Search results for: dilemma discussion

Authors: S. M. Abdus Sattar

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Introduction: The objectives of the study are to assess different aspects of the tourism and hospitality industry, analyze its contributions to the Gross Domestic Product of Bangladesh, identify the importance of the tourism and hospitality industry, explore future prospects in the sectors, identify challenges and provide recommendations for the development of these industries. The study explores the significance of the tourism and hospitality industry in economic growth and defines its role. Tourism is one of the fastest-growing industries in the world today. Methodology: The study adopts statistical methods and utilizes both quantitative and qualitative research techniques. Data is collected through surveys, interviews, visitor registration, online platforms and analysis of various tourism-related records. The study focuses on marketing, management, attractions and services in the tourism and hospitality sectors. Result: The tourism and hospitality industry offers great opportunities for emerging economies and developing countries. The industry provides job creation, infrastructure development, cultural assets and environmental conservation, essential skills development, revenue generated, foreign exchange earned, economic growth and reduced poverty and inequality. Discussion: The study focuses on improving infrastructure and service quality in the tourism and hospitality industry to attract tourists. The industry significantly contributes to the Gross Domestic Product of Bangladesh. It highlights how the tourism and hospitality sectors can drive economic development, reduce poverty and promote cultural and environmental conservation. It also explores the challenges and future prospects in the tourism and hospitality sectors. Conclusion and Future Scope: The opportunities for tourism of Bangladesh are agricultural tourism, religious tourism, sports tourism, eco-tourism, educational tourism, rural tourism and cultural tourism. However, there is a lack of research and plans to explore the development of the industry. The tourism and hospitality industry offers numerous opportunities for growth and development. There are job opportunities for travel consultants, tour operators, event planners, hotel managers, travel writers, tourism development officers and airline executives in the future. The study recommends to development of tourism infrastructure, maintaining tourist destinations, railway stations, airports, rest houses, hotels and improving the quality of services.

Keywords: tourism, hospitality, employment, economic, development

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Authors: David W. Hill, Linda W. Glass, Jakob L. Vingren

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Maximal accumulated oxygen deficit (MAOD), the gold standard measure of anaerobic capacity, is the difference between the oxygen cost of exhaustive severe intensity exercise and the accumulated oxygen consumption (O2; mL·kg–1). In theory, MAOD can be estimated as the sum of independent estimates of the phosphocreatine and glycolysis contributions, which we refer to as PCr+glycolysis. Purpose: The purpose was to test the hypothesis that PCr+glycolysis provides a valid measure of anaerobic capacity in cycling and running. Methods: The participants were 27 women (mean ± SD, age 22 ±1 y, height 165 ± 7 cm, weight 63.4 ± 9.7 kg) and 25 men (age 22 ± 1 y, height 179 ± 6 cm, weight 80.8 ± 14.8 kg). They performed two exhaustive cycling and running tests, at speeds and work rates that were tolerable for ~5 min. The rate of oxygen consumption (VO2; mL·kg–1·min–1) was measured in warmups, in the tests, and during 7 min of recovery. Fingerprick blood samples obtained after exercise were analysed to determine peak blood lactate concentration (PeakLac). The VO2 response in exercise was fitted to a model, with a fast ‘primary’ phase followed by a delayed ‘slow’ component, from which was calculated the accumulated O2 and the excess O2 attributable to the slow component. The VO2 response in recovery was fitted to a model with a fast phase and slow component, sharing a common time delay. Oxygen demand (in mL·kg–1·min–1) was determined by extrapolation from steady-state VO2 in warmups; the total oxygen cost (in mL·kg–1) was determined by multiplying this demand by time to exhaustion and adding the excess O2; then, MAOD was calculated as total oxygen cost minus accumulated O2. The phosphocreatine contribution (area under the fast phase of the post-exercise VO2) and the glycolytic contribution (converted from PeakLac) were summed to give PCr+glycolysis. There was not an interaction effect involving sex, so values for anaerobic capacity were examined using a two-way ANOVA, with repeated measures across method (PCr+glycolysis vs MAOD) and mode (cycling vs running). Results: There was a significant effect only for exercise mode. There was no difference between MAOD and PCr+glycolysis: values were 59 ± 6 mL·kg–1 and 61 ± 8 mL·kg–1 in cycling and 78 ± 7 mL·kg–1 and 75 ± 8 mL·kg–1 in running. Discussion: PCr+glycolysis is a valid measure of anaerobic capacity in cycling and running, and it is as valid for women as for men.

Keywords: alactic, anaerobic, cycling, ergometer, glycolysis, lactic, lactate, oxygen deficit, phosphocreatine, running, treadmill

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Authors: Devyani Shete, Sudeep Rai

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Background: The COVID-19 pandemic has caused one of the highest disruptions to the NHS (National Health Service), especially to the fundamental cervical cancer screening service. To prioritize screening response effectively, it is vital to understand the underlying disease risks amongst groups of women who are less likely to resume their screening/follow up at General Practices. The current government target is to have>=80% of women have an adequate test within the previous 3.5 years (ages 25-49) or 5.5 years (ages 50-64). Aims/Objectives: To increase the number of eligible people aged 25-49 attending cervical screening by 5% at Lakeside Healthcare (a General Practice in Corby). Methods: An online survey was posted on the Lakeside Healthcare website to find out what the barriers towards cervical screening were. It was apparent that patients needed more information catered to their responses. 6 informational videos and a “Cervical Screening Guide” were created for Lakeside patients about cervical screening, which were posted on the Healthcare website. Lakeside also started sending reminder texts to those eligible, with a link to a booking form. Results: On 18th January 2022, 69.7% of patients aged 25-49 years (7207) had an adequate cervical screening test in the last 3.5 years. There were 80 total responders to the online survey. In response to “which of the following are reasons why you have not attended screening”, 30% ticked “I kept putting it off/did not get around to it,” and 13% ticked “I was worried it would be painful or daunting.” In response to “which of the following would make you more likely to book an appointment”, 23% ticked “More detailed explanations of what the risks are if I don’t have screening,” and 20% ticked “I would like more information about the test and what the smear entails.” 10% of responders had previous trauma, whilst 28% of responders said the pandemic had impacted them getting a smear. Survey results were used to carry out interventions to increase smear uptake. On 23rdMarch 2022 (after a 2-month period), 75%of patients aged 25-49 (7119) attended the screening, which was a 5.3% increase from January. Discussion/Conclusion: The survey was vital in carrying out the exact interventions that were required for patients to increase screening uptake, as it is important to know what the populations’ needs are in order to create personalized invitations. This helps to optimise response during a pandemic. A HPV self-sample kit at home could be a popular method of dealing with further outbreaks.

Keywords: gynaecology, cervical screening, public health, COVID-19

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Authors: Angana Chatterjee

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The feminist scholars point out the various problematic issues in the traditional mainstream western thought and theories. The thought practices behind the discriminatory and oppressive social practices are based on concepts that play a pivotal role in theorisation. Therefore, many feminist philosophers take up reformation or reconceptualisation projects. Such projects have bearings on various aspects of philosophical thought, namely, ontology, epistemology, logic, ethics, social, political thought, and so on. In tune with this spirit, the present paper suggests a well-established thought pattern which is not western but has got the potential to deal with the problems of mainstream western thought culture that are identified by the feminist critics. The Indian thought pattern is theorised in the domain of Indian logic, which is a study of inference patterns. As, in the Indian context, the inference is considered as a source of knowledge, certain epistemological questions are linked with the discussion of inference. One of the key epistemological issues is one regarding justification. The study about the nature of derivation of knowledge from available evidence, and the nature of the evidence itself, are integral parts of the discipline called Indian logic. But if we contrast the western tradition of thought with the Indian one, we can find that the Indian logic has got some peculiar features which may be shown to deal with the problems identified by the feminist scholars in western thought culture more plausibly. The tradition of western logic, starting from Aristotle, has been maintaining sharp differences between two forms of reasoning, namely, deductive and inductive. These two different forms of reasoning have been theorised and dealt with separately within the domain of the study called ‘logic.’ There are various philosophical problems that are raised around concepts and issues regarding both deductive and inductive reasoning. Indian logic does not distinguish between deduction and induction as thought patterns, but their distinction is very usual to make in the western tradition. Though there can be found various interpretations about this peculiarity of Indian thought pattern, these mixed patterns were actually very close to the cross-cultural pattern in which human beings would tend to argue or infer from the available data or evidence. The feminist theories can successfully operate in the domain of lived experience if they make use of such a mixed pattern of reasoning or inference. By offering sound inferential knowledge on contextual evidences, the Indian thought pattern is potent to serve the feminist purposes in a meaningful way.

Keywords: feminist thought, Indian logic, inference, justification, mixed thought pattern

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Authors: Yuri Melis, Mattia Resteghini, Emanuela Apicella, Eugenia Dozio, Leonardo Mendolicchio

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Aim: This retrospective study was created to analyze the psychometric, anthropometric and body composition values in patients at the beginning and the discharge of their of hospitalization in the residential care clinic for eating and feeding disorders (EFD’s). Method: The sample was composed by (N=59) patients with mean age N= 33,50, divided in subgroups: Anorexia Nervosa (AN) (N=28), Bulimia Nervosa (BN) (N=13) and Binge Eating Disorders (BED) (N=14) recruited from a residential care clinic for eating and feeding disorders. The psychometrics level was measured with self-report questionnaires: Eating Disorders Inventory-3 (EDI-3) The Body Uneasiness Test (BUT), Minnesota Multiphasic Personality Inventory (MMPI – 2). The anthropometric and nutritional values was collected by Body Impedance Assessment (B.I.A), Body mass index (B.M.I.). Measurements were made at the beginning and at the end of hospitalization, with an average time of recovery of about 8,6 months. Results: The all data analysis showed a statistical significance (p-value >0,05 | power size N=0,950) in variation from T0 (start of recovery) to T1 (end of recovery) in the clinical scales of MMPI-2, AN group (Hypocondria T0 64,14 – T1 56,39) (Depression T0 72,93 – T1 59,50) (Hysteria T0 61,29 – T1 56,17) (Psychopathic deviation T0 64,00 – T1 60,82) (Paranoia T0 63,82 – T1 56,14) (Psychasthenia T0 63,82 – T1 57,86) (Schizophrenia T0 64,68 – T1 60,43) (Obsessive T0 60,36 – T1 55,68); BN group (Hypocondria T0 64,08 – T1 47,54) (Depression T0 67,46 – T1 52,46) (Hysteria T0 60,62 – T1 47,84) (Psychopathic deviation T0 65,69 – T1 58,92) (Paranoia T0 67,46 – T1 55,23) (Psychasthenia T0 60,77 – T1 53,77) (Schizophrenia T0 64,68 – T1 60,43) (Obsessive T0 62,92 – T1 54,08); B.E.D groups (Hypocondria T0 59,43 – T1 53,14) (Depression T0 66,71 – T1 54,57) (Hysteria T0 59,86 – T1 53,82) (Psychopathic deviation T0 67,39 – T1 59,03) (Paranoia T0 58,57 – T1 53,21) (Psychasthenia T0 61,43 – T1 53,00) (Schizophrenia T0 62,29 – T1 56,36) (Obsessive T0 58,57 – T1 48,64). EDI-3 report mean value is higher than clinical cut-off at T0, in T1, there is a significant reduction of the general mean of value. The same result is present in the B.U.T. test in the difference between T0 to T1. B.M.I mean value in AN group is (T0 14,83 – T1 18,41) BN group (T0 20 – T1 21,33) BED group (T0 42,32 – T1 34,97) Phase Angle results: AN group (T0 4,78 – T1 5,64) BN (T0 6 – T1 6,53) BED group (T0 6 – T1 6,72). Discussion and conclusion: The evident presence that on the whole sample, we have an altered serious psychiatric and clinic conditions at the beginning of recovery. The interesting conclusions that we can draw from this analysis are that a multidisciplinary approach that includes the entire care of the subject: from the pharmacological treatment, analytical psychotherapy, Psychomotricity, nutritional rehabilitation, and rehabilitative, educational activities. Thus, this Multidisciplinary treatment allows subjects in our sample to be able to restore psychopathological and metabolic values to below the clinical cut-off.

Keywords: feeding and eating disorders, anorexia nervosa, care clinic treatment, multidisciplinary treatment

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Authors: Johanna Perdomo, Riki Lamont, Edmund Pickering, Naomi C. Paxton, Maria A. Woodruff

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Background: Tissue Engineering (TE) has combined advanced materials, such as biomaterials, to create affordable scaffolds and dynamic systems to generate stimulation of seeded cells on these scaffolds, improving and maintaining the cellular growth process in a cell culture. However, Few TE skin products have been clinically translated, and more research is required to produce highly biomimetic skin substitutes that mimic the native elasticity of skin in a controlled manner. Therefore, this work will be focused on the fabrication of a novel mechanical system to enhance the TE treatment approaches for the reparation of damaged tissue skin. Aims: To archive this, a soft robotic device will be created to emulate different deformation of skin stress. The design of this soft robot will allow the attachment of scaffolds, which will then be mechanically actuated. This will provide a novel and highly adaptable platform for dynamic cell culture. Methods: Novel, low-cost soft robot is fabricated via 3D printed moulds and silicone. A low cost, electro-mechanical device was constructed to actuate the soft robot through the controlled combination of positive and negative air pressure to control the different state of movements. Mechanical tests were conducted to assess the performance and calibration of each electronic component. Similarly, pressure-displacement test was performed on scaffolds, which were attached to the soft robot, applying various mechanical loading regimes. Lastly, digital image correlation test was performed to obtain strain distributions over the soft robot’s surface. Results: The control system can control and stabilise positive pressure changes for long hours. Similarly, pressure-displacement test demonstrated that scaffolds with 5µm of diameter and wavy geometry can displace at 100%, applying a maximum pressure of 1.5 PSI. Lastly, during the inflation state, the displacement of silicone was measured using DIC method, and this showed a parameter of 4.78 mm and strain of 0.0652. Discussion And Conclusion: The developed soft robot system provides a novel and low-cost platform for the dynamic actuation of tissue scaffolds with a target towards dynamic cell culture.

Keywords: soft robot, tissue engineering, mechanical stimulation, dynamic cell culture, bioreactor

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Authors: Alsulami H., Alghamdi N., Alasker A., Almohen N., Shome D.

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Most conventional chemotherapeutic agents which are used for the treatment of cancers not only eradicate cancer cells but also affect normal hematopoietic Stem cells (HSCs) that leads to severe pancytopenia during treatment. Therefore, a need exists for novel approaches to treat cancer without or with minimum effect on normal HSCs. Parthenolide (PTL), a herbal product occurring naturally in the plant Feverfew, is a potential new chemotherapeutic agent for the treatment of many cancers such as acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). In this study we investigated the effect of different PTL concentrations on the viability of normal HSCs and also on the ability of these cells to form colonies after they have been treated with PTL in vitro. Methods: In this study, 24 samples of bone marrow and cord blood were collected with consent, and mononuclear cells were separated using density gradient separation. These cells were then exposed to various concentrations of PTL for 24 hours. Cell viability after culture was determined using 7ADD in a flow cytometry test. Additionally, the impact of PTL on hematopoietic stem cells (HSCs) was evaluated using a colony forming unit assay (CFU). Furthermore, the levels of NFҝB expression were assessed by using a PE-labelled anti-pNFκBP65 antibody. Results: this study showed that there was no statistically significant difference in the percentage of cell death between untreated and PTL treated cells with 5 μM PTL (p = 0.7), 10 μM PTL (p = 0.4) and 25 μM (p = 0.09) respectively. However, at higher doses, PTL caused significant increase in the percentage of cell death. These results were significant when compared to untreated control (p < 0.001). The response of cord blood cells (n=4) on the other hand was slightly different from that for bone marrow cells in that the percentage of cell death was significant at 100 μM PTL. Therefore, cord blood cells seemed more resistant than bone marrow cells. Discussion &Conclusion: At concentrations ≤25 μM PTL has a minimum or no effect on HSCs in vitro. Cord blood HSCs are more resistant to PTL compared to bone marrow HSCs. This could be due to the higher percentage of T-lymphocytes, which are resistant to PTL, in CB samples (85% in CB vs. 56% in BM. Additionally, CB samples contained a higher proportion of CD34+ cells, with 14.5% of brightly CD34+ cells compared to only 1% in normal BM. These bright CD34+ cells in CB were mostly negative for early-stage stem cell maturation antigens, making them young and resilient to oxidative stress and high concentrations of PTL.

Keywords: stem cell, parthenolide, NFKB, CLL

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Authors: Yu-Shi Ye, Jia-Min Wu, Jhih-Ci Li

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Background: Most orthopedic inpatients and primary caregivers are elderly, and patients are at high risk of falls. We set up a quality control team to analyze the root cause and found the following issues: 1. The nursing staff did not conduct cognitive assessments of patients and their primary caregivers to ensure that health education content was understood. 2. Nurses prefer to use spoken language in health education but lack the skills to use diverse teaching materials. 3. Newly recruited nurses have insufficient awareness of fall prevention. Methods: The study subjects were 16 nurses in the orthopedic ward of a teaching hospital in central Taiwan. We implemented the following strategies: 1. Developed a fall simulation teaching plan and conducted teaching courses and assessments in the morning meeting; 2. Designed and used a "fall prevention awareness card" to improve the prevention awareness of elderly patients; 3. All staff (including new staff) received experiential education training. Results: In 2021, 40% of patients in the orthopedic wards were aged 60-79 years (792/1979) with a high risk of falls. According to data collection, the incidence of falls in hospitalized patients was 0.04% (5/12651), which exceeded the threshold of 0.02% in our ward. After completing the on-the-job education training in October, the nursing staff expressed that they were more aware of the special situation of fall prevention. Through practical sharing and drills, combined with experiential teaching strategies, nurses can reconstruct the safety awareness of fall prevention and deepen their cognitive memory. Participants scored between 30 and 80 on the pretest (16 students, mean: 72.6) and between 90 and 100 on the post-test (16 students, mean: 92.6), resulting in a 73.8% improvement in overall scores. We have a total of 4 new employees who have all completed the first 3 months of compulsory PGY courses. From January to April 2022, the incidence of falls in hospitalized patients was 0.025% (1/3969). We have made good improvements and will continue to track the outcome. Discussion: In addition to enhancing the awareness of falls among nursing staff, how-to guide patients and primary caregivers to prevent falls is also the focus of improvement. The proper way of health education can be better understood through practical exercises and case sharing.

Keywords: experiential teaching strategies, fall prevention, cognitive card, elderly patients, orthopedic wards

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Authors: C. Scurr, J. Jeans, S. Srivastava

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Introduction: Acute type two respiratory failure (T2RF) has become a common presentation over the last two decades primarily due to an increase in the prevalence of chronic lung disease. Acute exacerbations can be managed either medically or in combination with non-invasive ventilation (NIV) which should be monitored with regular arterial blood gas samples (ABG). Arterial lines allow more frequent arterial blood sampling with less patient discomfort. We present the experience from a teaching hospital emergency department (ED) and level 2 medical high-dependency unit (HDU) that together form the pathway for management of acute type 2 respiratory failure. Methods: Patients acutely presenting to Charing Cross Hospital, London, with T2RF requiring non-invasive ventilation (NIV) over 14 months (2011 to 2012) were identified from clinical coding. Retrospective data collection included: demographics, co-morbidities, blood gas numbers and timing, if arterial lines were used and who performed this. Analysis was undertaken using Microsoft Excel. Results: Coding identified 107 possible patients. 69 notes were available, of which 41 required NIV for type 2 respiratory failure. 53.6% of patients had an arterial line inserted. Patients with arterial lines had 22.4 ABG in total on average compared to 8.2 for those without. These patients had a similar average time to normalizing pH of (23.7 with arterial line vs 25.6 hours without), and no statistically significant difference in mortality. Arterial lines were inserted by Foundation year doctors, Core trainees, Medical registrars as well as the ICU registrar. 63% of these were performed by the medical registrar rather than ICU, ED or a junior doctor. This is reflected in that the average time until an arterial line was inserted was 462 minutes. The average number of ABGs taken before an arterial line was 2 with a range of 0 – 6. The average number of gases taken if no arterial line was ever used was 7.79 (range of 2-34) – on average 4 times as many arterial punctures for each patient. Discussion: Arterial line use was associated with more frequent arterial blood sampling during each inpatient admission. Additionally, patients with an arterial line have less individual arterial punctures in total and this is likely more comfortable for the patient. Arterial lines are normally sited by medical registrars, however this is normally after some delay. ED clinicians could improve patient comfort and monitoring thus allowing faster titration of NIV if arteral lines were regularly inserted in the ED. We recommend that ED doctors insert arterial lines when indicated in order improve the patient experience and facilitate medical management.

Keywords: non invasive ventilation, arterial blood gas, acute type, arterial line

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Authors: Franco Bruno Castaldo

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Aim: The term bioethics is a term coined by VanPotter R ., who in 1970 thought of a discipline, capable of contributing to a better quality of human life and the cosmos. At first he intended bioethics as a wisdom capable of creating a bridge between bios and ethos and between bio-experimental science and ethical-anthropological sciences.Similarly, the modern sport is presented as a polysemic phenomenon, multidisciplinary, pluris value. From the beginning, the sport is included in the discussion of bioethical problems with doping. Today, the ethical problems of the sport are not only ascribable to doping, the medicalization of society, Techniques for enhancement, violence, Fraud, corruption, even the acceptance of anthropological transhumanist theories. Our purpose is to shed light on these issues so that there is a discernment, a fine-tuning also in educational programs, for the protection of all the sport from a scientist adrift, which would lead to an imbalance of values. Method: Reading, textual and documentary analysis, evaluation of critical examples. Results: Harold VanderZwaag, (1929-2011) in ancient times, asked: how many athletic directors have read works of sport philosophy or humanities? Along with E.A. Zeigler (North American Society for Sport Management) are recognized as pioneers of educational Sport Management. Comes the need to leave the confines of a scientific field, In order to deal with other than itself. Conclusion: The quantitative sciences attracts more funds than qualitative ones, the philosopher M. Nussbaum, has relaunched the idea that the training of students will have to be more disinterested than utilitarian, Offering arguments against the choice of anti-classical, analyzing and comparing different educational systems. schools, universities must assign a prominent place in the program of study to the humanistic, literary and artistic subjects, cultivating a participation that can activate and improve the ability to see the world through the eyes of another person. In order to form citizens who play their role in society, science and technology alone are not enough, we need disciplines that are able to cultivate critical thinking, respect for diversity, solidarity, the judgment, the freedom of expression. According to A. Camelli, the humanities faculties prepare for that life-long learning, which will characterize tomorrow's jobs.

Keywords: bioethics, management, sport, transhumanist, medicalization

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Authors: Meysam Saidi

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While the specific externalities and required regulatory measures in relation to Islamic banking are fairly uncertain, the business is growing across the world. Unofficial data indicate that the Islamic Finance market is growing with annual rate of 15% and it has reached 1.3 $ trillion size. This trend is associated with inherent systematic connection of Islamic financial institutions to other entities and different sectors of economies. Islamic banking has been subject of market development policies in major economies, most notably the UK. This trend highlights the need for identification of distinct risk features of Islamic banking and crafting customized regulatory measures. So far there has not been a significant systemic crisis in this market which can be attributed to its distinct nature. However, the significant growth and spread of its products worldwide necessitate an in depth study of its nature for customized congruent regulatory measures. In the post financial crisis era some market analysis and reports suggested that the Islamic banks fairly weathered the crisis. As far as heavily blamed conventional financial products such as subprime mortgage backed securities and speculative credit default swaps were concerned the immunity claim can be considered true, as Islamic financial institutions were not directly exposed to such products. Nevertheless, similar to the experience of the conventional banking industry, it can be only a matter of time for Islamic banks to face failures that can be specific to the nature of their business. Using the experience of conventional banking regulations and identifying those peculiarities of Islamic banking that need customized regulatory approach can aid to prevent major failures. Frank Knight has stated that “We perceive the world before we react to it, and we react not to what we perceive, but always to what we infer”. The debate over congruent Islamic banking regulations might not be an exception to Frank Knight’s statement but I will try to base my discussion on concrete evidences. This paper first analyzes both theoretical and actual features of Islamic banking in order to ascertain to its peculiarities in terms of market stability and other externalities. Next, the paper discusses distinct features of Islamic financial transactions and banking which might require customized regulatory measures. Finally, the paper explores how a more transparent path for the Islamic banking regulations can be drawn.

Keywords: Islamic banking, regulation, risks, capital requirements, customer protection, financial stability

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Authors: Andrea Zielke-Nadkarni

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Pain management is a question of quality of life and an indicator for nursing quality. Chronic pain which is predominant in oncology and palliative nursing situations is perceived today as a multifactorial, individual emotional experience with specific characteristics including the sociocultural dimension when dealing with migrant patients. This dimension of chronic pain is of major importance in professional nursing of migrant patients in hospices or palliative care units. Objectives of the study are: 1. To find out more about the sociocultural views on pain and nursing care, on customs and nursing practices connected with pain of both Turkish Muslim and German Christian women, 2. To improve individual and family oriented nursing practice with view to sociocultural needs of patients in severe pain in palliative care. In a qualitative-explorative comparative study 4 groups of women, Turkish Muslims immigrants (4 from the first generation, 5 from the second generation) and German Christian women of two generations (5 of each age group) of the same age groups as the Turkish women and with similar educational backgrounds were interviewed (semistructured ethnographic interviews using Spradley, 1979) on their perceptions and experiences of pain and nursing care within their families. For both target groups the presentation will demonstrate the following results in detail: Utterance of pain as well as “private” and “public” pain vary within different societies and cultures. Permitted forms of pain utterance are learned in childhood and determine attitudes and expectations in adulthood. Language, especially when metaphors and symbols are used, plays a major role for misunderstandings. The sociocultural context of illness may include specific beliefs that are important to the patients and yet seem more than far-fetched from a biomedical perspective. Pain can be an influential factor in family relationships where respect or hierarchies do not allow the direct utterance of individual needs. Specific resources are often, although not exclusively, linked to religious convictions and are significantly helpful in reducing pain. The discussion will evaluate the results of the study with view to the relevant literature and present nursing interventions and instruments beyond medication that are helpful when dealing with patients from various socio-cultural backgrounds in painful end-oflife situations.

Keywords: pain management, migrants, sociocultural context, palliative care

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Authors: Khushboo Shah

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Categorical bans on the death penalty and life-without-parole sentences for juvenile offenders in a growing number of countries have established a new era in juvenile jurisprudence. This has been brought about by integration of the growing knowledge in cognitive neuroscience and appreciation of the inherent differences between adults and adolescents over the last ten years. This evolving understanding of being a child in the criminal system can be aptly reflected through policies that incorporate the mitigating traits of youth. First, the presentation will delineate the structures in cognitive neuroscience and in particular, focus on the prefrontal cortex, the amygdala, and the basal ganglia. These key anatomical structures in the brain are linked to three mitigating adolescent traits—an underdeveloped sense of responsibility, an increased vulnerability to negative influences, and transitory personality traits—that establish why juveniles have a lessened culpability. The discussion will delve into the details depicting how an underdeveloped prefrontal cortex results in the heightened emotional angst, high-energy and risky behavior characteristic of the adolescent time period or how the amygdala, the emotional center of the brain, governs different emotional expression resulting in why teens are susceptible to negative influences. Based on this greater understanding, it is incumbent that policies adequately reflect the adolescent physiology and psychology in the criminal system. However, it is important to ensure that these views are appropriately weighted while considering the jurisprudence for the treatment of children in the law. To ensure this balance is appropriately stricken, policies must incorporate the distinctive traits of youth in sentencing and legal considerations and yet refrain from the potential fallacies of absolving a juvenile offender of guilt and culpability. Accordingly, three policies will demonstrate how these results can be achieved: (1) eliminate housing of juvenile offenders in the adult prison system, (2) mandate fitness hearings for all transfers of juveniles to adult criminal court, and (3) use the post-disposition review as a type of rehabilitation method for juvenile offenders. Ultimately, this interdisciplinary approach of science and law allows for a better understanding of adolescent psychological and social functioning and can effectuate better legal outcomes for juveniles tried as adults.

Keywords: criminal law, Juvenile Justice, interdisciplinary, neuroscience

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Authors: A. U. Ugwu

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Post-Apartheid South African education system had witnessed waves of curriculum reforms. Accordingly, there have been evidences of responsiveness towards local and global challenges of sustainable development over the past decade. In other words, the curriculum shows sensitivity towards issues of Sustainable Development (SD). Moreover, the paradigm of Sustainable Development Goals (SDGs) was introduced by the UNESCO in year 2015. The SDGs paradigm is essentially a vision towards actualizing sustainability in all aspects of the global society. Education for Sustainable Development (ESD) in retrospect entails teaching and learning to actualize the intended UNESCO 2030 SDGs. This paper explores how teaching and learning of ESD can be improved, by drawing from local context of the South African schooling system. Preservice natural sciences and technology teachers in their 2nd to 4th years of study at a university’s college of education in South Africa were contacted as participants of the study. Using qualitative case study research design, the study drew from the views and experiences of five (5) purposively selected participants from a broader study, aiming to closely understating how ESD is implemented pedagogically in teaching and learning. The inquiry employed questionnaires and a focus group discussion as qualitative data generation tools. A qualitative data analysis of generated data was carried out using content and thematic analysis, underpinned by interpretive paradigm. The result of analyzed data, suggests that ESD pedagogy at the location where this research was conducted is largely influenced by contextual factors. Furthermore, the result of the study shows that there is a critical need to employ/adopt local experiences or occurrences while teaching sustainable development. Certain pedagogical approaches such as the use of videos relative to local context should also be considered in order to achieve a more realistic application. The paper recommends that educational institutions through teaching and learning should implement ESD by drawing on local contexts and problems, thereby foregrounding constructivism, appreciating and fostering students' prior knowledge and lived experiences.

Keywords: context, education for sustainable development, natural sciences and technology preservice teachers, qualitative research, sustainable development goals

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Authors: A. Kalizhanova, T. Shelestova

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Teacher professional development (TPD) in Kazakhstan has followed a fairly standard format for centuries, with teachers learning new information from a lecturer and being tested using multiple-choice questions. In the online world, self-access courses have become increasingly popular. Due to their extensive multimedia content, peer-reviewed assignments, adaptable class times, and instruction from top university faculty from across the world, massive open online courses (MOOCs) have found a home in Kazakhstan's system for lifelong learning. Recent studies indicate the limited use of connectivism-based tools such as discussion forums by Kazakhstani pre-service and in-service English teachers, whose professional interests are limited to obtaining certificates rather than enhancing their teaching abilities and exchanging knowledge with colleagues. This paper highlights the significance of connectivism-based tools and instruments, such as MOOCs, for the continuous professional development of pre- and in-service English teachers, facilitators' roles, and their strategies for enhancing trainees' conceptual knowledge within the MOOCs' curriculum and online learning skills. Reviewing the most pertinent papers on Connectivism Theory, facilitators' function in TPD, and connectivism-based tools, such as MOOCs, a code extraction method was utilized. Three experts, former active participants in a series of projects initiated across Kazakhstan to improve the efficacy of MOOCs, evaluated the excerpts and selected the most appropriate ones to propose the matrix of teacher professional competencies that can be acquired through MOOCs. In this paper, we'll look at some of the strategies employed by course instructors to boost their students' English skills and knowledge of course material, both inside and outside of the MOOC platform. Participants' interactive learning contributed to their language and subject conceptual knowledge and prepared them for peer-reviewed assignments in the MOOCs, and this approach of small group interaction was given to highlight the outcomes of participants' interactive learning. Both formal and informal continuing education institutions can use the findings of this study to support teachers in gaining experience with MOOCs and creating their own online courses.

Keywords: connectivism-based tools, teacher professional development, massive open online courses, facilitators, Kazakhstani context

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Authors: Caroline Selai, Sushrut Jadhav

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Background: University College London (UCL), the first secular university in England to admit students regardless of their religion and gender, has nearly 29,000 students of which approximately 30% are international students. The UCL Cultural Consultation Service (CCS) for staff and students is a unique service that provides assistance to staff and students experiencing challenges in their teaching, enabling, support work or studies which they believe may have a cultural component. The service provides one-to-one and group consultations, lectures, seminars, ‘grand rounds’, interactive workshops and bespoke interventions. Data: This paper presents a content analysis of CCS referrals over the last 36 months. We focus on the experience of international students, many of whom experience not only a challenge to their academic identity but also a profound challenge to their personal cultural identity. We also present 3 vignettes to illustrate how students interpret, accept, contest and resist changes in their cultural and academic identity. Discussion: This paper highlights (i) how students from collectivist cultures attempt to assimilate within an individualistic, highly competitive western university that is bound by its own institutional norms; (ii) problems in negotiating challenges at the interface of culture and gender (iii) the impact of culturally different hierarchies of power, discrimination and authority and (iv) the significance of earlier traumatic and kinship conflicts. Many international students’ social identities are shaped by their cultural and family scripts. A large number have been taught that their teachers are to be revered and their teachings unchallenged. This is at odds with quintessential goal of the western university to encourage healthy scepticism and hone students’ critical thinking skills. Conclusions: Pupil-teacher ‘cultural transference’ and shifts in cultural academic identities of students underscore critical aspects of developmental and learning challenges for students. Staff-student cultural conflict requires a broader, systemic analysis of students, staff and the wider organisation. Our findings challenge Eurocentric psychodynamic concepts such as the nature of parent-child relationship in Western Europe. We argue for a broader, more inclusive approach to develop both effective pedagogic skills in euro-american academic institutions and culturally- appropriate psychodynamic theory to underpin counselling international students.

Keywords: academic identity, cultural transference, cultural consultation in higher education, cultural formulation, cultural identity.

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Authors: Charisse H. Tay

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Background: Schizophrenia is a severe chronic mental disorder that can result in hallucinations, delusions, reduced social engagement, and lack of motivation. While antipsychotic medications often provide the basis for treatment, psychosocial strategies complement the benefit of medications and can result in meaningful improvements in symptoms and functioning. The aim of the study was to investigate psychosocial strategies used by internet self-help forum participants to effectively manage symptoms caused by schizophrenia. Internet self-help forums are a resource for medical and psychological problems and are commonly used to share information about experiences with symptom management. Method: Three international self-help internet forums on schizophrenia were identified using a search engine. 1,181 threads regarding non-pharmacological, psychosocial self-management of schizophrenia symptoms underwent screening, resulting in the final identification and coding of 91 threads and 191 posts from 134 unique forum users that contained details on psychosocial strategies endorsed personally by users that allowed them to effectively manage symptoms of schizophrenia, including positive symptoms (e.g., auditory/visual/tactile hallucinations, delusions, paranoia), negative symptoms (e.g.., avolition, apathy, anhedonia), symptoms of distress, and cognitive symptoms (e.g., memory loss). Results: Effective symptom management strategies personally endorsed by online forum users were psychological skills (e.g., re-focusing, mindfulness/meditation, reality checking; n = 94), engaging in activities (e.g., exercise, working/volunteering, hobbies; n = 84), social/familial support (n = 48), psychotherapy (n = 33), diet (n = 18), and religion/spirituality (n = 14). 44.4% of users reported using more than one strategy to manage their symptoms. The most common symptoms targeted and effectively managed, as specified by users, were positive symptoms (n = 113), negative symptoms (n = 17), distress (n = 8), and memory loss (n = 6). 10.5% of users reported more than one symptom effectively targeted. 70.2% of users with positive symptoms reported that psychological skills were effective for symptom relief. 88% of users with negative symptoms and 75% with distress symptoms reported that engaging in activities was effective. Discussion: Individuals with schizophrenia rely on a variety of different psychosocial methods to manage their symptoms. Different symptomology appears to be more effectively targeted by different types of psychosocial strategies. This may help to inform treatment strategy and tailored for individuals with schizophrenia.

Keywords: psychosocial treatment, qualitative methods, schizophrenia, symptom management

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Authors: Bartłomiej K. Sołtysik, Agnieszka Guligowska, Łukasz Kroc, Małgorzata Pigłowska, Elizavetta Fife, Tomasz Kostka

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Introduction: Functional capacity is one of the basic determinants of health in older age. Functional capacity may be influenced by multiple disorders, including cardiovascular and metabolic diseases. Nevertheless, there is relatively little evidence regarding the association of functional status and cardiometabolic risk factors. Aim: The aim of this research is to check possible association between functional capacity and cardiovascular risk factor in a group of younger seniors. Materials and Methods: The study group consisted of 300 participants aged 60-65 years (50% were women). Total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), glucose, uric acid, body mass index (BMI), waist-to-height ratio (WHtR) and blood pressure were measured. Smoking status and physical activity level (by Seven Day Physical Activity Recall Questionnaire ) were analysed. Functional status was assessed with the Timed Up and Go (TUG) Test. The data were compared according to gender, and then separately for both sexes regarding prolonged TUG score (>7 s). The limit of significance was set at p≤0.05 for all analyses. Results: Women presented with higher serum lipids and longer TUG. Men had higher blood pressure, glucose, uric acid, the prevalence of hypertension and history of heart infarct. In women group, those with prolonged TUG displayed significantly higher obesity rate (BMI, WHTR), uric acid, hypertension and ischemic heart disease (IHD), but lower physical activity level, TC or LDL-C. Men with prolonged TUG were heavier smokers, had higher TG, lower HDL and presented with higher prevalence of diabetes and IHD. Discussion: This study shows association between functional status and risk profile of cardiometabolic disorders. In women, the relationship of lower functional status to cardiometabolic diseases may be mediated by overweight/obesity. In men, locomotor problems may be related to smoking. Higher education level may be considered as a protective factor regardless of gender.

Keywords: cardiovascular risk factors, functional capacity, TUG test, seniors

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Authors: A. De Serres-Lafontaine, S. Porlier, K. Poitras

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Introduction: Placement is, without doubt, a challenging experience for both foster children and biological parents who witness their child being removed from their care. Yet, few studies have examined parenting in such a context through critical parental skills such as parental sensitivity and commitment. Sensitivity is described as the capacity of parents to respond accurately to their child’s needs in a warm, predictable and consistent way, whereas commitment is the ability of the parent to get involved physically and emotionally in an enduring relationship with his child. The research confirms the important role of parental sensitivity and parental commitment on child development following placement in foster care. Nevertheless, these studies were mainly conducted with foster parents, and few studies have examined these components of parenthood with biological parents. Method: This study evolves in two times. At first, 17 parents participated throughout a 90-minutes interview. It allowed to collect information regarding the sociodemographic situation, contacts, placement trajectory. Parental sensitivity is observed during a supervised parent-child contact. The second time occurred one to two years later and implied an at-home 90-minutes interview where we updated the information from the first interview and were able to assess the level of parental commitment. In this ongoing part of the study, five parents have already participated in implying the rest of them remain to be interviewed in the coming months - from October through December 2018. Results: Descriptive analysis from the first part of the study suggests the examination of two groups: 11 children have been reunified whereas six are still in foster care. Qualitative analysis allows to compare themes of sensitivity and commitment regarding if the reunification project occurs or not. Preliminary analysis about thematic content shows key components of parental commitment through parent’s reveal of the way they nurture a relationship with their child. Furthermore, preliminary analysis suggests that parental sensitivity is not associated with family reunification (r = 0,11, p = 0,74). Further analysis will be assessed with the date from the second part of the study to examine the potential association between commitment and reunification. Discussion: Parental sensitivity and commitment are fundamental to the well-being of the child in a placement trajectory. They need to be understood better as two different complex concepts and as two parenting skills that might have a way of echoing to one another when engaged in a specific context. Above all, a more accurate comprehension of parenting in a placement trajectory allows to sustain adequate intervention practices for birth parents and could change the way parental adequacy is assessed when reaching for reunification.

Keywords: child welfare, foster care, intervention practices, parenthood

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Authors: Saeyoung Lee

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As the enthusiasm for education in Korea is too much high, it is well known by others that children in Korea get good scores in Mathematics. However, behind of this good reputation, children in Korea are easy to get lose self-confidence, tend to complaint and rarely participate in the class because of too much competition which leads to lack of competences. In this regard, the main goals of this paper are, by applying the programme based on peer-communication on Mathematics education field, it would like to improve self-managemental competence to make children gain self-confidence, communicative competence to make them deal with complaint and communitive competence to make them participated in the class for the age of 10 children to solve this problem. 14 children the age of 10 in one primary school in Gangnam, Seoul, Korea had participated in the research from March 2018 to October 2018. They were under the programme based on peer-communication during the period. Every Mathematics class maintained the same way. Firstly a problem was given to children. Secondly, children were asked to find many ways to solve the problem as much as they could by themselves. Thirdly all ways to solve the problem by children were posted on the board and three of the children made a group to distinguish the ways from valid to invalid. Lastly, all children made a discuss to find one way which is the most efficient among valid ways. Pre-test was carried out by the questionnaire based on Likert scale before applying the programme. The result of the pre-test was 3.89 for self-managemental competence, 3.91 for communicative competence and 4.19 for communitive competence. Post-test was carried out by the same questionnaire after applying the programme. The result of the post-test was 3.93 for self-managemental competence, 4.23 for communicative competence and 4.20 for communitive competence. That means by applying the programme based on peer-communication on Mathematics education field, the age of 10 children in Korea could improve self-managemental, communicative and communitive competence. Especially it works very well on communicative competence by increasing 0.32 points as it marked. Considering this research, Korean Mathematics education based on competition which leads to lack of competences should be changed to cooperative structure to make students more competent rather than just getting good scores. In conclusion, innovative teaching methods which are focused on improving competences such as the programme based on peer-communication which was applied in this research are strongly required to be studied and widely used.

Keywords: competences, mathematics education, peer-communication, primary education

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Authors: Agnieszka Rolinska, Marta Makara-Studzinska

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Introduction: In recent years, there has been an intensive development of research into the physiological relationships between the experienced stress and obesity. Moreover, strong chronic stress leads to the disorganization of a person’s activeness on various levels of functioning, including the behavioral and cognitive sphere (also in one’s diet). Aim: The present work addresses the following research questions: Is there a relationship between an increase in stress related to the disease and the need for the cyclicality of diabetologic education in gestational diabetes? Are there any differences in terms of the experienced stress during the last three months of pregnancy in women with gestational diabetes and in normal pregnancy between the patients with normal weight gains and those with abnormal weight gains? Are there any differences in terms of stress coping styles in women with gestational diabetes and in normal pregnancy between the patients with normal weight gains and those with abnormal weight gains? Method: The study involved pregnant women with gestational diabetes (treated with diet, without insulin therapy) and in normal pregnancy – 206 women in total. The following psychometric tools were employed: Perceived Stress Scale (PSS; Cohen, Kamarck, Mermelstein), Coping Inventory for Stressful Situations (CISS; Endler, Parker) and authors’ own questionnaire. Gestational diabetes mellitus was diagnosed on the basis of the results of fasting oral glucose tolerance test (75 g OGTT). Body weight measurements were confirmed in a diagnostic interview, taking into account medical data. Regularities in weight gains in pregnancy were determined according to the recommendations of the Polish Gynecological Society and American norms determined by the Institute of Medicine (IOM). Conclusions: An increase in stress related to the disease varies in patients with differing requirements for the cyclical nature of diabetologic education (i.e. education which is systematically repeated). There are no differences in terms of recently experienced stress and stress coping styles between women with gestational diabetes and those in normal pregnancy. There is a relationship between weight gains in pregnancy and the stress experienced in life as well as stress coping styles – both in pregnancy complicated by diabetes and in physiological pregnancy. In the discussion of the obtained results, the authors refer to scientific reports from English-language magazines of international range.

Keywords: diabetologic education, gestational diabetes, stress, weight gain in pregnancy

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Authors: Heping Dang, Raymond Yu Wang

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The Langcang-Mekong River is the most important international watercourse in mainland Southeast Asia. In recent years, the six riparian states, China, Myanmar, Laos, Thailand, Cambodia and Vietnam, have confronted increasing disputes over the use of the trans-boundary water. To settle these disputes and protect the fundamental right to water, quite a few inter-state mechanisms have been established, such as the Mekong River Commission, the economic cooperation program of the Greater Mekong Subregion, the ‘Belt and Road Initiative’ and the ‘Lancang-Mekong Cooperation Mechanism’ and the ‘Lower Mekong Initiative’. Non-Governmental Organizations (NGOs) have also been an important and constructive institutional entrepreneur in trans-boundary water governance. Although the status and extent of the right to water are yet to be clearly defined, this paper aims to 1) unpack how the right to water is interpreted and exercised in the Lancang-Mekong River Basin Dispute; and 2) to evaluate the roles of the right to water in settling international water disputes. To achieve these objectives, Secondary data such as archival documents of international law and relevant stakeholders will be compiled for analysis. First-hand information about the organizational structure, accountability, values and strategies of the international mechanisms and NGOs in question will also be collected through fieldwork in the Mekong river basin. Semi-structural interviews, group discussions and participatory observation will be conducted to collect data. The authors have access to the fieldwork because they have abundant experience of collaborating with Mekong-based international NGOs in previous research projects. This research will display how the concepts and principles of international law and the UN guidelines are interpreted in practice. These principles include the definition and extent of the right to water, the practical use of ‘vital human need’, the indicators of ‘adequacy of water’ including ‘availability, quality and accessibility’, and how the right to water is related to the progressive realization of the right to life. This down-to earth research will enrich the theoretical discussion of international law, particularly international human rights law, within the UN framework. Moreover, the outcomes of this research will provide new insights into the roles that the right to water might play in consensus-building and dispute settlement in a rapidly changing context, where water is pivotal for poverty alleviation, biodiversity conservation and the promotion of sustainable livelihoods.

Keywords: international water dispute, Lancang-Mekong River, right to water, state and non-state actors

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Authors: Anu Chandran, Reena Esther Rani

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Background of the Study: Dotted with multiple Unique Destination Prepositions (UDPs), Tamil Nadu is an established tourism brand as regards leisure, MICE, culture, and ecological flavors. Albeit, the enchanting destination possesses distinctive attributes and resources yet to be tapped for better competitive advantage. Being a destination that allures an incredible variety of migratory birds, Tamil Nadu is deemed to be an ornithologist’s paradise. This study primarily explores the prospects of developing Kaliveli, recognized as a bird sanctuary in the Tindivanam forest division of the Villupuram district in the State. Kaliveli is an ideal nesting site for migratory birds and is currently apt for a prospective analysis of regenerative tourism. Objectives of the study: This research lays an accent on avian tourism as part and parcel of sustainable tourism ventures. The impacts of projects like the Ornithological Conservation Centre on tourists have been gauged in the present paper. It maps the futuristic proactive propositions linked to regenerative tourism on the site. How far technological innovations can do a world of good in Kaliveli through Artificial Intelligence, Smart Tourism, and similar latest coinages to entice real eco-tourists, have been conceptualized. The experiential dimensions of resource stewardship as regards facilitating tourists’ relish the offerings in a sustainable manner is at the crux of this work. Methodology: Modeled as a case study, this work tries to deliberate on the impact of existing projects attributed to avian fauna in Kalveli. Conducted in the qualitative research design mode, the case study method was adopted for the processing and presentation of study results drawn by applying thematic content analysis based on the data collected from the field. Result and discussion: One of the key findings relates to the kind of nature trails that can be a regenerative dynamic for eco-friendly tourism in Kaliveli. Field visits have been conducted to assess the niche tourism aspects which could be incorporated with the regenerative tourism model to be framed as part of the study.

Keywords: regenerative tourism, Kaliveli bird sanctuary, sustainable development, resource Stewardship, Ornithology, Avian Fauna

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Authors: Sumit Kanwar, Manisha Chand, Gregory Gilot

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Background: Septic arthritis of the shoulder has infrequently been discussed. Focus on infection of the untouched shoulder has not heretofore been described. We present four patients with glenohumeral septic arthritis. Methods: Case 1: A 59 year old male with left shoulder pain in the anterior, posterior and superior aspects. Case 2: A 60 year old male with fever, chills, and generalized muscle aches. Case 3: A 70 year old male with right shoulder pain about the anterior and posterior aspects. Case 4: A 55 year old male with global right shoulder pain, swelling, and limited ROM. Results: In case 1, the left shoulder was affected. Physical examination, swelling was notable, there was global tenderness with a painful range of motion (ROM). The lab values indicated an erythrocyte sedimentation rate (ESR) of 96, and a C-reactive protein (CRP) of 304.30. Imaging studies were performed and MRI indicated a high suspicion for an abscess with osteomyelitis of the humeral head. Our second case’s left arm was affected. He had swelling, global tenderness and painful ROM. His ESR was 38, CRP was 14.9. X-ray showed severe arthritis. Case 3 differed with the right arm being affected. Again, global tenderness and painful ROM was observed. His ESR was 94, and CRP was 10.6. X-ray displayed an eroded glenoid space. Our fourth case’s right shoulder was affected. He had global tenderness and painful, limited ROM. ESR was 108 and CRP was 2.4. X-ray was non-significant. Discussion: Monoarticular septic arthritis of the virgin glenohumeral joint is seldom diagnosed in clinical practice. Common denominators include elevated ESR, painful, limited ROM, and involvement of the dominant arm. The male population is more frequently affected with an average age of 57. Septic arthritis is managed with incision and drainage or needle aspiration of synovial fluid supplemented with 3-6 weeks of intravenous antibiotics. Due to better irrigation and joint visualization, arthroscopy is preferred. Open surgical drainage may be indicated if the above methods fail. Conclusion: If a middle-aged male presents with vague anterior or posterior shoulder pain, elevated inflammatory markers and a low grade fever, an x-ray should be performed. If this displays degenerative joint disease, the complete further workup with advanced imaging, such as an MRI, CT scan, or an ultrasound. If these imaging modalities display anterior space joint effusion with soft tissue involvement, we can suspect septic arthritis of the untouched glenohumeral joint and surgery is indicated.

Keywords: glenohumeral joint, identification, infection, septic arthritis, shoulder

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Authors: Joshua Russell, Omar Zubair, Reuben Ndegwa

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Introduction: Mesenteric ischemia is an uncommon condition that can be challenging to diagnose in the acute setting, with the potential for significant morbidity and mortality. Very rarely has acute acalculous cholecystitis been described in the setting of mesenteric ischemia. Case: This was the case in a 78-year-old male, who initially presented with clinical and radiological evidence of small bowel obstruction, thought likely secondary to malignancy. The patient had a 6-week history of anorexia, worsening lower abdominal pain, and ~30kg of unintentional weight loss over a 12-month period and a CT- scan demonstrated a transition point in the distal ileum. The patient became increasingly hemodynamically unstable and peritonitic, and an emergency laparotomy was performed. Intra-operatively, however, no obvious transition point was identified, and instead, the gallbladder was markedly gangrenous and oedematous, consistent with acalculous cholecystitis. An open total cholecystectomy was subsequently performed. The patient was admitted to the Intensive Care Unit post-operatively and continued to deteriorate over the proceeding 48 hours, with two re-look laparotomies demonstrating progressively worsening bowel ischemia, initially in the distribution of the superior mesenteric artery and then the coeliac trunk. On review, the patient was found to have an aberrant right hepatic artery arising from the superior mesenteric artery. The extent of ischemia was considered non-survivable, and the patient was palliated. Discussion: Multiple theories currently exist for the underlying pathophysiology of acalculous cholecystitis, including biliary stasis, sepsis, and ischemia. This case lends further support to ischemia as the underlying etiology of acalculous cholecystitis. This is particularly the case when considered in the context of the patient’s aberrant right hepatic artery arising from the superior mesenteric artery, which occurs in 11-14% of patients. Conclusion: This case report adds further insight to the debate surrounding the pathophysiology of acalculous cholecystitis. It also presents acalculous cholecystitis as a complication of mesenteric ischemia that should always be considered, especially in the elderly patient and in the context of relatively common anatomical variations. Furthermore, the case brings to attention the importance of maintaining dynamic working diagnoses in the setting of evolving pathophysiology and clinical presentations.

Keywords: acalculous cholecystitis, anatomical variation, general surgery, mesenteric ischemia

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Authors: Susan Scott, Dina Hanna, Bassel Zebian, Gary Ruiz, Sreena Das

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Although the number of cases of TB in England has fallen over the last 4 years, it remains an important public health burden with 1 in 20 cases dying annually. The vast majority of cases present in non-UK born individuals with social risk factors. We present a case of non-pulmonary TB presenting in a healthy child born in the UK to professional parents. We present a case of a healthy 10 year old boy who developed acute back pain during school PE. Over the next 5 months, he was seen by various health and allied professionals with worsening back pain and kyphosis. He became increasing unsteady and for the 10 days prior to admission to our hospital, he developed fevers. He was admitted to his local hospital for tonsillitis where he suffered two falls on account of his leg weakness. A spinal X-ray revealed a pathological fracture and gibbus formation. He was transferred to our unit for further management. On arrival, the patient had lower motor neurone signs of his left leg. He underwent spinal fixture, laminectomy and decompression. Microbiology samples taken intra-operatively confirmed Mycobacterium Tuberculosis. He had a positive Mantoux and T-spot and treatment were commenced. There was no evidence of immune compromise. The patient was born in the UK, had a BCG scar and his only travel history had been two years prior to presentation when he travelled to the Phillipines for a short holiday. The patient continues to have issues around neuropathic pain, mobility, pill burden and mild liver side effects from treatment. Discussion: There is a paucity of case reports on spinal TB in paediatrics and diagnosis is often difficult due to the non-specific symptomatology. Although prognosis on treatment is good, a delayed diagnosis can have devastating consequences. This case highlights the continued need for higher index of suspicion and diagnosis in a world with changing patterns of migration and increase global travel. Surgical intervention is limited to the most serious cases to minimise further neurological damage and improve prognosis. There remains the need for a multi-disciplinary approach to deal with challenges of treatment and rehabilitation.

Keywords: tuberculosis, non-pulmonary TB, public health burden, diagnostic challenge

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Authors: Daisy Dutta, Chhanda Chakraborti

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Background and significance of the study: Menstrual Hygiene Management (MHM) is poor in many Lower and Middle-Income Countries (LMIC) such as India. Poor and inadequate menstrual hygiene has an adverse effect on the health and social life of adolescent girls and women. There are many well-known barriers to adequate Menstrual Hygiene Management (MHM); e.g., lack of awareness, lack of WASH (Water, Sanitation and Hygiene) facilities, lack of affordable menstrual absorbents, etc. But, there is a unique barrier which is very much avoidable; i.e., lack of proper guidance and counseling about menstruation. Menstruation is associated with various social and cultural restrictions and taboos and being a taboo topic; often there is no discussion in the society on this topic. Thus, many adolescent girls encounter the menarche with a lot of unnecessary and avoidable trauma, stress and awkwardness. This trauma, stress, and anxiety are even more prevalent among adolescent girls residing in rural areas. This study argues that this unnecessary stress and anxiety of the adolescent girls can be alleviated by reinforcing social support and adequate information and guidance about MHM and eliminating the futile socio-cultural restrictions during menstruation. Methodology: A qualitative study was conducted in a North-eastern State of India where 45 adolescent girls were interviewed both from rural and urban areas. The adolescent girls were asked about their experiences of stress and anxiety on their first menstruation, their preparedness for menarche, their source of information and guidance, their hygiene-practices, and the various restrictions they follow. Findings: Maximum number of girls did not receive any information about menstruation before menarche. Most of them reported that they were terrified about their first menstruation as they were unprepared. Among those who were aware before menarche, reported that they did not receive proper guidance to manage their menstruation in a hygienic manner. Hygiene-related practices are also influenced by their knowledge about MHM. In maximum cases, girls are bound to follow certain cultural and religious restrictions even if they don’t want to follow which created additional stress in managing their menstruation with dignity. Conclusion: Lack of proper guidance and counseling about menstruation and MHM along with an array of socio-cultural restrictions can enhance a negative attitude in adolescent girls towards menstruation due to which they have to go through an extra and unnecessary burden of stress and trauma. This stress and trauma is preventable by improving the provisions of proper guidance and counseling about menstruation in a supportive environment.

Keywords: adolescent girls, menstrual hygiene management, socio-cultural restrictions, stress, trauma

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Authors: Sanaa Riaz

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Spirits occupy a world that simultaneously dwells between the divine and the earthly binary while speaking to all forces of nature, marginality, and extremity in between. This paper examines the conceptualizations, interactions with, and experience of spiritual beings in relation to the concept of self and social agency, defined as a continuum of cooperation leaving those involved with an enhanced or diminished perception of self-agency. To do justice to the diverse mythological and popular interpretations of spirit entities, ethnographic examples from Africa, in particular, will be used. An examination of the nature and role of spirits in Africa allows one to understand the ways in which colonial influences brought by Catholicism and Islam added to the pre-colonial repertoire and syncretic imaginations of spirits. A comprehensive framework to analyze spirits requires situating them as a cognitive configuration of humans to communicate with other humans and forces of nature to receive knowledge about the normative in social roles, conduct, and action. Understanding spirits also requires a rethinking of the concept of self as not one encapsulated in the individual but one representing positionalities in collective negotiations, adversity, and alliances. To use the postmodern understanding of identity as a far from a coherent collection of selves fluidly moving between and dialoguing with gravitational and contradictory social forces, benevolent and maleficent spirit forces represent how people make sense of their origin, physiological and ecological changes, subsistence, and political environment and social relations. A discussion on spirits requires examining the rituals and mediational forces and their performance that allow participants to tackle adversity, voicelessness and continue to work safely and morally for the collective good. Moreover, it is important to see the conceptualization of spirits in unison with sorcery and spirit possession, central to voodoo practices, also because they speak volumes about the experiences of slavery and marginalization. This paper has two motives: It presents a critical literature review of ethnographic accounts of spirit entities in African spiritual experiences to examine the ways in which spirits become mediums through which the self is conceptualized and asserted. Second, the paper highlights the ways in which spirits become a medium to represent political and sociocultural ambiguities and desires along a spectrum of social agencies, including joint agency, vicarious agency, and interfered agency.

Keywords: spirits, social agency, self, ethnographic case studies

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Authors: Kalyan Sundar Som, Ghanshyam Prasad Jhariya

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Population growth is an important pervasive phenomenon in the world. Its survival depends upon many daily needs and food is one of them. Population factors play a decisive role in the human endeavor to attain food. Nutrition and health status compose integral part of human development and progress of a society. Therefore, the neglect any one of these components may leads to the deterioration of the quality of life. Food is also intimately related with economic growth and social progress as well as with political stability and peace. It refers to the availability of food and its access to it. It can be observed from global to local level. Food scarcity has emerged as a matter of great concern all over the world due to uncontrolled and unregulated growth of population .For this purpose this study try to find out the deficit or surplus production of food availability in terms of their total population in the study area. It also ascertains the population pressure, demand and supply of food stuff and demarcation of insecure areas.The data base of the study under discussion includes government published data regarding agriculture production, yield and cropped area in 2005-06 to 2011-12 available at commissioner land record Madhya Pradesh, Gwalior. It also includes the census of India for population data. For measuring food security or insecurity regions is based on the consumption of net food available in terms caloric value minus the consumption by the weighted total population. This approach has been adopted because the direct estimate of production and consumption is the only reliable way to ascertain food security in a unit area and to compare one area with another (Noor Mohammad, dec. 2002). The scenario in 2005-06 is 57.78 percent district has food insufficient in terms of their population. On the other hand after 5 years, there are only 22 % districts are deficit in term of food availability where Burhanpur is the most deficit (56 percent) district. While 20% district are highly surplus district in the state where Harda and Hoshangabad districts are very high surplus district (5 times and 3.95 times) in term of food availability(2011). The drastic change (agriculture transformation) is happen due government good intervention in the agricultural sector.

Keywords: agriculture transformation, caloric value method, deficit or surplus region, population pressure

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Authors: Yasser Y. Lenis, Daniela Garcia Gonzalez, Cristian Solarte Bacca, Diego F. Carrillo González, Amy Jo Montgomery, Dursun Barrios

Abstract:

Introduction: Artificial insemination in bovines helps to promote genetic improvement and can positively impact the rural economy. The Colombian armed conflict has forced a large portion of the rural population to abandon their territory, affecting their education, family integration, and economics. Justification: The achievement of education in rural populations was one of the Millennium Development Goals (MDGs) made by the United Nations. During the last World Summit on Sustainable Development (WSSD), it was concluded that most of the world’s poor, illiterate and undernourished population lives in rural areas; therefore, access to education is considered one of the most significant challenges for governments in countries with developing economies. Objectives: To study the effects of training in artificial insemination and rural management on the perception of knowledge and the level of knowledge in rural residents affected by the armed conflict in Nariño, Colombia. Methods: The perception of knowledge and the theoretical-practical knowledge of 63 rural residents were evaluated on the topics of bovine agribusiness management, artificial insemination, and genetic improvement through the application of three surveys. 1) evaluated the perceived level of knowledge each rural resident had about each topic using the Likert scale, 2) evaluated the theoretical knowledge before training, and 3) evaluated the theoretical knowledge upon completion of training. Results/discussion: Of the surveyed rural residents, 54% stated that they knew how business management improved the performance of their bovine agribusiness, 54% answered the pre-training knowledge test correctly, while 83% correctly answered the post-training knowledge test. Only 6% of surveyed residents perceived that they had prior knowledge of artificial insemination and reproductive anatomy topics. Before training, 35% of surveyed residents answered correctly on these topics, while upon completion of training, 65% answered correctly. Regarding genetic improvement, 11% of participating rural residents stated that they knew this subject. The correct answers on this topic went from 57% to 89% before and post-training. Conclusion: Rural extension programs contribute to closing knowledge gaps in relation to the use of reproductive biotechnologies and bovine management in rural areas affected by armed conflict.

Keywords: agribusiness, insemination, knowledge, reproduction

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