Daily Challenges Research Articles

(Re‐)Discoveries in a time of disruption

(Re‐)Discoveries in a time of disruption

Imaging Phenotypes of Stress Based on Functional MRI

Background: Stress is an adaptive response to daily challenges faced by the body to maintain its internal homeostasis. The pathophysiology of stress has been described based on the role of the sympatho-adrenergic system and the hypothalamic-pituitary- adrenal axis. Few studies have been done describing the role of functional MRI and PET to study the patterns of brain involvement in symptomatic patients. Methods: The author studied 50 post-acute covid-19 syndrome patients one year after the acute episodes along with 10 healthy control patients. Based on the patterns of stress on imaging the patients were phenotyped on the severity of the changes of stress into a classification system. Results: The results of the study showed a distinct temporal pattern of changes based on the severity of chronic stress. Class II and III Group patients on imaging formed the largest number 32(64%) and also showed good correlation with PCS-10 scores which were moderate in this group. The supra optic nucleus followed by para ventricular nuclei were the commonest affected during stress. The study showed that involvement of DMN and SALIEN was seen as the severity of stress progressed to a burn out stage IV which resulted in hypoactivation of all major networks and hypothalamic nuclei. Hippocampal and amygdala volumetric changes alongwith altered asymmetry was seen in class II-IV groups. Conclusion: The author concluded that functional MRI could detect the pattern of changes of stress and the findings not only can be helpful in the diagnosis but also in planning management of these patients.

SARS-CoV-2-Infektion und interstitielle Lungenerkrankungen – Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin

The SARS-CoV-2 pandemic had a tremendous impact on diagnosis and treatment of interstitial lung diseases (ILD). Especially in the early phase of the pandemic, when the delta variant was prevailling, a huge number of viral pneumonias were observed, which worsened pre-existing, triggered de novo occurence or discovery of previously subclincal interstitial lung diseases. The effect of SARS-CoV-2 infection - without or with accompanying viral pneumonia - on the further development of pre-existing ILD as well of new pulmonary inflitrates and consolidiations is difficult to predict and poses a daily challenge to interdisciplinary ILD boards. This position paper of the German Respiratory Society (DGP e.V.) provides answers to the most pressing questions based on current knowledge.

Detachable Shuddering Device for Visually Impaired People

Abstract: Our eyes are an important part of our health. Everyone rely on their eyes to see universe and make sense around them. Therefore, over the last decades, the development of navigation devices capable of guiding the blind through indoor and outdoor scenarios that has remained a challenge. Many researchers are working to assist visually impaired people in different ways like camera based assistance , voice based assistance , ultrasonic based assistance and in some advance way like transplantation of real eyes but that’s not possible in every case. The main idea of the proposed system is to make person aware of the path and the obstacle in path they are walking. Blind people do lead a normal life, but they definitely face troubles. Let us have an emphatic look at some of their daily life problems and challenges faced by them. The biggest challenge for a blind person especially for one with complete loss of vision is navigation. Obviously blind people roam easily around their familiar atmosphere without any help. But what when they are at unfamiliar place at that time the most valuable thing for a disabled is gaining independence. Conditions like cataract, glaucoma, diabetic-related retinopathy, macular degeneration are some eye disease that can lead to vision loss so instead of showing sympathy to give them an empathetic look here a vibrating hardware is presented. Because vibration is something that could be felt by everybody due to that we present a shuddering hardware for visually impaired people for the purpose of navigation.

DEMANDS STATED BY ARTISTIC GYMNASTICS COACHES AT THE BEGINNING OF THEIR CAREERS

High quality performance of sports coaches involves the use of professional, interpersonal and intrapersonal skills (Côté & Gilbert, 2009). The complexity of the work of sports coaches, especially in Artistic Gymnastics (AG), due to the profound technical and physical demands right from the basic categories, can be magnified for coaches with little experience entering the field. Thus, this study aimed to identify the perceptions of coaches at the beginning of their careers regarding the types of skills required for their professional routine. We interviewed five coaches affiliated with the Santa Catarina Gymnastics Federation (Brazil) with less than 10-year experience in AG. During the interviews, indicators, such as professional routine and knowledge required in this context, were addressed. We used Braun and Clarke's (2019) reflexive thematic analysis to analyze the data. The results show that the complexity of coaches' work requires an expanded repertoire of knowledge. In general, coaches realize that relevant professional and interpersonal skills to teach gymnastics are the most required types of knowledge in daily practice. Intrapersonal skills, on the other hand, seem to be less needed, which may contribute to the preservation of an authoritarian culture in sports training. The requirements discussed in this study lead to implications for and reflections on AG coaches’ training programs, especially in the structure of the body of knowledge that provides a good basis for dealing with their daily challenges.

GIGANTEA-ENHANCED EM LEVEL complex initiates drought escape response via dual function of ABA synthesis and flowering promotion

ABSTRACT Plants use the regulation of their circadian clock to adapt to daily environmental challenges, particularly water scarcity. During drought, plants accelerate flowering through a process called drought escape (DE) response, which is promoted by the circadian clock component GIGANTEA (GI). GI up-regulates the flowering inducer gene FLOWERING LOCUS T (FT). Phytohormone Abscisic acid (ABA) is also required for drought escape, and both GIGANTEA and Abscisic acid are interdependent in the transition. Recent research has revealed a new mechanism by which GIGANTEA and the protein ENHANCED EM LEVEL form a heterodimer complex that turns on ABA biosynthesis during drought stress by regulating the transcription of 9-CIS-EPOXYCAROTENOID DIOXYGENASE 3 (NCED3). This highlights the close connection between the circadian clock and ABA regulation and reveals a new adaptive strategy for plants to cope with drought and initiates the DE response.

"Holding Space": A Phenomenological Exploration of Mindfulness-Based Practice With Veterans Who Have Experienced Trauma.

The current phenomenological study examined the lived experiences of Veterans who completed a 4-month mindfulness program. One-on-one interviews were conducted with 12 Veterans using a Socratic method of interviewing, which yielded rich contextual narratives. Analysis was guided by a hermeneutic process to disclose concealed meanings. Findings demonstrate how holding space allowed deep healing and are presented under two distinct themes: It's a We Thing! encompasses what being in a community with nonjudgmental others afforded participants; and Quiet Your Mind, Quiet Yourself, Your Body is related to how practices of mindfulness taught participants to cope with daily challenges. Nurses working with Veterans may use mindfulness and peer support interventions to help transform trauma into profound healing and help Veterans find new meaning in life. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 47-55.].

POCUS and Fluid Responsiveness on Venoarterial ECMO

VA ECMO allows organ perfusion and oxygenation while awaiting myocardial recovery, cardiac transplantation, or long-term mechanical circulatory support. Diagnosis of hospital-acquired pneumonia (HAP) is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound (US) can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Point-of-care US (POCUS) is broadly used in patients with ARDS. POCUS is recommended to be performed regularly in COVID-19 patients for respiratory failure management. In this review, we summarized the US characteristics of COVID-19 patients, mainly focusing on lung US and echocardiography. Point-of-care lung US (LUS) was demonstrated to be an effective tool in case of acute respiratory failure for ICU patients, community-acquired pneumonia, and ventilator-associated pneumonia. This review describes the usefulness of LUS in the early detection of HAP in cardiac critically ill patients under VA ECMO as well as assess its sonographic features.

Continuous Professional Development of ESL Teachers

The task of teaching English as a second language (ESL) is complex, with the cognitive processes behind it is still only partly known. This complexity, along with the diverse roles assigned to ESL teachers, brings several challenges ranging from classroom management to parental expectations. Teachers need systematic support to learn more effective practices to deal with daily challenges, which in turn promote the achievements of students. It is indeed the need of the hour to ensure continuous professional development to equip teachers with a conducive attitude, to update their subject and content knowledge and also to hone their pedagogical skills.

Social participation of individuals with spinal injury using wheelchairs in rural Tanzania after peer training and entrepreneurial skills training.

Individuals with spinal cord injury (SCI) in less-resourced settings reported barriers to community integration, including inaccessible rehabilitation services, restricted environments and limited social integration. Peer training and entrepreneurial skills training are provided by Motivation, a nonprofit organisation, and Moshi Cooperative University to enhance occupational engagement of individuals with SCI in less-resourced settings. This study aimed to explore the impact of peer training and entrepreneurial skills training on the social participation of individuals with SCI living in Tanzania. Using a qualitative photovoice approach, 10 participants captured meaningful photos and provided captions according to five standardised questions (PHOTO technique) to convey their messages. Participants selected up to 34 photos that best illustrated their experiences in the community. A mixed inductive-deductive thematic analysis was guided by the International Classification of Functioning, Disability and Health. Two interrelated themes emerged: (1) 'influencing factors', which revealed how participants' inclusion in the community was influenced by their activities and personal and environmental factors and (2) 'empowerment', which highlighted participants' desire to advocate and promote awareness of needs and hopes. Participants emphasised the importance of accessibility and equal opportunities. Whilst some were able to overcome obstacles, others experienced continued inaccessibility that inhibited meaningful occupations. Daily participation challenges of individuals with SCI in rural Tanzania were highlighted. Although the Motivation programmes were perceived to have powerful impacts on social participation, continued efforts and advocacy are needed to overcome accessibility issues and to meet the physical, psychological and social needs of Tanzanians living with SCI. This article highlights the importance of accessibility and equal opportunities for individuals with disability living in rural Tanzania. Peer-training and entrepreneurial programs offer community-based rehabilitation services that were perceived by people with disabilities to have a powerful impact on social participation and vocation. However, continued efforts and advocacy are needed to meet the needs of Tanzanians living with spinal cord injury.

Contrast Enhanced EUS for Predicting Solid Pancreatic Neuroendocrine Tumor Grade and Aggressiveness.

Pancreatic neuroendocrine tumor (PNET) behavior assessment is a daily challenge for physicians. Modern PNET management varies from a watch-and-wait strategy to surgery depending on tumor aggressiveness. Therefore, the aggressiveness definition plays a pivotal role in the PNET work-up. The aggressiveness of PNETs is mainly based on the dimensions and histological grading, with sometimes a lack of specificity and sensibility. In the last twenty years, EUS has become a cornerstone in the diagnostic phase of PNET management for its high diagnostic yield and the possibility of obtaining a histological specimen. The number of EUS applications in the PNET work-up has been rapidly increasing with new and powerful possibilities. The application of contrast has led to an important step in PNET detection; in recent years, it has been gaining interesting applications in aggressiveness assessment. In this review, we underline the latest experiences and opportunities in the behavior assessment of PNETs using contact-enhanced EUS and contested enhanced harmonic EUS with a particular focus on the future application and possibility that these techniques could provide.

Connecting relational wellbeing and participatory action research: reflections on ‘unlikely’ transformations among women caring for disabled children in South Africa

ABSTRACT Participatory action research (PAR) is a form of community-driven qualitative research which aims to collaboratively take action to improve participants’ lives. This is generally achieved through cognitive, reflexive learning cycles, whereby people ultimately enhance their wellbeing. This approach builds on two assumptions: (1) participants are able to reflect on and prioritize difficulties they face; (2) collective impetus and action are progressively achieved, ultimately leading to increased wellbeing. This article complicates these assumptions by analyzing a two-year PAR project with mothers of disabled children from a South African urban settlement. Participant observation notes, interviews, and a group discussion served as primary data. We found that mothers’ severe psychological stress and the strong intersectionality of their daily challenges hampered participation. Consequently, mothers considered the project ‘inactionable’. Yet, many women quickly started expressing important individual and collective wellbeing transformations. To understand these ‘unlikely’ transformations, a feminist relational account, in particular, that of relational wellbeing, proves essential. We reflect on the consequences of these findings for the dominant PAR methodology and operationalization, and propose to sensitize future PAR with marginalized women by employing relational wellbeing as an overarching ontological awareness.

Quantitative NMR spectroscopy of complex mixtures.

Complex mixtures are ubiquitous in many branches of chemistry, be it a complex pharmaceutical formulation, a collection of biofluids analysed in a metabolomics workflow, or a flowing mixture in a reaction monitoring setting. The accurate quantitative determination of mixture components is one of the toughest challenges posed to analytical chemists, requiring the determination of often heavily overlapped signals from compounds in very diverse concentrations. NMR spectroscopists have developed an impressive variety of approaches to deal with such challenges, including the development of innovative pulse sequences, hyperpolarization methods and processing tools. We describe the most recent advances in the field of quantitative NMR, and the many subsequent application perspectives in fields where the sample complexity is a daily challenge, such as pharmaceutical science, metabolomics, isotopic analysis, and monitoring.

German first-year medical students' expectations of their professional life - concerns and hopes: A project report.

Expectations among medical students towards their future professional life are affected by intrinsic and extrinsic factors which may change during years of medical school. The aim of this study is to gain further insight into students' expectations of their professional life at the beginning of medical school. Findings regarding contextual influences can be used to improve curricula and student guidance. The project report based on an online survey among three cohorts of first year medical students at the LMU. The questionnaire consisted of six open-ended questions which addressed the student's motivation, expectations, anticipations and concerns of their professional life. Questions were also asked about presumed personal development and influence on private life. An inductive coding was used in this qualitative content analysis. Written responses from 591 participants were coded, categorized and summarized into four main themes: personal life, work, science, personal issue. Despite coming from different cohorts, the occurrence of the main themes showed the same trend in all student groups. Students are worried most about the work-life-balance, and they expect it to be a difficult issue. But many of our first-year students are optimistic that they will be able to establish a good work-life-balance or that the working conditions will have changed to a manageable workload at the time they will enter their first jobs. The majority of our students expect to become more self-confident with enhanced empathy and team-working ability and more patient and stress-resistant in daily challenges. The medical students emphasize the gender-neutral desire for work-life balance. So, they expect improved working conditions for the future - an ongoing challenge for the health care system.

A Thematic Analysis on an Exploration of Concerns of Cancer Patients and their Caregivers in the Context of the COVID-19 Pandemic

Background: COVID-19, a pandemic prevalent for a long time presents a multistep crisis;the first stage is an acute health crisis, followed by a healthcare recovery crisis in the second stage and a socio-economic crisis in an indefinite period. The study explores the challenges and specific concerns among patients diagnosed with cancer and their caregivers during the pandemic. Materials and Method: Qualitative research employs specific research methods such as in-depth interviews, content analysis, observation methods, and life histories or biographies to examine people’s experiences in detail. In the present study, a semi-structured questionnaire was developed and interviews were conductedto understand the experiences of cancer patients andtheir caregivers with health care and their daily challenges during the pandemic. A Non-random sampling method, involving males and females, within the age group of 18 to 65 years, and their primary care providers from the Regional Cancer Centre and other cancer hospitals are followed. Semistructured interview responses were collected from cancer patients and their caregivers., illustrative quotes were summarised and key themes from the interviews were extracted. Results and analysis: 9 Key themes with 20 subthemes were extracted in the content analysis. Difficulty having access to medical care, fear of infection transmission, lack of social support, loss of income source, drastic lifestyle changes, uncertainty about disease cure, and apprehension about the future,which result in cumulative disease burdenhave been frequently reported in the study.Conclusion: The current research is relevant in describing the experiences and perspectives of cancer patients and their caregivers, throwing light on the psychosocial issues and challenges during the pandemic situation, thus emphasizing the need for developing a supportive psychosocial intervention.

Women Taking Agency through Feminized Migration Patterns and Remittances: Socio-Economic Experiences of Migrant Street Vendors, Pietermaritzburg, Kwazulu-Natal-South Africa

Background: This anthropological paper contributes empirical findings which reveal that feminized migration patterns have allowed women to migrate from different parts of Southern Africa to trade as illegal street vendors in Pietermaritzburg, KwaZulu-Natal, South Africa, where they have earned remittances “their financial agency”. This economic/financial agency has shaped their resilience and has lowered their dependency on their husbands. Methodology: This study was guided by a qualitative phenomenological research design. Sampling: The study recruited twenty foreign women trading on the Pietermaritzburg through the purposive-snowballing sampling technique. Study Findings: This paper reveals that even though patriarchy and other structural issues have excluded African women, Pietermaritzburg streets have allowed foreign women to generate daily earnings which are between R1050 to R2500 per day through street vending amid many daily challenges. Earned remittances have changed their families’ socioeconomic statuses. Families have afforded basic survival needs such as food, school fees, medical care and clothing, which have been celebrated by their children and families. Through remittances, poverty no longer has the face of their families. Study Conclusion: This paper recognises that Pietermaritzburg streets as full of economic possibilities for foreign street vending women. Study Contribution: We contribute street vending a new context to the feminized migration literature which African women have entered into to generate remittances in South Africa to escape rife poverty. Study Recommendation: The paper further recommends that heads of state in Africa and internationally should forge policies that maximize the safety of street vending women worldwide.

End-expiratory Occlusion Test and Mini-fluid Challenge Test for Predicting Fluid Responsiveness in Acute Circulatory Failure.

Predicting which patients with acute circulatory failure will respond to the fluid by an increase in cardiac output is a daily challenge. End-expiratory occlusion test (EEOT) and mini-fluid challenge (MFC) can be used for assessing fluid responsiveness in patients with spontaneous breathing activity, cardiac arrhythmias, low-tidal volume and/or low lung compliance. The objective of the study is to evaluate the value of EEOT and MFC-induced rise in left ventricular outflow tract (LVOT) velocity time integral (VTI) in predicting fluid responsiveness in acute circulatory failure in comparison to the passive leg-raising (PLR) test. Hundred critically ill ventilated and sedated patients with acute circulatory failure were studied. LVOT VTI was measured by transthoracic echocardiography before and after EEOT (interrupting the ventilator at end-expiration over 15 s), and before and after MFC (100 ml of Ringer lactate was infused over 1 min). The variation of LVOT VTI after EEOT and the MFC was calculated from the baseline. Sensitivity, specificity, and area under the receiver-operating characteristic (AUROC) curve of LVOT VTI after EEOT and MFC to predict fluid responsiveness were determined. After PLR, stroke volume (SV) increased by ≥12% in 49 patients, who were defined as responders and 34 patients in whom the increase in SV <12% were defined as nonresponders. A cutoff of 9.1% Change in VTI after MFC (ΔVTIMFC) predicted fluid responsiveness with an AUROC of 0.96 (P < 0.001) with sensitivity and specificity of 91.5% and 88.9%, respectively. Change in VTI after EEOT (ΔVTIEEOT) >4.3% predicted fluid responsiveness with sensitivity and specificity 89.4% and 88.9%, respectively, with an AUROC of 0.97 (P < 0.001), but in 17 patients, EEOT was not possible because triggering of the ventilator by the patient's inspiratory effort. In conclusion, in mechanically ventilated patients with acute circulatory failure Δ VTIMFC and Δ VTI EEOT accurately predicts fluid responsiveness.

Humanização em neonatologia na perspectiva dos enfermeiros

Objective: To know the perception of nursing professionals about the applicability of the National Humanization Policy in the neonatology sector. Methods: This is a descriptive-exploratory study, with a qualitative approach, carried out through interviews with 20 (twenty) nurses working in neonatology environments in a maternal and child reference hospital in the North region. The analysis took place through Content Analysis, with the aid of the IRAMUTEQ software through Reinert's method. Results: Through the study, six categories were defined in line with the proposed objective: humanized practices in neonatology, humanization in the institutional and professional context, the relevance of humanization in the neonatal context, advances and obstacles of humanization in neonatology, kangaroo method as a guide for humanized care to the newborn and the policy of humanization in comprehensive care. Conclusion: It was observed that nurses perceive the changes that have occurred in care, arising from the National Humanization Policy within the neonatal environment, from the institutional to the professional context, effected through the provision of care for both the newborn and his family, in addition to creating a welcoming environment. However, it still presents its daily challenges in the routine of care.

Do matrix metalloproteinase and cathepsin K inhibitors work synergistically to reduce dentin erosion?

To evaluate the effects of matrix metalloproteinase (MMP) and cathepsin K (catK) inhibitors on resistance to dentin erosion. A total of 96 dentin specimens (3×3×2 mm) were prepared and randomly assigned into four groups (n=24): deionized water (DW); 1 µM odanacatib (ODN, catK inhibitor); 1 mM 1,10-phenanthroline (PHEN, MMP inhibitor); and 1 µM odanacatib + 1 mM 1,10-phenanthroline (COM). Each group was further divided into two subgroups for the application of treatment solutions before (PRE) and after erosive challenges (POST). All specimens were subjected to four daily erosive challenges for 5 d. For each erosive challenge, the specimens in subgroup PRE were immersed in the respective solutions before cola drinks, while the specimens in subgroup POST were immersed in the respective solutions after cola drinks (the immersion duration was 5 min in both cases). All specimens were stored in artificial saliva at 37°C between erosive challenges. The erosive dentin loss (EDL) was measured by profilometry. The residual demineralized organic matrix (DOM) of specimens was removed using type VII collagenase and evaluated by profilometry. Both the EDL and thickness of the residual DOM were statistically analyzed by two-way analysis of variance (ANOVA) and Bonferroni's test (α=0.05). The surface topography and transverse sections of the specimens were observed using SEM. MMPs and catK were immunolabeled in the eroded dentin and in situ zymography was performed to evaluate the enzyme activity. Significantly lower EDL was found in the groups ODN, PHEN, and COM than in the control group (all p<0.05), while no significant difference in EDL was found among the groups ODN, PHEN, and COM (all p>0.05). The application sequence showed no significant effect on the EDL of the tested groups (p=0.310). A significantly thicker DOM was observed in the group ODN than in the control group regardless of the application sequence (both p<0.05). The treatment with ODN, PHEN, and COM inhibited the gelatinolytic activity by approximately 46.32%, 58.6%, and 74.56%, respectively. The inhibition of endogenous dentinal MMPs and catK increases the acid resistance of human dentin but without an apparent synergistic effect. The inhibition of MMPs and catK is equally effective either before or after the acid challenge.

The Experience of ER Nurses in Lebanese Hospitals, During the COVID-19 Outbreak: A Qualitative Study.

The increasing number of COVID-19 cases, as well as the overwhelming workload, constitutes a serious occupational health threat to Emergency Room (ER) nurses working on the frontlines. In Lebanon, where unstable socio-economic conditions reign, the Covid-19 outbreak was added to the plethora of daily challenges faced by healthcare workers. The study's objective is to explore how Lebanese ER nurses perceived their duty on the frontlines amid the Covid-19 pandemic. This study employed a descriptive exploratory qualitative design. 15 Lebanese ER nurses working directly with Covid-19 patients were recruited from 3 university hospitals in Beirut. Interviews were held for data collection until data saturation. Subsequent analysis was done via coding of the transcribed verbatim. The findings showed significant gaps related to preparedness, support, and governmental action. Similarly, the frontliners faced serious challenges that increased their stress levels both physically and mentally. Furthermore, some participants were subject to stigma and had to face irresponsible behaviors during triage. Participants emphasized the need to guarantee a safe environment at work, to provide Covid-19 patients with the needed care. ER nurses struggled during this pandemic while working on the frontlines. They described their experience as not satisfying, with high levels of stress, danger, and challenges.