Humbling Experience Research Articles

Postoperative outcomes in distal pancreatectomy: A single-center experience

Abstract Context: With the development of new advanced diagnostic modalities, distal pancreatectomy is nowadays performed more frequently. Pancreatic surgeries are considered overall highly morbid, with fistula development being the most serious and feared complication. Aim: This study aims to review a tertiary care center’s experience with distal pancreatectomy and to define the outcomes and mortality associated with this procedure. Subjects and Methods: A retrospective observational study was conducted among 18 patients who underwent distal pancreatectomy in the time between 2012 and 2022, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Results: Of a total of 18 patients, 44.44% were above the age of 50, and 77.77% were females. Indications related to the procedure include: 38.88% were pancreatic tumors and 38.88% were cystic neoplasms. About 94.44% of patients had their procedure combined with splenectomy, and 50% of them underwent multivisceral resection. There was no reported mortality within the 30 days postoperatively. The most frequent complication was pancreatic fistula, which occurred in 16.66% of the patients. Conclusions: One of the limitations of our study is the small sample size, which restricts a strong conclusion. However, in our center’s humble experience, there were no mortalities among the patients undergoing distal pancreatectomy, although it was associated with some morbidity.

Malignant masquerade: Clinician dilemma revisited

Mimesis is a Greek word that means to imitate, while the word masquerade means pretending to be something or someone that he/she is not. In this case series of four cases pertaining to different organ subsets, we discuss and highlight the benign medical conditions, which pretended as neoplastic both clinically and radiologically preoperatively; however, the postoperatively histopathological report yielded surprising results. Though lots of literature on a malignant masquerade is available, there is a paucity of data on case series discussing the different subset organ involvement. These unique clinical scenarios also emphasize the fact that it is incorrect to judge a book by its cover. We would like to summarize our humbling experience in the word of William Osler “medicine is the science of uncertainty and art of probability.”

The Role of Energy Density for Grid-Scale Batteries

For grid-scale battery energy storage systems it is often presumed that cell level energy density is not too important. Yet, countless publications highlight low energy density as the key limitation of technologies such as redox flow batteries or aqueous alkali-ion batteries that are inherently developed for stationary applications.Here, we resolve this apparent conflict by quantifying the areal energy density, expressed in kWh m-2, of over forty MWh-scale battery energy storage systems deployed around the world.[1] Via satellite imagery we compare lithium-ion, sodium-sulfur, and flow battery projects and show that the amount of energy that is stored per land area is often comparable between these technologies, even though the energy density on cell level varies by an order of magnitude. We highlight excellent safety and vertical scalability as key untapped advantages of aqueous batteries and provide examples of where they can excel, besides simply competing with state-of-the-art lithium-ion batteries. We show, for example, that MWh-scale aqueous flow batteries can safely be deployed underground and within buildings, feats that due to safety constraints are not possible with current lithium-ion batteries at this scale.Seeing satellite images of battery installations near solar farms is a humbling experience that every researcher working in the field should come across and we provide the locations of all the examined battery installations in a Google Earth file. Grasping the fantastical scale at which renewables are, and must continue to be, deployed certainly provides some perspective regarding energy density of individual battery cells. [1] Reber, D., Jarvis, S.R., Marshak, M.P., The role of energy density for grid-scale batteries, ChemRxiv, 2022, doi: 10.26434/chemrxiv-2022-5ddhs

FRI326 Hypophysitis: A Formidable Diagnostic Challenge

Abstract Disclosure: S. Pandey: None. C. Houston: None. Background: Hypophysitis, defined as inflammation of the pituitary gland, may pose a formidable diagnostic challenge due to its protean clinical manifestations and growing spectrum of potential causes. We present a case of a young man with presumed hypophysitis in whom the etiology remains unknown. Case Summary: A previously healthy 20-year-old male with bilateral gynecomastia was referred to the endocrinology clinic. He reported a 1-year history of worsening fatigue, weight gain, intermittent headaches, bilateral breast enlargement, lack of morning erections, polydipsia, and polyuria. His childhood growth and pubertal development were reportedly normal. He denied prior head or testicular trauma, major systemic illnesses, and chronic opiate or glucocorticoid use. His physical exam was remarkable only for scant facial hair and bilateral nontender gynecomastia. His visual fields were normal, and sense of smell was intact. Laboratory evaluation at 8am revealed low total and free testosterone of 32 ng/dL (240-950) and 0.98 ng/dL (5.25-20.7), respectively, with LH of 1.4 mIU/mL (1.0-12.0) and FSH of 1.9 mIU/mL (1.0-12.0). Free T4, prolactin, IGF-1, and serum sodium were all within normal ranges. Serum cortisol was modestly elevated at 22.3 ug/dL (3.7-19.4) with normal ACTH of 49 pg/mL (7.2-63.0). Pituitary MRI showed diffuse thickening and enhancement of the pituitary stalk, compatible with infundibular hypophysitis, without evidence of mass effect upon the native gland or surrounding structures. Additional testing showed normal levels of serum calcium, iron, ferritin, ESR, and antinuclear antibodies. After overnight water deprivation, his serum sodium was elevated at 156 mmol/L (134-144) with low urine osmolality of 121 mOsmol/kg (300-900). He was started on desmopressin and testosterone, and close clinical monitoring was enacted. Conclusion: The diagnosis of hypophysitis poses multiple challenges. Its clinical manifestations can vary widely, including symptoms related to mass effect and/or symptoms of pituitary dysfunction. Diagnosis is often presumptive based on history and exam, biochemical evaluation, and neuroimaging. The spectrum of potential causes is broad and growing, including infiltrative, infectious, neoplastic, immunoglobulin G4-related, immunotherapy-induced, other autoimmune, and paraneoplastic causes. It is often a humbling experience for clinicians to narrow this exhaustive differential. Pituitary biopsy is the gold standard for diagnosis but poses significant risks, so is reserved for cases when the diagnosis remains uncertain or malignancy is suspected. Close clinical monitoring and re-evaluation is an acceptable alternative in select cases. Presentation: Friday, June 16, 2023

Тайваньский даосизм: вариативность форм и неизменность социальной миссии

This article is devoted to the analysis of the social structure of Taiwanese Dao­ism and its role in the everyday life of Taiwanese society. The emergence of Tao­ism in Taiwan dates back to the middle of the 17th century, when the first settlers arrived here from the areas of Quanzhou, Zhangzhou and Chaozhou, located in the southern coastal regions of mainland China. Until the 20th century, only Taoists of the Orthodox One school (Zhengyipai) were represented in Taiwanese society. The peculiarity of the ritualists of the Zhengyi school is their close con­nection with the local community, whose spiritual needs they serve. The author, based on the work of Taiwanese researchers and his own humble experience of field research in Taiwan, examines the social history of Taiwanese Daoism and characterizes its main currents. The article discusses the features of the Daoist tradition of Dao-fa er-men, the Lingbao lineage and the Chanhe lineage, as well as the social role of ritual masters fashi belonging to the “vernacular level” of the Taoist tradition, and grassroots spirit mediums tong-ki. As the results of modern research indicate, Taiwanese Daoism has many forms and historical variations, but it retains its social mission unchanged. The modern Taoist ritual­ists of Taiwan, first of all, ensure the normal functioning of the local social or­ganism, its unity and ethnocultural self-identification.

Learning to Listen

Learning to Listen

Role of homoeopathy in the management of motion sickness: A brief review

Motion sickness is humbling experience of travel. Suddenly becoming pale, perspiring, becoming nauseated and developing an urge to throw up all stomach contain due to the brain receives differing information from the visual, vestibular senses and body proprioceptors. This mismatch of sensory information gives rise to the release of brain chemical agent like neurotransmitter that stimulates the vomiting center. Several Homoeopathic medicines (Cocculus, Ipeacacuanha, Petroleum, Staphisagria, Tabacum, Theridion) are most effective for this common problem of traveler.

Advancing Entrepreneurship Theory Through Replication: A Case Study on Contemporary Methodological Challenges, Future Best Practices, and an Entreaty for Communality

Given that replication studies are important for theory building, theory testing, knowledge accumulation, and domain legitimacy, we attempted to replicate 19 seminal studies of new venture emergence that used PSED-type data; only six attempts were successful. Our humbling experience highlights how changes at the author, journal, and institutional levels—indeed, a communal effort—can encourage, facilitate, and expedite replication studies. We provide entrepreneurship scholars with ten best practices for conducting replication studies, as well as recommendations to other stakeholders to steer away from the replication “crisis” plaguing other research domains. As they say, it takes a village.

Depth of Field: Disorienting the “Ethnographic Gaze” through Zeme Naga Realms

Depth of Field: Disorienting the “Ethnographic Gaze” through Zeme Naga Realms

The Wax Ancient Historical Citadel: An exploratory field study: قلعة شمع الأثرية: دراسة ميدانية استطلاعية

Choosing the location of the big & small citadels & distributing them inside & outside Lebanon is undoubtedly mainly connected with geographic & strategic elements. If we consider these citadels geographically & look at their distribution & the way they are spread, we will notice the importance of the location where they have been built especially the Wax Citadel which is located in the south of Lebanon near the Lebanese & Palestinian border lines! This citadel is located at the highest area in the Wax country. It is 380 meters higher than sea level. It overlooks the cities & villages of Tyre & Bint Jubail from the East , overlooks the Palestinian Plain from the South , & the Lebanese Plain extending from the North to Tyre City to the Palestinian borders in the South. Similarly, it overlooks AlBayyada plains, Mina Iskandaroun, & Ras Al Naqoura. With respect to the naming of the country, this is related to the Wax/ Shama' naming of the citadel as well as of the country; it is related to the religious shrine situated at the highest place of the country near the citadel.This shrine is known as the Shrine of the prophet Shamaoun Al Safa. However, other studies claim that this citadel has been named as the Citadel of Iskandaron related to the sea port called Iskandaron which is situated at the head entrance of Al Bayyada & the road which leads to the(Wax) or Shama' country. Another study carried out by Mr Abdul Rahman Al Zaki claims for the first time that this Citadel is called Scanalium Citadel. With respect to the history of the citadel, this is still relatively unknown similar to other ancient ruins in Lebanon which are still unknown up to a certain extent. This is because of the absence of really specialised studies in this field, or the absence of excavations of ruins to stop the argument in this domain about this issue. This is why I shortened the information about this issue. I think it goes back to the crusaders era. I gave touristic information which is transferred every now & then, but it sometimes disappears. This aroused my interest to carry a deeper field action research depending on my humble experience in the science of ruins or Field of Archeology.

A Review of Studies of Geomagnetic Storms and Auroral/Magnetospheric Substorms Based on the Electric Current Approach

The progress of space physics is reviewed from my personal point of view, particularly how I have reached my present understanding of auroral substorms and geomagnetic storms from the time of the earliest days of space physics. This review is somewhat unique in two ways. First of all, instead of taking the magnetic field line approach (including magnetic reconnection), I have taken the electric current approach; it consists of power supply (dynamo), transmission (currents/circuits), and dissipation (auroral/magnetospheric substorms). This is the basic way to study electromagnetic phenomena and it is much more instructive in understanding the physics involved in the chain processes. Secondly, this is not a textbook-like review, but it is hoped that my humble experience may be useful to see how a new science of space physics has evolved with a number of controversies. On the other hand, it can be seen that the electric current approach is still in a very rudiment stage. Thus, new generations of researchers are most welcome in taking this new way of studying auroral/magnetospheric substorms and geomagnetic storms.

THE APPLICATION OF KIND OF CLASSROOM TEACHING CONTEXTUAL LEARNING ( CTL) THROUGH THE USE OF GOOGLE CLASSROOM FOR A PANDEMIC COVID 19 ECONOMICS TEACHER IN HIGH SCHOOL STUDENTS TAMAN SISWA PADANG

One of the media learning and an evaluation tool required teachers in the pendemi covid 19 this is google application that can be used classroom teachers in free in the learning process in the tissues .Google is a series of classroom produktivtas tools from google gmail are free , drive , and docs , made available to users google apps for education .Designed to help teachers or classroom teachers make and collect duty without using paper , including a feature to save time teachers like the ability to make a copy google docs automatically for each student .Classroom can also make folder drive for any task and each student , that they were still regularly .The desire to achieve in doing this is to provide humbling experience for teachers in using google online class which is very useful in the classroom covid 19 this pandemic

The Art of History Taking: an Unusual Presentation and a Humbling Experience

Traditional medical pedagogy is increasingly being threatened by sophisticated diagnostic and prognostic techniques. In a busy OPD, the impatient but eager clinician tends to bypass classical teachings and proceeds to diagnosis based on imaging and other findings. An unusual presentation of melanoma made us realize the importance of basic clinical methods and, how robust and relevant they remain, even in the present era.

Tele-fellowships for addiction medicine.

The COVID-19 pandemic has been an eye-opener to the world. Global shutdown for infection control has moved workers to virtual workplaces for working remotely. Considering the infectious globalized world, the humbling experience of the COVID-19 pandemic may not wear off even after the pandemic is scientifically and officially over because the COVID-19 pandemic may have impressed and permanently imprinted upon the humanity that (a) human-to-human in-person interactions may be potentially contagious, always and (b) feasibility of virtual interfaces among humans may make human-to-human interactions safer, always. Therefore, without being skeptical about the new normal due to global reshaping of humanity, it may be time for Accreditation Council for Graduate Medical Education (ACGME) to consider tele-fellowships because freshly graduating residents or already practicing physicians may be better off not putting off their fulltime tele-medicine practicing jobs for getting mandatorily institutionalized education before being rewarded/awarded with degrees/certifications especially if the warranted clinical skills to practice new normal medical sub-specialties may be safely honed remotely.

Looking Inward

Much reflection was spent on how this year should be remembered. Direction was established by our past presidents and I look to the same horizon. The world at our periphery is also changing, hurrying along the pace of necessity more urgently than ever. We entered the year with a deluge of surrounding agencies demanding attention followed by frenetic efforts to respond to each and every one of them on time, every time. That was when I realized that to go forward, we must pause and look inward. To reassess our resources, realign to the same goals and build greater commitment for a healthier future. This year, the PSO-HNS will strengthen the pillars of its own home constitutionally and administratively. We reach out to fellows in a spirit of community and togetherness. We strengthen the intellectual foundations that we have built upon for training, research, advocacies and continuing education.
 The PJO-HNS is a crucial part of this development. Through the irreplaceable leadership of Dr. Jose Florencio Lapeña as Editor-In-Chief, Dr. Erasmo Llanes and the Associate Editors, the PJO-HNS enjoys international recognition and respect. Much more can be done and with continued efforts, we expect the PJO-HNS to soar to greater heights.
 It is a humbling experience to come after the heels of great mentors in ORL, and often recall the sacrifices and bravery of the 9 who started this all. Every leader thereafter has left a mark; the road by which every single otorhinolaryngologist uses for guidance. Though we may not always realize it, our lives have been partially led to where it is by the service of many individual ORL colleagues. At the conclusion of this year, I pray that the mark we leave will be for the good of all.

Good morning Vietnam

The following is a reflection from two Auckland University of Technology (AUT) academics seconded as visiting professors to teach events and human resource management at a Vietnamese university. As this may be an ongoing project for AUT, they have provided these insights to guide other academics venturing to teach in Vietnam.
 It was a humbling experience and we recommend all academics make teaching overseas and entering into global classrooms part of their journey. Although others with experience of overseas teaching have recommended co-teaching with a translator/interpreter [1], interpreters are not always available when required. And when surprised by their absence, what do you do? Ten lessons were drawn from our experiences for you to include in your overseas teaching survival kit:
 Lesson #1. Expect the unexpected.
 Lesson #2. Brace yourself for culture shock – the first day you will feel like a fish out of water, which really makes you reset yourself to becoming a better teacher. Imagine you are without an interpreter and the students can only understand half of your slides.
 Lesson #3. Adapt your materials and revise your notes to include local examples. This will involve thinking on your feet; your assessment format may undergo many changes. Try to blend in your students’ local and pop-cultural interests.
 Lesson #4. Find your allies; the class monitor and the interpreter rule! Identify the ‘leaders of the pack’ – those who can help lead and manage the class.
 Lesson #5. Use language carefully. Remember that English words can have more than one meaning and that you will spend most of your time rephrasing sentences.
 Lesson #6. Co-teaching with an interpreter means half the time is spent translating your lessons. Be realistic about your learning outcomes.
 Lesson #7. There are no international standards in Vietnam, only regional standards. For example, the international hotel accreditation is not the same as Vietnam’s hotel quality standards.
 Lesson #8. Be prepared with multiple, fun teaching tools to engage your students in group activities. Team building is always welcome.
 Lesson #9. Bring small souvenirs from New Zealand as little treats and rewards to encourage participation from students.
 Lesson #10. Always travel in pairs and be prepared to ‘rough it’.
 Vietnam has transformed us into instructors with a global perspective. We went to impart knowledge, but we have had returned to us many times what we gave. We stepped outside of our comfort zones and this has certainly stretched our personal and professional limits in ways conventional teaching could never achieve. Like Stachowski and Sparks [2], we now know what it is to be cultural outsiders looking in, and how to find ways to gain acceptance as ‘foreign teachers’. Now that we are back on campus comfortably teaching in English, we should still consider the students we have in our classrooms. In a university that promotes the presence of a global community, we need to be mindful that some international students in our classrooms may need help to orientate them to what, for them, is an alien learning and teaching platform in a foreign language. 
 This teaching reflection was supposed to be written upon our return from Vietnam in November 2019. However, at the time of writing, COVID-19 has brought about unprecedented changes that are transforming the way universities are teaching – bringing their lessons online to students from all over the world. Although this article is not focused on COVID-19, the unusual times have triggered questions for academics and industry trainers planning on teaching overseas in the future, to consider beyond the above lessons, particularly about the accessibility of technology. Considerations include the availability of hardware and software to students in other countries. We did not have access to WIFI in the classrooms in Vietnam; students were dependent on their phones for the additional information they needed for our group activities.
 Corresponding author
 Tracy Harkison can be contacted at: tracy.harkison@aut.ac.nz
 References
 (1) Herman, W. E.; Bailey, M. P. Recommendations for Teaching Overseas. College Teaching 1991, 39 (3), 117–121. https://doi.org/10.1080/87567555.1991.10532443
 (2) Stachowski, L. L.; Sparks, T. Thirty Years and 2,000 Student Teachers Later: An Overseas Student Teaching Project that is Popular, Successful, and Replicable. Teacher Education Quarterly 2007, 34 (1), 115–132. https://files.eric.ed.gov/fulltext/EJ795147.pdf (accessed May 4, 2020).

Why do doctors in Norway choose general practice and remain there? A qualitative study about motivational experiences

Objective: To explore experiences motivating doctors to become and remain GPs.Design and contributors: Qualitative analysis of written responses from an open-ended question about motivational experiences posted on an internet discussion list for GPs in Norway. Texts from 25 contributors were analysed with Systematic Text Condensation, supported by theories about calling as motivation.Results: Analysis revealed numerous aspects of motivation to become and remain a general practitioner. Inspirations from early experiences and skilled role models had conveyed values and offered insight into a fascinating world of care, gratitude and respect. Close and continuous relationships with patients provided GPs with humbling experiences and learning moments. Contributors described how these encounters became rewarding sources of insight and mutual trust, improving interpersonal skills. Also, the extensive variety of tasks during the workday and the space for autonomy and independence was emphasised.Implications: Understanding motivational experiences influencing GPs’ choice of medical career is necessary to develop strategies for recruitment and stability and contribute to prevention of burn-out and improper work-life balance. GPs’ professional identities and commitments should be recognized and developed in dialogues between authorities and GPs to enhance communication, improve the structural frames of work environment and thereby sustainable recruitment.Key pointsGPs regard their choice of medical career as strongly influenced by motivational experiences in childhood, adolescence and as medical studentsRole models, diversity of work, feelings of being able to contribute and rewarding and continuous relationships with patients were mentioned to activate and maintain general practice commitmentKnowledge about motivational influences, professional identities and commitment for GPs is crucial for medical education and dialogue to promote general practice as a career choice and prevent dangers of work overload and burnout

Exile, Borders, and Poetry: A Study of Fang Xiaobiao's “Miscellaneous Poems on the Eastern Journey”

AbstractExile to Manchuria in the early Qing (1644–1912) is a peculiar historical, political, and cultural phenomenon whose scale and scope are unprecedented in premodern Chinese history. Among the exiles were some very accomplished writers who continued to write in the places of banishment, and their treatment of the trope of exile and exilic experiences in poems and prose writings is worthy of serious study. This article is a study of the exilic writings of the especially important yet understudied poet Fang Xiaobiao (1618–?), who in the wake of the examination scandal of 1657 was exiled to Ningguta 寧古塔, a remote town close to the borders of then Chosŏn Korea. The author conducts close readings of a series of poems titled “Miscellaneous Poems on the Eastern Journey” (Dongzheng zayong), written by Fang on his journey to Ningguta. The author studies not the historicity and historization of the actual exile event per se but, rather, the literary, aesthetic, and psychological representations of the exilic condition, to address the following questions: How is the uncanny psychic condition of the exile embedded in, and therefore reflected by, the literary and aesthetic configurations of the texts? How does the liminality of the exilic world interact with the liminality of exilic language? How do we understand and describe this “inbetweenness” historically, philosophically, and literarily? From these perspectives the author situates and fathoms the figure and voice of the exile turned poet, or poet turned exile. We can also see from these perspectives that the exiles are bound to encounter the “other” in the foreign landscapes, in the cultural and linguistic differences, and no less in the humbling experiences of themselves and their body and in the troubled subjectivity of the self.

Lessons on lymphangioleiomyomatosis: positivity and possibilities

Lessons on lymphangioleiomyomatosis: positivity and possibilities

'A truly rewarding and humbling experience'

'A truly rewarding and humbling experience'