Search results for: international clinic od rehabilitation

Authors: Cassandra Maffei, Effie Pomaki, Salomé Deslauriers-Brouillard, Levana Dahan, Caroline Storr, Ramasubramanian Ponnusamy, Philippe S. Archambault

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Sexual health education following spinal cord injury (SCI) remains poorly integrated into the rehabilitation process, especially in low-income countries where the topics of disability and sexuality are stigmatized. This research aimed to evaluate a sexual health manual that was created and distributed amongst males with SCI who had received rehabilitation services at Amar Seva Sangam (ASSA), a rehabilitation center located in rural South India. A service evaluation was completed to collect data from a convenience sample of 37 males with spinal cord injuries. Data were analyzed using descriptive statistics and content analysis. The service evaluation showed that the manual was well received by the sample and had positive impacts on secondary outcome measures, including relationship dynamics and quality of life. It can thus be used as an effective adjunct tool to support the improvement of sexual health knowledge, attitudes, and practices of individuals with SCI.

Keywords: spinal cord injury, sexual health, rehabilitation, India, education, service evaluation

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Authors: Arenca Trashani

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20 years after its first entrance in a General Assembly of the United Nation’s Resolution, human security has became a very important tool in a global debate affecting directly the whole main rules and regulations in international law and more closely in international human rights law. This paper will cover a very important issue of today at how the human security has its impact to the development of international human rights law, not as far as a challenge as it is seen up now but a tool of moving toward development and globalization. In order to analyze the impact of human security to the global agenda, we need to look to the main pillars of the international legal order which are affected by the human security in itself and its application in the policy making for this international legal order global and regional ones. This paper will focus, also, on human security, as a new and very important tool of measuring development, stability and the level of democratic consolidation and the respect for human rights especially in developing countries such as Albania. The states are no longer capable to monopolize the use of human security just within their boundaries and separated from the other principles of a functioning democracy. In this context, human security would be best guaranteed under the respect of the rule of law and democratization. During the last two decades the concept security has broadly developed, from a state-centric to a more human-centric approach: from state security to respect for human rights, to economic security, to environmental security as well. Last but not least we would see that human rights could be affected by human security not just at their promotion but also at their enforcement and mainly at the international institutions, which are entitled to promote and to protect human rights.

Keywords: human security, international human rights law, development, Albania, international law

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Authors: Hsin-Yu Lin, Ching-Hsia Hung

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Obstructive sleep apnea (OSA) is characterized by a complete or partial obstruction of the upper airway during sleep. The vulnerable sites of upper airway collapses are consequences of sleep state-dependent reductions in tone in specific pharyngeal dilators. Clinical examinations reveal multilevel collapses of the upper airway among the patients with OSA. Therefore, an anatomically-based oropharyngeal rehabilitation should comprise a multilevel approach, including retropalatal, retroglossal, hypopharyngeal, temporomandibular, and facial levels, all of which involve different muscle groups and contribute to multifunctional interaction and coordination, such as swallowing, breathing, and phonation. The purpose of the study was to exam the effects of this rehabilitation program with a multilevel approach. In this study, fifteen subjects with newly diagnosed moderate or severe OSA (Apnea-Hypopnea-Index≥15) were randomized into an intervention group and control group. The intervention group (N=8) underwent a 12-week-intervention of a hospital-based rehabilitation program, while the control group (N=7) was kept on the waiting list. The 12-week-intervention comprised an anatomically based multilevel approach. The primary outcome was Polysomnography (PSG) data, and the secondary outcome was oropharyngeal and respiratory muscle function. In the intervention group, Apnea-Hypopnea-Index significantly improved (46.96±19.45 versus 32.78±10.78 events/h, p=0.017) compared with control group (35.77±17.49 versus 42.96±17.32 events/h, p=0.043). While the control group remained no change, the intervention group demonstrated other PSG outcomes significantly improvement, including arousal index (46.04±18.9 versus 32.98±8.35/h, p=0.035), mean SpO2 (92.88±2.1 versus 94.13±1.46%, p=0.039). Besides, the intervention group demonstrated significant improvement in oropharyngeal and respiratory muscle function compared to the control group. This anatomically-based oropharyngeal rehabilitation with a multilevel approach can be proven as a non-invasive therapy for patients with OSA.

Keywords: obstructive sleep apnea, upper airway, oropharyngeal rehabilitation, multilevel approach

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Authors: Adriano Mortada

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Human history is rife with conflict, and the question of refugee status determination and their rehabilitation has been up for debate since. Refugee Status Determination is the administrative or legal process by which UNHCR or governments determine whether a person seeking international protection or asylum can be identified as a refugee under international, regional, or national law. Refugee Status Determination is considered to be a vital process in aiding refugees’ realization of their rights under international law. One of the major reasons why the refugee status determination is considered an “issue”, and is one that is much debated upon annually, is the fact that the national bureaucratic systems are rigid and unbending. This is particularly concerning in the 21st century despite human advancement in policy and diplomacy, working in tandem with the United Nations and their charters and resolutions on human rights and dignity. The paper seeks to criticize the European member states' response to the refugee crisis and their inflexible and prejudiced bureaucratic systems when it comes to refugee status determination. The paper looks at multiple case studies as primary evidence and the alternate case studies where the system helped refugees, like those in Jordan, Pakistan, Turkey, and Lebanon. The main concern of the paper is to highlight the bias in the selected European systems, which do not stem from the Human Rights Charter but rather on the basis of geographical backgrounds, cultural and religious affiliations of those seeking refugee status or asylum in their respective countries. The paper hopes to not only create awareness about this issue but also provide a research background to advocacy programs to bring a change in the systems.

Keywords: refugee status determination, human rights, bureaucracy, United Nations, European Union

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Authors: Ilirian Laçi, Alketa Spahiu

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Modality of treatment in hepatocellular carcinoma (HCC) patients depends on the stage of the disease. The Barcelona Clinic Liver Cancer Classification (BCLC) is the preferred staging system. There are many patients initially present with intermediate-stage disease. For these patients, transarterial chemoembolization (TACE) is the treatment of choice. The differences in individual factors that are not captured by the BCLC framework, such as the tumor growth pattern, degree of hypervascularity, and vascular supply, complicate further evaluation of these patients. Because of these differences, not all patients benefit equally from TACE. Several tools have been devised to aid the decision-making process, which have shown promising initial results but have failed external evaluation and have not been translated to the clinic aspects. Criteria for treatment decisions in daily clinical practice are needed in all stages of the disease.

Keywords: hepatocellular carcinoma, transarterial chemoembolization, TACE, liver

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Authors: Nafisatul Ulfa, Elok Budi Retnani, R. P. Agus Lelana

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Emerging zoonotic parasite infection could originate in wildlife so its time very important to identify zoonotic agents in wild populations or maintained. According to the International Union Conservation of Nature (IUCN), Sumateran slow loris (Nycticebus coucang) was protected primate which have vulnerable status. Their population in wildlife decreased cause hunting for trade and destroy habitat. Helminthiasis can caused dead regularly and its so The study was conducted to know prevalence of gastrointestinal helminth infection of slow loris (Nycticebus coucang) in The Centre of Primate Rehabilitation of International Animal Rescue Indonesia (YIARI). Total of 13 fecal sampel from captive group of Nycticebus coucang were collected for 6 days and analysed from Februari-Mei 2014 by using McMaster, flotasion and Baermann technique. All fecal sampel was examined based on its fecal pool. Out of 13 fecal sampel examined, all of sampel (100%) was infected with five types of helminth Ascaris (84,61%), Hymenolepis (76,92%), Strongylid (61,54%), Oxyurid (15,38%) dan Trichuris (7,69%). The average number of egg per gram (EPG) was 11-1810.

Keywords: fecal, helminth, Nycticebus coucang, parasite, prevalence, slow loris

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Authors: Juliana Bom-Tempo

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The proposed composition occurs between images, performances, clinics and philosophies. For this enterprise we depart for what is not known beforehand, so with a question as a compass: "would it be in the creation, production and implementation of images in a performance a 'when' for the event of a poetic clinic?” In light of this, there are, in order to think a 'when' of the event of a poetic clinic, images in performances created, produced and executed in partnerships with the author of this text. Faced with this composition, we built four indicators to find spatiotemporal coordinates that would spot that "when", namely: risk zones; the mobilizations of the signs; the figuring of the flesh and an education of the affections. We dealt with the images in performances; Crútero; Flesh; Karyogamy and the risk of abortion; Egg white; Egg-mouth; Islands, threads, words ... germs; Egg-Mouth-Debris, taken as case studies, by engendering risks areas to promote individuations, which never actualize thoroughly, thus always something of pre-individual and also individuating a environment; by mobilizing the signs territorialized by the ordinary, causing them to vary the language and the words of order dictated by the everyday in other compositions of sense, other machinations; by generating a figure of flesh, disarranging the bodies, isolating them in the production of a ground force that causes the body to leak out and undo the functionalities of the organs; and, finally, by producing an education of affections, by placing the perceptions in becoming and disconnecting the visible in the production of small deserts that call for the creation of a people yet to come. The performance is processed as a problematizing of the images fixed by the ordinary, producing gestures that precipitate the individuation of images in performance, strange to the configurations that gather bodies and spaces in what we call common. Lawrence proposes to think of "people" who continually use umbrellas to protect themselves from chaos. These have the function of wrapping up the chaos in visions that create houses, forms and stabilities; they paint a sky at the bottom of the umbrella, where people march and die. A chaos, where people live and wither. Pierce the umbrella for a desire of chaos; a poet puts himself as an enemy of the convention, to be able to have an image of chaos and a little sun that burns his skin. The images in performances presented, thereby, were moving in search for the power of producing a spatio-temporal "when" putting the territories in risk areas, mobilizing the signs that format the day-to-day, opening the bodies to a disorganization and the production of an education of affections for the event of a poetic clinic.

Keywords: Experimentations , Images in Performances, Poetic Clinic, Risk

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Authors: Andi Triswoyo

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The sacred has been a dominant influence in the human lives. International relations, as the mirror of the human relations in a whole, reflected such cases. Inter-state relations has been predominantly how the sacred played the main roles of. The relations between Indonesia and Palestine could be shot as the sacred-analyzed case of inter-state relations. The intimacy of them could be analyzed comfortably in IR normal perspective, such as realism, liberalism, and Marxism. Hopefully, Religion perspective would make better explanation how Indonesia-Palestine relations had so worth. This paper will use some narrative-explanatory stage to elaborate that cases. Moreover, the sacred can give such alternative analyses to interpret how international relations occurred in this time regard of the rise a new theory of International Relations.

Keywords: the sacred, international relations, Indonesia, Palestine

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Authors: Hakan Akgul

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Purpose: The use of firecrackers (i.e., Ramadan Cannon) during the month of Ramadan is a traditional way of indicating that the fasting period is over in Muslim countries. Here, we report the rehabilitation of a case of hand injury with pluridigital fractures due to premature explosion of a Ramadan cannon. Materials and Methods: A 48-year old man admitted to the Emergency Department due to left hand injury as a result of a premature explosion of a Ramadan cannon. The patient was immediately taken to operation room because of the multiple fractures, tendon loss, and soft tissue loss in the left hand. Range of motion (ROM) of joints was measured with goniometer, pain and oedema were measured and splinting was performed. Results: Rehabilitation team took over the patient at postoperative 9th week. During the 3 month rehabilitation, range of motion increased, oedema was taken under control, pain was reduced, the colour of the skin turned to the normal tone. According to the visual analog scale (VAS), pain decreased from 9 to 4. Oedema, around the metacarpofalangeal (MCP) joints, decreased from 27,5 cm to 23,5 cm. Total active range of motion of the wrist increased from 5 degrees to 50 degrees.Total active range of motion of supination and pronation increased from 55 degrees to 70 degrees. Discussion: The rehabilitation of multiple hand injury is quite difficult. Different aspects of trauma should be taken into consideration when rehabilitation is planned. Factors such as waiting for the bone union, wound healing, and use of external fixators may delay rehabilitation process. Joint mobilization, massage for reducing oedema and preventing scar tissue, exercise within the range of motion are efficient measures. Poor patient compliance to treatment may lead to poor outcome. First of all, oedema and scar formation must be taken under control. Removing fixators should not be delayed depending on the bone union, and exercise within the range of motion should be started.

Keywords: explosion, fracture, hand, injury

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Authors: Christina Tran, Lu Khoo, Andrea Waylen

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Introduction: The evolution of the dental consultation from paternalism to partnership has been well documented in developed Western countries. Great emphasis is now placed on the importance of empowering patients to make decisions regarding their care, obtaining informed consent, and maintaining patient privacy and confidentiality. With the majority of communication occurring non-verbally, clinicians often adopt behaviours which suggest an approachable and positive attitude. However, evidence indicates that in Asia, a paternalistic model may be favored in medicine. The power imbalance occurring in doctor-patient relationships worldwide may be exacerbated by various factors in Southeast Asia: the strong hierarchical culture, and the large education gap between doctor and patient. Further insight into this matter can be gained by observing patient-dentist communication in Cambodia. The dentist:population ratio in Cambodia is approximately 1:33,000, with rural areas remaining extremely underserviced. We have carried out an observational study of communication in a voluntary dental clinic in Cambodia with the aim of describing whether the patient-dentist relationship follows a paternalistic or patient-centred model. Method: Over a period of two weeks, two clinicians provided dental care as part of a voluntary program in two Cambodian settings: a temporary, rural clinic and a permanent clinic in Phnom Penh. The clinicians independently recorded their experiences in diaries, making observations on the verbal and non-verbal communication between patients and staff. General observations such as the clinic environment were also made. The diaries were then compared and analyzed using a thematic approach. Results: The overall themes that emerged were regarding the clinic environment, verbal communication, and non-verbal communication. Regarding the clinic environment, the rural clinic was arranged in order to easily direct patients from one dentist to another, with little emphasis on continuous patient care. There was also little consideration for patient privacy: patients were often treated in the presence of many observers, including other waiting patients. However, the permanent clinic was structured to allow greater patient privacy, with continuous patient care occurring throughout the appointment. Regarding verbal communication, there was a strongly paternalistic approach to gaining consent and giving instruction. Patients rarely asked questions regarding their treatment, with dentists doing little to encourage patient involvement. Non-verbal communication between patients and dentists was generally paternalistic, with the dentist often addressing the supine patient from above. Patients often avoided making eye-contact, which may have indicated discomfort or lack of engagement. Both adult and paediatric patients rarely raised verbal concerns regarding pain during treatment, despite displaying non-verbal signs of experiencing pain. Anxious paediatric patients were sometimes managed with physical restraint by their mothers to facilitate treatment. Conclusion: Patient-professional communication in the Cambodian dental setting was observed to be generally paternalistic in nature, although more patient-centred aspects were observed in the established, urban setting. However, it should be noted that these observations are subjective in nature, and that the patients’ actual perceptions of their communication experience were unexplored. Further observations in variety of dental settings in Cambodia are needed before any definitive conclusions can be made.

Keywords: patient-dentist communication, paternalism, patient-centered, non-verbal communication

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Authors: Birgit Rasmussen, Thomas Maribo, Bente S. Toft

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BACKGROUND: Cardiac rehabilitation is the standard treatment for ischemic heart disease. Cardiac rehabilitation improves quality of life, reduces mortality and the risk of readmission, and provides patients with valuable knowledge and encouragement from peers and staff. Still, less than half of eligible patients enroll. Face-to-face interventions have the potential to support patients' decision-making and increase enrolment in cardiac rehabilitation. However, we lack knowledge of the content and characteristics of interventions. AIM: The aim was to outline and evaluate the content and characteristics of studies that have reported on face-to-face interventions to encourage enrolment in cardiac rehabilitation in patients with ischemic heart disease. METHOD: This scoping review followed the Joanne Briggs Institute methodology. Based on an a-priori protocol that defined the systematic search criteria, six databases were searched for studies published between 2001 and 2023. Two reviewers independently screened and selected studies. All authors discussed the summarized data prior to the narrative presentation. RESULTS: After screening and full text review of 5583 records, 20 studies of heterogeneous design and content were included. Four studies described the key contents in face-to-face interventions to be education, support of autonomy, addressing reasons for change, and emotional and cognitive support while showing understanding. Two studies used motivational interviewing to target patients' experiences and address worries and anticipated difficulties. Four quantitative studies found associations between enrolment and intention to attend, cardiac rehabilitation barriers, exercise self-efficacy, and perceived control. When patients asked questions, enrolment rates were higher, while providing reassurance and optimism could lead to non-attendance if patients had a high degree of worry. In qualitative studies, support to overcome barriers and knowledge about health benefits from participation in cardiac rehabilitation facilitated enrolment. Feeling reassured that the cardiac condition was good could lead to non-attendance. DISCUSSION AND CONCLUSION: To support patients' enrolment in cardiac rehabilitation, it is recommended that interventions integrate a person-centered dialogue. Individual worries and barriers to cardiac rehabilitation should be jointly explored. When talking with patients for whom worries predominate, the recommendation is to focus on the patients' perspectives and avoid too much focus on reassurance and problem-solving. The patients' perspectives, the mechanisms of change, and the process evaluation of the intervention including person-centeredness are relevant to include in future studies.

Keywords: ischemic heart disease, cardiac rehabilitation, enrolment, person-centered, in-hospital interventions

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Authors: Veljko Turanjanin

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In this article, an author deals with the issue of life imprisonment. Life imprisonment represents a new sentence in the Serbian legislature, in addition to the standard one, imprisonment. The author elaborated on judgments of the European Court of Human Rights (ECtHR), imposing the possibility of parole for the person sentenced to life imprisonment, emphasizing rehabilitation as the primary goal of penalties. According to the ECtHR, life imprisonment without parole is not permitted. The right to rehabilitation is very strictly set in the ECtHR jurisprudence. Life imprisonment represents a new sentence in the Serbian legislature, in addition to the standard one, imprisonment. The legislator provided the possibility of parole for most criminal offenses after 27 years in prison, while for some of them, a possibility of parole is explicitly prohibited. The author points out the shortcomings of the legal solution that exists in Serbia, which flagrantly threatens to violate the human rights of the offenders.

Keywords: European Court of Human Rights, life imprisonment, parole, rehabilitation

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Authors: Jason Ceavers, Travis Thompson, Juan Torres, Ramanakumar Anam, Alan Wong, Andrei Carvalho, Shane Quo, Shawn Alonso, Moises Cintron, Ricardo C. Carrero, German Lopez, Vamsi Garimella, German Giese

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Introduction: Advance directives (AD) are essential for patients to communicate their wishes when they are not able to. Ideally, these discussions should not occur for the first time when a patient is hospitalized with an acute life-threatening illness. There is a large number of patients who do not have clearly documented ADs, resulting in the misutilization of resources and additional patient harm. This is a nationwide issue, and the Joint Commission has it as one of its national quality metrics. Presented here is a proposed protocol to increase the number of documented AD discussions in a community-based, internal medicine residency primary care clinic in South Florida. Methods: The SMART Aim for this quality improvement project is to increase documentation of AD discussions in the outpatient setting by 25% within three months in medicare patients. A survey was sent to stakeholders (clinic attendings, residents, medical assistants, front desk staff, and clinic managers), asking them for three factors they believed contributed most to the low documentation rate of AD discussions. The two most important factors were time constraints and systems issues (such as lack of a standard method to document ADs and ADs not being uploaded to the chart) which were brought up by 25% and 21.2% of the 32 survey responders, respectively. Pre-intervention data from clinic patients in 2020-2021 revealed 17.05% of patients had clear, actionable ADs documented. To address these issues, an AD pocket card was created to give to patients. One side of the card has a brief explanation of what ADs are. The other side has a column of interventions (cardiopulmonary resuscitation, mechanical ventilation, dialysis, tracheostomy, feeding tube) with boxes patients check off if they want the intervention done, do not want the intervention, do not want to discuss the topic, or need more information. These cards are to be filled out and scanned into their electronic chart to be reviewed by the resident before their appointment. The interventions that patients want more information on will be discussed by the provider. If any changes are made, the card will be re-scanned into their chart. After three months, we will chart review the patients seen in the clinic to determine how many medicare patients have a pocket card uploaded and how many have advance directives discussions documented in a progress note or annual wellness note. If there is not enough time for an AD discussion, a follow-up appointment can be scheduled for that discussion. Discussion: ADs are a crucial part of patient care, and failure to understand a patient’s wishes leads to improper utilization of resources, avoidable litigation, and patient harm. Time constraints and systems issues were identified as two major factors contributing to the lack of advance directive discussion in our community-based resident primary care clinic. Our project aims at increasing the documentation rate for ADs through a simple pocket card intervention. These are self-explanatory, easy to read and allow the patients to clearly express what interventions they desire or what they want to discuss further with their physician.

Keywords: advance directives, community-based, pocket card, primary care clinic

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Authors: Eun Jae Ko, In Young Sung, Eui Soo Joeng

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Cognitive impairment is commonly encountered problem in children with various clinical diseases, including Down syndrome, autism spectrum disorder, brain injury, and others. Cognitive impairment limits participation in education and society, and this further hinders development in cognition. However, young children with cognitive impairment tend not to respond well to traditional cognitive treatments, therefore alternative treatment choices are need. As a cognitive training program, touch screen technology can easily be applied to very young children by involving visual and auditory support. Injini was developed as tablet computer based cognitive rehabilitation program for young children or individuals with severe cognitive impairment, which targeted on cognitive ages of 18 to 36 months. The aim of this study was to evaluate the efficacy of a tablet computer based cognitive rehabilitation program (Injini) for children with cognitive impairment. 38 children between cognitive ages of 18 to 36 months confirmed by cognitive evaluations were recruited and randomly assigned to the intervention group (n=20) and the control group (n=18). The intervention group received tablet computer based cognitive rehabilitation program (Injini) for 30 minutes per session, twice a week, over a period of 12 weeks, in addition to the traditional rehabilitation program. The control group received traditional rehabilitation program only. Mental score of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), Laboratory Temperament Assessment Battery (Lab-TAB), Early Childhood Behavior Questionnaire (ECBQ), and Goal Attainment Scale (GAS) were evaluated before and after 12 weeks of therapeutic intervention. When comparing the baseline characteristics, there was no significant difference between the two groups in the measurements of cognitive function. After 12 weeks of treatment, both group showed improvements in all measurements. However, in comparison of improvements after treatment, the intervention group showed more improvements in the mental score of BSID II, social function domain of PEDI, observation domain of Lab-TAB, and GAS, as compared to the control group. Application of the tablet computer based cognitive rehabilitation program (Injini) would be beneficial for improvement of cognitive function in young children with cognitive impairment.

Keywords: cognitive therapy, computer-assisted therapy, early intervention, tablets

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Authors: Mohammad Muntasir Maruf, Muhammad Zillur Rahman Khan, Nasim Jahan, Md. Waziul Alam Chowdhury, Satparkash, Md. Nozrul Islam

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Background: Substance use disorders have become a major public health problem in Bangladesh. Objectives: The present study was designed to assess the pattern of substance use and factors related to it among the hospitalized patients. Methods: This was a cross-sectional study. All the patients who were admitted in a private drug de-addiction clinic in the capital city (Dhaka) of Bangladesh during 1 July-31 December, 2013 and diagnosed as a case of substance use disorder by applying Structured Clinical Interview for DSM- Clinician Version were enrolled in the study. Data were collected through face to face interview by a semi-structured questionnaire and the information was complemented by the case-notes. Study subjects were 105 in number. Data analysis was performed using Statistical Package for Social Sciences (SPSS). Results: Most (90.5%) of the respondents were male. The mean age of the respondents was 28.8 (± 8.0) years. Majority (91.4%) were poly-substance users. Most (27.6%) respondents used 3 types of substances. Smoking or inhalation was the route used by most (90.5%) respondents. More than three-fourth (81%) of the respondents used nicotine. Among the other substances, majority (79%) used opiates group, followed by cannabinoids group (55.2%) and alcohol (41%). Curiosity, peer pressure and to have enjoyment or fun were identified as the common reasons for initiating substance use. Conclusions: A high proportion of poly-substance use was found. The study findings would help in management and prevention strategy of substance use in Bangladesh.

Keywords: Bangladesh, de-addiction clinic, poly-substance users, substance use disorder

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Authors: Amaba, Marinela C., Espino, Gianne Ericka S. J. Valencia, Zeia Beatriz C.

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This study aims to determine the moderating role of attachment style on the relationship between psychological symptoms and well-being of mental health practitioners in rehabilitation centers that are accredited of the Department of Health in Pampanga. Using the data gathered from 46 mental health practitioners, multiple regression models were conducted to test the main and moderating effects of attachment styles. The findings show that all three psychological symptoms namely depression, anxiety, and stress have main effects on their general well-being on a negative direction. However, attachment style did not moderate the relationship between the psychological symptoms and general well-being. On one hand, results about the relationship of psychological symptoms and well-being are consistent to previous findings of other studies while on the other hand, results in moderation were contradicting.

Keywords: attachment style, psychological symptoms, well-being, mental health practitioners, rehabilitation centers

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Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) are a major cause of pain and disability. It is likely to become a greater economic and public health burden that is unnecessary. Thus, reliable prevalence figures are important for both clinicians and policy-makers to plan health care needs for those affected with the disease. This study estimated hospital based real-world prevalence of MSDs in Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out to identify common MSDs including low back pain (LBP), cervical spondylosis (CSD), post immobilization stiffness (PIS), sprain, osteoarthritis (OA), and other conditions. Occupational class of the patients was determined using the International Labour Classification (ILO). Data were analysed using descriptive statistics of frequency and percentages. Overall, medical charts of 3,340 patients were reviewed within the span of ten years (2009 to 2018). Majority of the patients (62.8%) were in the middle class, and the remaining were in low class (25.1%) and high class (10.5%) category. An overall prevalence of 47.35% of MSD was found within the span of ten years. Of this, the prevalence of LBP, CSD, PIS, sprain, OA, and other conditions was 21.6%, 10%, 18.9%, 2%, 6.3%, and 41.3%, respectively. The highest (14.2%) and lowest (10.5%) prevalence of MSDs was recorded in the year of 2012 and 2018, respectively. The prevalence of MSDs is considerably high among Nigerian patients attending outpatient a physiotherapy clinic. The high prevalence of MSDs underscores the need for clinicians and decision makers to put in place appropriate strategies to reduce the prevalence of these conditions. In addition, they should plan and evaluate healthcare services to improve the health outcomes of patients with MSDs. Further studies are required to determine the economic burden of the condition and examine the clinical and cost-effectiveness of physiotherapy interventions for patients with MSDs.

Keywords: musculoskeletal disorders, Nigeria, prevalence, real world

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Authors: H. Nakamura

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This study analyzes international strategic alliances in the information industry. The purpose of this study is to clarify the strategic intention of an international alliance. Secondly, it investigates the influence of differences in the target markets of partner companies on alliances. Using an international strategy theory approach to analyze the global strategies of global companies, the study compares a database business and an electronic publishing business. In particular, these cases emphasized factors attributable to "people" and "learning", reliability and communication between organizations and the evolution of the IT infrastructure. The theory evolved in this study validates the effectiveness of these strategies.

Keywords: database business, electronic library, international strategic alliances, partner selection

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Authors: Mrigakshi Das

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The private sector investments and quantum of money required in this sector critically hinges on the financial risk and returns the sector offers to providers of capital. Therefore, it becomes important to understand financial performance of hospitals. Financial Analysis is useful for decision makers in a variety of settings. Consider the small proprietary hospitals, say, Physicians Clinic. The managers of such clinic need the information that financial statements provide. Attention to Financial Statements of healthcare Organizations can provide answers to questions like: How are they doing? What is their rate of profit? What is their solvency and liquidity position? What are their sources and application of funds? What is their Operational Efficiency? The researcher has studied Financial Statements of 5 Private Healthcare Organizations in Guwahati City.

Keywords: not-for-profit organizations, financial analysis, ratio analysis, profitability analysis, liquidity analysis, operational efficiency, capital structure analysis

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Authors: Thanaa M. Sulaiman

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The Iraqi education system has suffered greatly as a result of wars, political instability, and economic problems. After the fall of Saddam’s regime in 2003, the Iraqi education system was proportionally the most impacted sector. The new administration prioritized educational reforms. International organizations, as well as foreign countries, were in the lead to achieve educational reforms. The current study aims to shed light on the reformation process and the roles of different stakeholders, especially international organizations. It also aims to explore the current problems facing the Iraqi education system. Additionally, it aims to explore the different programs and projects that are funded and implemented by international organizations and the impact of these programs and projects.

Keywords: Iraq, Iraqi education system, educational reform, international organizations

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Authors: Edith Podhovnik

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Cultures play a role in business communication and in research. At the example of language in international business, this paper addresses the issue of how the research cultures of management research and linguistics as well as cultures as such can be linked. After looking at existing research on language in international business, this paper approaches communication in international business from a linguistic angle and attempts to explain communication issues in businesses based on linguistic research. Thus, the paper makes a step into cross-disciplinary research combining management research with linguistics.

Keywords: language in international business, sociolinguistics, ethnopragmatics, cultural scripts

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Authors: Magda Olesiuk-Okomska

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The degree of international interdependence has grown significantly. Poland is a party to nearly 1000 binding multilateral treaties, including international legal instruments devoted to criminal matters and obliging the state to penalize certain crimes. The paper presents results of a theoretical research conducted as a part of doctoral research. The main hypothesis assumed that there was a separate category of crimes to penalization of which Poland was obliged under international legal instruments; that a catalogue of such crimes and a catalogue of international legal instruments providing for Poland’s international obligations had never been compiled in the domestic doctrine, thus there was no mechanism for monitoring implementation of such obligations. In the course of the research, a definition of transnational crimes was discussed and confronted with notions of international crimes, treaty crimes, as well as cross-border crimes. A list of transnational crimes penalized in the Polish Penal Code as well as in non-code criminal law regulations was compiled; international legal instruments, obliging Poland to criminalize and penalize specific conduct, were enumerated and catalogued. It enabled the determination whether Poland’s international obligations were implemented in domestic legislation, as well as the formulation of de lege lata and de lege ferenda postulates. Implemented research methods included inter alia a dogmatic and legal method, an analytical method and desk research.

Keywords: international criminal law, transnational crimes, transnational criminal law, treaty crimes

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Authors: Ashan Wijekoon, Abi Beane, Subashini Jayawardana

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Background: Soldiers' physical rehabilitation and long term health status has been hindered due to limited investment in and access to rehabilitation services. Home-based rehabilitation programmes could offer a potentially feasible alternative to facilitate long-term recovery. Objectives: To explore Sri Lankan soldiers' perceptions of barriers and facilitators to a home-based physical rehabilitation programme.Methods and Materials: We conducted qualitative semi-structured interviews with community re-integrated army veterans who had undergone unilateral lower limb amputation following war related trauma. Veterans were identified from five districts of Sri Lanka, based on a priori knowledge of veteran community settlements (Disabled Category Registry) obtained from Directorate of Rehabilitation, MoD, Sri Lanka. Individuals were stratified for purposive selection. The interview guide was developed from existing methods and adapted for context. Verbatim transcripts of interviews were analyzed for emerging themes using an inductive approach. Following consent, participants met the researcher (AW- a trained physiotherapist fluent in Sinhalese). Results: Twenty-five Interviews were conducted, totaling 7.2 hours of new data (Mean±SD: 0.28±0.11). All participants were male, aged 30-55 years (Mean±SD: 46.1±7.4), and had experienced traumatic amputation as a result of conflict. Twenty-four sub themes were identified. Inadequate space for exercises, absence of equipment and assistance to conduct the exercises at home, alongside absence of community healthcare services were all barriers. Burden of comorbidities, including chronic pain and disability level, were also barriers. Social support systems, including soldier societies, family, and kinship with other amputees, were seen as facilitators to an at-home programme. Motivation for independence was a strong indicator of engagement. Conclusion: Environment, chronic pain, and absence of well-established community health services were key barriers. Family and soldier support was a facilitator. Engagement with community healthcare providers (physiotherapist and primary care physicians) will be essential to the success of an at-home rehabilitation program.

Keywords: physical rehabilitation, home-based, soldiers, disability, lower-limb amputation, qualitative

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Authors: Zouari Ezzeddine, Tarchoun Monaem

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Despite the multiplicity of advanced approaches, the concept of financial integration couldn’t be an explicit analysis. Indeed, empirical studies appear that the measures of international financial integration are one-dimensional analyses. For the ambivalence of the concept and its multiple determinants, it must be analyzed in multidimensional level. The interest of this research is a proposal of a decision support by multicriteria approach for determining the positions of countries according to their international and financial dependencies links with the behavior of financial actors (trying to make governance decisions or diversification strategies of international portfolio ...

Keywords: financial integration, decision support, behavior, multicriteria approach, governance and diversification

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Authors: Uche A. Nnawulezi

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Undoubtedly, despite all efforts made to achieve overall peace through the application of the principles of international humanitarian law, crimes against mankind which are of unprecedented concern to the whole world have remained unabated. The fall back on war as a technique for settling disputes between nations, individuals, countries and ethnic groups with accompanying toll of deaths and destruction of properties have remained a conspicuous component of human history. Indeed, to control this conduct of warfare and the dehumanization of individuals, a body of law aimed at regulating the impacts of conflicts and hostilities in the theater of war has become necessary. Thus, it is to examine the conditions in which international humanitarian law will apply and also to determine the extent of the challenges of new progressions of warfare that this study is undertaken. All through this examination, we grasped doctrinal approach wherein we used text books, journals, international materials and supposition of law specialists in the field of international humanitarian law. This paper shall examine the distinctive factors responsible for the rebelliousness to the rules of International Humanitarian Law and furthermore, shall proffer possible courses of action that will address the challenges of new technologies of warfare all over the world. Essentially, the basic proposals made in this paper if totally utilized may go far in ensuring a sufficient standard in the application of the rules of international humanitarian law as it relates to an increasingly frequent phenomenon of contemporary developments in technologies of warfare which has in recent past, made it more difficult for the most ideal application of the rules of international humanitarian law. This paper deduces that for a sustainable global peace to be achieved, the rules of International Humanitarian Law as it relates to the utilization of new technologies of warfare should be completely clung to and should be made a strict liability offense. Likewise, this paper further recommends the introduction of domestic criminal law punishment of serious contraventions of the rules of international humanitarian law.

Keywords: international, humanitarian law, new technologies, warfare

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Authors: Joana Mourão

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Transition to a low carbon economy requires changes in consumption and production patterns, including the improvement of existing buildings’ environmental performance. Urban rehabilitation is a top policy priority in Europe, creating an opportunity to increase this performance. However, urban rehabilitation comprises different typologies of interventions with distinct levels of consideration for cultural urban heritage values and for environmental values, thus with different impacts. Cities rely on both material and non-material forms of heritage that are deep-rooted and resilient. One of the most relevant parts of that urban heritage is the historical pre-industrial housing stock, with an extensive presence in many European cities, as Lisbon. This stock is rehabilitated and transformed at the framework of urban management and local governance traditions, as well as the framework of the global economy, and in that context, faces opportunities and threats that need evaluation and control. The scope of this article is to define methodological bases and research lines for the assessment of impacts that urban rehabilitation initiatives set on the vulnerable and historical pre-industrial urban housing stock, considering it as an environmental and cultural unreplaceable material value and resource. As a framework, this article reviews the concepts of urban regeneration, urban renewal, current buildings conservation and refurbishment, and energy refurbishment of buildings, seeking to define key typologies of urban rehabilitation that represent different approaches to the urban fabric, in terms of scope, actors, and priorities. Moreover, main types of interventions - basing on a case-study in a XVIII century neighborhood in Lisbon - are defined and analyzed in terms of the elements lost in each type of intervention, and relating those to urbanistic, architectonic and constructive values of urban heritage, as well as to environmental and energy efficiency. Further, the article overviews environmental cultural heritage assessment and life-cycle assessment tools, selecting relevant and feasible impact assessment criteria for urban buildings rehabilitation regulation, focusing on multi-level urban heritage integrity. Urbanistic, architectonic, constructive and energetic integrity are studied as criteria for impact assessment and specific indicators are proposed. The role of these criteria in sustainable urban management is discussed. Throughout this article, the key challenges for urban rehabilitation planning and management, concerning urban built heritage as a resource for sustainability, are discussed and clarified.

Keywords: urban rehabilitation, impact assessment criteria, buildings integrity, embodied energy

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Authors: Alexandros Lioulemes, Michail Theofanidis, Varun Kanal, Konstantinos Tsiakas, Maher Abujelala, Chris Collander, William B. Townsend, Angie Boisselle, Fillia Makedon

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This paper presents a home-based robot-rehabilitation instrument, called ”MAGNI Dynamics”, that utilized a vision-based kinematic/dynamic module and an adaptive haptic feedback controller. The system is expected to provide personalized rehabilitation by adjusting its resistive and supportive behavior according to a fuzzy intelligence controller that acts as an inference system, which correlates the user’s performance to different stiffness factors. The vision module uses the Kinect’s skeletal tracking to monitor the user’s effort in an unobtrusive and safe way, by estimating the torque that affects the user’s arm. The system’s torque estimations are justified by capturing electromyographic data from primitive hand motions (Shoulder Abduction and Shoulder Forward Flexion). Moreover, we present and analyze how the Barrett WAM generates a force-field with a haptic controller to support or challenge the users. Experiments show that by shifting the proportional value, that corresponds to different stiffness factors of the haptic path, can potentially help the user to improve his/her motor skills. Finally, potential areas for future research are discussed, that address how a rehabilitation robotic framework may include multisensing data, to improve the user’s recovery process.

Keywords: human-robot interaction, kinect, kinematics, dynamics, haptic control, rehabilitation robotics, artificial intelligence

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Authors: Nhi Phuoc Thuc Le

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Cross-cultural adaptability —one’s readiness to interact with people who are different from oneself or to adapt to living in another culture— is essential to the well-being and experience of international students. This research was set out to find the correlation between certain personality traits of international students and their likelihood to adapt to the U.S., the host culture. The study used Qualtrics, an online survey, to investigate the relationships between international students’ social self-efficacy, ego-resiliency, cultural intelligence, Big Five personality traits and cross-cultural adaptability (sociocultural and psychological adaptability). The data were analysed with the software SPSS. The findings of this quantitative study show that high scores in ego-resiliency, social self-efficacy, cultural intelligence and personality traits (including extraversion, agreeableness, intellect and conscientiousness) are correlated with better cross-cultural adaptation. Meanwhile, the Big-Five trait neuroticism is correlated with lower cross-cultural adaptability. Such insight is suggested to help international students be better prepared for an immersion into the US culture.

Keywords: Big Five, cross-cultural adaptability, cultural intelligence, ego-resiliency, international students, personality, self-efficacy

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Authors: Saheb Yousefi, Kim T. Zebehazy, Parviz Sharifi Daramadi, Tahereh Najafi Fard, Kevin Murfitt

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Context: Children with visual impairments often face challenges in their cognitive, motor, and social development. Sensory-motor and spatial perception therapies can be beneficial for these children, but many existing programs only focus on a limited set of therapies. This study aims to investigate the effectiveness of a rehabilitation program for sensory- motor and spatial perception in reducing the fear of mobility in visually impaired children. Research Aim: The aim of this study is to determine if a rehabilitation program based on parent-child interaction can reduce the fear of mobility in visually impaired children. Methodology: This study uses a semi-experimental approach with an uneven control group design. Visually impaired children aged 10 to 14 and their parents from the Board of the Blind and Visually Impaired in Tehran Province were included in the study. The sample was divided into experimental and control groups, with a total of 30 participants. The experimental group participated in a rehabilitation program for sensory-motor and spatial perception based on parent-child interaction, while the control group did not receive this intervention. Data was collected using questionnaires on transportation issues and analyzed using multivariate and univariate mixed analysis of variance tests. Findings: The analysis of the data showed that the fear of movement was significantly improved in the experimental group compared to the control group after the intervention. Theoretical Importance: This study highlights the effectiveness of a rehabilitation program for sensory- motor and spatial perception based on parent-child interaction in reducing the fear of mobility in visually impaired children. It contributes to the existing knowledge by demonstrating the positive impact of this type of intervention on the cognitive, motor, and social development of these children. Data Collection and Analysis Procedures: Data was collected through the use of questionnaires administered to the children before and after the intervention. The data was analyzed using multivariate and univariate mixed analysis of variance tests to examine the effects of the rehabilitation program. Questions Addressed: This study addresses the question of whether a rehabilitation program based on parent-child interaction can reduce the fear of mobility in visually impaired children. Conclusion: The findings of this study support the effectiveness of the sensory-motor and spatial perception rehabilitation program based on parent-child interaction in reducing the fear of movement in visually impaired children. This intervention can be considered as a suitable method to enhance the fear of mobility in these children.

Keywords: vision impairment, sensory-motor rehabilitation, space perception, parent-child interaction, fear of movement.

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Authors: Lily Farris, Chantel E. Canessa, Rena Heathcote, Susan Shumay, Suzanna V. McRae, Alissa Collingridge, Minna K. Miller

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Objective: To describe how the Lean approach can be applied to improve access, quality and safety of care in an ambulatory pediatric primary care setting. Background: Lean was originally developed by Toyota manufacturing in Japan, and subsequently adapted for use in the healthcare sector. Lean is a systematic approach, focused on identifying and reducing waste within organizational processes, improving patient-centered care and efficiency. Limited literature is available on the implementation of the Lean methodologies in a pediatric ambulatory care setting. Methods: A strategic continuous improvement event or Rapid Process Improvement Workshop (RPIW) was launched with the aim evaluating and structurally supporting clinic workflow, capacity building, sustainability, and ultimately improving access to care and enhancing the patient experience. The Lean process consists of five specific activities: Current state/process assessment (value stream map); development of a future state map (value stream map after waste reduction); identification, quantification and prioritization of the process improvement opportunities; implementation and evaluation of process changes; and audits to sustain the gains. Staff engagement is a critical component of the Lean process. Results: Through the implementation of the RPIW and shifting workload among the administrative team, four hours of wasted time moving between desks and doing work was eliminated from the Administrative Clerks role. To streamline clinic flow, the Nursing Assistants completed patient measurements and vitals for Nurse Practitioners, reducing patient wait times and adding value to the patients visit with the Nurse Practitioners. Additionally, through the Nurse Practitioners engagement in the Lean processes a need was recognized to articulate clinic vision, mission and the alignment of NP role and scope of practice with the agency and Ministry of Health strategic plan. Conclusions: Continuous improvement work in the Pediatric Primary Care NP Clinic has provided a unique opportunity to improve the quality of care delivered and has facilitated further alignment of the daily continuous improvement work with the strategic priorities of the Ministry of Health.

Keywords: ambulatory care, lean, pediatric primary care, system efficiency

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