Individual Context Research Articles

Deprescribing in people living with frailty, multimorbidity and polypharmacy

Deprescribing is complex, and it should consider the individual context and embrace patient centredness and collaborative teamwork, including patients, relatives and/or caregivers. This article discusses the growing evidence supporting deprescribing in older patients and the barriers and challenges involved.

Rethinking the Concept of Al-Saadah (Happiness) in Light of the Quranic Istikhlaf Framework

This article analyses the Quranic Istikhlaf framework and its impact on redefining the notion of Al-Saadah and its different components. To rejuvenate the methods of understanding the Qur'an and implementing it in our present situation, it is essential to develop thorough and ingenious frameworks that are both unique and applicable to our current specific circumstances. This article aims at presenting the Istikhlaf framework as a guiding outline for revitalising our comprehension of the profound Quranic methodologies and teachings. Next, utilise the framework to redefine the concept of Al-Saadah. The article used an analytical descriptive method to investigate the degree to which the Quranic Istikhlaf framework can offer a more profound understanding of the idea of Al-Saadah, which is translated into English as happiness. This paper examines the different sources and content pertaining to Istikhlaf and Al-Saadah to construct the Istikhlaf framework. The article shows that there are various methodologies for studying Al-Saadah, depending on the different perspectives taken, such as religious, psychological, sociological, philosophical, cultural, economic, environmental and others. The proposed Quranic Istikhlaf framework offers a comprehensive approach to Al-Saadah by examining the four dimensions (4D) analysis: 1) the relationship with God, 2) the relationship with oneself, 3) the relationship with others, and 4) the relationship with nature and the universe. The article concluded that this framework integrates the concepts of religion, holistic man as a vicegerent, society as the centre of human civilisation and umran, and the environment and nature as key aspects in achieving Al-Saadah. It also emphasises the four aspects of Al-Saadah namely, the inner, the outer, the Dunya (worldly) and the Akhirah (hereafter). The article suggests doing a comprehensive analysis of the Quranic Istikhlaf model and utilising it to examine and elucidate the discourse, methodologies, and implementation of Al-Saadah approaches and programs in both individual and social contexts.

Just-in-time adaptive interventions for adolescent and young adult health and well-being: protocol for a systematic review

IntroductionHealth behaviours such as exercise and diet strongly influence well-being and disease risk, providing the opportunity for interventions tailored to diverse individual contexts. Precise behaviour interventions are critical during adolescence...

An Analysis of Dynamic Facades in Architecture

The presence of dynamic façades in buildings is a phenomenon that has captured the imagination and attention of many, when projects with said elements are announced and implemented. In order to derive an idea of what this phenomenon entails in the present and the future, this study delves into what dynamism is, and how it is applied in architecture as an element of design. This is achieved via viewing various case examples of dynamic façades in architecture, and the earliest usage of dynamic character as part of façade elements. Due to the various functions of dynamic façades in their individual contexts concerning climatic conditions, mode of operation, intended functions, etc. an analysis of the operations and benefits offered by dynamic façade systems is undertaken on a comparative basis, with unprejudiced inferences based on salient parameters taken as common factors to ponder upon. Based on the inferences, this study will deliberate on the beneficial aspects of implementing dynamic façade systems in buildings, and on whether those benefits outweigh the drawbacks and challenges of the same, especially concerning the feasibility of this element on a globalized scale in the coming era.

Digital Tools for the Preventive Conservation of Built Heritage: The Church of Santa Ana in Seville

Historic Building Information Modelling (HBIM) plays a pivotal role in heritage conservation endeavours, offering a robust framework for digitally documenting existing structures and supporting conservation practices. However, HBIM’s efficacy hinges upon the implementation of case-specific approaches to address the requirements and resources of each individual asset and context. This paper defines a flexible and generalisable workflow that encompasses various aspects (i.e., documentation, surveying, vulnerability assessment) to support risk-informed decision making in heritage management tailored to the peculiar conservation needs of the structure. This methodology includes an initial investigation covering historical data collection, metric and condition surveys and non-destructive testing. The second stage includes Finite Element Method (FEM) modelling and structural analysis. All data generated and processed are managed in a multi-purpose HBIM model. The methodology is tested on a relevant case study, namely, the church of Santa Ana in Seville, chosen for its historical significance, intricacy and susceptibility to seismic action. The defined level of detail of the HBIM model is sufficient to inform the structural analysis, being balanced by a more accurate representation of the alterations, through linked orthophotos and a comprehensive list of alphanumerical parameters. This ensures an adequate level of information, optimising the trade-off between model complexity, investigation time requirements, computational burden and reliability in the decision-making process. Field testing and FEM analysis provide valuable insight into the main sources of vulnerability in the building, including the connection between the tower and nave and the slenderness of the columns.

THE EFFECTIVENESS OF MINDFULNESS DEEP BREATHING TO INCREASE STUDENTS' ACADEMIC WELL-BEING

The study of positive psychology is currently an interesting part of efforts to form students who are active and happy in the learning process with meaningful activities. Mindfulness deep breathing in the learning process is not widely studied, because research is still limited to individual and group contexts. Thus, this research focuses on the application of classical mindfulness deep breathing format which is effective in improving students' academic well-being. The design used was multiple pretest post test with the research subjects being class X high school students. Data collection uses the Student Subjective Wellbeing Questionnaire (SSWQ). The results of the repeated measure test prove that the classical format mindfulness deep breathing is effective in improving students' academic well-being (f (1,72) = 272,80; p <0,001). The findings in this study show the effectiveness of the mindfulness deep breathing technique implemented in a classical format in improving students' academic well-being.

Shaping of andragogy for an immigrant teacher-educator in Aotearoa

Teaching is a complex process. The shaping of the process varies in individuals. One example of such is explained here which would demonstrate that beliefs and practice revolve around each other within the local and individual contexts. This reflextion narrates an early childhood teacher educator’s journey of understanding and applying practices of adult teaching in Aotearoa New Zealand. I analyse and describe the factors that contribute to the philosophy and practices that characterise my understanding of teaching adults.

Dental Aesthetic Perception of Dentistry Students: A Literature Review

The appearance of a smile has increasingly become a factor that significantly impacts an individual's self-esteem and social context. Consequently, there is a growing desire for changes in the oral region to achieve what is considered an ideal smile, particularly in light of new beauty standards, where white and aligned teeth are deemed highly relevant. However, the concept of beauty is highly subjective, and sometimes dental standards do not align with patients' aesthetic desires. This study aims to evaluate the dental aesthetic perception of dentistry students through an integrative review. For the reference framework, we searched articles from the PubMed and Lilacs databases from the past five years, using the keywords "Dental esthetic," "dental student," and "Smiling," with the Boolean operator "and." After a thorough reading of all the articles, nine studies were selected. This review showed that the level of education and gender presented differences in the perception of dental aesthetics. However, students generally agree that aesthetics must be associated with the health and naturalness of the smile, following dental anatomy, dental alignment, buccal corridor, level of gingival exposure, and color.

Balancing the Dialectic Gap in the Social Context of Work: Integrating Self-Determination Theory with Theory of Heedful Interrelating

With limited studies available to understand the human dimension of organizational sustainability, the present study contributes to the knowledge base by identifying what can be done to enable thriving at work among services sector employees by exploring the concept of heedful interrelating. Self-determination theory posits that individuals are autonomously motivated when the social context in which they function satisfies their basic psychological needs of competence, autonomy, and relatedness, causing them to not just survive but thrive towards effective functioning and enhanced positive outcomes. Research on self-determination theory highlights an unplugged dialectic gap that exists between the individual and social context, which arises when the same social context tends to support and thwart the forward momentum of an individual toward active engagement and psychological growth. Through semi-structured interviews and textual analysis conducted among service professionals, evidence of a dialectic gap and the mindset adopted to overcome the gap were tacitly identified. Using the knowledge of agentic work behaviours that are crucial to thriving at work, the researcher tries to plug this gap by introducing heedfulness as an agentic work behaviour to be engaged in by the employees as they collaborate in a social setting. A conceptual model was designed to validate the mediating role of heedful interrelating as self-determined behaviours facilitate thriving at work. This conceptual model utilizes a self-empowerment perspective, helping service professionals move from an a motivated to a thriving state in the course of their group tasks.

Neurosurgical management of posterior communicating artery aneurysmal perforators

Background: Posterior communicating artery (PCom) aneurysms are prevalent intracranial aneurysms, frequently leading to subarachnoid haemorrhage and third nerve palsy. "True" perforators originating directly from the PCom aneurysmal sac are rare and pose unique surgical challenges. We present two illustrative cases where "true" PCom perforators were identified during surgery, necessitating tailored microsurgical approaches. Case Reports: In case one, a 35-year-old female presented with a large PCom aneurysm. During surgery, a modified clipping technique successfully preserved a perforator originating from the aneurysmal sac. In case two, a 36-year-old male with a PCom aneurysm was found to have a perforator supplying the mesial temporal cortex. Sacrificing this perforator was necessary for aneurysm clipping. Conclusion: This paper underscores the rarity of "true" PCom perforators and their impact on microsurgical approaches. Preoperative imaging techniques often fail to detect these small-calibre vessels, highlighting the importance of intraoperative identification. Tailored approaches based on individual anatomy and clinical context are essential. While endovascular procedures provide alternatives, adaptability in microsurgical techniques remains crucial for cases requiring intraoperative perforator management. Overall, understanding the complex vascular intricacies of PCom aneurysms, including "true" perforators, is vital for neurosurgeons. The delicate balance between preservation and necessity, along with ongoing research for improved preoperative identification, stands as the cornerstone for enhancing surgical outcomes in these complex cases.

Analysis Of The Character Of Karin In The Novel Maharku Surah Ar-Rahman By Ahliya Mujahidin: Gestalt Approach (Kurt Kofkka)

The novel "Maharku Surah Ar-Rahman" by Ahliya Mujahidin depicts the journey of its main character, Karin, through the lens of a life filled with meaning. In analyzing Karin's character, the Gestalt approach, developed by Kurt Kofkka, can provide deep insight into the way Karin organizes and integrates her life experiences. The Gestalt approach emphasizes observation of the whole, where parts of an individual's experience form a larger whole. In the context of Karin's character, this reflects how every event in her life is interconnected and contributes to her overall understanding. Karin as the main character in this novel has complex emotional layers. The Gestalt approach can help us see how important events in his life, such as loss and happiness, form a complete picture of his personality. For example, how feelings of loss in the past affect the way Karin interacts with the people around her and shapes her thinking patterns. In Gestalt, there is the concept of "organization" which shows how individuals structure their experiences into a meaningful pattern. Karin, as a character, may face internal conflicts that need to be organized to achieve unity in her development. Gestalt analysis can help identify key points in the story that help shape this character organization. Additionally, the Gestalt approach highlights the importance of context in understanding individuals. Karin is not only analyzed as a separate entity, but also in relation to her environment, social relationships, and cultural context. This opens up the opportunity to understand how external factors play a role in his character development. By applying the Gestalt Approach in analyzing Karin's character, we can find continuity and integration between various aspects of her life. This provides a richer understanding of the complexity of the character in the context of the novel "Maharku Surah Ar-Rahman" by Ahliya Mujahidin, and how his life experiences form the overall pattern that makes him a strong and multidimensional character.

Aneurisma de aorta abdominal - reparación endovascular vs cirugía abierta: revisión sistemática de la literatura Abdominal

Background: Abdominal aortic aneurysm is a pathology with a prevalence in men over 65 years of age of more than 8% worldwide. It has a high mortality and morbidity rate, representing between 1 and 2% of deaths. When surgical repair is indicated there are two options, endovascular repair and open abdominal surgery. Endovascular repair in elective patients seems to be the best option as it is a less invasive method, although so far there is no conclusive evidence on the advantages in certain subgroups. On the other hand, open surgery, taking into account the anatomy, age and context of the patient, could be more beneficial in certain groups. In conclusion, the choice of the therapeutic method in an elective situation will depend on the individual context of each patient, considering the possible complications and reinterventions that may affect the quality of life and put the patient's life at risk. Material and methods: An in-depth literature search will be performed in the PubMed database, using inclusion and exclusion criteria, and filters in the last ten years where randomized clinical trial studies, case-control studies and systematic reviews will be evaluated. Always using the following search terms: "abdominal aortic aneurysm", "endovascular repair" and "open abdominal surgery". Results: Six studies were selected after applying the inclusion and exclusion criteria. The articles compared and analyzed the use of endovascular repair (EVAR) and open surgical repair (OSR). Both methods were evaluated and compared using the variables of short- and long-term complications and the rate of reinterventions. It was found that patients who received EVAR had a higher rate of total complications with a high predominance after 4 years post intervention. As for reinterventions, there was a significantly higher rate in those who received EVAR with respect to those who underwent OSR. Conclusion: Endovascular repair showed a higher rate of reinterventions than open surgery. As well as a greater number of long-term complications. These are results that should be taken into account when evaluating it as a therapeutic option, especially in certain groups of patients. Thus, open surgery appears to be a safer treatment. Especially in the long term and in groups of young patients without comorbidities

Perspectives on Health and Health Education

This study highlights different perspectives on health education. The naturalistic/bio-medical, functionalist, post-modernist, and Marxist perspectives on health and health education were all looked at in this study. The analysis is based on both published and unpublished materials, including online sources. Desk inquiry is the method used for analyzing the literature. Based on biological function and statistical normality, the naturalistic/bio-medical perspective regards health as belonging to a medical origin. By using an organismic illustration, the functionalist perspective emphasizes protecting social equilibrium and stability in order to explain human societies and social phenomena. While pursuing health and health education, the post-modernist perspective emphasizes the multiple realities of human health and class struggle. Each perspective offers a unique lens for understanding health and health education, emphasizing the importance of considering individual and societal contexts.

Residential mobility and new forms of spatial inequality in the settlement system: A comparative study of Estonia and Lithuania

This study examines how socio-spatial inequalities are associated with population concentration and de-concentration processes shaped by residential mobility. The study explores whether the patterns of residential mobility vary in different settlement system contexts. It reviews the cyclical urbanization models and the inequality of opportunities they provide in urban, suburban, and counter-urban contexts for individuals in various life stages. The theoretical models are tested by analysing individual-level data covering the entire populations of Estonia and Lithuania – two countries with similar social but different settlement system contexts. The study utilizes linked individual-level data from the 2011 and 2021 censuses, and harmonized variables in the two countries. The results show that individuals engaging in concentration, suburbanization, or de-concentration have distinct characteristics, with little differences between countries characterized with different settlement systems. While the life-course approach assumes that young people are most likely to urbanize (concentrate), those in family ages shift towards suburbanization, and older individuals tend to counter-urbanize (de-concentrate), our findings challenge these assumptions, demonstrating that young adults have a high likelihood of migration in all three directions. These findings call for more in-depth studies on the interplay between age and migration patterns that would go beyond the life-course approach and delve deeper into the residential decision-making of young people.

Unpacking the Discourse on Youth Pathways into and out of Homelessness: Implications for Research Scholarship and Policy Interventions

Youth homelessness presents a complex and persistent challenge worldwide, particularly affecting young adults between 16 and 24 years of age in the US and Canada. This population faces elevated risks of exploitation, victimization, and various health issues upon detachment from familial support structures. Understanding the multi-faceted nature of youth homelessness requires the consideration of individual, structural, and systemic factors within the socio-ecological model. Historically, when examining youth homelessness, traditional methods have concentrated either on individual factors contributing to homelessness or on broader structural issues within society. The emergence of the new orthodoxy attempted to bridge the apparent gap between individual- and structural-level factors by considering both to be equally significant, but it faced skepticism for its theoretical framework. In response, the “pathways” approach gained traction, emphasizing the subjective experiences and agency of youth experiencing homelessness. Departing from conventional epidemiological models, the pathways approach views homelessness as a dynamic process intertwined with individual life contexts. This paper navigates the scholarly discourse on youth homelessness and examines the distinct characteristics of the pathways approach. By exploring its implications for research and policy, this study contributes to a nuanced understanding of youth homelessness and informs future prevention-focused interventions.

Culturally adapted cognitive behavioral therapy for psychosis (CaCBTp): A review of key features of cultural adaptation and considerations for psychologists.

Cognitive behavioral therapy for psychosis is an effective treatment for psychosis. However, psychosis presents differentially according to an individual's cultural context, and it is currently unclear which methods have been used to formulate culturally adapted cognitive behavioral therapy for psychosis (CaCBTp). The current systematic review examines the approaches to CaCBTp that have been evaluated to date and comments on preliminary evidence for the efficacy of CaCBTp. Key features of CaCBTp interventions are discussed in reference to broader cultural adaptations of psychosocial interventions for psychosis and culturally adapted cognitive behavioral therapy for other disorders. Overall, our results identified 12 studies and highlighted five overarching themes of cultural adaptation that clinicians should integrate into the design of future CaCBTp interventions, including family members in treatment, targeting stigma, relying on spiritual leaders, using multifaceted models of mental health, and ensuring adequate language match. The results of this review also highlight the paucity of literature in global CaCBTp interventions, as only 10 studies examining CaCBTp interventions were found. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Implementing absolute cardiovascular disease risk assessment into pathology collection services.

Pathology services represent an ideal setting to integrate absolute cardiovascular disease (CVD) risk estimation when patients attend for routine cholesterol testing. This study aimed to explore the process of implementing CVD risk estimation into point-of-care service delivery by pathology staff to inform future implementation and sustainability. A new service for CVD risk estimation via a self-directed screening station was implemented into 14 pathology service sites across Tasmania, Australia. Before implementation, observations at pathology services (n = 26) and semi-structured interviews were undertaken with 26 pathology staff (88% female, 77% aged 41-60 years) to identify factors that could impact implementation of the service. The process of implementation was then evaluated using participant observations and clinical trial recruitment data. Transcripts and field notes were analysed thematically according to the Medical Research Council Framework and used to develop a programme logic model to understand how the service could be adapted to be successfully integrated into routine workflow at pathology services. Eight key themes were identified during the pre-implementation phase as important factors that could impact upon integration of CVD risk estimation into pathology services. Themes related to factors within the organisation, including available resources, logistics and workflow, as well as having sufficient time to complete the intervention. Additional factors related to the individual motivations of staff, collaborative leadership and patient characteristics. Success of implementation varied among sites, requiring the trialling of different strategies to support uptake of the service and patient recruitment. Implementing CVD risk estimation into point-of-care pathology services required an understanding of the core implementation components specific to each context, and for implementation strategies to be targeted to the individual and organisational contexts. The generated programme logic model may be useful in guiding future implementation endeavours within these services and aiding the selection of apt implementation strategies. ClinicalTrials.gov Identifier: NCT04896021, registered 19/05/2021, https://clinicaltrials.gov/study/NCT04896021.

GP workforce sustainability to maximise effective and equitable patient care: a realist review of what works, for whom and in what circumstances?

UK general practice has been described as being in crisis. A shortage and exodus of GPs is an urgent and challenging problem, attracting significant media attention, widespread public debate, and policy action. Our review aims to examine which aspects of the healthcare system affect GP workforce sustainability, how, why, and for whom. A realist review is an interpretive, theory-driven approach to evidence synthesis, that brings together data from quantitative, qualitative, mixed methods research, and the wider grey literature (e.g., policy documentation). Using this data allows us to examine a diverse range of evidence with a clear focus on understanding factors which support (or hinder) GP workforce sustainability, how these are shaped by contexts, and the mechanisms that underpin them. We identify important individual and system-level contexts that may be amenable to change. We present our emerging findings in the form of a programme theory which explores human connection with patients, colleagues, and across organisations, gaining intellectual enrichment and learning systems comprising socially-situated knowledge. Relational continuity is key across these, supporting GP workforce sustainability. Challenges include standardisation, alienation and professional loneliness, inflexible organisation, and restrictive technologies. Our research generates new knowledge about the interdependencies between contexts, mechanisms, and outcomes. The findings can inform strategies and interventions intended to support, facilitate, and assist the GP workforce in delivering equitable and effective patient care. We identify critical gaps in knowledge and prioritise the expectations for scope and nature of future GP work and retention strategies.

Negotiating between speech and silence as a form of agency: Understanding Dalit women's experiences of sexual violence in India

This article explores the complexities of non-disclosure among female Dalit survivors of rape who negotiate between speech and silence as a means of exercising agency. It analyses the role of Brahmanical patriarchy, Dalit feminism and social constructionist theory to unpack the silence, shame, secrecy and cultural censorship surrounding sex and sexual violence both in India at large and for Dalit women in particular. The study comprised 28 qualitative interviews with Dalit women who had been raped by men; it employs Foucault's notion of resistance, regulation and subjectivity to explore when and to whom these participants chose to disclose their rape. It thus seeks to theories these women's varied responses to their rape as acts of agency and resistance, demonstrating how silence can operate on multiple levels: individual, family and community. It draws on India's #LoSHA movement to demonstrate the dangers of universalizing victim-survivors' experiences of sexual violence and to parse the complexities of speaking out or remaining silent and how these play out in individual and collective contexts. In focusing on Dalit women and situating their non-disclosure within an intersectional context, this work differentiates between the passivity of being silenced and the agency and resistance inherent in the decision to remain silent. Therefore, this paper makes a unique contribution to the literature on patriarchy, Dalit studies, feminism and social constructivism.

The Impact of Large Language Models on Medical Education: Preparing for a Revolutionary Shift in Doctor Training

This article presents insights gained from utilizing Collaborative Autoethnography (CA), a qualitative research method, by two international faculty members who documented their experiences from a year-long participation in a Faculty Learning Community (FLC) at a midwestern university in the US. The FLC aimed to create a supportive environment where international faculty and graduate students could discuss their challenges, struggles, and joys related to their 'international-ness'. Through autoethnographic reflection, the study highlights how FLC participation helped mediate initial anxieties and dilemmas for one faculty member (Galina) and facilitated a productive reconceptualization of teaching for the other (Henny). The findings demonstrate the value of reflecting on personal experiences through autoethnography, allowing the participants to draw practical lessons that connect their FLC involvement to their individual teaching contexts and personal struggles in establishing a viable teacher identity. The article concludes with pedagogical recommendations on structuring future FLCs to better address the needs of international faculty.