Careful Observation Research Articles

Liraglutide-Induced Depression with Suicidality in an Obese Adult: A Case Report

Obesity is a major health issue worldwide. Treating adults with obesity often involves lifestyle and diet changes and sometimes medication. Liraglutide is a drug that is being closely studied for treating obesity. However, the potential side effects of liraglutide, particularly its impact on mood and the development of depression, may be of concern. Given the frequent co-occurrence of obesity and depression, it is important to understand how obesity treatments like liraglutide might affect a person’s mood. A 47-year-old schoolteacher with no personal or family history of mental illness or chronic physical condition sought help for his steadily increasing weight. Despite having a sedentary job and reporting no major stress or substance use, he did not attempt to change his diet or activity level, occasionally experiencing sleep difficulties. He was overweight, with a body mass index of 42. The patient was diagnosed with adult obesity and prescribed liraglutide, diet changes, and exercise. Initially, he lost weight, but he also developed depressive symptoms, including fatigue, loss of interest, sleep disturbances, and suicidal ideation. Following cessation of liraglutide treatment, his depression symptoms got better, but his weight slightly increased. This case sheds light on the possible link between liraglutide and depression in managing obesity. It is crucial for healthcare providers to be aware of potential mental health side effects of obesity drugs like liraglutide. Although the exact reasons behind these mood changes are not fully understood, this case emphasizes the need for careful observation and decision-making in treatment. Understanding these issues can help balance the benefits and risks of liraglutide and ensure better care and treatment options for people with obesity.

Systemic lupus erythematosus causes necrosis of the jejunum: a case report

BackgroundLupus mesenteric vasculitis (LMV) is a serious complication of systemic lupus erythematosus (SLE) that can lead to a range of gastrointestinal issues, such as intestinal bleeding, necrosis, and perforation. The optimal surgical approach for cases of intestinal necrosis in LMV remains a topic of debate.Case presentationWe present the first documented instance of jejunal necrosis in a 56-year-old woman undergoing SLE treatment. The patient presented with symptoms including abdominal distension, pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, rebound pain, and muscle tension. Following surgery and steroid therapy, the patient experienced successful recovery and was discharged from the hospital.ConclusionsPatients with jejunal necrosis due to SEL, during intraoperative exploration, surgical decisions should be made based on careful observation. In cases of extensive jejunal necrosis that cannot be preserved, it is advisable to resect the necrotic tissue as much as possible, with a recommended extended resection margin of 2–3 cm.

Islamic Religious Education Social Competence of Teachers in Increasing Students' Tolerant Attitudes: Qualitative Study in State High Schools of Jambi City

This research describes the efforts of Islamic religious education teachers to increase students' attitudes of tolerance and the social competence of Islamic religious education teachers as contributors to increasing students' attitudes of tolerance. The author's approach in this research is qualitative; the type of research is descriptive research analysis. The research location is State High School X, Jambi City. Data collection was carried out using observation, interviews, and documentation techniques. Determining research subjects used Snowball sampling. Data analysis techniques were carried out using data reduction, data presentation, drawing conclusions, and verifying research results' trustworthiness using extended participation techniques, careful observation, data triangulation, and supervisor consultation. The results of this research refer to the social competence of Islamic Religious Education Teachers as a factor that encourages students at State High School X Jambi City to increase their tolerance attitudes as well as the efforts made by teachers to increase students' tolerance attitudes, the need for an attitude of tolerance in various aspects, including tolerance in different opinions, or differences in religion, different ethnicities and cultures which makes it a benchmark that an attitude of tolerance is needed by every Indonesian citizen who has a variety of cultures, ethnicities and religions and as a solution in dealing with ethnic, cultural and religious differences in the school, community and state environment.

Asuhan Keperawatan Medikal Bedah dengan Intervensi Penerapan Slow Stroke Back Massage Therapy pada Pasien Stroke Non Hemoragik dengan Masalah Perfusi Serebral Tidak Efektif dan Gangguan Mobilittas Fisik di Ruang Flamboyan RSUD dr. T.C Hillers Maumere

Non-hemorrhagic stroke is a clinical sign of dysfunction or damage to brain tissue caused by lack of blood flow to the brain, thereby disrupting the need for blood and oxygen in brain tissue. Slow stroke back massage therapy is a non-pharmacological therapy to overcome problems in patients with stroke. This research aims to be able to carry out nursing care for clients with non-hemorrhagic stroke using slow stroke back massage therapy in the Flamboyan Room at RSUD dr. T.C Hillers Maumere. The research design used was a case study. The approach used is a nursing care approach which includes identifying data from assessment results, nursing diagnoses, planning, implementation and evaluation. Slow stroke back massage therapy is carried out for 3 days. Data collection techniques used a medical-surgical nursing care assessment format, observation and literature study. The results of the case study showed that clients were diagnosed with ineffective cerebral perfusion and impaired physical mobility. The application of slow stroke back massage therapy showed improvements or changes on the third day, which resulted in the client experiencing a decrease in blood pressure from 180/100 mmHg to 160/90mmHg, not complaining of dizziness, and the patient's right hand was starting to be able to move. The conclusion of this case study is that slow stroke back massage therapy is effective in reducing blood pressure and also helps in increasing physical mobility in non-hemorrhagic stroke patients.

Insights into Shared Decision-Making in Interprofessional Teams for a Boy with Down Syndrome with Communication and Language Issues: Simulation-Based Training for Medical and Allied Health Students.

Shared decision-making is one key element of interprofessional collaboration. Communication is often considered to be the main reason for inefficient or ineffective collaboration. Little is known about group dynamics in the process of shared decision-making in a team with professionals, including the patient or their parent. This study aimed to evaluate just that. Simulation-based training was provided for groups of medical and allied health profession students from universities across the globe. In an overt ethnographic research design, passive observations were made to ensure careful observations and accurate reporting. The training offered the context to directly experience the behaviors and interactions of a group of people. Overall, 39 different goals were defined in different orders of prioritizing and with different time frames or intervention ideas. Shared decision-making was lacking, and groups chose to convince the parents when a conflict arose. Group dynamics made parents verbally agree with professionals, although their non-verbal communication was not in congruence with that. The outcome and goalsetting of an interprofessional meeting are highly influenced by group dynamics. The vision, structure, process, and results of the meeting are affected by multiple inter- or intrapersonal factors.

Molecular pathological approach to cancer epigenomics and its clinical application.

Careful microscopic observation of histopathological specimens, accumulation of large numbers of high-quality tissue specimens, and analysis of molecular pathology in relation to morphological features are considered to yield realistic data on the nature of multistage carcinogenesis. Since the morphological hallmark of cancer is disruption of the normal histological structure maintained through cell-cell adhesiveness and cellular polarity, attempts have been made to investigate abnormalities of the cadherin-catenin cell adhesion system in human cancer cells. It has been shown that the CDH1 tumor suppressor gene encoding E-cadherin is silenced by DNA methylation, suggesting that a "double hit" involving DNA methylation and loss of heterozygosity leads to carcinogenesis. Therefore, in the 1990s, we focused on epigenomic mechanisms, which until then had not received much attention. In chronic hepatitis and liver cirrhosis associated with hepatitis virus infection, DNA methylation abnormalities were found to occur frequently, being one of the earliest indications that such abnormalities are present even in precancerous tissue. Aberrant expression and splicing of DNA methyltransferases, such as DNMT1 and DNMT3B, was found to underlie the mechanism of DNA methylation alterations in various organs. The CpG island methylator phenotype in renal cell carcinomawas identified for the first time, and its therapeutic targets were identified by multilayer omics analysis. Furthermore, the DNA methylation profile of nonalcoholic steatohepatitis (NASH)-related hepatocellular carcinomawas clarified in groundbreaking studies. Since then, we have developed diagnostic markers for carcinogenesis risk in NASH patients and noninvasive diagnostic markers for upper urinary tract cancer, as well as developing a new high-performance liquid chromatography-based diagnostic system for DNA methylation diagnosis. Research on the cancer epigenome has revealed that DNA methylation alterations occur from the precancerous stage as a result of exposure to carcinogenic factors such as inflammation, smoking, and viral infections, and continuously contribute to multistage carcinogenesis through aberrant expression of cancer-related genes and genomic instability. DNA methylation alterations at the precancerous stages are inherited by or strengthened in cancers themselves and determine the clinicopathological aggressiveness of cancers as well as patient outcome. DNA methylation alterations have applications as biomarkers, and are expected to contribute to diagnosis, as well as preventive and preemptive medicine.

Knockdown of orthotospovirus-derived silencing suppressor gene by plant-mediated RNAi approach induces viral resistance in tomato

RNA interference (RNAi) shows significant effectiveness in conferring resistance to viral infections in various plants. The current study was conducted to develop transgenic tomato (Solanum lycopersicum cv. Rio Grande) lines expressing a 320 bp conserved inverted region of the integral 35S promoter region. The molecular cloning was done for the construction of expression vectors in a hairpin structure by the Tomato spotted wilt orthotospovirus (TSWV) species Orthotospovirus tomatomaculae, silencing suppressor (NSs) gene. It contains both sense and antisense orientation in a binary vector pFGC5941. Short hairpin RNA (shRNA) structures were employed to reduce the possibility of inducing endogenous non-specific antiviral responses, which usually target longer double-stranded RNAs (dsRNAs). To confirm the transgenic plants, molecular analysis was performed using TSWV gene-specific primers (TSWV-NSs). Based on the EHA105 Agrobacterium strain and the pFGC5941 vector carrying NSs and nptII genes in the T-DNA region, the results validate the insertion of kanamycin resistance into the regenerated transgenic plants. The virus source harboring TSWV was used to inoculate putative transgenic plants for evaluating the confirmation of successful transformation strategy for inducing virus resistance. Quantitative real-time polymerase chain reaction (qRT-PCR) assays were performed by using qRT-NSs primer pairs to determine the relative gene expression of all constructs (TSWV-NSs both sense and antisense orientation) after inoculations. In comparison to the control groups, which contained wild type control (non-transgenic tomato plant), empty pFGC5941 vector and the pFGC5941+sense construct, the expression of the NSs gene was noticeably reduced in the full clone (pFGC5941+sense + antisense) construct. For the validation of RNAi effectiveness, Nicotiana tabacum plants were also inoculated with viral constructs. Specifically, they displayed severe symptoms of TSWV in plants containing the pFGC5941+sense, pFGC5941 empty vector, and in wild-type tomato plants that are correlated with bioassay results. The lack of TSWV symptoms validated the hypothesis after careful observation of the expression of NSs genes in terms of pathogenicity. This research demonstrates the RNA interference effectiveness by targeting NSs gene as a reliable technique for achieving long lasting antiviral protection in tomatoes. The findings have practical relevance and the potential to be a tool for limiting tomato crop losses caused by TSWV worldwide.

Analysis of the Study of Midwifery Care for Malnourished Toddlers at the Linge Health Center, Central Aceh Regency, Indonesia

Malnutrition among toddlers is still a public health problem in Indonesia, including in Central Aceh Regency. Comprehensive and quality midwifery care is very important to help malnourished toddlers achieve optimal nutritional status. This study aims to analyze the study of midwifery care for malnourished toddlers at the Linge Health Center, Central Aceh Regency, Indonesia. This research uses a case study design with a qualitative approach. Data was collected through in-depth interviews with midwives, observation, and documentation of midwifery care. The study shows that midwifery care for malnourished toddlers at the Linge Health Center is quite good. Midwives have carried out assessment, diagnosis, intervention and evaluation using midwifery care standards. Midwifery care for malnourished toddlers at the Linge Health Center is quite good, but still needs to be improved by increasing mothers' knowledge about nutrition, strengthening coordination between sectors, and increasing resources.

The neurology of creativity: 2023 Hower lecture

AbstractThe neurology of creativity implies network activity; no singular cerebral area is invoked. A clinician‐scientist can develop a creative research project from a single patient, combined with critical scientific alliances, careful observations, and correlations. The developing nervous system poses additional complexity, as changes are expected over time in physiologic circumstances, to which must be added compensatory responses to underlying pathology. The arts represent an especially productive area to study the neurology of creativity, especially with functional imaging, tractography, and intracranial electrophysiology. Music activates widespread bilateral areas, including temporal, orbitofrontal, insular, fusiform, and cerebellar cortex. There are different neuronal clusters for different levels of sound volume, duration, timbre, and pitch. Heschl's gyrus and the arcuate fasciculus correlate with pitch. The orbitofrontal cortex is involved in expectancy generation and appears to be active with no music and then deactivates with music, as if the cortex has an editing function. This appears to correlate with the default mode network being key during improvisation, whereas the central executive network is invoked in effortful, repetitive playing. Furthermore, plasticity is associated with music, from the pathologic development of musicogenic seizures, to protection from musician's dystonia in pianists who begin lessons before age 9 years, to benefits of increased temporal cortex in older adults taking piano lessons after six months. Creativity, reducing negativity bias, and juggling life s priorities are key to countering burnout and building resilience.

Global Warming and Climate Change

On a careful observation, we find that in recent times there has been a striking change in the average temperatures in many regions. The global average surface temperature had risen since last century. The 1990s have been the warmest decade and the year 1998 has been the warmest year recorded so far and the second warmest year 2001. The tropical and coastal areas are facing cold temperatures, rainfall is either in excess or scanty, and there is an increase in the frequency and intensity of the droughts. The human activities are primarily responsible for these and the climate change due to global warming is going to alter their lives so much that the very survival of the mankind is at stake. Globalization, development, climate change and human health are closely interconnected. These are also causing conflicts among states with regard to responsibilities of causing and reducing environmental changes. Only consistent and serious efforts to mitigate them can alter the existing conditions and prevent further deterioration. In this research paper highlights the Global warming effects, indicators of climate change and worldwide efforts to Global Warming and Climate Change.

Advancing the Management of Skull Base Chondrosarcomas: A Systematic Review of Targeted Therapies.

Chondrosarcomas rank as the second most common primary bone malignancy. Characterized by the production of a cartilaginous matrix, these tumors typically exhibit resistance to both radiotherapy (RT) and chemotherapy (CT), resulting in overall poor outcomes: a high rate of mortality, especially among children and adolescents. Due to the considerable resistance to current conventional therapies such as surgery, CT, and RT, there is an urgent need to identify factors contributing to resistance and discover new strategies for optimal treatment. Over the past decade, researchers have delved into the dysregulation of genes associated with tumor development and therapy resistance to identify potential therapeutic targets for overcoming resistance. Recent studies have suggested several promising biomarkers and therapeutic targets for chondrosarcoma, including isocitrate dehydrogenase (IDH1/2) and COL2A1. Molecule-targeting agents and immunotherapies have demonstrated favorable antitumor activity in clinical studies involving patients with advanced chondrosarcomas. In this systematic review, we delineate the clinical features of chondrosarcoma and provide a summary of gene dysregulation and mutation associated with tumor development, as well as targeted therapies as a promising molecular approach. Finally, we analyze the probable role of the tumor microenvironment in chondrosarcoma drug resistance. A systematic search was conducted across major medical databases (PubMed, Embase, and Cochrane Library) up to 10 November 2023. The search strategy utilized relevant Medical Subject Heading (MeSH) terms and keywords related to "chondrosarcomas", "target therapies", "immunotherapies", and "outcomes". The studies included in this review consist of randomized controlled trials, non-randomized controlled trials, and cohort studies reporting on the use of target therapies for the treatment of chondrosarcoma in human subjects. Of the initial 279 articles identified, 40 articles were included in the article. The exclusion of 140 articles was due to reasons such as irrelevance, non-reporting of selected results, systematic literature review or meta-analysis, and lack of details on the method/results. Three tables highlighted clinical studies, preclinical studies, and ongoing clinical trials, encompassing 13, 7, and 20 studies, respectively. For the clinical study, a range of molecular targets, such as death receptors 4/5 (DR4 and DR5) (15%), platelet-derived growth factor receptor-alpha or -beta (PDGFR-α, PDGFR-β) (31%), were investigated. Adverse events were mainly constitutional symptoms emphasizing that to improve therapy tolerance, careful observation and tailored management are essential. Preclinical studies analyzed various molecular targets such as DR4/5 (28.6%) and COX-2 (28.6%). The prevalent indicator of antitumoral activity was the apoptotic rate of both a single agent (tumor necrosis factor-related apoptosis-inducing ligand: TRAIL) and double agents (TRAIL-DOX, TRAIL-MG132). Ongoing clinical trials, the majority in Phase II (53.9%), highlighted possible therapeutic strategies such as IDH1 inhibitors and PD-1/PD-L1 inhibitors (30.8%). The present review offers a comprehensive analysis of targeted therapeutics for skull base chondrosarcomas, highlighting a complex landscape characterized by a range of treatment approaches and new opportunities for tailored interventions. The combination of results from molecular research and clinical trials emphasizes the necessity for specialized treatment strategies and the complexity of chondrosarcoma biology.

The Role Anesthesiologist in Management of Obstetric Haemorrhage: A Literature Review

Hemorrhagic shock in obstetrics is still a major cause of maternal mortality and morbidity worldwide. Recognition of bleeding in obstetric patients is complicated by the normal physiologic changes that occur during pregnancy. Visual estimates of blood loss are often erroneous and underestimated because of contamination with amniotic fluid, or internal or hidden blood loss. Thus, careful clinical observation and a high index of suspicion are required for the early detection and management of obstetric hemorrhage. The usage of ultrasound (US) is considered as the first line method for detecting abnormal condition which might serve as a predictor for hemorrhagic shock. Despite of careful risk assessment given, obstetric-specific bleeding protocols, such as resuscitation and blood transfusion, are required to facilitate the integration and timely escalation interventions. The intervention of choice for hemorrhagic shock in obstetrics encompasses a wide variety of options, such as the usage of tranexamic acid, cell salvage, resuscitative endovascular balloon occlusion of the aorta (REBOA), anesthetic management, and surgical, as well as radiological provides multiple available approach, each with their own risk and advantages. The purpose of this review is to describe the management of obstetric hemorrhage from anesthetic point of view, encompassing the identification of patients at risk, resuscitative management, and perioperative management.

A trio of maps: chaos on an ellipse, a shark’s fin, and Sluze’s pearls

Three one-dimensional maps are presented. The maps are analysed with a combination of Feigenbaum diagrams, the calculation of global Lyapunov exponents, and the evaluation of fixed points. It is shown that in certain cases period two orbits can be evaluated by careful observation of the form of the related pairs of equations. A range of classroom exercises are provided to enable students to investigate the maps further.

Independent Association between Cognitive Frailty and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults

Introduction: Although arterial stiffness has been suggested to be associated with poor physical function and mild cognitive impairment (MCI), its association with cognitive frailty (CF), a comorbidity of both, is unclear. This study aims to examine the association between CF and arterial stiffness in community-dwelling older adults. Methods: A cross-sectional analysis of 511 community-dwelling older adults aged 65 years or older (mean age 73.6 ± 6.2 years, 63.6% women), who participated in a community cohort study (Tarumizu Study, 2019), was conducted. Poor physical function was defined as either slowness (walking speed <1.0 m/s) or weakness (grip strength <28 kg for men and <18 kg for women). MCI was defined by the National Center for Geriatrics and Gerontology Functional Assessment Tool as a decline of at least 1.5 standard deviation from age- and education-adjusted baseline values in any one of the four cognitive domains (memory, attention, executive, and information processing). CF was defined as the combination of poor physical function and MCI. Arterial stiffness was measured using the Cardio-Ankle Vascular Index (CAVI), and the average of the left and right sides (mean CAVI) was used. Results: Multinomial logistic regression analysis adjusted for covariates was performed with the four groups of robust, poor physical function, MCI, and CF as dependent variables and mean CAVI as an independent variable. Using the robust group as reference, the poor physical function and MCI groups showed no significant relationship with the mean CAVI. The mean CAVI was significantly higher in the CF group (odds ratio 1.62, 95% confidence interval: 1.14–2.29). Conclusion: A significant association was found between CF and the higher CAVI (progression of arterial stiffness). Careful observation and control of CAVI, which is also an indicator of arterial stiffness, may be a potential target for preventive interventions for CF.

(In)visibilising pregnancy loss in Southern Malawi

Miscarriages, stillbirths and neonatal deaths have received limited attention in global health programmes and research, even though pregnancy loss is common, traumatic and stigmatised. This paper seeks to illuminate lived experiences of pregnancy loss in southern Malawi, drawing on findings from semi-structured interviews and focus groups with women who have experienced loss, health professionals and community members, and observations of maternity care. Combining thematic and discourse analysis, we show how societal and medical discourses frame women as responsible for (failed) reproduction, and restrict possibilities to speak about, and respond to, loss. Some accounts and (care) practices invisibilise loss and associated suffering. However, invisibilisation may also be intended as support, and underscores rather than denies the social significance of parenthood. Other accounts (e.g. women emphasising faith and acceptance) constitute moral survival strategies to avoid the acquisition of a ‘spoiled identity’. We conclude that societal and medical discourses of loss enact stigmatised, subaltern subject positions for women experiencing pregnancy loss, create social suffering, and amount to a form of structural violence. Programmes and interventions should change these discourses.

Communication Patterns and Characteristics of Family Caregivers and Persons Living With Dementia: Secondary Analysis of Video Observation.

It is essential to characterize communication patterns for better health outcomes for family caregivers and persons living with dementia. This study aimed to examine the relationships between communication patterns and the characteristics of dyads of family caregivers and persons living with dementia. A secondary analysis was conducted using 75 video-recorded home care observations from 19 dyads. Participant characteristics and caregiver burden, depression, and sense of competence were collected from the parent study. The video-recorded dyadic communication patterns were assessed using a coding scheme developed based on Communication Accommodation Theory and Classical Test Theory. The relative frequency of the communication patterns was compared between groups. Overall, 8311 caregiver and 8024 care recipient communication behaviors were observed. Caregiver communication patterns were categorized as facilitative, disabling, and neutral. Care recipient communication patterns were categorized as engaging, challenging, and neutral. Caregiver gender, care recipient gender, care recipient education level, dementia diagnosis length, types of dementia, dyadic gender difference, burden, depression, and competence of caregiver, and types of communication were significantly associated with caregiver communication. Dementia diagnosis length, caregiver competence, dyadic gender difference, and types of communication were significantly associated with care recipient communication. The findings demonstrated different communication patterns depending on individual and dyad characteristics and evidence for dyadic communication support to promote meaningful interaction for persons living with dementia. Further analysis is needed to identify mediating factors and causal relationships.

Risk factor of non-tuberculous Mycobacterium infection in patients with rheumatoid arthritis and other autoimmune diseases receiving biologic agents: A multicenter retrospective study

BackgroundEvidence regarding the association of the usage of biologic agents (Etanercept, Tocilizumab, adalimumab and so on), such as anti-tumor necrosis factor α, with the incidence and risk factors of non-tuberculous Mycobacteria (NTM) infection is limited. Therefore, this study aimed to investigate the incidence and risk factors of NTM and their associations with biologic agents’ usage, and also investigated the potential of Mycobacterium avium complex (MAC) antibodies as a predictor of NTM infection development. MethodsThis retrospective study included 672 patients with autoimmune diseases from four hospitals in Nagasaki, Japan, from January 1, 2011, to June 30, 2019, who fulfilled the inclusion criteria. ResultsOf the 672 patients, 9 (1.3%) developed complicated NTM infection, including two with disseminated infection, after the introduction of biologic agents. Of the nine patients, two died due to NTM infection but none tested positive for MAC antibodies prior to initiation of biologic agents. The mortality rate was higher in patients complicated with NTM than without NTM (22.2% vs 2.6%, P = 0.024). The corticosteroids dosage at the time of initiating the biologic agents was significantly higher in the NTM group than in the non-NTM group (median, 17 mg vs 3 mg, P = 0.0038). Conclusion: In the patients undergoing therapy with biologic agents, although NTM complication was rare, it could be fatal. In particular, for patients on a relatively high dose corticosteroids, careful observation is essential for identifying NTM complication, even if the MAC antibody test is negative.

THE ROLE AND SIGNIFICANCE OF LIP-READING

Lip-reading is a complex psychophysiological process, which involves the visual perception of oral movements, their kinaesthetic memorisation, and the psychological act of recognising (identifying) words for their better understanding. The need of each person to supplement and clarify the received message is emphasised by the careful observation of the face and lips, especially in unfavourable environmental conditions. The main aim of the study is to point to the role, importance, specific features, and the benefits and limitations of lip-reading through the review of available literature. The methods of analysis and evaluation were applied to the relevant available literature. Numerous pieces of data on the characteristics, factors and features which affect lip-reading were obtained. Lip-reading, i.e. the ability to understand speech on the basis of observing the movements of speech organs is a very specific skill. It is one of the components of speech development, and it represents a part of the communication speech chain which comprises the speaker and the one who reads speech. It has a manifold application in the transcription of speech in cases when sound is not available. What can have a negative impact on the perception of speech is the possibility of sound and lip movements not being synchronised. It is of particular significance for deaf persons and persons hard of hearing who rely on this process fully in their everyday communication, which makes it easier for them to receive information from their surroundings. It enables their better communication, education, independence and coping in their daily functioning.

The Business of Race-making in the Torrid Zone: Dr Jonathan Troup’s Illustrated Diary of Dominica, 1789–90

This article focuses on the manuscript diary of a Scottish doctor, Jonathan Troup, who during a truncated fifteen-month period, from 1789 to 1790, practised medicine on the island of Dominica, part of the climatic ‘torrid zone’ in the British West Indies. While the relevant textual contents of his diary are already familiar to scholars of medical humanities, the analysis seeks to complement and extend these existing discussions by addressing an aspect of the illustrated and inscribed pages of Troup’s diary that has not been previously discussed, namely his diurnal account of race-making. The article argues that Troup was a product of Scottish enlightenment medical training, with its blended curricula of medicine, natural history and moral philosophy. The diary in turn, is shown to be a product of the diagnostic tools of that education, which equipped practitioners with the skills to classify human diversity through careful observation in the ‘colonial field’. In his diurnal sketches, Troup employs a tiered racial system or calculus of colour to differentiate between peoples of different races, based on the visual proximity of their skin to either European whiteness or shades of blackness associated with African descent. In the textual descriptions that variously accompany, envelope, elucidate and ignore the drawings, Troup’s race-making schema is shown to be informed by factors other than the gradations of skin complexion, including social temper and moral temperament. Such factors are given particular prominence in his discussion of multi-racial women, making gender an innate constituent of his race-making schema. The article is framed by the concept of business, which for most professionals in the Caribbean involved more than one economic occupation. It offers a prognosis as to the significance of Troup’s diary for a range of academic disciplines, historical, literary and visual, and their discreet historiographies which pertain to his imperial careering.

Selected aspects of nursing care for a patient after ischemic stroke in a care and treatment facility - a case study

Cerebrovascular diseases (including strokes) are currently the second leading cause of death in the world [1,2]. In Poland, statistical data are quite diverse, depending on their source. Stroke patients are often at risk of chronic disability. A significant number of them are doomed to lose their independence and self-care for the rest of their lives. The aim of the study is to present selected nursing problems and ways to solve them in a patient after ischemic stroke who requires round-the-clock care in the field of nursing and care services as part of inpatient long-term care. The subject of the study is the process of nursing a patient diagnosed with ischemic stroke who requires round-the-clock care in the field of nursing and care services as part of long-term care. The study uses a research method - a case study, supported by individual observation, measurements, interview and analysis of medical records. Two scales were used to assess the patient's condition: Barthel and Norton. Conclusions: The individual care plan takes into account the most important problems arising from the specificity of the disease entity, needs and individual situation of the patient. The patient's care problems after a stroke are presented and proposed an effective solution to ensure the best possible care. Nursing and care difficulties have been properly recognized, which has enabled appropriate nursing interventions. Due to systematic prophylactic measures, the patient did not suffer from complications. A detailed interview and careful observation made it possible to plan and implementation of interventions (not only nursing) to provide comprehensive care. The urgent procedure of admitting the patient to the care and treatment facility contributed to the improvement of the quality and availability of health care services, which translated into an improvement in the patient's general condition.