Personal Reasons Research Articles

Transforming Home Community Nursing Practice Through Nurse Empowerment: H.O.P.E. Approach to Care

Ageing at home is the expressed wish of the fastest growing older adult population. Life care, not just medical/health care, can holistically address care needs of this population. Receiving care at home provides the best opportunity for care providers to address a person’s care needs within their natural environment- the place they call home. With heightened concerns of COVID-19 transmission, older audits are hesitant to have multiple care providers in the home and staff are overwhelmed with work as several team members are off due to personal and/or medical reasons. Coupled with the current state of the Canadian homecare practice setting at the system level, a change is needed. The pandemic became the catalyst to transform/evolve the way SE Health provides care for the betterment of our clients, staff and organization- thus spearheading the H.O.P.E.- Home, Opportunity, People, Empowerment model of care. This leading organizational model of care provides nurses with optimal autonomy and flexibility to deliver best life, home and community care. Empowerment provides nurses with optimal autonomy and flexibility to deliver excellent life care with clients and their circle of care members. Caseload management and self-directed scheduling are unique home and community care competencies that are fostered and supported by optimization of operational processes. Therefore, operationalization of nursing practice in this model requires both optimization of Service Coordination function and digital enablement. One digital innovation, MySE Life App was created to address this need. The MySE Life App is a bespoke digital application designed by nurses, for nurses that provides access to key information to support holistic care delivery in a single application. The tool empowers informed decision making around planning, coordination, and delivering exceptional quality care by giving nurses access to client information on demand. The components of H.O.P.E. Model of Care brings homecare back to basics and care back to the future. To bring this ambition to life, we employed implementation science to bring rigor to the implementation approach and support the change management of over 8,000 leaders across the organization nationally. As Primary Nursing is the core of this organizational model, first year of implementation has focused on optimizing scope of nursing practice and continuity of care. H.O.P.E. nursing competency development through a Novice to Expert journey was also undertaken. Three key success insights will be shared with real life implementation scenarios: 1) empowering the nurse and the client, 2) implementation science informed execution, and 3) operationalizing nurse practice with enabling technology and redesigned structures, processes, and leadership. Learning insights can inform healthcare organizations in how creating a nurse empowered practice culture impacts client safety, quality care and sustainable business outcomes. As the implementation moves towards sustainability in nursing, the learnings will also be applied to accelerate the implementation across other health care disciplines such as personal support workers and allied health disciplines in the organization. The implementation of H.O.P.E. Model of Care illustrates how home and community care can work better for people and the broader system in a resource constrained environment.

Incidental Finding of Subannular Perfused Aortic Root Abscess.

An 83-year-old female presented with aortic valve stenosis requiring surgery, which was diagnosed with a transthoracic echocardiography three years ago. However, the patient declined the surgery at that time due to personal reasons. Three years later she presented again with signs of dizziness and weakness and progression of the aortic valve stenosis. Cardiac catheterization and a computed tomography scan were performed before the planned surgery. Surprisingly, a huge subannular perfused abscess hole around the aortic root companying a pericardial effusion was revealed. The patient underwent an urgent aortic root replacement with a tissue valve and an aortic ascending replacement without any complications. Intraoperative inspection confirmed an active aortic root and valve endocarditis.

Penilaian Gereja Katolik Terhadap Perkawinan Tanpa Anak

Since the beginning of creation, as written in the Book of Genesis, God created men and women who were united in marriage. One of God's commands to them is to reproduce. In the Church doctrine it is further outlined that one of the purposes of marriage is the good of the child (bonum prolis). One of the important points in this concept is the openness of married couples to accept the presence of children in their marriage. In contrast to the Church doctrine above, nowadays there are married couples who have taken the stance of refusing to have children in marriage. This reality is known as childfree. With the freedom, humans feel they have the right to reject God's great plan for married life. There are various reasons for choosing childfree, including: personal, medical, economic and environmental reasons. The Catholic Church in principle rejects the childfree movement, because it is contrary to God's plan for marriage.

Personal and community values behind sustainable food consumption: a meta-ethnography

Various aspects of sustainable food consumption have been studied within the Social Sciences in the last years. Specifically, the analysis of motivations and determinants behind alternative economic practices has gained prominence in disciplines such as Sociology, Psychology, Economics and Marketing, seeking to understand, measure and calculate consumers’ decision-making processes and actions through the application of cognitive theories and qualitative predictive models. Anthropology—more specifically through the practice of ethnography—, has also made significant contributions, mostly toward the analysis and description of contemporary cooperative experiences, both in rural and urban settings. However, within this field, few studies have focused on the underlying values, as well as the symbolic, emotional/affective, and identity-based incentives that exist behind the participation in sustainable, pro-environmental, organic, and fair-trade food initiatives. This kind of perspective might help in comprehending how different people or social groups conceptualize their habits and link them to certain representations or beliefs. At the same time, it can provide information about the way in which action-related values appear in discourse and become embodied, whether they are uniform, conflicting, precede practice or emerge as a post-personal reflection of those involved. Through a review, synthesis, and analysis of qualitative literature—meta-ethnography—this paper seeks to present an overview of available academic work on the social, political, personal, material, and ethical reasons associated with partaking in alternative food networks. The findings will be analyzed and discussed in relation to a constructivist perspective, as well as debates around identity, social distinction, and gender.

Effects of kisspeptin on the maturation of human ovarian primordial follicles in vitro.

At this time, with advances in medical science, many cancers and chronic diseases are treatable, but one of their side effects is infertility. Some women also want to delay pregnancy for personal reasons. There has been some evidence that kisspeptin activates broad signals by binding to its receptor, suggesting that the role of kisspeptin in direct control of ovarian function includes follicle growth and steroid production. In this study, the effect of kisspeptin on improving the quality and results for human ovarian follicles was investigated. A section of ovary was removed laparoscopically from women between 20 and 35 years of age (n = 12). Pieces were divided randomly into two groups, control and treatment (with 1 μM kisspeptin). Real-time PCR was performed for GDF9, BMP15 and mTOR gene expression assessments. Western blotting was carried out to measure AKT and FOXO3a protein expression. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey's test; means were considered significantly different at a P-value < 0.05. During treatment with the kisspeptin group, maturity genes are expressed. Therefore, kisspeptin is an effective substance to improve the quality of the human ovarian medium as it increases the maturity of follicles.

Delay in Care Seeking for Menstrual Regulation

In Bangladesh menstrual regulation (MR) services are available at all major government and private hospitals, and even at government primary health care facilities. In spite of wide availability, women who do not use menstrual regulation services from proper facilities may resort to induce unsafe abortion by non-medical or untrained health workers in unhygienic condition. Worldwide, nearly 1 in 10 pregnancies end in unsafe abortion and World Health Organization (WHO) estimates that 18 out of 20 unsafe abortions takes place in developing countries. Induced abortion leading to complication such as bleeding, infection injuries and even death, these deaths could be prevented if women had an access to safe abortion facilities. This cross sectional study was carried out among fifty two women from family planning unit of Institute of Child and Mother Health (ICMH), Dhaka from December 2009 to May 2010. The purpose of this study was to identify the factors for delay in care seeking of menstrual regulation (MR). The data were collected by using the pretested questionnaires and cases were selected from the women who came for seeking care of MR after 10 weeks of amenorrhoea. Duration of amenorrhoea was confirmed by taking history and in some cases by ultrasonography. After incorporation of the socio-demographic data; factors or reasons of delay in MR were found due to personal, social, service and family related events. The mean age of respondents was 22.14 years. About 75% of the respondents were housewives and 79% were illiterate. The mean age of marriage 19.5 years. Regarding husband’s educational level of the respondent, more than one-third (37%) was class I – V, others one-third (33%) was above the primary level rest of the husbands were higher secondary and above. More than two-third (70%) of the respondents delivered 1 to 3 live children and used oral contraceptive pills. Most of the (87%) of women gave right answer about MR and most of them (85%) had knowledge about adverse effect of MR. Nearly two-third (65%) came to know about MR form relatives/neighbors, where one-fourth (25%) from health workers and rest them from mass media/ others. Most of the (87%) respondents answered correctly about advantages of MR, however, 60% did not know about the proper time of performing MR after cessation of menstruation. Most of the respondents (85%) knew about the side effects of MR; among them more than one-third (37%) told excessive bleeding was adverse effects of MR, however 33%, 8%, 6% and rest 4% told pain, sterility, perforation and infection respectively were the adverse effects of MR. Three-fifth (60%) of the patients didn't know about the right time of pursue care for MR and 63% of them were unaware about legal aspects of MR that they have right to seek MR. More than half of the respondents (56%) stated the reasons for the delay due to their personal problem where, 19%, 15% and 10% of them were specified the reasons as social factor, service related reason and family conflict respectively. Among the respondents of personal reason for delaying MR, more than half of them (52%) took oral tablets for abortion at home, 41% failed to understand their amenorrhoea and only 7% were unaware about service facility for MR. Regarding familial reasons for delay of MR, 60% pointed out the security problem and remaining 40% told about resistance by husband/others or absence of husband in the houses. The main (70%) social reasons of delaying MR was due to spiritual bindings and 30% was due to public disgrace. Service facility related reasons for delaying MR were treatment cost (62%), distance of facility (25%) and substandard services (13%). The study findings suggested that women had good knowledge about MR even they made delay due to unawareness of their legal rights, personal issues, social and service related causes. Strengthening of reproductive health services through community clinic at community level with available awareness building program on MR may minimize the delay for care seeking of MR among women. Bangladesh Med J. 2022 May; 51(2): 37-44

Exploring the Influence of Information Cocoon on the Mental Health of Social Platform Users

Today, with the rapid development of the information age, the network has become almost everyones habitat. While social media and the Internet bring users the pleasant experience of quick access to information, they also produce information cocoons. When users are still swimming in the ocean of interest created by big data, they are already unknowingly surrounded by limited and biased information. This paper will focus on the popular social phenomenon of information cocoon and explore its impact on the mental health of social platform users. The information cocoon includes the users automatic habitual information search and network big data analysis push under the guidance of their own interests. The combination of the two has successfully established a perfect interest barrier for users. When people are passively, actively or unconsciously imprisoned in the information cocoon constructed by the combination of personal reasons and external reasons for a long time, they will not only lose the motivation to understand and contact different information, but also due to the reduction of communication between different interest groups, the characteristics of alienation between groups become more and more obvious, forming a closed information space information cocoon. When trapped in the information cocoon, the users emotional and psychological care is guided and affected by the barrier, and its emotions are easily driven by the information content, which is difficult to realize and jump out of.

Abortion restrictions and medical residency applications

Residency selection is a challenging process for medical students, one further complicated in the USA by the recent Dobbs v Jackson Women’s Health Organization (Dobbs) decision over-ruling the federal right...

Metode Imam Al-Razi Dalam Berhujah Menggunakan Hadis Berdasarkan Tafsīr Mafatīhul Ghayb

Imam Fakhr al-Din al-Razi’s Tafsīr Mafatīhul Ghayb is an interpretive book that uses personal reasoning (ijtihad) to analyze Quranic verses. The author’s diverse expertise in language, jurisprudence, science, philosophy, and theology influenced his approach significantly. While Imam Al-Razi did not dismiss foundational methods such as Quranic verses, hadith, and the words of companions, the extent of his reliance on hadith in his interpretation is called into question. This study examines Imam Al-Razi’s use of hadith in this tafsīr through qualitative text and content analysis. Findings showed that hadith usage primarily centres around jurisprudential matters, with a lack of rigorous selection. Weak hadiths are included without clear verification from their origins. This research contributes to understanding Imam Al-Razi’s hadith-based arguments and provides recommendations for using Tafsīr Mafatīhul Ghayb as a study resource. Overall, this tafsīr’s approach is characterized by personal reasoning, though its reliance on hadith, particularly for clarifying Quranic meanings, remains as a source of concern.

Abstract B139: Parental reasons for lack of intent to initiate HPV vaccination among adolescents ages 13-17 years: National Immunization Survey – Teen 2019-2021

Abstract Introduction: The purpose of this study was to examine changes in parents’ reasons for not initiating HPV vaccination among their adolescents from 2019 to 2021. Methods: We used NIS-Teen data from 2019 through 2021. Adolescents aged 13-17 who had adequate provider information and had not received HPV vaccines, as reported by both parents and healthcare providers, were eligible for this analysis. Parents of these adolescents were asked, “How likely is it that your teen will receive an HPV shot in the next 12 months?” Parents who responded, “not too likely,” “not likely at all,” or “not sure/don’t know” were then asked the main reason their teen would not be receiving the HPV vaccine in the next 12 months. We created eight domains for the reasons parents reported: i) safety and effectiveness concerns, ii) systemic barriers, iii) vaccine misinformation and lack of knowledge, iv) sociocultural barriers, v) already up to date (UTD), vi) personal reasons, vii) handicapped/special needs/illness, and viii) other reasons. Each domain was treated as a binary outcome. Binomial regression models were then used to assess changes in the estimated prevalence of each domain for 2020 and 2021, when compared to 2019, by calculating adjusted prevalence ratios (PR) and 95% confidence intervals (95% CI). Results: From 2019 to 2021, the top 3 reasons for not initiating HPV vaccination reported by parents were vaccine misinformation and lack of knowledge, safety and effectiveness concerns, and systemic barriers (37.9%, 27.1%, and 14.1%, respectively). In 2021, the prevalence of reporting safety and effectiveness concerns was 20% lower (PR adj =0.80, 95% CI=0.73, 0.89) in comparison to 2019, whereas the prevalence of reporting sociocultural barriers was 62% higher (PR adj =1.62, 95% CI=1.33, 1.97) in comparison to 2019. There were no significant changes between the years 2019 and 2020 for any of the domains. Conclusions: Vaccine misinformation and lack of knowledge was the main reason reported during 2019-2021. To decrease vaccine misinformation and lack of knowledge, future efforts should consider strategies focusing on educational tools that will help inform parents about the HPV vaccine and its benefits. Although the prevalence of Safety and Effectiveness Concerns has decreased since 2019, it remained one of the main reasons parents reported not having initiated the HPV vaccine series in their adolescents. Policies such as school-entry requirements across all states and ensuring schools have the tools necessary to inform parents about the vaccine should be considered. Citation Format: Erika I. Escabí, Paola Alvelo-Fernández, Erick Suárez, Vivian Colón-López. Parental reasons for lack of intent to initiate HPV vaccination among adolescents ages 13-17 years: National Immunization Survey – Teen 2019-2021 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B139.

Investigation on Safety Problems and Risk Prevention of College Students' Sports Activities

Recent years, the country has placed sports in an important strategic position for development, and put forward red documents such as Quanming Fitness and Sports Power, which shows the important influence of sports on national nations. Under the background of the new era, especially the contemporary college students, their physical quality and cultural accomplishment play an extremely important role in the development of the Chinese Dream. Sports can strengthen muscles, bones, knowledge and will. The vigorous development of sports plays a positive role in promoting the country. The great rejuvenation of the Chinese nation is inseparable from the development of the national physique.The research object of this paper is the safety problems and risk prevention in college students&amp;apos; sports. The research methods are literature, expert interview, questionnaire survey and mathematical analysis to get the source of the problems and make some suggestions. At present, the safety problems of College Students&amp;apos; Sports emerge in endlessly, the risk accidents increase sharply, and the problems are not properly handled. College students love sports activities, but their safety awareness is weak. Sports injuries are mostly caused by personal reasons, followed by sports facilities.Most of the injured parts occur in the joints, and the body recovery after exercise is improper. It is necessary for students to strengthen the awareness of sports safety accidents, and schools should also pay attention to training students&amp;apos; safety knowledge and improving equipment. As for the safety problems at this stage, it is inevitable for schools to participate in sports insurance, which can not only properly deal with students&amp;apos; sports safety accidents.

Falling Out of Love: Divorce of Three Acehnese Ubanan Couples in the Islamic Law Perspective

“The most hated of permissible things to Allāh the Exalted is divorce”—this Prophetic tradition is narrated by AbūDāwūd and Ibn Mājah. Yet divorce is now on the rise in Aceh where Islamic Sharī‘ah is supposedly being implemented; there were 6,823 divorce cases in the province during the first ten months of 2022, with most proposed by young couples. This study examines divorce in mature families aged fifty and above, who have been married for many years in the perspective of Islamic law. We analyze their marriage and the nature of their life leading to divorce, the reasons for falling out of love, and the impact of separation on their well-being and on their loved ones. We review the Islamic sources and academic literature about marriage and divorce, the government and media reports for statistics, and we interview three couples along with several of their children in order to obtain insights into their experience. We uncover the complexity surrounding marriage and divorce, as well as religious, social, and personal reasons guiding their action or non-action. The study recommends that governments and religious institutions implement premarital courses as a condition of marriage so that divorce rates can be reduced. Such policies must be accompanied by meaningful and well-funded national government programs to save the institution of marriage and be able to maintain family cohesion in Indonesia.

Pharmacokinetics, Safety and Preliminary Efficacy of Multiple Doses of Pegylated Recombinant Human Coagulation Factor VIII-Fc Fusion Protein (FRSW117) in Previously Treated Adult and Adolescent Subjects with Severe Hemophilia a: Results from an Open-Label, Multicenter, Phase 2 Study

Introduction ：Prophylaxis of severe hemophilia A (HA) with standard half-life Factor VIII (FVIII) products necessitates frequent administration, and low trough FVIII activity levels lead to higher risk of bleeds. FRSW117 is a PEGylated recombinant human coagulation factor VIII Fc fusion protein (PEGylated rhFVIII-Fc), in a phase 1 study, single-dose FRSW117 was well tolerated and provided a prominently longer t1/2 with FVIII activity maintaining at ≥ 1% for more than 7 days. This open-label, multicenter phase 2 study (NCT05265286) aimed to evaluate the PK, safety, and preliminary efficacy of multiple 4 doses of FRSW117 in previously treated subjects with severe HA. Methods ：Severe HA (FVIII:C &amp;lt;1%) patients aged 12 (inclusive) to 65 years, previously treated with FVIII products ≥ 150 exposure days (EDs) were enrolled in two cohorts (M1, 40IU/kg; M2, 50IU/kg), to receive 4 once-weekly doses of FRSW117 on day 1, 8, 15, and 22 (ED1 to ED4), respectively. The PK characteristics, safety, and immunogenicity of FRSW117 were evaluated. PK samples were collected pre-dose on day 1, 8, 15, 22, and at multiple times after infusion on day 1 and day 22. The primary endpoints were the PK parameters, the occurs of AEs, inhibitor development, and other immunogenicity profiles; the secondary endpoints were the bleeding episodes during multiple dosing. FVIII activity was determined using one-stage clotting assay. FVIII inhibitor was tested using the Nijmegen-modified Bethesda assay. PK analyses were performed using noncompartmental analysis (Phoenix WinNonlin 8.3). Results ：Between April 2022 and August 2022, a total of 15 male subjects were enrolled in cohort M1 (N=8) and M2 (N=7). 13/15 (86.7%) of the subjects were adults, 2 of them were adolescent, both in M1. The mean age was 28.1 (range: 13, 44) in M1 and 30.6 (range: 23, 36) in M2. 14 subjects completed the study, with 1 subject in M2 withdrew early after the PK sampling of ED1 due to personal reasons. Baseline-corrected PK parameters were summarized in Table 1. Geometric mean elimination half-life (t 1/2) of M1 and M2 were 29.536h and 31.545 h, respectively, consisting with the first-in-human single dose study. Area under the activity-time curve (AUC 0-t), and steady-state maximum concentration (C max) after 4 weekly doses for M1 and M2 were 4557.1 and 4937.9 h*IU/dL, 101.26 and 122.76 IU/dL, respectively. The mean FVIII activity at 168h after dose for M1 and M2 were summarized in Table 2, and it were 3.25 and 2.88 IU/dL on 168 h (7 day) after the dose on D22. Baseline-corrected FVIII activity over time of 2 cohorts are shown in Figure 1. The accumulation index based on AUC tau were 1.008 and 1.098, respectively, indicating there was minimal accumulation after 4 once-weekly doses. A total of 10 (66.7%,10/15) subjects reported 20 treatment emergent adverse events (TEAE) during the study. No ≥ grade 3 adverse events, serious adverse events (SAE), adverse event leading to treatment discontinuation, or AESI were reported. No positive FVIII inhibitor was detected during the study. Pre-existing Anti-PEG-rhFVIII-Fc antibodies (ADA) were observed in 4/15 (26.7%) subjects.Pre-existing anti-PEG antibodies were observed in 3/15 (20.0%) subjects. No treatment emergent ADA and anti-PEG antibodies were observed, no treatment-boost ADA and anti-PEG antibodies were observed in subjects with pre-existing ADA and anti-PEG antibodies. No significant impact of pre-existing ADA and/or anti-PEG antibodies on PK variable, safety profile and preliminary efficacy was observed. 12/15 (80.0%) patients experienced zero bleeding episodes during the 4-week FRSW117 treatment period (from day 1 through day 28, 7 days after D22 dosing). Three of 15 (20.0%) subjects experienced 6 bleeding events among which only 1 spontaneous bleeding episode in cohort M1. 2 bleeds episodes were treated with FRSW117 of mean dose of 30.01 IU/kg and both were controlled after one infusion, with a hemostatic response rate of 100%. Conclusion: The therapy of 4 once-weekly doses of FRSW117 displayed favorable safety profile and provided about 3% mean FVIII activity on day 7 postdose with minimal accumulation. These results suggest that FRSW117 may offer extended bleeding protection with weekly dose interval and support further assessment of FRSW117 in phase 3 study.

Flumatinib for the Treatment of Adult Patients with Resistant or Intolerant Chronic-Phase Chronic Myeloid Leukemia: Results from Real-World Data

Introduction Over the past decades, BCR-ABL1 tyrosine kinase inhibitors (TKIs) as the initial treatment for chronic phase Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML-CP) have dramatically turned CML-CP into a manageable and potentially curable chronic disease. Nonetheless, in spite of the massive improvement in CML treatment over the last years with the introduction of TKIs, some patients (20%-30%) display intrinsic or acquired resistance to treatment during the disease course. Flumatinib Mesylate is a newer and orally available TKI with higher selectivity and potency against BCR-ABL1 kinase versus imatinib. According to the previous data，flumatinib can be an effective first-line treatment for CML-CP. Patients and Methods This study was initiated mainly to observe the safety and efficacy of flumatinib in the treatment of adult patients with resistant or intolerant Chronic-Phase Chronic Myeloid Leukemia, especially in second-line or above treatment in the real world. Efficacy and safety assessments were collected for the intent-to-treat population. Major molecular response (MMR) was defined as BCR-ABL1 transcript level ≤ 0.1% on the International Scale (IS), molecular response (MR4) was defined as BCR-ABL1 transcript level (IS) ≤ 0.01%; MR4.5 was defined as a BCR-ABL1 (IS) transcript level ≤ 0.0032%. DMR was defined as MR 4.0 or MR 4.5. Results Among the 58 evaluable patients with CML-CP, 54% were male, 47% were female. The median age of these patients is 45Y. During the observation period, there were 28 second-line conversion patients (48%), 19 third-line conversion patients (33%), and 11 fourth-line and above patients (19%). Prior therapies included imatinib, dasatinib, nilotinib, olverembatinib, radotinib and ponatinib. All patients converted to treatment of 600mg flumatinib daily. Among the 58 evaluable patients, 20 patients who had been treated with imatinib alone were converted to flumatinib, including 9 cases of IM resistance, 8 cases of IM intolerance and 2 case of personal reasons. During the 1-year follow-up, 52% of patients (n=30) were evaluable for the achievement of MMR. The patients with BCR-ABL1 (IS) &amp;gt; 10% at baseline, 3, 6 and 12 months were 48%, 17%, 23% and 26%, respectively; for patients with BCR-ABL1 (IS) &amp;lt; 0.1% were 26%, 40%, 49% and 52%, respectively; for patients with DMR were 26%, 40%, 49% and 52%, respectively. For imatinib-intolerant or -resistant patients, MMR was 44%. Subgroup analyses showed that the imatinib-intolerant or -resistant patients with BCR-ABL1 (IS) &amp;gt;10% at baseline, 3, 6 and 12 months were 65%, 0%, 10% and 0%, respectively; for patients with BCR-ABL1 (IS) &amp;lt; 0.1% were 10%, 33%, 80% and 44%, respectively; for patients with DMR were 5%, 11%, 30% and 11%, respectively. Meanwhile, 11% of patients could not be detected at molecular level (0.000%). Of the 58 patients, only Grade 1 AEs were reported, including diarrhea, rash and eye edema. Conclusion Flumatinib has good efficacy and safety in the treatment of adult patients with resistant or intolerant Chronic-Phase Chronic Myeloid Leukemia, it will be a good choice for second-line or above treatment for CML-CP In clinical practice.

Real-World Experience with Selinexor -Containing Regimens in Post-Transplant AML/MDS Patients Who MRD Still Positive after First-Line Preemptive Treatment

Background: Hematopoietic stem cell transplantation (HSCT) is the only cure for acute myeloid leukemia (AML), but relapse is the most important cause of transplant failure. Patients with remission but measurable residual disease (MRD) positive have a higher probability of hematologic relapse. The MRD-directed preemptive treatments can spare some patients in remission from further therapy. The conventional first-line preemptive treatment has been ineffective in some patients, so it's necessary to find a new preemptive treatment to prevent relapse and improve the prognosis. Our study aimed to evaluate the efficacy and safety of selinexor-containing regimens in the preemptive treatment of MRD positive in post-transplant patients with AML or myelodysplastic syndrome (MDS). Methods: The study was conducted in Tongji Hospital from March 2022 to May 2023. The inclusion criteria of post-transplant AML/MDS patients included the followings: (a) Persistent MRD positive. (b) MRD turned negative after first-line preemptive treatment but was positive again. (c) Patients at high risk for hematologic relapse after transplantation; (d) AML-M4/5. The end of the follow-up was in June 2023. Bone marrow aspiration was assessed for MRD using multiparameter flow cytometry (MFC) combined with real-time quantitative polymerase chain reaction (RT-qPCR) as follows: 1) MRD assessed by MFC: MRD negativity was defined as &amp;lt;0.1%. 2) MRD assessed by RT-qPCR: Abnormal genes associated with prognosis were used for molecular MRD detection. 3) WT1 was used for molecular MRD assessment if no molecular marker was available at diagnosis. MRD negativity was defined as &amp;lt;0.6%. Results: A total of 11 patients were included in the study. There were 10 patients with AML and one patient with MDS, with a median age of 43 years old. Two patients had received autologous HSCT, nine patients had received allogeneic HSCT, of which two matched sibling donor, one matched unrelated donor, and six were haploidentical donor. All patients were WT1 positive and two of the cases were both WT1 and MFC positive. Seven patients with post-transplant MRD positive were treated with selinexor-containing regimens after first-line preemptive therapy (azacytidine, azacytidine combined with venetoclax, decitabine combined with venetoclax, etc.) failed or MRD positive again. The remaining four patients were treated directly with selinexor-containing regimens for personal reasons or with a diagnosis of AML-M4/5 may be resistant to venetoclax. The selinexor-containing regimens used in this study were either selinexor (35mg/m 2 biw) alone or in combination with other drugs (decitabine, azacytidine, venetoclax, low-dose cytarabine, and CAG (cytarabine, aclarubicin, G-CSF) regimen). MRD was evaluated after two weeks of the selinexor-containing regimens. And selinexor 20 to 40 mg per week was used as maintenance therapy after MRD converted to negative. Eight patients (72.7%) successfully cleared the MRD. Of the three patients who didn't clear the MRD, two patients successfully converted to negative after continuing the selinexor-containing regimens. It is worth mentioning that 7 of the 11 patients were treated with the selinexor-containing regimens after first-linepreemptive treatment failure, and six of them had successfully cleared the MRD (71.4%). At the end of follow-up, 10 (90.9%) patients survived and one (9.1%) died due to disease progression. In terms of hematological adverse events (AEs), grade 3-4 neutropenia occurred in nine (81.8%) patients, the median duration was 2 days (IQR 1,4). Grade 3-4 thrombocytopenia occurred in three (27.3%) patients, and the median duration was 5 days (range 4-7). Although the number of people with grade 3-4 neutropenia was large, the duration was short after using granulocyte colony-stimulating factor, and no patient developed a severe infection. Most of the non-hematological AEs were mild, including nausea (100.0%), fatigue (63.6%), hyponatremia (58.3%), and vomiting (45.5%). The AEs can be alleviated after symptomatic treatment and no patient discontinued treatment. Conclusion: Selinexor-containing regimens have been shown to be effective and well tolerated in post-transplant AML/MDS patients with MRD-positive, including those who have failed first-line preemptive treatment.

Fallen Stars: A Comparative Study of the Poetic Works of John Keats and Li He

Due to the short lives and similar poetic styles, the British Romantic poet John Keats and Li He from the Mid-Tang dynasty have always been the hotspot for research. However, most past research compared them by stating the superficial, factual details and failed to address their subtle differences and attribute them. Therefore, this paper aims to compare the pursuit of the ideal, use of imagery, and presence of the narrator to thoroughly contrast Keats’ and Li He’s poetic works and then propose personal and cultural reasons for such differences. It is concluded that Keats pursued poetry to reach the idealized integration, while poetry for Li was a means to enter the political arena until reality turned him down. Regarding imagery, Keats followed the “the death of beauty” pattern, while Li directly utilized macabre imagery to express his poignancy. Finally, Keats’ narrator demonstrates a shift between “realm with the poet” and “without the poet” due to his existential anxiety, while Li’s work demonstrates an unorthodox “realm without the poet”, where the narrator utterly detaches himself from the poem. While Keats’ poetry highlights a struggle to grasp the ideal, metaphorically an impeded upward tendency, Li He’s poetry reflects a downward tendency of merely portraying the macabre, the grotesque, and the degenerate. Personally, this could be attributed to Keats’ internal locus of control and Li’s external locus of control, while culturally, abundant social outlets for a poet in 19th century England and limiting careers for those in the Mid-Tang dynasty explained those discrepancies.

An Information Service Platform for Decision Support in Academic Admissions Using Data Fabrics and Artificial Intelligence

This paper presents the architecture of an information service platform for decision support in academic admissions, utilizing data fabrics and artificial intelligence. The factors affecting students’ further education can be classified into four main types: (1) the course, (2) image, (3) personal reasoning of the student, and (4) public relations. The process of providing information for decision support in academic admissions can be divided into six stages: (1) collecting information, (2) matching study guidance, (3) recommending appropriate education, (4) confirming information, (5) assessing student admissions, and (6) providing feedback. Data fabric is an increasingly popular technology application for data management. The data fabric architecture consists of six layers: (1) an augmented data catalog, (2) a knowledge graph enriched with semantics, (3) metadata activation, (4) a recommendation engine for active metadata, (5) data preparation and integration, and (6) orchestration and data operations. A smart decision support system (DSS) technology is used to assist in decision-making. The results showed that this architecture has an excellent level of suitability (mean = 4.56, standard deviation = 0.35). It can be applied to a university to help it become a digital university and align with its mission.

Use of Peer-Led Web-Based Platforms for Peer-Assisted Learning Among Canadian Anesthesia Residents and Fellows: Cross-Sectional Study.

Peer-assisted learning (PAL) using peer-led web-based platforms (PWPs), including social media, can be a highly effective method of supporting medical trainees. PWPs, such as mobile apps for sharing anesthesia resources and social media groups or discussion forums pertaining to anesthesia training, may play a role in facilitating anesthesia trainee-led web-based education. However, there have been many challenges facing anesthesia trainees when it comes to incorporating PWPs, especially social media and mobile apps for PAL. The primary objective of this survey was to assess the proportion of trainees that use social media and mobile apps. The secondary objective was to identify the trainees' perceptions on the use of social media and mobile apps for educational purposes, including PAL. This cross-sectional study was conducted through a survey administered via email at a single large academic center. The survey tool collected data between 2016 and 2017 on the following: demographic data (year of study, field of specialty), use of technology and web-based resources for medicine, use of social media platforms for anesthesia or training, benefits and barriers to future uses of social media for training, and ideas for trainee-led websites. Descriptive statistics were reported. In total, 80 anesthesia trainees (51 residents and 29 fellows) responded to the survey (response rate of 33% of out 240 trainees contacted). All trainees reported having a mobile device that most (n=61, 76%) reported using multiple times a day to access medical resources. The highest perceived benefits of PWPs according to residents were that the most valuable information was available on-demand (n=27, 53%), they saved time (n=27, 53%), and they improved their overall learning experience within anesthesia (n=24, 47%). In comparison, fellows thought that PWPs were beneficial because they provided multiple perspectives of a single topic (n=13, 45%) and served as an additional platform to discuss ideas with peers (n=13, 45%). The most popular platforms used by both residents and fellows were Facebook (residents: n=44, 86%; fellows: n=26, 90%) followed by LinkedIn (residents: n=21, 42%; fellows: n=9, 29%). Even though most anesthesia trainees used social media for personal reasons, only 26% (n=21) reported having used resident- or fellow-driven PWP resources. Examples of PWPs that trainees used included anesthesia groups and a resident Dropbox resource folder. There was generally an acceptance for using PWPs for PAL as they provided various benefits for trainees at all levels of learning. PWPs have the potential to garner an increased sense of community and sharing within learning experiences throughout all levels of training.The information gained from this survey will help inform the basis for developing an anesthesia trainee-led e-learning platform.

Nazi persecutee and opponent of racial hygiene: The extraordinary life of the “ethnopathologist” Max Kuczynski (1890–1967)

The pathologist Max Kuczynski (1890–1967) gained recognition for his bacteriological research but is also considered the founder of the so-called ethnopathology. As a “non-Aryan,” Kuczynski emigrated from Nazi Germany to Peru, where his elder son was later even to become president. However, the circumstances surrounding the end of Kuczynski’s career in Germany are hardly known. This article takes this research gap as an opportunity to reconstruct his life, the circumstances of his emigration, and his work in South America. Numerous archival documents serve as sources. In the mid-1920s, Kuczynski developed “ethnic pathology,” a new interdisciplinary approach that offered a counter-concept to the increasingly popular racial hygiene in Germany. But his career in Germany ended even before the Nazis came to power in 1933. He was dismissed from the Charité Pathological Institute in October 1932 at the instigation of its new director, Robert Rössle (1876–1956). Personal and financial reasons played a role, but Kuczynski’s rejection of racial hygiene may also have been a decisive factor: Rössle himself turned increasingly to questions of racial hygiene in the Third Reich and used the corpses of Nazi victims for his research. It can be shown that the circumstances of Kuczynski’s dismissal were already catalyzed by anti-Semitic and eugenic tendencies, which were to unleash themselves radically in Germany only a few months later – and even caught up with him in Peruvian exile.

Dual modality feeders: a group of human milk feeders with unique practices and needs.

Dual modality feeding (DMF) - feeding human milk interchangeably from the breast and from a bottle - comes with unique practical, emotional and relational challenges, as well as support needs. Yet, there is little research that explores the experiences of individuals who use DMF in the Canadian context. The aim of this study is to explore the practices, challenges, reasons and enablers of DMF. Repeat, semi-structured one-on-one interviews were conducted at 8 weeks and 22 weeks postpartum. Interview transcripts were thematically analysed using a critical feminist lens. Nova Scotia, Canada. Ten DMF mothers. DMF practices were influenced by a mix of social and material circumstances, including breast-feeding challenges, the involvement of support persons, finances and access to lactation support. Individuals who predominantly fed at the breast expressed milk strategically to mitigate transitory breast-feeding challenges, for convenience under specific circumstances, and to share feeding responsibilities with other caregivers for personal and practical reasons. Individuals who mainly bottle-fed did so due to long-term breast-feeding challenges or a need to return to employment. Enablers of successful DMF were consistent between the two groups and included practical, personal and relational aspects. DMF is a unique practice compared to feeding human milk solely from the breast or bottle. Despite the potential growing prevalence of DMF, it is currently understudied and inadequately addressed in existing support programmes in Nova Scotia. Tailored programming and public messaging are needed to support DMF families.