Inappropriate Context Research Articles

Barriers to effective clinical supervision from the perspective of nurses: A descriptive qualitative study.

The present study aimed to explain the barriers to effective clinical supervision from the perspective of nurses. Qualitative descriptive study. The present study enrolled 21 nurses selected by purposive sampling. Data were collected through semi-structured interviews, which were digitally recorded and immediately transcribed verbatim, and analysed using content analysis method. From the nurses' perspective, the influential barriers included poor academic, ethical, communicational, professional competencies at the passive management level, defects in supervision prerequisites, conventional beliefs, ineffective organization, shortage of workforce at the level of inappropriate context, lack of motivation and poor accountability at inadequate professional maturity level. The following items affect how clinical supervision is implemented: Motivation, accountability at the personal level, sufficient workforce, conducive conditions, effective organization of resources, and preparing the individual for supervision at the organizational level to implement effective clinical supervision.

An Epigenetic LINE-1-Based Mechanism in Cancer.

In the last fifty years, large efforts have been deployed in basic research, clinical oncology, and clinical trials, yielding an enormous amount of information regarding the molecular mechanisms of cancer and the design of effective therapies. The knowledge that has accumulated underpins the complexity, multifactoriality, and heterogeneity of cancer, disclosing novel landscapes in cancer biology with a key role of genome plasticity. Here, we propose that cancer onset and progression are determined by a stress-responsive epigenetic mechanism, resulting from the convergence of upregulation of LINE-1 (long interspersed nuclear element 1), the largest family of human retrotransposons, genome damage, nuclear lamina fragmentation, chromatin remodeling, genome reprogramming, and autophagy activation. The upregulated expression of LINE-1 retrotransposons and their protein products plays a key role in these processes, yielding an increased plasticity of the nuclear architecture with the ensuing reprogramming of global gene expression, including the reactivation of embryonic transcription profiles. Cancer phenotypes would thus emerge as a consequence of the unscheduled reactivation of embryonic gene expression patterns in an inappropriate context, triggering de-differentiation and aberrant proliferation in differentiated cells. Depending on the intensity of the stressing stimuli and the level of LINE-1 response, diverse degrees of malignity would be generated.

Barriers to rational antibiotic prescription in Iran: a descriptive qualitative study

IntroductionRational antibiotic prescription (RAP) refers to the purposeful and appropriate antibiotic prescription with correct dose and course to produce the most possible benefits and less possible side effects. Identification and management of the barriers to RAP can help promote RAP. The aim of the study was to explore the barriers to RAP in Iran.MethodsThis descriptive qualitative study was conducted in 2021 on 46 physicians (including general physicians, specialists, and subspecialists), pharmacologists, microbiologists, and nurses. Participants were purposefully selected from five specialty and subspecialty hospitals in Isfahan, Iran, and the Treatment Administration of Isfahan University of Medical Sciences, Isfahan, Iran. Data were collected via semi-structured interviews and were analyzed via conventional content analysis.ResultsThe barriers to RAP in Iran came into sixteen subcategories and four main categories, namely physicians’ limited professional competence (with six subcategories), poor informational and functional resources (with four subcategories), ineffective supervision of RAP (with three subcategories), and inappropriate context for RAP (with three subcategories). The subcategories of these categories were physicians’ limited professional knowledge, physicians’ poor attitude towards RAP, physicians’ routine-based practice instead of evidence-based practice, physicians’ limited accountability, physicians’ fear over the legal consequences of not prescribing antibiotics, physicians’ financial motives, limited access to quality educational materials, poor in-service training for physicians, lack of culturally appropriate guidelines, inefficiency of the stewardship committee, limited supervision of physicians’ performance, ineffective managerial supervision, limited supervision of sampling for antimicrobial susceptibility testing, sociocultural factors contributing to irrational antibiotic prescription, poor adherence of insurance companies to their financial commitments, and financial incentives of pharmaceutical companies for physicians.ConclusionThe barriers to RAP are different and complex and include physician-related, resource-related, supervision-related, and contextual factors. Physicians with limited professional competence, limited access to resources, and limited supervision will have problems in RAP. Effective management of the barriers to RAP can promote RAP and minimize irrational antibiotic prescription and its consequences, chiefly antimicrobial resistance.

Take a Break to Repair: A Dip in the World of Double-Strand Break Repair Mechanisms Pointing the Gaze on Archaea.

All organisms have evolved many DNA repair pathways to counteract the different types of DNA damages. The detection of DNA damage leads to distinct cellular responses that bring about cell cycle arrest and the induction of DNA repair mechanisms. In particular, DNA double-strand breaks (DSBs) are extremely toxic for cell survival, that is why cells use specific mechanisms of DNA repair in order to maintain genome stability. The choice among the repair pathways is mainly linked to the cell cycle phases. Indeed, if it occurs in an inappropriate cellular context, it may cause genome rearrangements, giving rise to many types of human diseases, from developmental disorders to cancer. Here, we analyze the most recent remarks about the main pathways of DSB repair with the focus on homologous recombination. A thorough knowledge in DNA repair mechanisms is pivotal for identifying the most accurate treatments in human diseases.

Representing the Lived Experience of High School Students in the Flipped Classroom: Benefits and Challenges

The present paper is qualitative and interpretive study that uses the strategy of phenomenological research to explain the experience of high school students in flipped classroom; therefore, the analysis unit of the present study includes all the eleventh grade students of the art school who have been trained in the eleventh grade of 96-97 academic year; fifteen students are considered as a sample. The data collection tool is an in-depth interview which is analyzed based on the thematic method of in-text approach. Findings show that the majority of students are satisfied with the implementation of this method; dissatisfaction is related to problems of student, teacher performance and inappropriate context. Also, the advantages of this method are deep learning and the possibility of re-learning at home, and discussion in the classroom.

Exploring the barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a qualitative study

BackgroundThe complexity of chronic obstructive pulmonary disease (COPD) and its different physical, mental, familial, occupational, and social complications highlight the necessity of pulmonary rehabilitation (PR) for afflicted patients. However, PR for patients with COPD usually faces some barriers. The aim of this study was to explore the barriers to PR for patients with COPD.MethodsThis qualitative descriptive study was conducted in January 2019 to October 2020. Participants were 19 patients with COPD, 11 family caregivers of patients with COPD, and 12 healthcare providers, who all were recruited purposively from two teaching hospitals in Isfahan, Iran. Data were collected through semi-structured interviews and were analyzed through conventional content analysis.ResultsThe barriers to PR for patients with COPD fell into three main categories, namely barriers related to patients and their families, inefficiency of PR services, and inappropriate organizational context for PR. Each category had four subcategories, namely patients’ and families’ lack of knowledge, complexity and chronicity of COPD, heavy financial burden of COPD, patients’ frustration and discontinuation of PR, lack of patient-centeredness, lack of coordination in PR team, inadequate professional competence of PR staff, lack of a holistic approach to PR, limited access to PR services, inadequate insurance for PR services, ineffective PR planning, and discontinuity of care.ConclusionPR for patients with COPD is a complex process which faces different personal, familial, social, financial, organizational, and governmental barriers. Strategies for managing these barriers are needed in order to improve the effectiveness and the quality of PR services for patients with COPD.

PROBLEMS OF LANGUAGE DEVELOPMENT IN CHILDREN ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

The purpose of this study is to provide an overview of language development in children with ADHD. Researchers use literature study research methods. The data that has been collected is then analyzed qualitatively with the Miles and Huberman model. Some of the problems in language development in children are ADHD, namely, not responding to questions or statements addressed to them, the focus of attention last for a short period, absence of eye contact when communicating, often answering in inappropriate context questions, and a lack of understanding of the explanation of the material that has been submitted by the teacher. In addition, phonological errors are also a problem experienced by ADHD children such as problems when pronouncing the last letter in words, pronouncing words, removing or changing phonemes, and removing phonemes when speaking. Language development in ADHD children also has disturbances in the delivery of speech intent, is less able to carry out conversations with a complete structure, does not pay attention to whether the interlocutor has the same knowledge or information as him, often makes ambiguous sentences, pragmatic language development in ADHD children has not yet developed well.

Evaluating Use of 99mTc-PYP Scan in Diagnosis of ATTR- A Tertiary Care Center Experience

Purpose The 99mTc-pyrophosphate (PYP) scan for the diagnosis of Transthyretin Related Cardiac Amyloidosis (ATTR) may be used in an inappropriate context or with incorrect interpretation, leading to misdiagnosis and futile financial burden. Here we report the use of PYP scans at our institution. Methods We retrospectively reviewed 99 consecutive patients’ data who underwent PYP between May 2018 and June 2020. ATTR diagnostic criteria were defined as any of: 1) cardiac biopsy-proven ATTR; 2) non cardiac biopsy-proven ATTR with evidence of echocardiographic features (unexplained left ventricular hypertrophy or apical sparing); 3) ATTR mutation with echocardiographic features and no evidence of plasma cell dyscrasia; 4) MRI suggestive of cardiac amyloidosis and no evidence of plasma cell dyscrasia. Comparisons between ATTR and non-ATTR were made using Chi-square, Fisher's Exact or Wilcoxon rank-sum tests. Sensitivity and specificity of PYP scan were estimated with Clopper-Pearson confidence intervals (CI). Results 48 (48%) patients had adequate data to evaluate diagnostic ATTR criteria. These patients were male (73%), African American (44%), with median age of 68 yrs, NYHA class ≥ 3 (50%), NICM (62%), neuropathy (44%) and orthopedic manifestations (31%). PYP scan (100%), cardiac MRI (44%), cardiac biopsy (31%), genetic testing (58%) and other organ biopsy (21%) were used to diagnose ATTR. The sensitivity of PYP scan for cardiac ATTR was 100% (95% CI: 78-100) and the specificity was 58% (95% CI: 41-74). All indeterminate PYP scans (17%) were negative for ATTR. On TTE, median septal wall thickness was 1.7 mm in those with cardiac ATTR compared to 1.2 mm in those without (p=0.002); median posterior wall thickness was 1.6 mm and 1.1 mm, respectively (p=0.007). 88% of patients who did not have adequate data to evaluate for ATTR had normal or indeterminate PYP scans. Conclusion In our center representing real world data, PYP scan had similar sensitivity but reduced specificity compared to previously reported data. Our data shows the need for more selective use of PYP scan and reiterates need for ruling out plasma cell dyscrasia if only imaging is used to diagnose ATTR.

Pharmacist-led medication for pain in France: What population are we talking about? Results of the Optymed study

Self-medication for alleviating pain is very prevalent in most countries. While safe self-medication is supposed to be dependent on both patient's behaviour and pharmacist's counselling, little is known about the context of the delivery of analgesics available without prescription. The primary objective of the study was to define sociodemographic profiles and behaviours of patients seeking non-prescribed analgesics in French community pharmacies. Secondary objectives included the assessment of pharmacist management and identification of risk-associated patients. This is a cross-sectional, national and multicentre study, including adults who asked for a prescription-free medication for acute or chronic physical pain. Information was collected through separate patient and healthcare professional (HCP) questionnaires. The analysis was based on 1215 and 1271 patient and HCP questionnaires, respectively, collected from 164 pharmacies. The patient population consisted in women and men (ratio 6:4), mainly (71%) under 60 years old. Headaches, rheumatologic and musculoskeletal pains were the most frequent reasons for getting analgesics, with a median pain intensity of 6 on a scale graded from 0 (no pain) to 10 (intolerable pain). The main reasons guiding self-medication were time saving, a well-known pain and a well-known product. The mean time allocated to delivery was 4.7minutes. Indications, dose and posology were almost systematically addressed by the pharmacy staff, while contra-indications, drug-drug interaction or safety were mentioned in around two-third of cases. The proportion of patients identified at risks due to an inappropriate context of self-medication was 15.5%. This study shows a great heterogeneity of the population asking for non-prescribed analgesics in French community pharmacies. While pharmacists were able to identify patients at risks, a significant part may have 'slipped through the net'. The results support further studies to better define patient care pathway and optimize pharmacist-led medication.

Major accident prevention illustrated by hydrocarbon leak case studies: A comparison between Brazilian and Norwegian offshore functional petroleum safety regulatory approaches

Despite laws, regulations, or risk management tools designed to avoid loss events, a hydrocarbon leak (HCL) in an offshore oil and gas platform11Also mentioned in this paper as ‘offshore platform’ or ‘platform’. is a major hazard event that reveals failures in risk control. In addition, similarities between different HCLs challenge the efficiency of current improvement mechanisms and the completeness of applied risk management practices. Accident causation models sustain that different roles in different levels, including regulators, companies, and the work environment, create the necessary conditions to a loss event, and therefore should be part of the accident analysis. This paper analyzes similar HCLs occurred in Norwegian and Brazilian offshore platforms to compare the regulatory approaches to risk control, aiming to identify influences related to the recurrence of HCLs in functional regulatory regimes (FRRs). As a result, each HCL among case studies consists of human errors that occurred while offshore crews were operating unsafe systems created by improper design or changes to address operational demands. An inappropriate context may support the impairment of safeguards that may not always be available or reliable in an environment which has as particular aspects the remoteness and the need to be self-sufficient. As a consequence, unsafe systems impose safety rules to offshore personnel and more relevance to human performance in the overall risk picture. In FRRs, the combination of regulatory requirements and enforcement activities is part of the safety context and influence risk owners’ behavior. The current comparison identifies differences between Brazilian and Norwegian regulatory regimes that may influence safety in offshore systems, as well as risk constraints related to human performance, which is strongly dependent on influencing factors such as safety culture.

The Diversity of Internet Memes Interpretations: A Discourse Analysis of Incongruity of Popular Memes Made by Indonesian Netizen

In the modern era, human has varied ways to communicate, interact, and express ideas. Using memes is one of contemporary human approaches to sending messages. However, similar to language, they have linguistics rules which have to be obeyed by the user. Memes also have its binding codes which are accepted by the memetic communities. This study is intended to reveal how widespread memes are violated by the netizen since there are diversities in using memes within Indonesian internet communities. To expose the violation phenomenon, the multimodal approach is conducted by using discourse analysis and social semiotics (Chandler, 2013) which focus on observing the visual and textual aspect of favorite memes. The paper claimed, that most of the Indonesian internet communities often force memes and use them in an inappropriate context.

Entrepreneurial and Managerial Experience Matter for Startups operate in an Academic Incubator

A founding team’s prior experience shapes the types of skills and learning path it engages with when forming its startup. Prior entrepreneurial experience enhances exploration of new knowledge and testing of current assumptions, because founders understand that their previously-obtained information may not be relevant to the current endeavor. Prior managerial experience encourages the exploitation of said information and it is reuse in an inappropriate way or context when trying to duplicate familiar routines. Based on 75 startups operating in the Harvard Innovation Lab, we find that managerial experience negatively affects survival while entrepreneurial experience does not exert a significant positive influence on it. The incubator’s intangible resource, its mentoring program, moderates the negative relationship between the team’s prior managerial experience and the startup’s survival. We also find that mentoring strengthens the positive association of entrepreneurial experience and startup survival.

Analysis of Students’ Difficulties about Rotational Dynamic Topic Based on Resource Theory

<p>Students’ difficulties commonly are analyzed based on misconception theory. This paper aimed to analyze students’ difficulties on the rotational dynamic based on resource theory. The subject of research consisted of 108 first-year undergraduate students of Physics Education, State University of Malang. Firstly, the students were asked to solve 15 multiple-choice questions and gave open explanation. We then implemened a constant comparative method to identify and categorize some resources that students employed in solving several problems that most the students failed to respond correctly. The results indicated that the students had difficulties in solving problems related to the torque and the equilibrium of rigid body. The students’ difficulties were not merely caused by the lack of correct knowledge. Instead, they have the correct knowledge or resources but they activated them on inappropriate context. The students will be successfully used the resources to solve problems if they activated them in the right context.</p>

Cancer Is to Embryology as Mutation Is to Genetics: Hypothesis of the Cancer as Embryological Phenomenon.

Despite numerous advances in cell biology, genetics, and developmental biology, cancer origin has been attributed to genetic mechanisms primarily involving mutations. Embryologists have expressed timidly cancer embryological origin with little success in leveraging the discussion that cancer could involve a set of conventional cellular processes used to build the embryo during morphogenesis. Thus, this “cancer process” allows the harmonious and coherent construction of the embryo structural base, and its implementation as the embryonic process involves joint regulation of differentiation, proliferation, cell invasion, and migration, enabling the human being recreation of every generation. On the other hand, “cancer disease” is the representation of an abnormal state of the cell that might happen in the stem cells of an adult person, in which the mechanism for joint gene regulating of differentiation, proliferation, cell invasion, and migration could be reactivated in an entirely inappropriate context.

7th Grade Students’ Understandings of Negative Integer

<p>The aim of the research is to determine 7<sup>th</sup> grade students’ understandings relating the concept of negative integer. For this purpose, a total of 100 7<sup>th</sup> grade students who were selected randomly from 4 middle school in Burdur centre were asked those two questions: “what do negative integers mean, where do they use”, “write a problem appropriate for the expression of “+3-7=-4”. The research is a qualitative research and the model is general scanning model. Descriptive analysis was conducted in analysis of the data. The students’ responses were tried to be given directly and presented categorically. The students indicated commonly the contexts of “temperature below 0 degree”, altitude below sea level (minus elevation)” and “debt” as usage areas of the negative integers. 38% of the students couldn’t give any example for usage areas of the negative integers. 22% of the students couldn’t write a problem appropriate for the given expression. These students indicated inappropriate context or inappropriate problem mathematically. 45% of the students didn’t write any problem. As a result, 67% of the students couldn’t write an appropriate problem. 33% of the students could write problems that are considered as appropriate. These students used commonly the contexts of “dept, dept owed, lose money”.</p>

STRUKTUR SEMANTIK VERBA PERSEPSI BAHASA MELAYU KUPANG: PERSPEKTIF METABAHASA SEMANTIK ALAMI (MSA)

East Nusa Tenggara is one of archipelago provinces consisting of various ethnics and languages. Kupang Malay (KM) is a lingua franca used in daily communication. The use of KM lexicons especially in an inappropriate context can create misunderstanding among individual. To avoid this, it is important to comprehend the lexical meaning and how to use it properly. This short paper explains an approach of natural semantic meta-language in analyzing KM data especially perception Verb SEE by using descriptive analysis method and applying natural semantic meta-language theory proposed by Weirzbicka (1996). In natural meaning viewpoint proposed by Weirzbicka, perception Verbs in Kupang Malay are formed by mental predicate SEE. This paper focuses only on describing semantic features of every lexicon which has meanings derived from verb SEE. NMS uses semantic analysis approach which is based on the formation of the paraphrase. Semantic Structure of Perception Verb in KM is formed by mental predicate consisting of natural meaning expalined as follows: “someone saw something” in Kupang Malay liat “see” is realized with “ maloi ”, “ malerok ”, “ loti ”, “ pareksa ”, “ basuk ”. Based on the results of analysis, it is concluded that the semantic structure of Perception verb Kupang Malay has 3 types, sub-types and even sub-sub-type that describe the meaning configuration of each lexicon. Distinguishing features can be seen in the mapping and explication.

알레고리적 변용의 오류: 소포클레스와 프로이트의 오이디푸스 = A Modern False Allegory: Sophocles’s Oedipus the King and Freud’s “Oedipus Complex”

The Graeco-Roman thinkers and dramatists played a significant role in Europe, providing an important source of raw material for modern arts, science, and literature. Their influence in modern appropriation continued developing and postulating comparative relationships between the original, pre-existing objects and the newly adopted forms either in the same area or in an interdisciplinary one. In this article, I try to show a case which created distorted perceptions of comparative relationship in terms of appropriation: the Freudian theoretical formulation of the “Oedipus complex” based on Sophocles’s Oedipus the King within the framework of family relationships. Firstly, I examine how Freud formulated the metaphoric nature of oedipal concepts from a Greek tragedy to assume that his scientific field will have its ‘universal’ interpretive framework with respect to the “Oedipus complex” occurrence conditions of in-family relationships. Secondly, I’ll examine how Freud’s premise of the theory is misplaced in light of the Greek tragedy to demonstrate the analogy between the plot of Oedipus the King and his theoretical framework of psychoanalysis as inappropriate to be defined as scientifically “universal.” Finally, I’d argue that how this intercultural, interdisciplinary appropriation can be read as false analogy in which Freudian claims, defined as scientifically “universal,” are presented in an inappropriate context. Thus, a conclusion may be obtained for further possible arguments in the interpretation of the theory by looking at another facet of the problem: we discuss how the act of a Freudian formulation of the “Oedipus complex” may be observed in terms of human desire (“machines désirantes”).

Identifying targets for diagnosis, prognosis, and treatment.

This issue of Neurology® Neuroimmunology & Neuroinflammation (N2) incorporates exciting studies on the biology of immunologic and inflammatory biomarkers and the importance of knowing the benefits and complications of targeted therapies. In addition, the issue includes several clinically relevant reports on viral and autoimmune encephalitis. The concept of precision medicine, recently re-enhanced by public media, is not new in clinical and basic research. An interesting example is the case presented by Euskirchen et al.1 of a patient with life-threatening brainstem neurohistiocytosis in the context of Erdheim-Chester disease and cutaneous Langerhans cell histiocytosis. Detection of a BRAF mutation in affected tissues led to the selection of a specific BRAF inhibitor (vemurafenib), resulting in a rapid clinical response. On the other hand, Kornberg et al.2 suggest that the use of targeted therapies in an inappropriate context, such as fingolimod and natalizumab in neuromyelitis optica (NMO) instead of multiple sclerosis (MS), carries the risk of disease exacerbation. The authors postulate that a combination of drug effects, including an increase of blood-brain barrier permeability allowing CNS entry of Th17 lymphocytes, was responsible for the clinical worsening in the case they present. In another report, Hillen et al.3 postulate that natalizumab may have contributed to fulminant liver failure related to hepatitis B infection in a patient receiving the drug for relapsing-remitting MS (RRMS). Svenningsson et al.4 show that rituximab, a drug used for both MS and NMO, rapidly distributes to the peripheral compartment following intrathecal administration. Ultra-low doses of intrathecal rituximab were sufficient to cause complete and prolonged depletion of B lymphocytes in both the CNS and systemic compartments, an observation with potential implications for other disorders, such as autoimmune encephalitis.

Diagnostic pitfalls in soft tissue pathology

This lecture will focus on commonly encountered traps which may mislead pathologists when interpreting soft tissue lesions. These have been selected to reflect issues raised most frequently in consultation cases, based mainly on either over- or under-interpretation of morphological or immunohistochemical findings. Key themes include awareness of natural history (e.g., an inappropriate clinical context for a given diagnosis), benign lesions often mistaken for malignant (e.g., cellular benign fibrous histiocytoma, cellular schwannoma or lipomas with microscopic fat necrosis), malignant lesions easily mistaken as benign (e.g., low-grade fibromyxoid sarcoma and solitary fibrous tumour) and misinterpretation of immunohistochemical stains (e.g., use of needlessly broad panels, excessive antigen retrieval, mistaken assumptions regarding specificity and speculative but unvalidated use of biomarkers to distinguish benign from malignant).

From credit valuation adjustments to credit capital commitments

We argue that capital requirements are needed to cover unexpected losses arising in incomplete markets. After observing that a complete market is an inappropriate context for answering such questions we turn to a theory of capital requirements developed for an incomplete markets economy where the law of one price is replaced by the law of two prices. We follow Carr, Madan and Vicente Alvarez (2011) in defining capital requirements and apply these methods to the problems of cross default exposures. We contend that credit valuation adjustments, being based on fundamentally contradictory principles fall short of what is required. We replace these computations by direct computations of credit capital commitments necessitated by credit exposures that we term a CCC theory. A variance swap example illustrates our CCC computations.