Search results for: consent

Authors: Jamuna Rajeswaran

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In the past two decades, with a population of more than a billion. India is passing through a major socio-demographic and epidemiological transition with consequent changes in health scenario. TBI constitute significant burden on health care resources in India The impact on a person and family can be devastating. Patients with TBI experience persistent cognitive deficits, emotional changes, which contribute to the disruption of life activities. The recovery of TBI would be maximized by appropriate rehabilitation. Neurofeedback is an emerging neuroscience-based clinical application. Sixty patients were recruited for this study after obtaining informed consent. Rivermead Head Injury Follow-up Questionnaire, Rivermead Post Concussion Symptoms Questionnaire and Visual Analog Scale were used to assess the behavioral and symptomotolgy associated with post TBI. Neuropsychological assessment was carried out using NIMHANS neuropsychological battery 2004. The Intervention group received neurofeedback training and the waitlist group did not receive any treatment during this phase. Patients were allocated to intervention and waitlist group at random. There were 30 patients in each group. Patients were given 20 sessions of NFT Patients were trained on the O1 and O2 channels for alpha theta training. Each session was of 40 minutes duration with 5-6 sessions per week. The post-training assessment was carried out for the intervention group after 20 sessions of NFT. The waitlist group underwent assessment after one month. Results showed neurofeedback training is effective in ameliorating deficits in cognitive functions and quality of life in patients with TBI. Improvements were corroborated by the clinical interview with patients and significant others post NFT.

Keywords: assessment, rehabilitation, cognition, EEG neurofeedback

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Authors: Teja Joshi

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Laterality has shown to play a role in performance as well as injuries especially in unilateral sports disciplines. Uniquely, Artistic Gymnastics involves combination of unilateral, bilateral and complex multi-planer elements as well as gymnastics specific rotational preference. Therefore, this study was conducted to explore if any such preferences are associated with number of injuries in artistic gymnasts. To explore the association between lateral preferences, rotational preferences and injuries incidence in artistic gymnastics. Artistic gymnasts above 16 years of age, were invited to participate in an online survey. The survey included consent, lateral preference inventory, injury data collection according to anatomical locations and rotational preference for selected gymnastics elements performed on the floor exercise. SPSS version 24 was used to analyse Non-parametric data using Kruskal-Wallis (K- independent test) test. Multiple regression was performed to identify the predictor for injuries and their side in gymnasts. Total number of injuries per gymnast was associated with handedness (p value-0.049) and no significant association was noted for footdness (p value-0.207), eyedness (p value-0.491) and eardness (p value-0.798). Additionally, rotational preferences did not influence number of injuries (p value-0.521). In multiple regression, eyedness was identified as a predicting factor to determine the number of injuries. Rotational preferences were neither determined as a national strategy nor a product of lateral preference. Dominant hand had higher number of injuries in artistic gymnasts. Rotational preference is independent of laterality, number of injuries and nationality.

Keywords: sports injury, rotational preference, gymnastics, handedness

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Authors: Sheimah El Bejjaji, Lara Gorsek, Chandler Quilchez, Joaquim Suñer, Mireia Mallandrich

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Flurbiprofen is an anti-inflammatory drug used in several treatments. The purpose of this study was to compare the permeation of two different formulations of flurbiprofen through the human skin. The first formulation was a solution of flurbiprofen dissolved with polyethylene glycol 3350 (PEG 3350). The second formulation was flurbiprofen encapsulated in poly-ɛ-caprolactone (PɛCL) nanoparticles (NPs), stabilized with poloxamer 188, submitted individually for freeze-drying with PEG 3350 as a cryoprotectant and sterilized by gamma-irradiation. Human skin was obtained from the abdominal region of a healthy patient. The experimental protocol was approved by the Bioethics Committee of Barcelona SCIAS Hospital (Spain), and they obtained the written informed consent forms. After being frozen to -20ºC, the skin samples were cut with a dermatome at 400 µm. The ex vivo permeation study was performed in Franz diffusion cells with a diffusion area of 2.54 cm². Skin samples were placed between two compartment sites, the dermal side in contact with the receptor medium and the epidermis side in contact with the donor chamber to which the formulation was applied. The permeation study was conducted for 24 hours at 32 ± 0.5 °C in accordance with sink conditions. The results were analyzed with an unpaired t-test, and the p-values indicate the formulation with nanoparticles had a higher permeability coefficient, flux, partition parameter, diffusion parameter, and lag time. The applicability of this formulation topically can benefit articulations and ligament inflammation as an alternative to oral drugs.

Keywords: anti-inflammatory drug, flurbiprofen, human skin, nanoparticles, skin permeation

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Authors: Dechen Tshering Vogel, Johannes T. Heverhagen, Bernard Kiss, Spyridon Arampatzis

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In addition to computed tomography (CT), contrast enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI) are being increasingly used for imaging of renal lesions. The aim of this prospective study was to compare the classification of complex cystic renal lesions using the Bosniak classification with CEUS and MRI to CT. Forty-eight patients with 65 cystic renal lesions were included in this study. All participants signed written informed consent. The agreement between the Bosniak classifications of complex renal lesions ( ≥ BII-F) on CEUS and MRI were compared to that of CT and were tested using Cohen’s Kappa. Sensitivity, specificity, positive and negative predictive values (PPV/NPV) and the accuracy of CEUS and MRI compared to CT in the detection of complex renal lesions were calculated. Twenty-nine (45%) out of 65 cystic renal lesions were classified as complex using CT. The agreement between CEUS and CT in the classification of complex cysts was fair (agreement 50.8%, Kappa 0.31), and was excellent between MRI and CT (agreement 93.9%, Kappa 0.88). Compared to CT, MRI had a sensitivity of 96.6%, specificity of 91.7%, a PPV of 54.7%, and an NPV of 54.7% with an accuracy of 63.1%. The corresponding values for CEUS were sensitivity 100.0%, specificity 33.3%, PPV 90.3%, and NPV 97.1% with an accuracy 93.8%. The classification of complex renal cysts based on MRI and CT scans correlated well, and MRI can be used instead of CT for this purpose. CEUS can exclude complex lesions, but due to higher sensitivity, cystic lesions tend to be upgraded. However, it is useful for initial imaging, for follow up of lesions and in those patients with contraindications to CT and MRI.

Keywords: Bosniak classification, computed tomography, contrast enhanced ultrasound, cystic renal lesions, magnetic resonance imaging

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Authors: L. José, S. Vieira, E. Melo, A. R. Pinheiro

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Objectives: This study aims to characterize the stroke profile and the health care provided for people with a stroke in Luanda, Angola. Methods: A prospective longitudinal study was conducted at two Health centers, from March to November 2023, enrolling stroke patients. Data was gathered using a survey created by the researchers and validated by a health panel of experts from Angola. The analysis focused on demographic and stroke characteristics, as well as the care provided. Ethical approval and informed consent were obtained. Results: Preliminary results of a total of 186 patients are described, 122 from a Central Acute Care Hospital, with a mean age of 51.3±14.35 years old, a BMI of 26.7±4.15 kg/m2, 41% male, and 64 patients from a Rehabilitation Center, with 55.6±11.55 years old, a BMI of 27.0±3.8 kg/m2, 53% male. Ischemic stroke was reported as the most representative type in both centers (71.3% and 70.3%, respectively), though 100% of patients had no imaging diagnosis confirmation, neither data about the subtype was given. For patients admitted to the Hospital, discharge occurred before rehabilitation, and no follow-up was possible. No rehabilitation care was delivered in the first 7 days after the stroke. In the Rehabilitation Center, patient’s rehabilitation started in the late subacute phase, after a mean of 171.8±11.5 days. Conclusions: Stroke diagnosis lacks imaging confirmation, which is decisive for proper treatment, and rehabilitation starts during the late subacute phase, which is too late considering the international guidelines and the best window of opportunity for neuroplasticity and recovery. These results highlight the urgent need for the definition of Stroke-directed Health Care Policies in Angola.

Keywords: stroke, personalized health care, functional recovery, quality of life, health policies

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Authors: Jabulani Gilford Kheswa

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This paper reports on the effects of unemployment on the sexual behaviour of male youth. Drawing from Jahoda’s deprivation theory, unemployed male youth is prone to psychological distress and as a result, they resort to drugs and alcohol abuse as a way to cope with discrimination. Studies showed that such youth is more inclined to be sexually aggressive and very often engage in criminal activities and risky sexual behaviour such as multiple sexual partners and unprotected sex to cover their feelings of emotional insecurities and negative self-concept. The purpose of the study was to investigate the impact of unemployment on the sexual behaviour of Xhosa- speaking male youth, aged 19-35, from Quzini Location, Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual design was followed using phenomenological method. The purposively sampled comprised fifteen unemployed males who gave their informed consent to be interviewed. For trustworthiness of the study, the researcher met the Lincoln and Guba’s principles, namely; credibility, dependability confirmability and transferability. The following themes were identified, namely; patriarchy, gender- based violence, drug abuse, stigma and discrimination, criminal activities, depression and low- self-esteem. Based on the findings, the recommendations are that the government and private sectors should create jobs aimed at reducing unemployment for unemployed youth and psycho-educational programmes that will equip them in the areas of sexual values and attitudes, communication and decision-making skills.

Keywords: discrimination, male-youth, sex, unemployment

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Authors: Pankhudi Khandelwal

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The revenue models of digital giants such as Facebook and Google, use targeted advertising for revenues. Such a model requires huge amounts of consumer data. While the data protection law deals with the protection of personal data, however, this data is acquired by the companies on the basis of consent, performance of a contract, or legitimate interests. This paper analyses the role that competition law can play in evading these loopholes for the protection of data and privacy of online consumers. Digital markets have certain distinctive features such as network effects and feedback loop, which gives incumbents of these markets a first-mover advantage. This creates a situation where the winner takes it all, thus creating entry barriers and concentration in the market. It has been also seen that this dominant position is then used by the undertakings for leveraging in other markets. This can be harmful to the consumers in form of less privacy, less choice, and stifling innovation, as seen in the cases of Facebook Cambridge Analytica, Google Shopping, and Google Android. Therefore, the article aims to provide a legal framework wherein the data protection law and competition law can come together to provide a balance in regulating digital markets. The issue has become more relevant in light of the Facebook decision by German competition authority, where it was held that Facebook had abused its dominant position by not complying with data protection rules, which constituted an exploitative practice. The paper looks into the jurisdictional boundaries that the data protection and competition authorities can work from and suggests ex ante regulation through data protection law and ex post regulation through competition law. It further suggests a change in the consumer welfare standard where harm to privacy should be considered as an indicator of low quality.

Keywords: data protection, dominance, ex ante regulation, ex post regulation

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Authors: Marissa C. Esperal

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This university-based research project attempted to determine the relevance and effectiveness of the technology-based psychological services extended to selected adults experiencing symptoms of mild anxiety and depression. Ninety-seven participants who voluntarily availed the free online psychological services advertised through a Facebook page (Techno-Psych Serv) signed up for the Informed Consent and Psychological Services Contract Agreement form. These clients availed a maximum of 5 online sessions devoted to online assessment, online counseling and brief therapy sessions using the Google Meet App. Participants who, upon evaluation, were found to still be needing extended psychological and other services were referred to other mental health services institutions. Post-evaluations were conducted using Google Forms upon termination. Findings showed that with a mean of 4.87 (n=97), it was noted that the services provided through the online platform were effective. However, it was noted that the majority of those who availed the services were professionals and skilled workers, thus defeating the objective of extending free psychological services to the marginalized group. It was concluded that offering free technology-based psychological services, though proven effective, is found to be less relevant if the intention is to reach out to the less fortunate and marginalized group. It was further concluded that there is still a need for psychoeducation and mental health promotion among the marginalized sectors. It was recommended that if mental health services are extended to the community of marginalized group, providing physical services are still a better option.

Keywords: technology-based psychological services, adults, mild anxiety, depression

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Authors: Shantanu Prakash, Suruchi Shukla, Amita Jain

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Introduction: The hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. Injection drug use and individuals receiving blood and blood products are the primary modes of HCV transmission. Our study aims to establish the prevalent genotypes/ subtypes of HCV circulating in Uttar Pradesh, North India, as reported from a tertiary care hospital. Methods: It is a retrospective observational analysis of consecutive 404 HCV RNA positive cases referred to our hospital during September 2014 to April 2017. The study was approved by an institutional ethics committee. Written informed consent was taken from each participant. Clinical and demographic details of these patients were recorded using predesigned questionnaires. All the laboratory testing was carried on stored serum sample of enrolled cases. Genotyping of all 404 strains was done by Sanger’s sequencing of the core region. The phylogenetic analysis of 179 HCV strains with high -quality sequencing data was performed. Results: The distribution of prevalent genotypes/ subtypes as noted in the present study was; Genotype (GT)1a [n-101(25%)], GT1b [n-12(2.9%)], GT1c [1(0.25%)], GT3a [275(68.07%)], GT3b [9(2.2%)], GT3g [2(0.49%)], GT3i [3(0.74%)], and GT4a [1(0.24%)]. HCV genotypes GT2, GT5 and GT6 were not detected from our region. Sequence analysis showed high genotypic variability in HCV GT3. Phylogenetic analysis showed that HCV GT3 and GT1 circulating in our region were related to Indian strains reported earlier. Conclusions: HCV genotypes 3a and 1a are commonest circulating genotypes in Uttar Pradesh (UP), India.

Keywords: Hepatitis C virus, genetic variation, bioinformatics, genotype, HCV

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Authors: Orkide Donma, M. Metin Donma, Burcin Nalbantoglu, Birol Topcu, Feti Tulubas, Murat Aydin, Tuba Gokkus, Ahmet Gurel

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Increasing prevalence of childhood obesity has increased the interest in early and late indicators of gaining weight. Cell blood counts may be indicators of proinflammatory states. The aim was to evaluate associations of hematological parameters, including Hematocrit (HTC), hemoglobin, blood cell counts, and their indices with the degree of obesity in pediatric population. A total of 249; -139 morbidly obese (MO), 82 healthy Normal Weight (NW) and 28 Overweight (OW) children were included into the scope of the study. WHO BMI-for age percentiles were used to form age- and sex-matched groups. Informed consent forms and the Ethics Committee approval were obtained. Anthropometric measurements were performed. Hematological parameters were determined. Statistical analyses were performed using SPSS. The degree for statistical significance was p≤0.05. Significant differences (p=0.000) between waist-to-hip ratios and head-to-neck ratios (hnrs) of MO and NW children were detected. A significant difference between hnrs of OW and MO children (p=0.000) was observed. Red cell Distribution Width (RDW) was higher in OW children than NW group (p=0.030). Such finding couldn’t be detected between MO and NW groups. Increased RDW was prominent in OW children. The decrease in Mean Corpuscular Hemoglobin Concentration (MCHC) values in MO children was sharper than the values in OW children (p=0.006 vs p=0.042) compared to those in NW group. Statistically higher HTC levels were observed between MO-NW (p=0.014), but none between OW-NW. Though the cause-effect relationship between obesity and erythrocyte indices still needs further investigation, alterations in RDW, HTC, MCHC during obesity may be of significance in the early life.

Keywords: anthropometry, children, erythrocytes, obesity

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Authors: Marica Pidor-Quingco, Francis Cabatingan

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Background: One of the essential roles of a physician is to assess a patient’s worth and support them in making decisions regarding their future preferences when it comes to medical care. Advance Directives is a patient-centered approach which is liked to a better-quality treatment at the end of life. General Objective: To assess and describe the knowledge, attitudes and practices of resident physicians regarding advance directive among the resident physicians in Vicente Sotto Memorial Medical Study. Methods: An analytical cross-sectional study was conducted at Vicente Sotto Memorial Medical Center. There was a total of 129 respondents who gave their consent and was given survey questionnaire containing the demographic profile, knowledge, attitude and practices. Categorical variables were presented as frequency and percentage. Chi Square Test was used to determine the association of demographic profile with knowledge and attitude. Man-Whitney U test was utilized for the association of age with knowledge and attitude. Results: Out of 129 respondents, 36.59% were in favor towards self-determination and autonomy. Majority of the revealed an adequate knowledge and positive attitude regarding advance directives. Based on the results, there were no significant correlations between sociodemographic of the residents towards to knowledge and attitude. Over 66.7% of the respondents had used Advance Directives to their patients but 25% were not comfortable about it. Though most of the respondents was able to discuss AD with their patients, 7.0% of them are not willing to open the topic to the family. Conclusion: VSMMC is a tertiary hospital which also caters Hospice, Palliative and Supportive care to the patients. One of the services offered is initiating Advance Directives which may be a factor for a positive knowledge, attitude and practices towards this topic.

Keywords: advance directives, philippines, physicians, palliative

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Authors: Mehdi Razeghi

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Background: The purpose of this case series was to quantify gait to study muscular dystrophy disease. In this research, the quantitative differences between normal and waddling gaits were assessed by force plate analysis. Methods: Nineteen myopathy patients and twenty normal subjects serving as the control group participated in this research. In this study, quantitative analyses of gait have been used to investigate the differences between the mobility of normal subjects and myopathy patients. This study was carried out at the Iranian Muscular Dystrophy Association in Boali Hospital, Tehran, Iran, from October 2015 to July 2020. Patient data were collected from Iranian Muscular Dystrophy Association members. individuals signed an informed consent form approved by the ethics committee of the Azad University. All of the gait tests were performed using a Kistler force platform. Participants walked at a self-selected speed, barefoot, independently, and without assistive devices. Results: Our findings indicate that there were no significant differences between the patients and the control group in the anterior-posterior components of the ground reaction forces; however, there were considerable differences in the force components between the groups in the medial-lateral and vertical directions of the ground reaction force. In addition, there were significant differences in the time parameters between the groups in the vertical and medial-lateral directions.

Keywords: biomechanics, force plate analysis, gait disorder, ground reaction force, kinetic analysis, myopathy disease, rehabilitation engineering

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Authors: Roshan Kamal Topno, Maneesh Kumar, Manas Ranjan Dikhit, Krishna Pandey, Major Madhukar, Vidhya Nand Rabidas, Vahab Ali, Ganesh Chandra Sahoo, Bhawana, Devendra Prasad Yadav, Rishikesh Kumar, Pradeep Das

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A diagnostic marker for asymptomatic subject becomes a crucial need for advocating early prophylactic majors to control protozoal infection. The main issue in epidemiological affected regions is the presence of an asymptomatic individual that might potentially convert to a symptomatic visceral leishmaniasis (VL). The epidemiological study has been conducted at highly VL endemic Moriyama village in Patna district, Bihar, India that covers total population of 1540 individuals. Here, 1104(74.02%) people had been randomly screened and only 46 (4.17%) asymptomatic individuals were found sero-positive by the rK39 test. After taking signed informed consent form, blood samples were collected from 46 asymptomatic subjects for further hematological and immunological tests. Total leukocyte count, hemoglobin (gm%), neutrophil, lymphocyte, platelet count and interleukin-10 (IL-10) had been included as diagnostic markers. Interestingly only 5 (10.86%) individuals showed their asymptomatic conversion into symptomatic VL patients during quarterly surveillance. In overall analysis only two markers are suggestive for disease conversion that is hemoglobin (gm%) and IL-10. In all the infected patients, both the mean decrease in hemoglobin and mean increase of IL-10 was 19.23% from its normal value. The results might suggest that hematological and immunological changes would become helpful for early diagnosis of asymptomatic to symptomatic VL conversion.

Keywords: asymptomatic, epidemiological, symptomatic visceral leishmaniasis, hemoglobin (gm%), interleukin-10, diagnosis

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Authors: Mohamed M. Diab, Koura G. Mohamed, A. Balbaa, Radwan Sh. Ahamed

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Background: Chronic mechanical low back pain (CMLBP) is the most common complaint of the working-age population. Mechanical low back pain is often a chronic, dull, aching pain of varying intensity that affects the lower spine. In the current proposal the hip rotation-CMLBP relationship is based on that limited hip motion will be compensated by motion in the lumbopelvic region and this increase force translates to the lumbar spine. The purpose of this study was to investigate if there a relationship between chronic mechanical low back pain (CMLBP) and hip medial and lateral rotation (peak torque and Range of motion (ROM) in patients with CMLBP. Methods: Sixty patients with CMLBP diagnosed by an orthopedist participated in the current study after signing a consent form. Their mean of age was (23.76±2.39) years, mean of weight (71.8±12.7) (Kg), mean of height (169.65±7.49) (Cm) and mean of BMI (25.5±3.86) (Kg/m2). Visual Analogue Scale (VAS) was used to assess pain. Fluid Filled Inclinometer was used to measure Hip rotation ROM (medial and lateral). Isokinetic Dynamometer was used to measure peak torque of hip rotators muscles (medial and lateral), concentric peak torque with tow Isokinetic speeds (60ᵒ/sec and 180ᵒ/sec) was selected to measure peak torque. Results: The results of this study demonstrated that there is poor relationship between pain and hip external rotation ROM, also there is poor relation between pain and hip internal rotation ROM. There is poor relation between pain and hip internal rotators peak torque and hip external rotators peak torque in both speeds. Conclusion: Depending on the current study it is not recommended to give an importance to hip rotation in treating Chronic Mechanical Low Back Pain.

Keywords: hip rotation ROM, hip rotators strength, low back pain, chronic mechanical

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Authors: Akaki Qatamidze

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Implementation of the project will be a step forward in terms of reliability in Georgia and the improvement of the construction and the development of construction. Completion of the project is expected to result in a complete knowledge, which is expressed in concrete and stone structures of assessing the technical condition of the processing. This method is based on a detailed examination of the structure, in order to establish the injuries and the elimination of the possibility of changing the structural scheme of the new requirements and architectural preservationists. Reinforced concrete and stone structures research project carried out in a systematic analysis of the important approach is to optimize the process of research and development of new knowledge in the neighboring areas. In addition, the problem of physical and mathematical models of rational consent, the main pillar of the physical (in-situ) data and mathematical calculation models and physical experiments are used only for the calculation model specification and verification. Reinforced concrete and stone construction defects and failures the causes of the proposed research to enhance the effectiveness of their maximum automation capabilities and expenditure of resources to reduce the recommended system analysis of the methodological concept-based approach, as modern science and technology major particularity of one, it will allow all family structures to be identified for the same work stages and procedures, which makes it possible to exclude subjectivity and addresses the problem of the optimal direction. It discussed the methodology of the project and to establish a major step forward in the construction trades and practical assistance to engineers, supervisors, and technical experts in the construction of the settlement of the problem.

Keywords: building, reinforced concrete, expertise, stone structures

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Authors: Maria Lita Sudo

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The debate is an effective tool in cultivating critical thinking skills in English classes. It involves writing evidence-based arguments about a resolution in a form of constructive speech and oral discussion using constructive speech, which will then be attacked and defended. In the process of writing, EFL learners may experience anxiety, an emotional problem that affects writing achievement and cognitive processing. Thus, this study explored the sources and effect of English writing anxiety in the context of debate writing with a view to providing EFL teachers pedagogical suggestions in alleviating English writing anxiety in debate writing. The participants of this study are 95 Japanese senior high school EFL learners and 3 Japanese senior high school English teachers. In selecting the participants, opportunity sampling was employed and consent from Japanese English teachers was sought. Data were collected thru (1) observation (2) open-ended questionnaire and (3) semi-structured interview. This study revealed that not all teachers of English in the context of this study recognize the existence of English writing anxiety among their students and that the very nature of the debate, in general, may also be a source of English writing anxiety in the context of debate writing. The interview revealed that English writing anxiety affects students’ ability to retrieve L2 vocabulary. Further, this study revealed different sources of writing anxiety in debate writing, which can be categorized into four main categories: (1) L2 linguistic ability-related factors (2) instructional –related factors, (3) interpersonal-related factors, and (4) debate- related factors. Based on the findings, recommendations for EFL teachers and EFL learners in managing writing anxiety in debate writing are provided.

Keywords: debate, EFL learners, English writing anxiety, sources

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Authors: Jessica Hemberg, Mikaela Miller

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Unreasonable workload and work-related stress can reduce nurse leaders’ job satisfaction and productivity and can increase absence and burnout. Nurse leaders’ workload in public healthcare settings is relatively unresearched. The aim of this study was to investigate nurse leaders’ perceptions of workload and task distribution with relation to leading work tasks in public healthcare. A qualitative explorative design was used. The data material consisted of texts from interviews with nurse leaders in public healthcare (N=8). The method was inspired by content analysis. The COREQ checklist was used. Informed consent was sought from the participants regarding study participation and the storage and handling of data for research purposes. Six main themes were found: Increased and unreasonable workload, Length of work experience as nurse leader affects perception of workload, Number of staff and staff characteristics affect perception of workload, Versatile and flexible task distribution, Working overtime as a way of managing high workload, and Insufficient time for leadership mission. The workload for nurse leaders in a public healthcare setting was perceived to be unreasonable. Common measures for managing high workload included working overtime, delegating work tasks and organizing more staff resources in the form of additional staff. How nurse leaders perceive their workload was linked to both the number of staff and staff characteristics. These should both be considered equally important when determining staff levels and measuring nurse leaders’ workload. Future research should focus on investigating workload and task distribution from nurses’ perspectives.

Keywords: nurse leaders, workload, task distribution, public healthcare, qualitative

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Authors: Bhawana, Roshan Kamal Topno, Maneesh Kumar, Major Madhukar, Krishna Pandey, Ganesh Chandra Sahoo, Manas Ranjan Dikhit, Surya Suman, Devendra Prasad Yadav, Rishikesh Kumar, Pradeep Das

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Viral co-infection is now very common across taxa and environments that are involved in congenital infections. Herpes simplex virus (HSV) and Rubella are the two serious viral infections, well categorized in TORCH Syndrome. Here we had endeavoured the seroprevalence of co-infection of HSV and Rubella. Systematic tests have been performed to check the virulence pattern of the co-infection. The study was conducted at Department of Virology, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, Bihar, India during January 2018-July 2018. 299 newly cases were attended with the sign and symptoms of HSV and Rubella. After taking written consent forms from all the subjects, blood samples were collected for serological detection. ELISA was performed to detect the presence of IgM antibody level. 12 patients were found to be IgM positive from each HSV and Rubella infection. The findings of our study showed that 6 patients were positive for both HSV and rubella and hence were co-infected. Such co-infection causes severe health problems as it leads to the mortality rate of the patients during viral infectivity. Epidemiologically, proper screening should be needed to check any chance of occurrence of such co-infection in the affected regions in large scale and take suitable preventive approach to decrease the case totality. Concern has to be given to aid proper diagnosis and treatment in order to decrease the spread of HSV and Rubella co-infection.

Keywords: HSV, Rubella, seroprevalence, co-infection, ELISA, viral infectivity

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Authors: Fabiana Souza Orlandi, Juliana Gomes Duarte, Gabriela Dutra Gesualdo

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Chronic renal disease (CKD), accompanied by hemodialysis, causes chronic renal failure in a number of situations that compromises not only physical, personal and environmental aspects, but also psychological, social and family aspects. Objective: To verify the level of cognitive impairment of chronic renal patients on hemodialysis. Methodology: This is a descriptive, cross-sectional study. The present study was performed in a Dialysis Center of a city in the interior of the State of São Paulo. The inclusion criteria were: being 18 years or older; have a medical diagnosis of CKD; being in hemodialysis treatment in this unit; and agree to participate in the research, with the signature of the Informed Consent (TCLE). A total of 115 participants were evaluated through the Participant Characterization Instrument and the Addenbrooke Cognitive Exam - Revised Version (ACE-R), being scored from 0 to 100, stipulating the cut-off note for the complete battery <78 and subdivided into five domains: attention and guidance; memory; fluency; language; (66.9%) and caucasian (54.7%), 53.7 (±14.8) years old. Most of the participants were retired (74.7%), with incomplete elementary schooling (36.5%) and the average time of treatment was 46 months. Most of the participants (61.3%) presented impairment in the area of attention and orientation, 80.4% in the spatial visual domain. Regarding the total ACE-R score, 75.7% of the participants presented scores below the established cut grade. Conclusion: There was a high percentage (75.7%) below the cut-off score established for ACE-R, suggesting that there may be some cognitive impairment among these participants, since the instrument only performs a screening on cognitive health. The results of the study are extremely important so that possible interventions can be traced in order to minimize impairment, thus improving the quality of life of chronic renal patients.

Keywords: cognition, chronic renal insufficiency, adult health, dialysis

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Authors: Pratima Tatke, Archana Avhad, Bhanu Duggal, Meeta Rajivlochan, Sujata Saunik, Pradip Vyas, Nidhi Pandey, Aditee Dalvi, Jyothi Subramanian

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Background: Smoking is well established risk factor for the development and progression of coronary artery disease. It is strongly related to morbidity and mortality from cardiovascular causes. The aim of this study is to observe effect of smoking status on percutaneous coronary intervention(PCI) after 1 year. Methods: 2527 patients who underwent PCI at different hospital of Maharashtra(India) from 2012 to 2015 under the health insurance scheme which is launched by Health department, Government of Maharashtra for below poverty line(BPL) families which covers cardiology. Informed consent of patients was taken .They were followed by telephonic survey after 6months to 1year of PCI . Outcomes of interest included myocardial infarction, restenosis, cardiac rehospitalization, death, and a composite of events after PCI. Made group of two non smokers-1861 and smokers (including patients who quit at time of PCI )-659. Results: Statistical Analysis using Pearson’s chi square test revealed that there was trend seen of increasing incidence of death, Myocardial infarction and Restenosis in smokers than non smokers .Smokers had a greater death risk compared to nonsmoker; 5.7% and 5.1% respectively p=0.518. Also Repeat procedures (2.1% vs. 1.5% p=0.222), breathlessness (17.8% vs. 18.20% p=0.1) and Myocardial Infarction (7.3% vs. 10%) high in smoker than non smokers. Conclusion: Major adverse cardiovascular events (MACE) were observed even after successful PCI in smokers. Patients undergoing percutaneous coronary intervention should be encouraged to stop smoking.

Keywords: coronary artery diseases, major adverse cardiovascular events, percutaneous coronary intervention, smoking

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Authors: Ashok Pandey, Rajan Adhikari

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Introduction: Menstruation is part of the female reproductive cycle that starts when girls become sexually mature at the time of puberty. It is a phenomenon unique to the females. During a menstrual period, a woman bleeds from her uterus via the vagina. For decades, in many countries, academic school ‘type,’ private or public, as a predictor of or factor in future academic success has been researched and debated. MATERIAL AND METHODS: The comparative study was carried out with adolescent girls studying in both public and private schools of Kathmandu valley. A total of 100 girls participated in the survey, and out of them 21 participated in the FGD and 5 in the in- depth interview. Quantitative data from the survey was analyzed using SPSS 16.0 software. Informed verbal consent with the respective head of school and the respondents were taken before data collection. Results:The age of the respondents ranges from 11 to 18 years, with mean age of menarche being 12.37 years in both school adolescent girls. 70 percent of the public school adolescent girls and 72 percent of the private school adolescent girls are feeling upset and tension during menarche. There is a statistically significant difference on take rest during the period and good hygienic practice during menstruation of public/private school, at α=0. 05 level of significance. There is a statistically significant difference on overall score of practice during menstruation between public and private adolescent girls. Conclusion: Private schools children are more knowledgeable and maintain hygiene as compere to public school even though, it can be said that among the adolescent school girls both in public and private school, menstrual knowledge and perceptions are poor and practices often not optimal for proper hygiene. Often ignored issues of privacy affect the hygienic practices and daily lives.

Keywords: Comparison, Menstruation, Private school, Public School

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Authors: David Segun Adeniyi, Tongvwam P. J., Wekpe S., Owolagba F. E., Ofuche E., Samuels J. O., Okonkwo P.

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Background: Pediatrics HIV viral suppression remains a major challenge across Africa. In this study, we sought to establish the relationship between AMP and sustained plasma HIV viremia among a population of pediatric clients on Antiretroviral Therapy (ART). We also seek to determine the prevalence of AMP among the study population. Methods: 180 pediatrics clients on ART at four (4) Comprehensive Hospitals in Jos, Nigeria, participated in this study between the months of October to December 2022. The mean age of the study participants was 13 years. Venous blood was drawn from the participants after consent was sought, and ethical approval was obtained from the Plateau State Specialist Hospital (PSSH) Research and Ethics Committee. All samples were screened for AMP using the CareStart® HRP2 Malaria kit. The Absolute and % CD4 values of the clients were obtained using the BD Presto® CD4 Analyzer. The separated plasma samples were assayed for HIV viral load using the Roche Cobas C4800® system. Obtained data were analyzed using simple descriptive statistics. Results: From the 180 participants in this study, 12.8% (23) have AMP. 90.6% (163) were virally suppressed (<1000 copies/ml), while 9.4% (17) were virally unsuppressed (>1000 copies/ml). 11.7% (19/163) of the virally suppressed population have AMP, with mean absolute and % CD4 values of 648 and 31%, respectively. The virally suppressed population without AMP has mean absolute and % CD4 values of 719 and 32%, respectively. 24% (4/17) of the virally unsuppressed population have AMP, with mean absolute and % CD4 values of 514 and 26%, respectively. The virally unsuppressed population without AMP has mean absolute and % CD4 values of 292 and 16%, respectively. Conclusion: Our study shows that there is a high prevalence of AMP among the study populations (11.7% and 24%, respectively). The high prevalence of AMP among the virally unsuppressed with mean absolute and % CD4 values of 514 and 26% alludes to the fact that malaria co-infection with HIV fosters a dysregulated immune complex response which favors an increased HIV plasma viremia. We thus recommend the routine use of Malaria IPT in pediatric HIV clients.

Keywords: pediatrics, HIV, Malaria, viral suppression

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Authors: Shih-Heng Sun, Hsiu-Yu Chang

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“Family centered service model” becomes mainstream in early intervention. Family outcome should be evaluated in addition child improvement in terms of outcome evaluation in early intervention. The purpose of this study is to develop a surveys to evaluate family outcomes in early intervention. Method: “Family Outcomes Survey- Revised Taiwan Version” (FOS-RT) was developed through translation, back-translation, and review by the original author. Expert meeting was held to determine the content validity. Two hundred and eighty six parent-child dyads recruited from 10 local Early Intervention Resource Centers (EIRC) participated in the study after they signed inform consent. The results showed both parts of FOS-RT exhibits good internal consistency and test-retest reliability. The result of confirmatory factor analysis indicated moderate fit of 5 factor structure of part A and 3 factor structure of part B of FOS-RT. The correlation between different sessions reached moderate to high level reveals some sessions measure similar latent trait of family outcomes. Correlation between FOS-RT and Parents‘ Perceived Parenting Skills Questionnaire was calculated to determine the convergence validity. The moderate correlation indicates the two assessments measure different parts of early intervention outcome although both assessments have similar sub-scales. The results of this study support FOS-RT is a valid and reliable tool to evaluate family outcome after the family and children with developmental disability receive early intervention services.

Keywords: early intervention, family service, outcome evaluation, parenting skills, family centered

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Authors: Intanri Kurniati, Raja Iqbal Mulya Harahap, Agustyas Tjiptaningrum, Reni Zuraida

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Background: Diabetes mellitus is still increasing and has become a health and social burden in the world. It is known that glycation among various proteins is increased in diabetic patients compared with non-diabetic subjects. Some of these glycated proteins are suggested to be involved in the development and progression of chronic diabetic complications. Among these glycated proteins, glycated hemoglobin (HbA1C) is commonly used as the gold standard index of glycemic control in the clinical setting. HbA1C testing has some methods, and the most commonly used is immunoturbidimetry. This research aimed to compare the HbA1c level between immunoturbidimetry and HbA1C level in T2DM patients. Methods: This research involves 77 patients from Abd Muluk Hospital Bandar Lampung; the patient was asked for consent in this research, then underwent phlebotomy to be tested for HbA1C; the sample was then examined for HbA1C with Turbidimetric Inhibition Immunoassay (TINIA) and High-Performance Liquid Chromatography (HPLC) method. Result: Mean± SD of the samples with the TINIA method was 9.2±1,2; meanwhile, the level HbA1C with the HPLC method is 9.6±1,2. The t-test showed no significant difference between the group subjects. (p<0.05). It was proposed that the two methods have high suitability in testing, and both are eligibly used for the patient. Discussion: There was no significant difference among research subjects, indicating that the high conformity of the two methods is suitable to be used for monitoring patients clinically. Conclusion: There is increasing in HbA1C level in a patient with T2DM measured with HPLC and or Turbidimetric Inhibition Immunoassay (TINIA) method, and there were no significant differences among those methods.

Keywords: diabetes mellitus, glycated albumin, HbA1C, HPLC, immunoturbidimetry

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Authors: Leonardo C. Pacheco-Londoño, Nataly J Galan-Freyle, Lisandro Pacheco-Lugo, Antonio Acosta-Hoyos, Elkin Navarro, Gustavo Aroca-Martinez, Karin Rondón-Payares, Alberto C. Espinosa-Garavito, Samuel P. Hernández-Rivera

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At the Life Science Research Center at Simon Bolivar University, a primary focus is the diagnosis of various diseases, and the use of gold nanoparticles (Au-NPs) in diverse biomedical applications is continually expanding. In the present study, Au-NPs were employed as substrates for Surface-Enhanced Raman Spectroscopy (SERS) aimed at diagnosing kidney diseases arising from Lupus Nephritis (LN), preeclampsia (PC), and Hypertension (H). Discrimination models were developed for distinguishing patients with and without kidney diseases based on the SERS signals from urine samples by partial least squares-discriminant analysis (PLS-DA). A comparative study of the Raman signals across the three conditions was conducted, leading to the identification of potential metabolite signals. Model performance was assessed through cross-validation and external validation, determining parameters like sensitivity and specificity. Additionally, a secondary analysis was performed using machine learning (ML) models, wherein different ML algorithms were evaluated for their efficiency. Models’ validation was carried out using cross-validation and external validation, and other parameters were determined, such as sensitivity and specificity; the models showed average values of 0.9 for both parameters. Additionally, it is not possible to highlight this collaborative effort involved two university research centers and two healthcare institutions, ensuring ethical treatment and informed consent of patient samples.

Keywords: SERS, Raman, PLS-DA, kidney diseases

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Authors: Racheal Ayanga, Nancy Katumba Muwangala, Jane Babirye, Harriet Kivumbi

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Background: Deaf adolescents are vulnerable. Deafness limits their access to resources that are accessed by their hearing peers. There is minimal attention placed on the SRH needs of persons with disabilities, especially in developing countries. We sought to assess barriers to access of SRH education and services for deaf adolescents in Uganda. Methods: We performed a cross sectional study using a questionnaire on knowledge of and access to SRH education and services from a selected sample of deaf adolescents aged 13-19 years at Wakiso Secondary school for the deaf. A consecutive sample of eligible participants was asked to join the study after obtaining informed consent until the target sample size was reached. Results: From 01 Jul 2022 to 30 Jan 2023, 70 quantitative interviews were conducted. Participants’ mean age was 17 years, and 66% were female. 89% had heard about several components of SRH. 99% reported a need for education and services but had challenges with access 85% of the time. 54% reported receipt of education and services from government or private facilities, and the rest from friends, parents, siblings, teachers and the internet. Conclusion: Government needs to look into availing tailored, sustainable SRH education/services to deaf adolescents at health facilities and teach health workers sign language. SRH education to parents, teachers and communities of deaf adolescents improves access in hard-to-reach areas. Integration of services into routine health care is key in creating and improving models of access to wider communities of persons with disabilities to improve their mental health.

Keywords: sexual and reproductive health, deaf, adolescents, education, services, disabilities, mental health, hard-to-reach areas

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Authors: Nour Mohammad

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The concept of International Criminal Court is not a new idea.It goes back to the late 19th century and was first mooted in 1872 by Gustave Moynier of the International Commitee of the Red Cross(ICRC). This paper attempts to focus on jurisdictional problem of the international criminal court (ICC) over national of states of non parties to the Rome statute. Mor than 120 countries are state parties to the Rome Statute representing all regions, Afria, the Asia-pacofoc Eastern Europe, Latin America and the Caribben as well as Western Europe and North America.The Statute is the core document of internationa criminal law todaycontaining 128 Articles and divided in 13 parts.The Rome Statute provides that the court may sit elsewhere the judge consider it desirable.The International Criminal Court is not in a position to adjudicate all international crimes but its jurisdiction is limited to the four categories of crime viz. genocide, crimes against humanity, war crimes and crime of aggression as stipulated in Article 5 of the ICC Statute. It also mention here that the Court will be able to exercise its jurisdiction over the crime of aggression only when this crime is defined. Due to the highly political nature of this crime, it is unlikely that a consensus in this regard would be arrived at in the near future.The main point of this article is to discuss the mandate of international criminal court to prosecute and punish persons responsible for the henious crimes of concern to the international community.The author highlighted the principles which support the delegation of criminal jurisdiction by state to international tribunals and discuss the precedents of such delegation.It also argued that the exercise of ICC jurisdiction over acts done pursuant to the officially policy of non-party state would not be contrary to the principles requiring consent for the exercise of jurisdiction by international tribunals. The article explore the limit to jurisdiction of ICC over non-party nationals.

Keywords: jurisdiction, international, criminal, court, non-parties

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Authors: Takeshi Sato, Mizuki Nakajima, Macky Kato, Shoji Igawa

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The purpose of study was to investigate the effect of varying pole weights on energy expenditure, upper limb and lower limb muscle activity as Electromyogram during Nordic walking (NW). Four healthy men [age = 22.5 (±1.0) years, body mass = 61.4 (±3.6) kg, height = 170.3 (±4.3) cm] and three healthy women [age = 22.7 (±2.9) years, body mass = 53.0 (±1.7) kg, height = 156.7 (±4.5) cm] participated in the experiments after informed consent. Seven healthy subjects were tested on the treadmill, walking, walking (W) with Nordic Poles (NW) and walking with 1kg weight Nordic Poles (NW+1). Walking speed was 6 km per hours in all trials. Eight EMG activities were recorded by bipolar surface methods in biceps brachii, triceps brachii, trapezius, deltoideus, tibialis anterior, medial gastrocnemius, rectus femoris and biceps femoris muscles. And heart rate (HR), oxygen uptake (VO₂), and rate of perceived exertion (RPE) were measured. The level of significance was set at a = 0.05, with p < 0.05 regarded as statistically significant. Our results confirmed that use of NW poles increased HR at a given upper arm muscle activity but decreased lower limb EMGs in comparison with W. Moreover NW was able to increase more step lengths with hip joint extension during NW rather than W. Also, EMG revealed higher activation of upper limb for almost all NW and 1kgNW tests plus added masses compared to W (p < 0.05). Therefore, it was thought either of NW and 1kgNW were to have benefit as a physical exercise for safe, feasible, and readily training for a wide range of aged people in the quality of daily life. However, there was no significant effected in leg muscles activity by using 1kgNW except for upper arm muscle activity during Nordic pole walking.

Keywords: Nordic walking, electromyogram, heart rate, RPE

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Authors: R. Chinyakata, N. R. Raselekoane

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Migration has always been part of human history. Migration is spurred by globalisation which connects nations by encouraging the flow of goods, services, ideas and people across borders. Migration does not only involve movement of adults from one country to another. It also affects and involves the youth as they are the most mobile group. Musina area, like many other border areas, experiences a variety of challenges as a result of the influx of people from the neighbouring Zimbabwe and other African countries. Of great concern about this migration is the fact that the host country or area may become unsafe and unstable as a result of huge influx of migrants. There may also be tensions between local people and migrants over the resources. The study sought to investigate the effects of the Zimbabwean youth migration on Musina area. The study was undertaken in Musina area which is situated 18km from the Beit-Bridge border post. A qualitative research approach was used. Semi-structured interviews were used to collect data. Non-probability quota sampling technique was used to select the respondents. The study sample consisted of sixteen female and male respondents. Thematic coding was used to analyse the data. Ethical considerations such as informed consent, confidentiality, anonymity and voluntary participation were taken into account to protect the participants. The study found that the effects of the Zimbabwean youth migration on the Musina area include, among others, tensions between locals and the Zimbabwean youth migrants over resources, job and business opportunities, overcrowding and crime. Multi-pronged strategies which involve different stakeholders should be applied to address tensions over job and business opportunities, overcrowding and crime in the Musina area.

Keywords: host country, effects, migrant, migration, Musina, youth, Zimbabwe

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Authors: Martina I. Reinhold, Theresa Bacon-Baguley

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A core challenge of physician assistant education is preparing professionals for lifelong learning. While this conventionally has encompassed scientific advances, students must also embrace new care delivery models and technologies. Telemedicine, the provision of care via two-way audio and video, is an example of a technological advance reforming health care. During a three-semester sequence of Hospital Community Experiences, physician assistant students were assigned experiences with Answer Health on Demand, a telemedicine collaborative. Preceding the experiences, the agency lectured on the application of telemedicine. Students were then introduced to the technology and partnered with a provider. Prior to observing the patient-provider interaction, patient consent was obtained. Afterwards, students completed a reflection paper on lessons learned and the potential impact of telemedicine on their careers. Thematic analysis was completed on the students’ reflection papers (n=13). Preceding the lecture and experience, over 75% of students (10/13) were unaware of telemedicine. Several stated they were 'skeptical' about the effectiveness of 'impersonal' health care appointments. After the experience, all students remarked that telemedicine will play a large role in the future of healthcare and will provide benefits by improving access in rural areas, decreasing wait time, and saving cost. More importantly, 30% of students (4/13) commented that telemedicine is a technology they can see themselves using in their future practice. Initial results indicate that collaborative interaction between students and telemedicine providers enhanced student learning and exposed students to technological advances in the delivery of care. Further, results indicate that students perceived telemedicine more favorably as a viable delivery method after the experience.

Keywords: collaboration, physician assistant education, teaching innovative health care delivery method, telemedicine

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