Search results for: patient perspectives

Authors: Samira Brahimi

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Throughout Aisha, her first collection of short stories, Ahdaf Soueif draws a multilayered picture of the Other as others, picturing a series of encounters of her protagonist with this very Other as a set of binary elements. The current essay includes a comparative study between two narratives, namely The Returning and The Nativity. The Other is portrayed as a male/female binary in The Returning and as 'The Foreigner' in an exotic land vs. the local in The Nativity. The analysis is to focus on Aisha, the main female character, who figures as conforming to the portrait of the stereotyped Arab Muslim woman as a sex-subject, submissive, and maudlin character, confining her vision of the Other to the boundaries of her cocooned self, epitomizing a self-centered vision of the world. This reduced vision results in the possibility of viewing the Other as a hindrance to her attaining a clarified and centrifugal representation of the latter, herself, and the outside world. The encounters could also be considered as the character's opportunity for a less stigmatized perception of the elements set forth. The main queries to be probed are: what are the different perceptions of the Other by the author in the narratives set forth? How does the protagonist's encounter with the Other(s) impede her ability to understand the Other, herself, and the world around her? Or how does this encounter allow her an enlightened vision of the aforementioned elements to forge a new start? The possibility of imagining a dialogic relation between different perceptions of the Other opens up new perspectives for adopting magnified representations of the later, oneself, and the world, dilating one's imagination.

Keywords: dialogic, female, foreigner, local, male, other, others

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Authors: Alia Al Rayssi, Mahra Al Marar, Alyazia Alkhaili, Reem Al Dhaheri, Shayma Alkobaisi, Hoda Amer

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We present in this paper a web-based system called “HelpMeBreathe” for managing asthma. The proposed system provides analytical tools, which allow better understanding of environmental triggers of asthma, hence better support of data-driven decision making. The developed system provides warning messages to a specific asthma patient if the weather in his/her area might cause any difficulty in breathing or could trigger an asthma attack. HelpMeBreathe collects, stores, and analyzes individuals’ moving trajectories and health conditions as well as environmental data. It then processes and displays the patients’ data through an analytical tool that leads to an effective decision making by physicians and other decision makers.

Keywords: asthma, environmental triggers, map interface, web-based systems

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Authors: Oluwole Enoch Adeniran

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Peace studies and conflict resolution; though a relatively new discipline had attracted scholars from far and near. It had enhanced a purposeful training of mind of young adult among other categories of learners. It provides a platform through which university under-graduates and post-graduates students are exposed to the rudiments of peace building, peacemaking and peace keeping towards a successful conflict resolution. The paper historicizes peace education as most desirable in any human society that desired development. It aims at educating children and young adults in the dynamics of peaceful conflicts resolution at home, in school and communities (states) throughout the world for a purposeful technological development. It also aims at exposing students to the nature of conflict and how to manage and resolve conflicts in order to promote national unity for meaningful development. The paper argues that, for a state to record any meaningful socio-economic, political and technological development; a conducive and peaceful atmosphere must be put in place. This theoretical paper emerged in the context of historical specificities of conflict resolution from a general conceptual framework. It then concludes with suggestions on the modes of conflict prevention, conflict management and conflict resolution for an ideal technologically advanced society.

Keywords: history, education, peace, unity, technology and development

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Authors: Christi Jackson, Chuka Onaga

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Introduction: We report a case of delayed diagnosis of extra-pulmonary INH-mono-resistant Tuberculosis (TB) in a South African patient with drug-resistant HIV. Case Presentation: A 36-year old male was initiated on 1st line (NNRTI-based) anti-retroviral therapy (ART) in September 2009 and switched to 2nd line (PI-based) ART in 2011, according to local guidelines. He was following up at the outpatient wellness unit of a public hospital, where he was diagnosed with Protease Inhibitor resistant HIV in March 2016. He had an HIV viral load (HIVVL) of 737000 copies/mL, CD4-count of 10 cells/µL and presented with complaints of productive cough, weight loss, chronic diarrhoea and a septic buttock wound. Several investigations were done on sputum, stool and pus samples but all were negative for TB. The patient was treated with antibiotics and the cough and the buttock wound improved. He was subsequently started on a 3rd-line ART regimen of Darunavir, Ritonavir, Etravirine, Raltegravir, Tenofovir and Emtricitabine in May 2016. He continued losing weight, became too weak to stand unsupported and started complaining of abdominal pain. Further investigations were done in September 2016, including a urine specimen for Line Probe Assay (LPA), which showed M. tuberculosis sensitive to Rifampicin but resistant to INH. A lymph node biopsy also showed histological confirmation of TB. Management and outcome: He was started on Rifabutin, Pyrazinamide and Ethambutol in September 2016, and Etravirine was discontinued. After 6 months on ART and 2 months on TB treatment, his HIVVL had dropped to 286 copies/mL, CD4 improved to 179 cells/µL and he showed clinical improvement. Pharmacy supply of his individualised drugs was unreliable and presented some challenges to continuity of treatment. He successfully completed his treatment in June 2017 while still maintaining virological suppression. Discussion: Several laboratory-related factors delayed the diagnosis of TB, including the unavailability of urine-lipoarabinomannan (LAM) and urine-GeneXpert (GXP) tests at this facility. Once the diagnosis was made, it presented a treatment dilemma due to the expected drug-drug interactions between his 3rd-line ART regimen and his INH-resistant TB regimen, and specialist input was required. Conclusion: TB is more difficult to diagnose in patients with severe immunosuppression, therefore additional tests like urine-LAM and urine-GXP can be helpful in expediting the diagnosis in these cases. Patients with non-standard drug regimens should always be discussed with a specialist in order to avoid potentially harmful drug-drug interactions.

Keywords: drug-resistance, HIV, line probe assay, tuberculosis

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Authors: Nirali Sanghavi, Julia Ash, Amy Wasserman

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Introduction: To the best of our knowledge, there is only one case report that found an association between leuprolide and scleroderma renal crisis (SRC). Leuprolide has been noted to cause acute renal failure in some patients. Given the close timing of the leuprolide injection and the worsening renal function in our patient, leuprolide likely caused exacerbation of lupus nephritis and SRC. Interestingly, our patient on long-term hydroxychloroquine (HCQ) with normal baseline cardiac function was found to have HCQ cardiomyopathy highlighting the need for close monitoring of HCQ toxicity. We know that some of the risk factors that are involved in HCQ induced cardiomyopathy are older age, females, increased dose and >10 years of HCQ use, and pre-existing cardiac and renal insufficiency. Case presentation: A 34-year-old African American woman with a history of overlap of systemic lupus erythematosus (SLE) and scleroderma features and class III lupus nephritis presented with severe headaches, elevated blood pressure (180/120 mmHg) and worsening creatinine levels (2.07 mg/dL). The headaches started 1 month ago after she started leuprolide injections for fibroids. She was being treated with mycophenolate mofetil 1 gm twice a day, belimumab weekly, HCQ 200mg, and prednisone 5 mg daily. She has been on HCQ since her teenage years. The examination was unremarkable except for proximal interphalangeal joint contractures in the right hand and sclerodactyly of bilateral hands, unchanged from baseline. Laboratory findings include urinalysis, which showed 3+ protein, 1+ blood, 6 red blood cells, and 14 white blood cells ruling out thrombotic microangiopathy. C3 was 32 mg/dL, C4 <5 mg/dL, and +dsDNA increased >1000. She was started on captopril and discharged once creatinine and blood pressure was controlled. She was readmitted with hypertension, hyperkalemia, worsening creatinine, nephrotic range proteinuria, complaints of chest pressure, and shortness of breath with pleuritic chest pain. Physical examination and lab findings were unchanged. She was treated with pulse dose methyl prednisone followed by taper and multiple anti-hypertensive agents, including captopril, for presumed lupus nephritis flare versus SRC. Renal biopsy was consistent with SRC and class IV lupus nephritis and was started on cyclophosphamide. While cardiac biopsy showed borderline myocarditis without necrosis and cytoplasmic vacuolization consistent with HCQ cardiomyopathy, hence HCQ was discontinued. Summary: It highlights a rare association of leuprolide causing exacerbation of lupus nephritis or SRC. Although rare, the current case reinforces the importance of close monitoring for HCQ toxicity in patients with renal insufficiency.

Keywords: leuprolide, lupus nephritis, scleroderma, SLE

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Authors: Todor Nickolov Stoyanov

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These factors appear as a reason for difficulties in financing from programs for rural development of the European Union. Credit conditions for commercial banks are difficult to implement, and its interest rate is too high. One of the possibilities for short-term loans at preferential conditions for the small and medium-sized agricultural and forest owners is credit cooperative. After the changes, occurred in the country after 1990, the need to restore credit cooperatives raised. The purpose for the creation of credit cooperatives is to assist private agricultural and forest owners to take care for them, to assist in the expansion and strengthening of their farms, to increase the quality of life and to improve the local economy. It was found that: in Bulgaria there is a legal obstacle for credit cooperatives to expand their business in the deposit and lending sphere; private forest and agricultural owners need small loans to solve a small problem for a certain season; providing such loans is not attractive for banks, but it is extremely necessary for owners of small forests and lands; if a special law on credit cooperatives is adopted, as required by the Cooperatives Act, it will allow more local people to be members of such credit structures and receive the necessary loans. In conclusion, proposals to create conditions for the development of credit cooperatives in the country are made and positive results expected from the creation of credit cooperatives, are summarized.

Keywords: cooperatives, credit cooperatives, forestry, forest owners

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Authors: Susanna Vanhamäki, Gabor Schneider, Kati Manskinen

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‘Bioeconomy’ is a complex concept that cuts across many sectors and covers several policy areas. To achieve an overall understanding and support a successful bioeconomy, a cross-sectorial approach is necessary. In practice, due to the concept’s wide scope and varying international approaches, fully understanding bioeconomy is challenging on policy level. This paper provides a background of the topic through an analysis of bioeconomy strategies in the Baltic Sea region. Expert interviews and a small survey were conducted to discover the current and intended focuses of these countries’ bioeconomy sectors. The research shows that supporting sustainability is one of the keys in developing the future bioeconomy. The results highlighted that the bioeconomy has to be sustainable and based on circular economy principles. Currently, traditional bioeconomy sectors like food, wood, fish & waters as well as fuel & energy, which are in the core of national bioeconomy strategies, are best known and are considered more relevant than other bioeconomy industries. However, there is increasing potential for novel sectors, such as textiles and pharmaceuticals. The present research indicates that the opportunities presented by these bioeconomy sectors should be recognised and promoted. Education, research and innovation can play key roles in developing transformative and sustainable improvements in primary production and renewable resources. Furthermore, cooperation between businesses and educators is important.

Keywords: bioeconomy, circular economy, policy, strategy

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Authors: Hema Bhardwaj, D. Srinivasa Rao

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Technology for analysing, processing, and extracting meaningful data from enormous and complicated datasets can be termed as "big data." The technique of big data mining and big data analysis is extremely helpful for business movements such as making decisions, building organisational plans, researching the market efficiently, improving sales, etc., because typical management tools cannot handle such complicated datasets. Special computational and statistical issues, such as measurement errors, noise accumulation, spurious correlation, and storage and scalability limitations, are brought on by big data. These unique problems call for new computational and statistical paradigms. This research paper offers an overview of the literature on big data mining, its process, along with problems and difficulties, with a focus on the unique characteristics of big data. Organizations have several difficulties when undertaking data mining, which has an impact on their decision-making. Every day, terabytes of data are produced, yet only around 1% of that data is really analyzed. The idea of the mining and analysis of data and knowledge discovery techniques that have recently been created with practical application systems is presented in this study. This article's conclusion also includes a list of issues and difficulties for further research in the area. The report discusses the management's main big data and data mining challenges.

Keywords: big data, data mining, data analysis, knowledge discovery techniques, data mining challenges

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Authors: Malin Isaksson

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Teaching French as a foreign language usually implies teaching French literature, especially in higher education. Training university students in literary reading in a foreign language requires addressing several aspects at the same time: the (foreign) language, the poetic language, the aesthetic aspects of the studied works, and various interpretations of them. A pilot study sought to test a teaching model that would support students in learning to perform competent readings and short analyses of French literary works, in a rather independent manner. This shared practice paper describes the use of a flipped classroom method in two French literature courses, a campus course and an online course, and suggests that the teaching model may provide efficient tools for teaching literary reading and analysis in a foreign language. The teaching model builds on a high level of student activity and focuses on attentive reading, meta-perspectives such as theoretical concepts, individual analyses by students where said concepts are applied, and group discussions of the studied texts and of possible interpretations.

Keywords: attentive reading, flipped classroom, literature in foreign language studies, teaching literature analysis

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Authors: Yusra Ibrahim

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This study explores the online discourse of justice-involved youth on Reddit, focusing on how anonymity and asynchronicity influence their ability to share and reflect on their incarceration experiences within the "Ask Me Anything" (AMA) community. The study utilizes a quantitative analysis of speech acts to examine the varied communication patterns exhibited by youths and commenters across two AMA threads. The results indicate that, although Reddit is not specifically designed for formerly incarcerated youths, its features provide a supportive environment for them to share their incarceration experiences with non-incarcerated individuals. The level of empathy and support from the audience varies based on the audience’s perspectives on incarceration and related traumatic experiences. Additionally, the study identifies a reciprocal relationship where youths benefit from community support while offering insights into the juvenile justice system and helping the audience understand the experience of incarceration. The study also reveals cultural shocks in physical and digital environments that youth experience after release and when using social media platforms and the internet. The study has implications for juvenile justice personnel, policymakers, and researchers in the juvenile justice system.

Keywords: juvenile justice, online discourse, reddit AMA, anonymity, speech acts taxonomy, reintegration, online community support

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Authors: Kateryna Merkulova, Alessio Castello, Maria Kreuzer

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This research investigates the drivers of long-term relationship building between customers and suppliers within the luxury food supply chain, a topic that remains largely unexplored in the current state of academic literature. This paper identifies for the first time the key elements that influence the formation and maintenance of effective supply chain relationships, which are crucial for navigating the complexities of the luxury food industry. In particular, it explores the critical role of trust in a business-to-business context, specifically emphasizing its significance in the luxury food supply chain. Empirically, this research is contextualized in the region of the French Riviera, which offers a gastronomic playground for food enthusiasts, making it ideally suited to explore the luxury food sector. Qualitative in-depth interviews with stakeholders along the luxury supply chain (i.e., suppliers, chefs, restaurant owners, and fine food shop managers) allow identifying key drivers of trustful business relationships. Triangulating different perspectives of stakeholders within the luxury supply chain adds validity and robustness to the findings. The findings have important theoretical and managerial implications for the effective functioning of long-term supplier-buyer relationships.

Keywords: luxury food, relationship building, B2B, supply chain, trust

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Authors: Tsai-Hsiu Lin

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Dan C. Lortie’s Schoolteacher: A sociological study is one of the best works on the sociology of teaching since W. Waller’s classic study. It is a book worthy of review. Following the tradition of symbolic interactionists, Lortie demonstrated the qualities who studied the occupation of teaching. Using several methods to gather effective data, Lortie has portrayed the ethos of the teaching profession. Therefore, the work is an important book on the teaching profession and teacher culture. Though outstanding, Lortie’s work is also flawed in that his perspectives and methodology were adopted largely from symbolic interactionism. First, Lortie in his work analyzed many points regarding teacher culture; for example, he was interested in exploring “sentiment,” “cathexis,” and “ethos.” Thus, he was more a psychologist than a sociologist. Second, symbolic interactionism led him to discern the teacher culture from a micro view, thereby missing the structural aspects. For example, he did not fully discuss the issue of gender and he ignored the issue of race. Finally, following the qualitative sociological tradition, Lortie employed many qualitative methods to gather data but only foucused on obtaining and presenting interview data. Moreover, he used measurement methods that were too simplistic for analyzing quantitative data fully.

Keywords: education reform, teacher culture, teaching profession, Lortie’s Schoolteacher

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Authors: Heping Wang

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Social interaction has increased as a result of rapid economic expansion. Particularly in China, gift exchanges have developed into a social tradition of showing gratitude. Most gifts, on the other hand, are lavishly presented or overpacked to impress or demonstrate respect to the gift receiver. Overpackaging wastes enormous resources and produces a lot of municipal solid waste (MSW), which can seriously harm the environment if it is not handled properly. The purpose of this study is to investigate consumers' perceptions, preferences, and perspectives regarding gifts overpackaging in order to identify potential solutions for reducing gifts overpackaging to achieve sustainable packaging objectives. The research was conducted by means of an online survey focusing on residents in Shanghai, China, and the data was quantitatively analyzed by SPSS software. According to research, consumers' perception of excessive packaging is approximately 3.5 points out of 5, and this perception has a significant impact on consumers' behavioral intentions; The preferences of givers and receivers for gift packaging are significantly different in three aspects; Customers prefer incentives for eco-packaging when it comes to measures to reduce gift overpackaging. Finally, the study also identifies suitable gift packaging options for customers.

Keywords: gift packaging, consumer perception, consumer preference, consumer perspective, overpackaging, solutions

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Authors: Adel Gurel, Ozge Ceylin Yildirim

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Nowadays, design and architecture are being affected and underwent change with the rapid advancements in technology, economics, politics, society and culture. Architecture has been transforming with the latest developments after the inclusion of computers into design. Integration of design into the computational environment has revolutionized the architecture and new perspectives in architecture have been gained. The history of architecture shows the various technological developments and changes in which the architecture has transformed with time. Therefore, the analysis of integration between technology and the history of the architectural process makes it possible to build a consensus on the idea of how architecture is to proceed. In this study, each period that occurs with the integration of technology into architecture is addressed within historical process. At the same time, changes in architecture via technology are identified as important milestones and predictions with regards to the future of architecture have been determined. Developments and changes in technology and the use of technology in architecture within years are analyzed in charts and graphs comparatively. The historical process of architecture and its transformation via technology are supported with detailed literature review and they are consolidated with the examination of focal points of 20th-century architecture under the titles; parametric design, genetic architecture, simulation, and biomimicry. It is concluded that with the historical research between past and present; the developments in architecture cannot keep up with the advancements in technology and recent developments in technology overshadow the architecture, even the technology decides the direction of architecture. As a result, a scenario is presented with regards to the reach of technology in the future of architecture and the role of the architect.

Keywords: computer technologies, future architecture, scientific developments, transformation

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Authors: Endale Fantahun Tadesse, Sabika Khalid

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The global call for increased male representation in early childhood education (ECE) has garnered significant attention. Emerging studies have indicated that involving men in ECE can yield positive outcomes for children's physical and psychological development. Challenging the prevailing misconception and stereotype that women dominate the ECE sector is crucial. In light of this, the present study undertakes a systematic review of nine studies on males working in ECE, revealing a dearth of male presence in the field in China as well. To address this issue, substantial structural changes must be implemented to enhance the inadequate pay and working conditions that dissuade both men and women from pursuing a sustainable career in ECE. It is recommended that school leadership raise awareness among female teachers and parents, encouraging them to support and uphold virtuous values for male teachers. Additionally, governing bodies should provide explicit guidelines during training programs to address concerns regarding potential abuse and gender biases. The findings of this review underscore the need for future studies to examine the self-identities of male teachers from various stakeholders' perspectives and explore the consequences of being in the profession through rigorous and robust methodologies that can inform policymakers.

Keywords: male teachers, Early Childhood Education (ECE), self-identity, perception of stakeholders

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Authors: Mohammed Salahat, Steve Wade

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This paper presents and compares the SSDDD “Systematic Soft Domain Driven Design Framework” to DDD “Domain Driven Design Framework” as a soft system approach of information systems development. The framework use SSM as a guiding methodology within which we have embedded a sequence of design tasks based on the UML leading to the implementation of a software system using the Naked Objects framework. This framework has been used in action research projects that have involved the investigation and modelling of business processes using object-oriented domain models and the implementation of software systems based on those domain models. Within this framework, Soft Systems Methodology (SSM) is used as a guiding methodology to explore the problem situation and to develop the domain model using UML for the given business domain. The framework is proposed and evaluated in our previous works, a comparison between SSDDD and DDD is presented in this paper, to show how SSDDD improved DDD as an approach to modelling and implementing business domain perspectives for Information Systems Development. The comparison process, the results, and the improvements are presented in the following sections of this paper.

Keywords: domain-driven design, soft domain-driven design, naked objects, soft language

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Authors: F. A. Thomas, M. Schrafl-Altermatt, R. Treier, S. Kaufmann

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Stroke is the main cause of adult disability. Especially upper limb function is affected in most patients. Recently, cooperative hand movements have been shown to be a promising type of upper limb training in stroke rehabilitation. In these movements, which are frequently found in activities of daily living (e.g. opening a bottle, winding up a blind), the force of one upper limb has to be equally counteracted by the other limb to successfully accomplish a task. The use of standardized and reliable clinical assessments is essential to evaluate the efficacy of therapy and the functional outcome of a patient. Many assessments for upper limb function or impairment are available. However, the evaluation of cooperative hand movement tasks are rarely included in those. Thus, the aim of this study was (i) to develop a novel clinical assessment (CASA - Cooperative Activity Stroke Assessment) for the evaluation of patients’ capacity to perform cooperative hand movements and (ii) to test its inter- and interrater reliability. Furthermore, CASA scores were compared to current gold standard assessments for upper extremity in stroke patients (i.e. Fugl-Meyer Assessment, Box & Blocks Test). The CASA consists of five cooperative activities of daily living including (1) opening a jar, (2) opening a bottle, (3) open and closing of a zip, (4) unscrew a nut and (5) opening a clipbox. Here, the goal is to accomplish the tasks as fast as possible. In addition to the quantitative rating (i.e. time) which is converted to a 7-point scale, also the quality of the movement is rated in a 4-point scale. To test the reliability of CASA, fifteen stroke subjects were tested within a week twice by the same two raters. Intra-and interrater reliability was calculated using the intraclass correlation coefficient (ICC) for total CASA score and single items. Furthermore, Pearson-correlation was used to compare the CASA scores to the scores of Fugl-Meyer upper limb assessment and the box and blocks test, which were assessed in every patient additionally to the CASA. ICC scores of the total CASA score indicated an excellent- and single items established a good to excellent inter- and interrater reliability. Furthermore, the CASA score was significantly correlated to the Fugl-Meyer and Box & Blocks score. The CASA provides a reliable assessment for cooperative hand movements which are crucial for many activities of daily living. Due to its non-costly setup, easy and fast implementation, we suggest it to be well suitable for clinical application. In conclusion, the CASA is a useful tool in assessing the functional status and therapy related recovery in cooperative hand movement capacity in stroke patients.

Keywords: activitites of daily living, clinical assessment, cooperative hand movements, reliability, stroke

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Authors: Babarina Maria, Andropova Margarita

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Introduction: Hypoparathyroidism (HypoPT) is a rare endocrine disorder with an estimated prevalence of 0.25 per 1000 individuals. The most common cause of HypoPT is the loss of active parathyroid tissue following thyroid or parathyroid surgery. Sometimes permanent postoperative HypoPT occures, manifested by hypocalcemia in combination with low levels of PTH during 6 months or more after surgery. Cognitive impairments in patients with hypocalcemia due to chronic HypoPT are observed, and this can lead to problems and challenges in everyday living: memory loss and impaired concentration, that may be the cause of poor compliance. Clinical case: Patient K., 66 years old, underwent thyroidectomy in 2013 (at the age of 55) because of papillary thyroid cancer T1NxMx, histopathology findings confirmed the diagnosis. 5 years after the surgery, she was followed up on an outpatient basis, TSH levelsonly were monitored, and the dose of levothyroxine was adjusted. In 2018 due to, increasing complaints include tingling and cramps in the arms and legs, memory loss, sleep disorder, fatigue, anxiety, hair loss, muscle pain, tachycardia, positive Chvostek, and Trousseau signs were diagnosed during examination, also in blood analyses: total Ca 1.86 mmol/l (2.15-2.55), Ca++ 0.96 mmol/l (1.12-1.3), P 1.55 mmol/l (0.74-1.52), Mg 0.79 mmol/l (0.66-1.07) - chronic postoperative HypoPT was diagnosed. Therapy was initiated: alfacalcidol 0.5 mcg per day, calcium carbonate 2000 mg per day, cholecalciferol 1000 IU per day, magnesium orotate 3000 mg per day. During the case follow-up, hypocalcemia, hyperphosphatemia persisted, hypercalciuria15.7 mmol/day (2.5-6.5) was diagnosed. Dietary recommendations were given because of the high content of phosphorus rich foods, and therapy was adjusted: the dose of alfacalcidol was increased to 2.5 mcg per day, and the dose of calcium carbonate was reduced to 1500 mg per day. As part of the screening for complications of hypoPT, data for cataracts, Fahr syndrome, nephrocalcinosis, and kidney stone disease were not obtained. However, HypoPT compensation was not achieved, and therefore hydrochlorothiazide 25 mg was initiated, the dose of alfacalcidol was increased to 3 mcg per day, calcium carbonate to 3000 mg per day, magnesium orotate and cholecalciferol were continued at the same doses. Therapeutic goals were achieved: calcium phosphate product <4.4 mmol2/l2, there were no episodes of hypercalcemia, twenty-four-hour urinary calcium excretion was significantly reduced. Conclusion: Timely prescription, careful explanation of drugs usage rules, and monitoring and maintaining blood and urine parameters within the target contribute to the prevention of HypoPT complications development and life-threatening events.

Keywords: hypoparathyroidism, hypocalcemia, hyperphosphatemia, hypercalciuria

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Authors: Madhavi-Priya Singh, Liam Lowe, Farouk Arnaout, Ludmilla Pillay, Giordan Perez, Luke Mischker, Steve Costa

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Introduction: An Emergency Department consultant identified the failure of medical students to complete the task of clerking a patient in its entirety. As six medical students on our first clinical placement, we recognised our own failure and endeavored to examine why this failure was consistent among all medical students that had been given this task, despite our best motivations as adult learners. Aim: Our aim is to understand and investigate the elements which impeded our ability to learn and perform as medical students in the clinical environment, with reference to the prescribed task. We also aim to generate a discussion around the delivery of medical education with potential solutions to these barriers. Methods: Six medical students gathered together to have a comprehensive reflective discussion to identify possible factors leading to the failure of the task. First, we thoroughly analysed the delivery of the instructions with reference to the literature to identify potential flaws. We then examined personal, social, ethical, and cultural factors which may have impacted our ability to complete the task in its entirety. Results: Through collation of our shared experiences, with support from discussion in the field of medical education and ethics, we identified two major areas that impacted our ability to complete the set task. First, we experienced an ethical conflict where we believed the inconvenience and potential harm inflicted on patients did not justify the positive impact the patient interaction would have on our medical learning. Second, we identified a lack of confidence stemming from multiple factors, including the conflict between preclinical and clinical learning, perceptions of perfectionism in the culture of medicine, and the influence of upward social comparison. Discussion: After discussions, we found that the various factors we identified exacerbated the fears and doubts we already had about our own abilities and that of the medical education system. This doubt led us to avoid completing certain aspects of the tasks that were prescribed and further reinforced our vulnerability and perceived incompetence. Exploration of philosophical theories identified the importance of the role of doubt in education. We propose the need for further discussion around incorporating both pedagogic and andragogic teaching styles in clinical medical education and the acceptance of doubt as a driver of our learning. Conclusion: Doubt will continue to permeate our thoughts and actions no matter what. The moral or psychological distress that arises from this is the key motivating factor for our avoidance of tasks. If we accept this doubt and education embraces this doubt, it will no longer linger in the shadows as a negative and restrictive emotion but fuel a brighter dialogue and positive learning experience, ultimately assisting us in achieving our full potential.

Keywords: ethics, medical student, doubt, medical education, faith

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Authors: Melikulov A. A., Toshpulotov Sh. G., Akhmedova M. F., Beshimov A. S., Rakhimov M. K. Zokirov N. K.

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Postinfarction ventricular septal defect (PVSD) is a rare but life-threatening complication of acute myocardial infarction. Currently, an alternative direction of minimally invasive treatment of postinfarction ventricular septal defect (PVSD) is being developed - transcatheter closure of the defect using an occluder, but surgical closure of the defect remains the <> correction of post-infarction VSD. Our article presents a case of successful surgical treatment of a patient with a large post-infarction rupture of the interventricular septum (IVS) and post-infarction LV aneurysm under cardiopulmonary bypass and parallel perfusion.

Keywords: echocardiography, myocardial infarction, ventricular septal defect, parallel perfusion

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Authors: Divya SY. Ang, Mark B. Tan, Nicholas EM. Yeo, Siti RB. Sudirman, Khong Yik Chew

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Introduction: The importance of the amalgamation of technological and engineering advances with surgical principles of reconstruction cannot be overemphasized. With earlier detection of cancer, consequences of high-speed living and neglect, like traumatic injuries and infection, resulting in increasingly younger patients with bone defects. This may result in malformations and suboptimal function that is more noticeable and palpable in the younger, active demographic. Our team proposes a technique that encapsulates a mesh of multidisciplinary effort, tissue engineering and reconstructive principles. Methods/Materials: Our patient was a young competitive footballer in his early 30s who was diagnosed with submandibular adenoid cystic carcinoma with bony involvement. He was thus counselled for a right hemi mandibulectomy, the floor of mouth resection, right selective neck dissection, tracheostomy, and free fibular flap reconstruction of his mandible and required post-operative radiotherapy. Being young and in his prime sportsman years, he was unable to accept the morbidities associated with using his fibula to reconstruct his mandible despite it being the gold standard reconstructive option. The fibula is an ideal vascularized bone flap because it’s reliable and easily shaped with relatively minimal impact on functional outcomes. The fibula contributes to 30% of weightbearing and is the attachment for the lateral compartment muscles; it is stronger in footballers concerning lateral bending. When harvesting the fibula, the distal 6-8cm and up to 10% of the total length is preserved to maintain the ankle’s stability, thus, minimizing the impact on daily activities. There are studies that have noted gait variability post-operatively. Therefore, returning to a premorbid competitive level may be doubtful. To improve his functional outcomes, the decision was made to try and restore the fibula's form and function. Using the concept of Fused Deposition Modelling (FDM), our team comprising of Plastics, Otolaryngology, Orthopedics and Radiology, worked with Osteopore to design a 3D bioresorbable implant to regenerate the fibula defect (14.5cm). Bone marrow was harvested via reaming the contralateral hip prior to the wide resection. 30mls of his blood was obtained for extracting platelet rich plasma. These were packed into the Osteopore 3D-printed bone scaffold. This was then secured into the fibula defect with titanium plates and screws. The flexor hallucis longus and soleus were anchored along the construct and intraosseous membrane, done in a single setting. Results: He was reviewed closely as an outpatient over 10 months post operatively. He reported no discernable loss or difference in ankle function. He is satisfied and back in training and our team has video and photographs that substantiate his progress. Conclusion: FDM allows regeneration of long bone defects. However, we aimed to also restore his eversion and inversion that is imperative for footballers and hence reattached his previously dissected muscles along the length of the Osteopore implant. We believe that the reattachment of the muscle stabilizes not only the construct but allows optimum muscle tensioning when moving his ankle. This is a simple but effective technique in restoring complete function and form in a young patient whose minute muscle control is imperative to life.

Keywords: fused deposition modelling, functional reconstruction, lower limb bony defects, regenerative surgery, 3D printing, tissue engineering

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Authors: Badryah Alshehri, Kevin Gormley, Gillian Prue, Karen McCutcheon

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In a disaster event, sharing patient information between the pre-hospitals Emergency Medical Services (EMS) and Emergency Department (ED) hospitals is a complex process during which important information may be altered or lost due to poor communication. The aim of this study was to critically discuss the current evidence base in relation to communication between pre-EMS hospital and ED hospital professionals by the use of Information and Communication Systems (ICT). This study followed the systematic approach; six electronic databases were searched: CINAHL, Medline, Embase, PubMed, Web of Science, and IEEE Xplore Digital Library were comprehensively searched in January 2018 and a second search was completed in April 2020 to capture more recent publications. The study selection process was undertaken independently by the study authors. Both qualitative and quantitative studies were chosen that focused on factors which are positively or negatively associated with coordinated communication between pre-hospital EMS and ED teams in a disaster event. These studies were assessed for quality and the data were analysed according to the key screening themes which emerged from the literature search. Twenty-two studies were included. Eleven studies employed quantitative methods, seven studies used qualitative methods, and four studies used mixed methods. Four themes emerged on communication between EMTs (pre-hospital EMS and ED staff) in a disaster event using the ICT. (1) Disaster preparedness plans and coordination. This theme reported that disaster plans are in place in hospitals, and in some cases, there are interagency agreements with pre-hospital and relevant stakeholders. However, the findings showed that the disaster plans highlighted in these studies lacked information regarding coordinated communications within and between the pre-hospital and hospital. (2) Communication systems used in the disaster. This theme highlighted that although various communication systems are used between and within hospitals and pre-hospitals, technical issues have influenced communication between teams during disasters. (3) Integrated information management systems. This theme suggested the need for an integrated health information system which can help pre-hospital and hospital staff to record patient data and ensure the data is shared. (4) Disaster training and drills. While some studies analysed disaster drills and training, the majority of these studies were focused on hospital departments other than EMTs. These studies suggest the need for simulation disaster training and drills, including EMTs. This review demonstrates that considerable gaps remain in the understanding of the communication between the EMS and ED hospitals staff in relation to response in disasters. The review shows that although different types of ICTs are used, various issues remain which affect coordinated communication among the relevant professionals.

Keywords: communication, emergency communication services, emergency medical teams, emergency physicians, emergency nursing, paramedics, information and communication technology, communication systems

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Authors: Henok Metaferia Gebremariam

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Worldwide, considerable resources are spent implementing public health interventions that are interrupted soon after the initial funding ends. However, ambiguity remains as to how health programs can be effectively sustained over time because of the diversity of perspectives, definitions, study methods, outcomes measures and timeframes. From all the above-mentioned research challenges, standardized measures of sustainability should ultimately become a key research issue. To resolve this key challenge, the objective of the study was to adapt a tool for measuring the program’s capacity for sustainability and evaluating its reliability and validity. To adapt and validate the tool, a cross-sectional and cohort study design was conducted at 26 programs in Addis Ababa between September 2014 and May 2015. An adapted version of the tool after the pilot test was administered to 220 staff. The tool was analyzed for reliability and validity. Results show that a 40-item PSAT tool had been adapted into the Amharic version with good internal consistency (Cronbach’s alpha= 0.80), test-retest reliability(r=0.916) and construct validity. Factor analysis resulted in 7 components explaining 56.67 % of the variance. In conclusion, it was found that the Amharic version of PAST was a reliable and valid tool for measuring the program’s capacity for sustainability.

Keywords: program sustainability, public health interventions, reliability, validity

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Authors: Won-Gon Kim

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A standardized system to describe the pressure-flow characteristics of a given cannula has recently been proposed and has been termed ‘the M-number’. Using three different sizes of aortic cannulas in 50 pediatric cardiac patients on hypothermic cardiopulmonary bypass, we analyzed the correlation between experimentally and clinically derived M-numbers, and found this was positive. Clinical M-numbers were typically 0.35 to 0.55 greater than experimental M-numbers, and correlated inversely with a patient's temperature change; this was most probably due to increased blood viscosity, arising from hypothermia. This inverse relationship was more marked in higher M-number cannulas. The clinical data obtained in this study suggest that experimentally derived M-numbers correlate strongly with clinical performance of the cannula, and that the influence of temperature is significant.

Keywords: cardiopulmonary bypass, M-number, aortic cannula, pressure-flow characteristics

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Authors: Atitallah Sofien, Bouyahia Olfa, Romdhani Meriam, Missaoui Nada, Ben Rabeh Rania, Yahyaoui Salem, Mazigh Sonia, Boukthir Samir

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Introduction: Traditional medicine refers to a diverse range of therapeutic practices and knowledge systems that have been employed by different cultures over an extended period to uphold and rejuvenate health. These practices can involve herbal remedies, acupuncture, massage, and alternative healing methods that deviate from conventional medical approaches. In Tunisia, we often use unidentified utensils to scratch the oral cavity internally in infants in order to widen the oral cavity for better breathing and swallowing. However, these practices can be risky and may jeopardize the patients' prognosis or even their lives. Aim: This is the case of a nine-month-old infant, admitted to the pediatric department and subsequently to the intensive care unit due to a peritonsillar abscess following the utilization of an unidentifiable tool to scrape the interior of the oral cavity. Case Report: This is a 9-month-old infant with no particular medical history, admitted for high respiratory distress and a fever persisting for 4 days. On clinical examination, he had a respiratory rate of 70 cycles per minute with an oxygen saturation of 97% and subcostal retractions, along with a heart rate of 175 beats per minute. His white blood cell count was 40,960/mm³, and his C-reactive protein was 250 mg/L. Given the severity of the clinical presentation, the infant was transferred to the intensive care unit, intubated, and mechanically ventilated. A cervical-thoracic CT scan was performed, revealing a ruptured 18 mm left peritonsillar abscess in the oropharynx associated with cellulitis of the retropharyngeal space. The oto-rhino-laryngoscopic examination revealed an asymmetry involving the left lateral wall of the oropharynx with the presence of a fistula behind the posterior pillar. Dissection of the collection cavity was performed, allowing the drainage of 2 ml of pus. The culture was negative. The patient received cefotaxime in combination with metronidazole and gentamicin for a duration of 10 days, followed by a switch to amoxicillin-clavulanic acid for 7 days. The patient was extubated after 4 days of treatment, and the clinical and radiological progress was favorable. Conclusions: Traditional medicine remains risky due to the lack of scientific evidence and the potential for injuries and transmission of infectious diseases, especially in children, who constitute a vulnerable population. Therefore, parents should consult healthcare professionals and rely on evidence-based care.

Keywords: children, peritonsillar abscess, traditional medicine, respiratory distress

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Authors: Marvin R. Tenecio

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The analysis of "religious resistance" has been prevalent in Asian and Philippine studies. Discussions on religious resistance from a variety of perspectives are deemed as crucial turning points in the concept's ongoing development and expansion. By broadening the backdrop of religious protest between the early 1960s and the late 1980s, the researchers contend that a study examining the role carried by the Catholic Church in the upheavals against dictatorships in South Korea and the Philippines would be beneficial to the body of knowledge. This study examines a variety of historical writings about the activities occurring at that time. The researchers also compare and contrast the Catholic Church's contributions to the Korean and Philippine resistance against Park Chung-Hee and Ferdinand Marcos Sr., respectively, during the early 1960s until the late 1980s, using the lens of history from below, particularly the Pasyon and Revolution. The Catholic Church stood out against human rights abuses, promoted social justice, and mobilized the public for political reform in response to the dictatorships in South Korea and the Philippines. Even though the specific circumstances and personalities may have changed, the Church's position in both countries was vital in opposing authoritarian governments and supporting democratic movements.

Keywords: resistance, movements, catholic, church, dictatorship

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Authors: Ilona Buchem, Carolin Gellner

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Over the last few years, the call for the support of senior learners in the development of their digital literacy has become prevalent, mainly due to the progression towards ageing societies paired with advances in digitalisation in all spheres of life, including e-health and electronic patient record (EPA). While major research efforts in supporting senior learners in developing digital literacy have been invested so far in e-learning focusing on knowledge acquisition and cognitive tasks, little research exists in learning models which target virtual mentoring and coaching with the help of pedagogical agents and address the social dimensions of learning. Research from studies with students in the context of formal education has already provided methods for designing intelligent virtual agents in support of personalised learning. However, this research has mostly focused on cognitive skills and has not yet been applied to the context of mentoring/coaching of senior learners, who have different characteristics and learn in different contexts. In this paper, we describe how insights from previous research can be used to develop an intelligent virtual learning coach (agent) for senior learners with a focus on building the social relationship between the agent and the learner and the key task of the agent to socialize learners to the larger context of digital literacy with a focus on electronic health records. Following current approaches to mentoring and coaching, the agent is designed not to enhance and monitor the cognitive performance of the learner but to serve as a trusted friend and advisor, whose role is to provide one-to-one guidance and support sharing of experiences among learners (peers). Based on literature review and synopsis of research on virtual agents and current coaching/mentoring models under consideration of the specific characteristics and requirements of senior learners, we describe the design framework which was applied to design an intelligent virtual learning coach as part of the e-learning system for digital literacy of senior learners in the ePA-Coach project founded by the German Ministry of Education and Research. This paper also presents the results from the evaluation study, which compared the use of the first prototype of the virtual learning coach designed according to the design framework with a voice narration in a multimedia learning environment with senior learners. The focus of the study was to validate the agent design in the context of the persona effect (Lester et al., 1997). Since the persona effect is related to the hypothesis that animated agents are perceived as more socially engaging, the study evaluated possible impacts of agent coaching in comparison with voice coaching on motivation, engagement, experience, and digital literacy.

Keywords: virtual learning coach, virtual mentor, pedagogical agent, senior learners, digital literacy, electronic health records

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Authors: Eyup Ozkan, Ozkan U. Nalbantoglu, Aycan Gundogdu, Mehmet Hora, A. Emre Onuk

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The human microbiome has been associated with cardiological conditions and this relationship is becoming to be defined beyond the gastrointestinal track. In this study, we investigate the alteration in circulatory microbiota in the context of Coronary Artery Disease (CAD). We received circulatory blood samples from suspected CAD patients and maintain 16S ribosomal RNA sequencing to identify each patient’s microbiome. It was found that Corynebacterium and Methanobacteria genera show statistically significant differences between healthy and CAD patients. The overall biodiversities between the groups were observed to be different revealed by machine learning classification models. We also achieve and demonstrate the performance of a diagnostic method using circulatory blood microbiome-based estimation.

Keywords: coronary artery disease, blood microbiome, machine learning, angiography, next-generation sequencing

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Authors: Meng-Yu Wun, Jiunde Lee

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Participatory design transfers the role of design team becoming the facilitator who manages to work collaboratively with the 'partners of innovation': users. This facilitator role not just concerns the users’ behaviors or insights under the common practice of user-centered design, it emphasizes the importance of communication experience conducted by various strategies and tools in a workshop session which could profoundly impact the quality of the co-creation process. To investigate the communication experience in the participatory design, this study proposed a qualitative research to analyze communication strategies and tools. A participatory design workshop and following in-depth interviews were carried out to explore how participants (facilitators, users) might apply different strategies and tools to enhance the communication process. The major study findings are as follows: (a) roles had influence on communication experience; facilitators’ principles and methods influenced the usage of facilitation strategies in various situations, while users put more emphasis on communication activities and goals aimed to complete the design tasks, (b) communication tools should be both fixed and changeable: participants had fixed cognition on different forms of communication tools; with the fundamental cognition, they could choose and make use of tools according to their needs, (c) the management of workshop communication should be flexible: controlling the schedule, stimulating innovations, and creating the space for conversation are crucial to facilitate in a participatory workshop.

Keywords: communication experience, facilitation, participatory design, workshop

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Authors: Eriba Christopher Inyila, Godwin Egena Oga

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Statecraft appears to be one of the greatest cultural achievements in the history of man’s civilization. The state itself is often portrayed as the supreme community of the citizen’s collective goodness and will. However, history experience reveals that the state has often been held in captivity permanently in the hand of the political class to almost a total exclusion of the labouring class of workers, artisans and peasants. Consequently, the hallmark of the Nigerian state and society in contemporary era is state of permanent crisis characterized by poverty, unemployment and profound insecurity. A lasting solution to this state of anomie is often touted in terms of ethnic, religious and regional integration which border on non-material perception of realities. A neglected aspect of the approach to the study of recurrent problems in contemporary is the materialist conception of realties through class perspectives of the society. The cutting edge of the approach is found in the attempt to reconcile the contradiction between the productive forces and the social relation of production. In other words, the contemporary state is skewed in favour of ownership of properties/commanding height of economy predominantly in the hands of the few monopoly companies to the total exclusion of majority of Nigerian population classified as peasant, workers and artisan. The lopsided situation creates economic and social disequilibria.

Keywords: national development, class, the state, Nigeria

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