Daily Challenges Research Articles

Molecular/biomarker testing in lung cytology: A practical approach.

The increasing comprehension of molecular mechanisms underlying lung cancer and the discovery of targetable genomic alterations has dramatically change the pathological approach to lung cancer, especially non-small cell lung cancer (NSCLC). This unstoppable knowledge has taken pathologists to the leading front on lung cancer management. This is especially relevant in the world of cytopathology where "doing more with less" is a daily challenge. Nowadays with a growing number of predictive biomarkers needed to manage patients with NSCLC, there has been a paradigm shift in care and handling of diagnostic samples. One of the main emphasis and interest relies on the utilization of cytologic samples and small biopsies for not only diagnostic purposes but also for ancillary testing. Moreover, lung cytopathology is in continuous evolutions with implementation of new diagnostic techniques, new tools, and facing new challenges. The goal of this paper will be to provide the reader with the necessary concepts than can be used to exploit the cytological samples in order to use these samples for comprehensive diagnosis and relevant ancillary testing purposes.

Automatic Detection of Cases of COVID-19 Pneumonia from Chest X-ray Images and Deep Learning Approaches.

Machine learning has already been used as a resource for disease detection and health care as a complementary tool to help with various daily health challenges. The advancement of deep learning techniques and a large amount of data-enabled algorithms to outperform medical teams in certain imaging tasks, such as pneumonia detection, skin cancer classification, hemorrhage detection, and arrhythmia detection. Automated diagnostics, which are enabled by images extracted from patient examinations, allow for interesting experiments to be conducted. This research differs from the related studies that were investigated in the experiment. These works are capable of binary categorization into two categories. COVID-Net, for example, was able to identify a positive case of COVID-19 or a healthy person with 93.3% accuracy. Another example is CHeXNet, which has a 95% accuracy rate in detecting cases of pneumonia or a healthy state in a patient. Experiments revealed that the current study was more effective than the previous studies in detecting a greater number of categories and with a higher percentage of accuracy. The results obtained during the model's development were not only viable but also excellent, with an accuracy of nearly 96% when analyzing a chest X-ray with three possible diagnoses in the two experiments conducted.

Self-management Strategies for Patients with Risk Factors to Reduce the Impact of Cardiovascular Disease in Selected Clinics in Limpopo Province, South Africa

Background: Cardiovascular diseases are now the leading cause of death worldwide, amounting to 17.8% of all deaths recorded. In Sub-Saharan Africa, it contributes to about 13% of deaths, whereas 80% were recorded from developing countries. A quarter of all deaths are attributable to behavioural and metabolic risk factors due to patients` lack of self-management strategies, which are practices and activities that the patients can use and manage themselves, effectively preventing the development of CVD. Objective: The study aimed to explore patients at risk of CVD’s knowledge of self-management strategies to prevent the development of CVD. Methods: This was a qualitative exploratory and descriptive study conducted in four primary health care settings in two contexts (i.e., a rural and peri-urban setting) in the Capricorn District of Limpopo Province, South Africa. The target population were patients with risk factors and diagnosed with either hypertension or diabetes mellitus. Twenty-five patients (male n=9; female n=16) were purposefully sampled and participated in semi-structured individual interviews with a schedule guide. The data was analysed using thematic Tesch’s open coding qualitative data analysis method. Results: Thematically analysed data resulted in three main themes and their related subthemes enumerating patients at risk of CVD’s knowledge regarding disease onset, risk factors, and self-management, including daily challenges affecting disease progression. The major themes isolated are 1) knowledge related to CVD onset, symptoms, and self-management strategies, 2) challenges experienced by persons at risk of developing CVD, 3) suggestions to help improve health and the prevention of the onset of CVD. Conclusion: The study concludes by recommending in-depth CVD awareness and education programs for patients at risk. More importantly, the provision of mental health awareness, counselling, and equipping patients with coping skills are recommended.

Primary and secondary prevention of atherosclerotic cardiovascular disease: A case-based approach.

Estimating the risk of atherosclerotic cardiovascular disease (ASCVD) is a daily challenge for clinicians and is crucial to tailoring preventive medical care and guiding shared decision-making. New imaging modalities and novel biomarkers allow for more accurate assessment of patient risk and minimize the risk of over- or undertreating patients. Major cardiovascular medicine societies have incorporated new diagnostic modalities in their guidelines to aid clinical decision-making for primary and secondary prevention of ASCVD. This review presents commonly encountered cases relevant to estimating and reducing ASCVD risk based on available guidelines and expert opinion.

P03-12 Falling between two stools: parents' experience of supporting their children with cerebral palsy (GMFCS I-II) living an active life

BackgroundChildren and adolescents with cerebral palsy (CP) are a vulnerable group who find it challenging to meet current physical activity guidelines, which predispose them to the negative health implications associated with low levels of physical activity and high levels of sedentary time. For these reasons, a key role for many clinicians, parents, and other practitioners is to encourage and facilitate an increase in habitual physical activity and reduce the amount of time spent sedentary, in order to optimize long-term health outcomes.In Denmark, there is a strong tradition of practicing habitual exercise at leisure activities (83% of children and adolescents). When participating in leisure activities these children are being physically active as well as experiencing being a part of a community. Children and adolescents living with CP are often not able to participate in regular leisure activities, which excludes them from the active and social life that's happening there. This study focuses on parents of children with GMFCS I-II, who, due to their good walking abilities, may be more likely to be able to participate in regular leisure activities.This study aims to explore the daily life and challenges described by parents in their pursuit of supporting their children with CP living a physically active life. This knowledge can be used by parents, clinicians, coaches, teachers, and other practitioners to guide families living with CP towards a more physically active lifestyle and possibly optimize long-term physical and social health outcomes for children and adolescents with CP.MethodsEleven parents of children with CP (n = 7) (GMFCS I-II) aged 7-15 years participated in seven semi-structured interviews. Thematical analysis was performed to understand the data material.Results and conclusionsThe main challenge described by parents was formulated as ‘Falling between two stools’ referring to the experience of their child being ‘too good’ for adapted leisure activities, but at the same time wanting to participate in regular leisure activities, but performing a little too poorly, to feel included. It was found that a reigning performance culture in regular leisure activities was perceived as a barrier for the participation of these children.

Living in a reshaped reality: Exploring social participation and self-identity after TBI

ABSTRACT Individuals with a moderate to severe traumatic brain injury (TBI) experience substantial changes in their life. This constructivist grounded theory study aimed to develop an explanatory model that explores the impact of changes in social participation and self-identity after sustaining a TBI. Sixteen participants with moderate to severe TBI (mean age = 49.8, 69% male) were recruited, and were on average 16.4 years post-injury (SD = 10.4). Data from semi-structured interviews were analysed thematically. An overarching theme of “living in a reshaped reality” was identified, which depicted how changes in social participation and self-identity influenced ongoing experiences with TBI. Three main themes were generated: (1) “there's nothing that's the same” highlighted the daily challenges individuals faced post-injury, (2) “rebuilding and restarting” described how individuals with TBI navigated through their unfamiliar reality, and (3) “embrace it and run with it” explored participants’ reactions towards life with a TBI. An explanatory model was developed, consisting of the overarching theme (“living in a reshaped reality”) with the three integrated themes. Future research and clinical practices can build on this understanding to develop programmes to help individuals address their needs in post-injury life.

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

Background: 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. Objective: 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. Method: 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. Results: 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. Conclusion: 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. Contribution: 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.

Assessing drug use relapse rate and its associated factors among Iranian users

ABSTRACT Background Relapse of drug use makes addiction more complex and difficult. This study aims to access the rate of drug use relapse and its determining factors among users referred to addiction treatment centers in Saveh, Iran. Methods This cross-sectional study was conducted among 403 users referred to Saveh addiction clinics, in Iran. Data were collected using a survey using stratified random sampling methods. Results A total of 374 men and 29 women participated in this study. The mean age of participants was 37.9 ± 10.1 years old but the mean age of first use was 17.6 ± 5.3 years old. More than half of the participants had elementary education. Most of those (74%) had a history of relapse. Escape from daily life challenges, place of residency, unemployment, and availability of drugs were dominant factors for relapse. The demographic factors of gender, and duration of the addiction and psychological factors of resilience, positive outcome expectancies, urges and temptations to use, self-efficacy, social support, and emotion-oriented coping were significant variables in predicting relapse (p < .05). Conclusion This study finding has significant implications for policy decision makers and educational interventions. Addressing determinants of drug use relapse is the primary strategy for preventing and reducing drug use.

New Zealand emergency nurses’ perspectives and experiences of professional joy in clinical practice: An exploratory qualitative study

BackgroundNursing is becoming an increasingly stressful occupation, identified by high rates of burnout, compounded by a worldwide nursing shortage. Differing solutions to combat burnout have not provided long-term positive outcomes. This research explored emergency nurses’ perspectives and experiences of one potential solution, known as joy in work, or professional joy. MethodsA qualitative, descriptive design was used to conduct semi-structured interviews with six registered nurses from two New Zealand emergency departments. Thematic analysis techniques were used. FindingsProfessional joy was frequently experienced, despite the difficulties faced in the emergency environment. Joy was identified as being like a spark which provided an uplift. The experience of joy positively impacted the nurse, and beyond, and potentially provided a buffer that assisted with mitigating the daily challenges. Recalling or sharing experiences of joy evoked a sense of wellbeing in the nurse, which in turn provided motivation to keep on nursing. This research identified a link between nurse wellbeing, joy and the importance of a healthy work environment. ConclusionWhile this study was relatively small, the findings highlight the significant positive impact the experience of joy had on these nurses. Further research is recommended to gain greater understanding of this important topic.

Levels of Emotional Intelligence: A Study of Students in Kenya Medical Training College

Nature bestowed humans with emotions. The stresses of the modern-day world have a negative effect; hence, people are becoming more emotionally volatile, less self-motivated, and less compassionate. Consequently, the levels of Emotional Intelligence (EI) continue to decline. Furthermore, the daily challenge of dealing effectively with emotions is critical to human beings because our brains are hard-wired to give emotions the upper hand: Our view of the world, how we react to it and adjust our behaviour accordingly is largely influenced by emotions. Emotional Intelligence (EI) skills are huge contributors to overall health as well as success in life, which is attributed to their impact on the ability to motivate and self-manage. This study assesses the level of EI among Students in Kenya Medical Training Colleges. The sample comprised 372 participants aged between 17 and 25 years. Data were collected using a researcher developed questionnaire and an emotional intelligence assessment tool with five components/subscales. These are: intrapersonal skills, interpersonal skills, stress management skills, adaptability, and general mood. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20. The average scores for all participants were as follows: 41.9 for intrapersonal; 28.3 for interpersonal; 30.8 for stress management; 23.9 for adaptability; and 25.3 for general mood. Consequently, the overall average scores were 150.2 which falls under the high level of EI based on the criteria for measuring EI. The implication is that the students at Kenya Medical Training College have a high level of emotional intelligence

Alleviating experimental allergic eye disease by inhibiting pro-lymphangiogenic VEGFR3 signal

PurposeOcular allergy leads to acute and chronic inflammation that may deteriorate the conjunctiva and other ocular tissue. The conjunctiva is covered with abundant lymphatic vessels but how the conjunctival lymphatic system patriciates in the development of allergic eye disease (AED) remains to be elucidated. Methods and resultsBy using ovalbumin (OVA)+pertussis toxin (PTX) as a sensitizer followed by daily OVA challenges, we induced optimized AED manifestations in mice. We show that conjunctival lymphatics underwent significant expansion after 28 days of chronic OVA challenge, and this process can be prevented by inducible genetic ablation of lymphatic Vegfr3. Through transcriptomic profile analysis in combination with histopathological examinations, we found that pro-lymphangiogenic VEGFR3 signal promoted allergy-induced activation of T helper 2 (Th2) type immune responses, including antigen presentation, and Th2 cells, B cells and mast cell-related pathways in the conjunctiva, thereby critically contributing to the immunoglobulin E (IgE) production and AED manifestations. As a result, ocular allergy can be alleviated by genetic inhibition of lymphatic Vegfr3. Interestingly, pro-lymphangiogenic VEGFR3 signal did not appear to affect the obstruction of meibomian glands (MGs) or the activation of Th17 type and neutrophil pathways that are associated with AED. ConclusionsThese data reveal the key role of pro-lymphangiogenic VEGFR3 signaling in the development of AED and provide experimental evidence that VEGFR3 inhibition may be useful in treating ocular allergy in patients.

How to Improve the Contribution of Support Services to a Hospital’s Performance

Working together is the daily challenge faced by all hospital staff, despite the great diversity of their professions and the complexity of their organizations. Behind the healthcare staff, support services are active to provide the right service at the right time and in the right place. The contribution of support services to the implementation of hospital strategy is studied here thanks to the socio-economic intervention research conducted in a French hospital during a doctoral research project. The results show the preponderant place of communication, coordination and cooperation in achieving the desired synergy. The calculation of hidden costs highlights a significant room for manoeuvre to improve the performance of hospitals through the improvement of communication-coordination-concertation systems.

Poverty Alleviation Strategies for Sivomo Villagers in Nkayi District, Zimbabwe

Poverty continues to be a challenge in Zimbabwe, with increased levels recorded during the COVID pandemic. In rural areas such as Nkayi, interventions targeting poverty cut across numerous fields such as agriculture, education, and infrastructure. Despite these interventions, poverty continues to be a daily confrontation and challenge. This paper uses Michel de Certeau's theoretical tools to discuss the everyday contests between development agencies and community members as they formulate interventions to address poverty. It identifies strategies employed by agencies and the concomitant tactics deployed by community members. While these sometimes conflict, the paper argues that they culminate in processes of progression and regression or stages of poverty which translate to a little-to-no change in the poverty situation. As such, a rethink of strategies and their relevance is suggested.

A novel automated depression detection technique using text transcript

AbstractDepression is one of the most common mental illnesses, impacting billions of people worldwide. The lack of existing resources is impeding the country's economic prosperity. As a result, new approaches for detecting and treating mental diseases as well as reaching out to individuals are required so that people can overcome their daily challenges and become more productive. An automated depression detection system can greatly aid in clinical findings and early treatment of depression. Automatic detection, like in a clinical interview can be derived from various modalities that include video, audio, and text. Among these modalities, audio characteristics are the most commonly researched while text elements are seldom investigated. In the light of the above, this paper proposes a novel automated depression identification approach based on linguistic material gathered from patient interviews. The focus is to enhance both the accuracy and efficiency of detection. The proposed approach is made up of two parts: a Bidirectional Gated Recurrent Unit (BGRU) network for dealing with linguistic information and a fully coupled network that integrates the model outputs to measure the depressed state. The proposed approach is validated using Distress Analysis Interview Corpus‐Wizard‐of‐Oz interviews dataset. To evaluate the performance precision, recall, and F1 score are computed using the proposed approach and then the comparative analysis is done with the existing approaches. The proposed approach yielded an F1 score of 0.92, indicating the existence of depression as well as the projected severity level. It is realized from the generated results that the proposed approach has outperformed the previous ones. The proposed approach can not only automatically assess the severity of depression but also enhances both the accuracy and efficiency of detection. The proposed approach indicates the feasibility of BGRU over Long Short Term Memory by achieving exceptional results for recognition of depression.

Supporting patients' daily challenges with plaque management

Supporting patients' daily challenges with plaque management

Women in Cantonments: Evolution of Regulated Military Prostitution in Colonial India

From the mid-19th century the existence of a large number of native prostitutes in the British military cantonments confirmed the widespread prevalence of state-authorised prostitution in colonial India. The colonial administration induced new laws that tried to restrict prostitution as a practice exclusively for the service of the British military men and also made it a sanctioned part of the military establishment. Consequently, a new form of regulated military prostitution evolved that radically changed the nature of prostitution as it used to be in the pre-colonial period. In this article, I have tried to explore the causes behind the emergence of regulated military prostitution and how it was implemented and systematised in British India. It would also focus on a new pattern of brothel life which emerged throughout military cantonments and finally the women’s life in cantonments that would provide a glimpse of their daily chores and challenges.

Challenges faced by the Indian Pharmaceutical Companies in protecting various forms of Intellectual Property Rights

Intellectual Property (IP) is a pharmaceutical or Biotech Company’s most valuable resource, and its protection is a key to that company’s future success. Recent challenges over patents for HIV drugs has reminded the industry that progress is still needed in balancing the opposing forces of innovation through protection of IP rights, versus the provision of affordable drugs for the developing world. Pharmaceuticals companies must face the daily challenge of creating value through the exploitation of IP rights, but avoiding considerable reputational harm. This situation was well illustrated in South Africa during the late 1990s when the balance between IP protection and the urgent needs of patients were not aligned. Since then, companies have become more aware of the potential damage that can be caused by too strict an interpretation of IP rights. Working in collaboration with national governments, trans-national organizations such as the WHO, and non-governmental organizations such as the Bill and Melinda Gates Foundation, pharmaceuticals companies have begun to find ways through the minefield of IP protection in less developed countries, and most now have donation schemes for drugs to treat diseases such as leprosy and HIV.

Supporting patients' daily challenges with plaque management

Supporting patients' daily challenges with plaque management

Selected Methods of Therapeutic Interactions With People With Mild Symptoms of Autism Spectrum Disorder.

In this review we present the behavioral aspects of interaction in people with autism spectrum disorders (ASD), taking into account some aspects of pharmacotherapy. In the treatment of people with ASD, an individual approach to emotional, social and cognitive functioning is very important. The specificity of symptoms and their severity in people with ASD results from deficits/disfunction of various areas of the brain and is associated with different levels of intelligence. This manuscript considers selected methods of interaction with ASD patients with normal IQ. Due to the different ways of functioning, these people often find it difficult to adapt to social expectations. The most important thing is to understand their perception of themselves and the world around them in order to support them in coping with the daily challenges. Due to the increasing problem, more and more attention is being focused on early detection of ASD, what allows to intervene as fast as possible and in consequence affect the quality of life of people with this dysfunctions. However, participants with mild autism symptoms are still difficult to diagnose in the practice. The effectiveness of the therapy depends largely on the cooperation of educational institutions. It is also necessary to contact specialist clinics, including a mental health counseling center. However, in the case of children and adolescents, the cooperation between the therapist and their parents is the basis. Systemic family therapy is also important in adults with ASD. An overview of the methods of therapeutic interactions in ASD, what may be helpful in diagnosing of mild ASD, were presented in our manuscript.

AFRICA’S WATER INSECURITY AND ITS TRIGGERS

Even Africa boasts some of the greatest water resources in the world with large rivers, they are unevenly distributed on the continent, some countries being well endowed with water resources, other being forced to make difficult choices in order to get sustainable access to water; in the same time, precipitations’ regime has the same feature: too much during specific part of the year, lower (or missing altogether) precipitations doubled by high evaporation rate due to high temperatures. Overlapping these natural elements, there have been engineering actions and urban planning – both, during colonial period and after Africa’s countries gained independence – influencing the access to this vital resources in a discriminatory manner. Climate changes doubled with the dynamic population trend on this continent are newcomers, influencing in a negatively way the possible evolution on the continent. Water commodification is another element hitting hard the poor in Africa; as wealthy parts of African cities are well connected to urban water pipes and facilities, poorer parts of the same city totally misses access to water facilities. The poorest people must buy bottled water to get through daily challenges, large part of their incomes being diverted to gaining access to water. The paper intends to bring to East-European audience the problems and challenges the most dynamic continent is going to face, and how can it influence the evolution there, and in other parts of the world, due to migration. Poor access to water, and when available its dubious quality, are other components of African water landscape with great medical consequences and costs at both personal and state level.