which represents a Mature animation industry; Egypt, which represents an established Growth stage industry; and the United Arab of Emirates, which is an early Growth stage industry. This study suggests adopting appropriate strategies that arise as findings from the comparative case studies, to overcome barriers and facilitate the growth of the Saudi animation industry.

Keywords: barriers, industry life-cycle, Saudi animation, industry

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Authors: Mahbuba Rahman, Sabri Boughorbel, Scott Presnell, Charlie Quinn, Darawan Rinchai, Damien Chaussabel, Nico Marr

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Collections of large-scale datasets made available in public repositories can be used to identify and fill gaps in biomedical knowledge. But first, these data need to be made readily accessible to researchers for analysis and interpretation. Here a collection of transcriptome datasets was made available to investigate the functional programming of human hematopoietic cells in early life. Thirty two datasets were retrieved from the NCBI Gene Expression Omnibus (GEO) and loaded in a custom, interactive web application called the Gene Expression browser (GXB), designed for visualization and query of integrated large-scale data. Multiple sample groupings and gene rank lists were created based on the study design and variables in each dataset. Web links to customized graphical views can be generated by users and subsequently be used to graphically present data in manuscripts for publication. The GXB tool also enables browsing of a single gene across datasets, which can provide information on the role of a given molecule across biological systems. The dataset collection is available online. As a proof-of-principle, one of the datasets (GSE25087) was re-analyzed to identify genes that are differentially expressed by regulatory T cells in early life. Re-analysis of this dataset and a cross-study comparison using multiple other datasets in the above mentioned collection revealed that PMCH, a gene encoding a precursor of melanin-concentrating hormone (MCH), a cyclic neuropeptide, is highly expressed in a variety of other hematopoietic cell types, including neonatal erythroid cells as well as plasmacytoid dendritic cells upon viral infection. Our findings suggest an as yet unrecognized role of MCH in immune regulation, thereby highlighting the unique potential of the curated dataset collection and systems biology approach to generate new hypotheses which can be tested in future mechanistic studies.

Keywords: early-life, GEO datasets, PMCH, interactive query, systems biology

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Authors: Henrique Veras De Paiva Fonseca

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This paper investigates the long-term relationship between early life exposure to malaria and adult socioeconomic outcomes in Brazil. The identification strategy relies on exogenous variation in the risk of malaria outbreaks in different states and seasons of the year to identify early life exposure according to the timing and location of birth. Furthermore, Brazil has undergone a successful campaign of malaria eradication during the late 1950s, which allows for comparing outcomes of birth cohorts born just prior to and just after eradication to identify the extent of in utero exposure. Instrumental variables estimates find consistent negative treatment effects of in utero exposure to malaria on socioeconomic outcomes, such as educational attainment and health status. The effects are stronger for exposure during the first trimester of pregnancy than during other periods of gestation. Additionally, consistent with previous findings, men are more likely to exhibit larger long-term effects.

Keywords: malaria, exposure, eradication, instrumental variables, education, health

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Authors: Abdullah S. El-Ammari, Omar M. El-Sanousi, Fathi S. El-Mesmari

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One distinct virus namely bean yellow mosaic potyvirus (BYMV) was isolated from naturally infected faba bean plants and identified through the serological reaction, mechanical transmission, host range and symptomology. To study the effect of BYMV on faba bean crop productivity, the experiment was carried out in naturally infected field in a completely randomized design with two treatments (the early infected plants and the lately infected plants). T- test was used to analyze the data. plants of each treatment were harvested when the pods were fully ripened. Early infection significantly reduced the yield of broad bean crop leading to 85.04% yield loss in productivity of seeds per plant, 72.42% yield loss in number of pods per plants, 31.58% yield loss in number of seeds per pod and 18.2% yield loss in weight of seeds per plant.

Keywords: bean yellow mosaic potyvirus, faba bean, productivity, libya

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Authors: Kanik Sharma

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In the year of 2011, the global production of carbon nano-materials (CNMs) was around 3,500 tons, and it is projected to expand at a compound annual growth rate of 30.6%. Expanding markets for applications of CNMs, such as carbon nano-tubes (CNTs) and carbon nano-fibers (CNFs), place ever-increasing demands on lowering their production costs. Current technologies for CNM generation require intensive premium feedstock consumption and employ costly catalysts; they also require input of external energy. Industrial-scale CNM production is conventionally achieved through chemical vapor deposition (CVD) methods which consume a variety of expensive premium chemical feedstocks such as ethylene, carbon monoxide (CO) and hydrogen (H2); or by flame synthesis techniques, which also consume premium feedstock fuels. Additionally, CVD methods are energy-intensive. Renewable and replenishable feedstocks, such as those found in municipal, industrial, agricultural recycling streams have a more judicious reason for usage, in the light of current emerging needs for sustainability. Agricultural sugarcane bagasse and corn residues, scrap tire chips as well as post-consumer polyethylene (PE) and polyethylene terephthalate (PET) bottle shreddings when either thermally treated by sole pyrolysis or by sequential pyrolysis and partial oxidation result in the formation of gaseous carbon-bearing effluents which when channeled into a heated reactor, produce CNMs, including carbon nano-tubes, catalytically synthesized therein on stainless steel meshes. The structure of the nano-material synthesized depends on the type of feedstock available for pyrolysis, and can be determined by analysing the feedstock. These feedstocks could supersede the use of costly and often toxic or highly-flammable chemicals such as hydrocarbon gases, carbon monoxide and hydrogen, which are commonly used as feedstocks in current nano-manufacturing process for CNMs.

Keywords: nanomaterials, waste plastics, sugarcane bagasse, pyrolysis

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Authors: Xavier Bertrand, Alexandre Cayrel

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The early phase of an aircraft development is instrumental as it really drives the potential of a new concept. Any weakness in the high-level design (wing planform, moveable surfaces layout etc.) will be extremely difficult and expensive to recover later in the aircraft development process. Aerodynamic evaluation in this very early development phase is driven by two main criteria: a short lead-time to allow quick iterations of the geometrical design, and a high quality of the calculations to get an accurate & reliable assessment of the current status. These two criteria are usually quite contradictory. Actually, short lead time of a couple of hours from end-to-end can be obtained with very simple tools (semi-empirical methods for instance) although their accuracy is limited, whereas higher quality calculations require heavier/more complex tools, which obviously need more complex inputs as well, and a significantly longer lead time. At this point, the choice has to be done between accuracy and lead-time. A brand new approach has been developed within Airbus, aiming at obtaining quickly high quality evaluations of the aerodynamic of an aircraft. This methodology is based on a joint use of Surrogate Modelling and a lifting line code. The Surrogate Modelling is used to get the wing sections characteristics (e.g. lift coefficient vs. angle of attack), whatever the airfoil geometry, the status of the moveable surfaces (aileron/spoilers) or the high-lift devices deployment. From these characteristics, the lifting line code is used to get the 3D effects on the wing whatever the flow conditions (low/high Mach numbers etc.). This methodology has been applied successfully to a concept of medium range aircraft.

Keywords: aerodynamics, lifting line, surrogate model, CFD

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Authors: Hamida Hamed Said Al Harthi

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Background: Illegal drug use is a rising problem that affects Omani youth. This research aimed to study a group of young Omani men who were imprisoned more than once for illegal drug use, focusing on exploring their lifestyle experiences inside and outside the prison and whether these contributed to their early relapse and re-imprisonment. This is the first study of its kind from Oman conducted in a prison setting. Methods: 19 Omani males aged 18–35 years imprisoned in Oman Central Prison were recruited using purposive sampling. Focused ethnography was conducted over 8 months to explore the drug-related experiences outside the prison and during imprisonment. Face-to-face semi-structured interviews with the participants yielded detailed transcripts and field notes. These were thematically analyzed, and the results were compared with the existing literature. Results: The participants’ voices yielded new insights into the lives of young Omani men imprisoned for illegal drug use, including their sufferings and challenges in prison. These included: entry shock, timing and boredom, drug trafficking in prison, as well as physical and psychological health issues. Overall, imprisonment was reported to have negatively impacted the participants’ health, personality, self-concept, emotions, attitudes, behavior and life expectations. The participants reported how their efforts to reintegrate into the Omani community after release from prison were rebuffed due to stigmatization and rejection from society and family. They also experienced frequent unemployment, police surveillance, accommodation problems and a lack of rehabilitation facilities. The immensity of the accumulated psychophysiological trauma contributed to their early relapse and re-imprisonment. Conclusion: This thesis concludes that imprisonment is largely ineffective in controlling drug use in Oman. Urgent action is required across multiple sectors to improve the lives and prospects of users of illegal drugs within and outside the prison to minimize factors contributing to early relapse. Key Words: illegal drugs, drug users, Oman, addiction, Omani culture, prisoners, relapse, re-imprisonment, qualitative research, ethnography.

Keywords: illigal drugs, Prison, Omani culture lifestyle, post prison life

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