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Teaching moral dilemma in the COVID-19 pandemic

The COVID-19 pandemic has caused various moral dilemmas. In Indonesia, there is a dilemma of whether to stay at home or go outside for work, whether to study at school or from home, whether to return home or not on holidays for migrants and whether to pray from home or at the place of worship. These various dilemmas can be used as materials or learning sources for students. They can learn to make moral decisions based on factual arguments through value clarification techniques by utilizing information and communication technology. The implementation of this model can provide students with a good learning experience in making a rational moral decision based on the facts revealed by the students’ active participation in online learning. This model can also be applied in other situations when people are faced with various dilemmas.

In Reply: The State of Cerebrovascular Care in Africa.

In Reply: The State of Cerebrovascular Care in Africa.

Teaching moral dilemma in the COVID-19 pandemic

The COVID-19 pandemic has caused various moral dilemmas. In Indonesia, there is a dilemma of whether to stay at home or go outside for work, whether to study at school or from home, whether to return home or not on holidays for migrants and whether to pray from home or at the place of worship. These various dilemmas can be used as materials or learning sources for students. They can learn to make moral decisions based on factual arguments through value clarification techniques by utilizing information and communication technology. The implementation of this model can provide students with a good learning experience in making a rational moral decision based on the facts revealed by the students’ active participation in online learning. This model can also be applied in other situations when people are faced with various dilemmas.

Oscillometry helps assess treatment responsiveness in adults with asthma exacerbations

BackgroundIt is necessary to evaluate the severity of asthma exacerbations for subjective symptoms and objective indicators. When patients cannot perform spirometry, oscillometry is a surrogate test. ObjectiveWe assessed the usefulness of oscillometry for the evaluation of treatment responsiveness in patients with asthma exacerbations. MethodsThe subjects included 21 consecutive patients with asthma exacerbations. Symptomatic responses, oscillometry, and spirometry (if possible) were assessed before and after treatment with corticosteroids and aminophylline. ResultsAfter treatment, all of the patients were allowed to return home and had no hospital visits. Oscillometry was feasible in all patients; however, spirometry could not be performed in 9 patients. Overall, there was a significant improvement in wheezing scores and oscillometric parameters, but not in FEV1 after treatment. The thresholds for a positive bronchodilator response in oscillometry were observed in 4 or more patients, while the minimal clinically important differences in FEV1 were observed in one patient. ConclusionOscillometry can detect improvements that cannot

Discharge Planning to Improve Readiness Transition Care in-Patient Cerebrovaskuler Accident: A Literature Review

Background: Effective and continuity discharge planning is vital in care continuity and integrated care. Continuity discharge planning can reduce avoidable hospital readmission, and fulfillment improves the quality of care. Prevention efforts to prevent the re-attacks and readmission because of this CVA attack should be started early before the patients return home from the hospital. Purpose: This research aims to review the effect of discharge planning on the readiness of returning home in CVA patients. Methods: We included english materials published between Science Direct, PubMed, Research Gate, and Google Scholar that were used to find studies on discharge planning, readiness, and transitional care between 2016- 2021. Results: Discharge planning is carried out in three-stage, inpatient admission and intra-hospital when the patient is about to be discharged from the hospital. In the first stage, the nurse explains patient admission, regulation, and management when the patient enters the hospital. The second stage is when the patient is hospitalized, which consists of nurses providing education about medication, environment, health, outpatient referral, and diet. While the last stage is when the patient will be discharged, the nurse explains the control, medication, and nutrition schedule at home. Post-stroke rehabilitation and recovery is a chronic process. Conclusion: Review of discharge planning can be influenced by several factors: individual characteristics (clients' potential with special needs early, motivation), family factors (social resources, home environment), and health care system (teaching home care skills with community/ hospital professionals. These factors will affect the implementation of discharge planning in health services which is hospital accreditation.

Safeguarding survival: Older persons with multiple chronic conditions' unplanned readmission experiences: A mixed methods systematic review.

The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes. Mixed methods systematic review. Six electronic databases (Ovid MEDLINE (R) All 1946-present, Scopus, CINAHL, Embase, PsychINFO and Web of Science). Peer-reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta-synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration. Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences. Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival. Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health-care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge. PRISMA guidelines. No patient or public contribution due to design.

Social and economic determinants of post-war re-emigration

Introduction. After the full-scale invasion of the russian federation a large number of citizens left Ukraine. Most of them have chosen Euro­pean countries as their place of residence, whose government have shown interest in the assimi­lation of Ukrainian refugees, and some of the migrants plan to return home. Problem. The departure of a significant num­ber of Ukrainian citizens abroad had a negative impact both on the state of the domestic market due to a significant drop in demand, and on the labour market, in particular in the service sector, which suffered significantly during the war. In the future, for some families, the question of reunification may arise not in Ukraine, but abroad. The aim of the study is to determine the factors that will influence the return of Ukrai­nian refugees after the end of the war. Methods. The research was conducted using methods of systematic and comparative analysis, sociological method in combination with cultu­ral and behavioural methods. Results. Despite the strong "sense of home" many parents have, their decision to return home to Ukraine is influenced by the desire to ensure a stable life for their children in countries that guarantee social protection, security and trans­parency of business, opportunities for social growth. Conclusions. At the beginning of Russia’s full-scale invasion, mostly representatives of small and medium-sized businesses and/or their relatives or friends left Ukraine. The possible threat to their lives and health during hostilities keeps them from returning. The availability of housing is a determining motivational factor for return for a relatively small number of respon­dents, the most important factor is the opportu­nity to work or manage legitimate business structures.

BIOMEDICAL SMART HOME SYSTEMS

Biomedical engineering is a system that includes the design, manufacture and operation of various systems, devices and methods used in the diagnosis and treatment of problems that may occur in human health. In recent years, as in the whole world, some important innovations in this field apply in the research conducted in Azerbaijan. Over the past 30 years, biomedical engineering has been established as an independent field of science and engineering. Currently, biological medicine is not limited to the field of medicine, it has continued to develop as a potential field, making an important contribution to the dentistry, veterinary medicine, rehabilitation, physical education, and sports fields. The types of biomedical devices available in stationary health care institutions are expressed in hundreds, and the number is expressed in thousands. From implant to stethoscope, from complex imaging medical devices such as MRI (magnetic resonance imaging) and X-rays devices to patient beds, many products that could be considered simpler have been designed by engineers. In modern hospitals, sophisticated engineering devices are used by doctors to treat patients. Biomedical smart home system or health-based smart homes are designed for patients who feel the need to return home after an average time from a hospital or healthcare facility, or who need to receive care at home. The article presents information about innovations in the mentioned field. Keywords: Bioengineering, biomedical equipment, biomedical sensor, smart home

Dilemma Over Repatriation - Sri Lankan Tamil Refugees In The Camps Of Tamil Nadu, India

A large number of Tamils had fled from Sri Lanka during the prolonged devastating ethnic war. According to a report of the ministry of Home Affairs, more than 3 lakhs Sri Lankan Tamil refugees entered India in different phases between 1983 and 2012. At present about one lakh refugees belonging to over 18,000 families are living in the state of Tamil Nadu, of whom 68,606 Sri Lankan Tamils are in 114 refugee camps. While 79,773 refugees were repatriated to Sri Lanka till 1995, some left to other countries on their own. After 1995, there is no organized repatriation. Indian government is reluctant to integrate the refugees into society. In the recent past, the delegations of India and Sri Lanka begin to discuss about the steps to be taken for the voluntary repatriation of refugees. Those who want to end their refugee status in India are willing to return home. Others want to remain in India. And many are unable to even decide whether to go back to Sri Lanka or to stay in India.

Clinical outcome of ambulatory anterior cruciate ligament reconstruction compared with the standard in-patient surgery

Purpose There is a current trend toward performing anterior cruciate ligament reconstruction (ACLR) as a day surgery procedure. However, the full evaluation of this process compared with the traditional inpatient ACLR was not accomplished particularly from the perspective of patient satisfaction, pain improvement, and final outcome. Furthermore, several centers described refusal of patients to pass through the day surgery protocol with more preference to admission. The aim of this study is the evaluation of early/late results of short-term hospital stay following arthroscopic ACLR with regard to patient recovery, complications, patient satisfaction, and return to daily activities through our algorithm. Patients and methods Through a prospective randomized study, 284 patients were operated for ACLR through two pathways; G1 is the day surgery pathway and G2 is the traditional inpatient pathway. Patients were evaluated postoperatively for pain severity, satisfaction, the need for additional analgesia, any readmission, complications, and final outcome. Results Patients in both groups showed similar pain and satisfaction levels with no difference regarding the amount of extra-analgesia needed and with no readmission from the day surgery group. However, seven patients were recorded as reattending the hospital seeking for pain medication which was given in ER and the patient was satisfied to return home with no need for readmission. Conclusions In conclusion, day surgery can be considered as the protocol of choice for patients undergoing ACLR with no difference from the former standard in-patient ACLR.

Combined multidisciplinary in/outpatient rehabilitation delays definite nursing home admission in advanced Parkinson's disease patients.

Advanced Parkinson's disease (aPD) patients have a high risk on definite nursing home admission. We analyzed the effectiveness of an in-and outpatient multidisciplinary rehabilitation, focusing on activities of daily living (ADL) and delaying definite nursing home admission. This study included 24 aPD patients, who received a 6-week inpatient multidisciplinary rehabilitation program, including optimization of pharmacotherapy, which was followed by an individualized outpatient support program during 2 years (intervention group). A non-randomized matched control group (n = 19), received care as usual. Primary endpoints consisted of the Amsterdam Linear Disability Scale (ALDS) and percentage of patients being able to live independently at home after 2 years. Secondary endpoints included changes in medication (LEDD), motor performance (SCOPA-SPES), cognition (SCOPA-COG), hallucinations (NPI) and depression (BDI). Overall, 83% of patients were able to return home after the 6-week inpatient intervention, and 65% still lived at home at 2 years follow-up. Median ALDS scores after 2 years in the intervention group were significantly better, compared to the control group (p = 0.002). All secondary endpoints had improved significantly vs. baseline directly after the 6-week inpatient rehabilitation, which had disappeared at 2 years follow-up, with the exception of the daily dose of medication, which was significantly higher in the intervention group. This 2-year follow-up study showed that a combined multidisciplinary in/outpatient rehabilitation program for aPD patients, was able to stabilize ADL functions, and finally delayed definite nursing home admissions in 65% of treated patients. filenumber M10.091051; ABR code NL32699.042.10.

Of catarrh and catharsis

Of catarrh and catharsis

International academic or citizen scholar?: Singaporean returnees in the global city

Research on return migration has tended to focus their analyses on two imagined places: a host country where they used to live, and an origin country where they must reintegrate after a long period of being away. This paper reveals how spaces within the city can undermine the reintegration of former migrants seeking to reestablish themselves in their home countries. Based on in-depth interviews with 25 Singaporean academics, we discuss how the priorities of globally oriented universities can impact the reintegration of highly skilled returnees within their home city. Specifically, this paper reveals how returnees face the challenge of negotiating two conflicting demands upon their return home. As academics, they must adhere to the needs of their fast-changing universities, where the pressures of world rankings demand “global impact” through research and publications. Yet, as Singaporean citizens, they also face expectations to fulfill the responsibilities of being “home” in their city, juggling calls for national service and community outreach among local university faculty. We examine the conflict between these two demands as an understudied factor that shapes migration flows into Asia's global cities.

Empirical study of psychological war-related problems of Ukrainians living in Germany

Introduction. The war in Ukraine caused a huge increase in the number of Ukrainians seeking temporary shelter in other countries of the world. A particularly significant number of Ukrainians found refuge in Germany. In this connection, researching the psychological problems faced by the Ukrainians who live in Germany seems quite topical. Aim: to analyze psychological war-related problems faced by Ukrainians in Germany. Methods: To carry out a study, a special questionnaire "Social and Psychological Survey of Ukrainians Who Are Staying in Germany Due to the War" (O.V. Kredentser) was developed and used. Results. The study showed the existence of a number of problems related to the conditions of Ukrainians' staying in Germany. These are, first of all, socio-professional problems, which include lack of knowledge of German language, problems with children's education, problems with work in Ukraine and Germany, lack of support from the German community and lack of support from German relatives and/or acquaintances. Secondly, social and psychological problems: conflicts with the nearest and dearest who are in Germany, lack of life prospects, conflicts with the loved ones who remained in Ukraine, loss of the meaning of life. Thirdly, the economic and household problems: lack of their own separate housing, problems with finding housing, lack of finances for living, and other problems. The German Ukrainians' mental health was assessed to be lower than their physical health, with the main psychological problems being uncertainty, desire to return home, self-doubt, anxiety, helplessness, depression, despair, "rejection" of the country of staying, apathy, fear, etc. There is both an objective and a subjective need for special individual and group intervention programs and psychological support, which will help maintain mental health, increase resilience, and contribute to the personal development of Ukrainians in Germany. Conclusions. The obtained data can be helpful in developing psychosocial support technologies for Ukrainians in Germany.

Екслібрис у творчості Богдана Хаварівського (1990-ті рр.).

The aim of the study is to analyze the bookplate as a component of Bohdan Khavarivskyi’s cultural and artistic heritage in the 1990s. Th e research methodology is based on the principles of historicism, objectivity, scientifi city, and systematicity. Th e methods used are generalization, quantitative, historical and comparative, chronological, retrospective, and local history. Th e scientifi c novelty is based on the fact that the author is the fi rst in Ukrainian historiography to comprehensively analyze the problem under study, to fi nd out its impact on the crea tive work of famous Ukrainian artists in the fi eld of bookplate. Conclusions. B. Khavarivskyi was not only personally actively involved in cultural and artistic aff airs, but also tried to popu- larize the creative work of famous artists of Ternopil region in the fi eld of bookplates, which was important for libraries and museums. Th e bookplates preserved in the private collection of B. Khavarivskyi’s are individual bookplates associated with the libraries of certain individuals. Th e artist sought to familiarize a wide audience with the art of bookplates, to show works of diff erent content, form, and technique. He actively involved students who were members of the literary and artistic club «Silver Octaves» in the creation of the bookplate. In the early 1990s, not only the subject matter of the bookplate changed dramatically, but also its plotting: histori- cal motifs, everyday scenes, portraits of writers, artists, and actors. B. Khavarivskyi was directly involved in the exposition of bookplates «Let’s Give Ukraine Back to Our Children», which was to feature bookplates by more than twenty professional artists of Ukraine. He initiated the celeb- ration of the 125th anniversary of the birth of B. Lepkyi, a writer and public fi gure, and prepared the All-Ukrainian exhibition «Cranes Return Home» (the life and work of B. Lepkyi in the book- plate), which invited artists from Ukraine and the diaspora. Th e collection of book miniatures «Shevchenkiana in the bookplates of Ukrainian artists», presented by twelve authors, had a rather positive response among artists. Th e artistic events initiated by B. Khavarivsky contri- buted to the popularization of the original national culture, attracting small graphic artists to popularize their creative potential.

Eli and Susannah Wiggill: South African Saints

Eli and Susannah Wiggill: South African Saints

Finding "Miss Canada"

During the First World War, many Canadian women served on the front lines as nurses, both as working professionals and volunteers. Although the experiences of Canadian women during WWI have been addressed by historians more frequently in recent decades, the experience of professional nurses has been overshadowed by that of Volunteer Aid Detachment nurses (VADs) and women on the home front and of course by studies on soldiers’ experiences. Many historians have found the personal narrative, diary, or journal to be an invaluable source to understanding the First World War. However, there is a gap in the study of the personal narratives, diaries, and journals of Canadian professional nurses specifically. This paper seeks to bridge this gap in WWI history through a specific focus on a selection of the surviving personal papers of Canadian professional nurses. Their personal writings reveal new insights into nursing experience on the front, nursing work, and how Canadian professional nurses sought and found meaning in extraordinary and violent circumstances. They made sense of the war through sociability, relationality, and through recording their time overseas both to cope with the experience itself, and to remember it upon their return home.

Investigating Path Integration Cues in Sand Scorpion Homing Behavior

Many sand scorpions are faithful to the burrows they dig; however, it is unknown how these animals get back home after hunting excursions. Of the many mechanisms of homing that exist, path integration (PI) is one of the more common tools used by arachnids. In PI, an animal integrates its distance and direction while leaving its home, enabling it to compute an approximate homebound vector for the return trip. The objective of our study was to test whether scorpions use PI to return home under absolute darkness in the lab. We first allowed the animals to establish burrows in homing arenas. Then, after they left their burrow, we recorded the scorpion’s location in the homing arena before we transferred it to the center of the testing arena. We used overhead IR cameras to record its movements in the testing arena. If scorpions exhibited PI, we predicted they would follow a vector in the test arena that approximated the same angle and distance from the capture point to their burrow in their home arena. However, under the conditions of this experiment, we found no evidence that scorpions moved along such homebound vectors. We speculated that scorpions may need a reliable reference cue to accommodate path integration.

Stroke Rehabilitation and Motor Recovery

Up to 50% of the nearly 800,000 patients who experience a new or recurrent stroke each year in the United States fail to achieve full independence afterward. More effective approaches to enhance motor recovery following stroke are needed. This article reviews the rehabilitative principles and strategies that can be used to maximize post-stroke recovery. Evidence dictates that mobilization should not begin prior to 24 hours following stroke, but detailed guidelines beyond this are lacking. Specific classes of potentially detrimental medications should be avoided in the early days poststroke. Patients with stroke who are unable to return home should be referred for evaluation to an inpatient rehabilitation facility. Research suggests that a substantial increase in both the dose and intensity of upper and lower extremity exercise is beneficial. A clinical trial supports vagus nerve stimulation as an adjunct to occupational therapy for motor recovery in the upper extremity. The data remain somewhat mixed as to whether robotics, transcranial magnetic stimulation, functional electrical stimulation, and transcranial direct current stimulation are better than dose-matched traditional exercise. No current drug therapy has been proven to augment exercise poststroke to enhance motor recovery. Neurologists will collaborate with rehabilitation professionals for several months following a patient's stroke. Many questions still remain about the ideal exercise regimen to maximize motor recovery in patients poststroke. The next several years will likely bring a host of new research studies exploring the latest strategies to enhance motor recovery using poststroke exercise.

Another Option for Aggression and Self-Injury, Alternative Benzodiazepines for Catatonia in Profound Autism.

Introduction: Individuals with profound autism often present for inpatient care due to aggression. Diagnostic and treatment options are limited. Agitated catatonia is a treatable comorbidity in autism, which should be considered in cases of aggression. Preliminary data report high clinical response rates of catatonia in autism when treated with electroconvulsive therapy (ECT), with poor response to lorazepam. However, access to ECT is often limited, especially in pediatric populations. Methods: We conducted a retrospective chart review to identify cases of hyperactive catatonia with partial response to lorazepam in profoundly autistic children presenting to the pediatric medical hospital. Five cases were identified, all of whom were followed by the child and adolescent psychiatry consult-liaison service during admission and treated without the use of ECT. Data from the medical record were obtained after institutional review board (IRB) approval including the following: (1) treatment course, (2) Bush-Francis Catatonia Rating Scale (BFCRS) scores, and (3) Kanner Catatonia Rating Scale (KCRS) severity scores. The Clinical Global Impressions-Improvement (CGI-I) Scale was applied retrospectively to each case. Results: All five patients demonstrated clinically significant improvements. The average CGI-I score was 1.2. The average percentage reduction in the BFCRS and KCRS severity scores was 63% and 59%, respectively. Two of five patients were first stabilized with infusions midazolam and dexmedetomidine due to the symptom severity and then transitioned to long-acting oral benzodiazepines. Overall, four of five patients were stabilized with oral clonazepam and one of five with oral diazepam. Notably, four of five patients experienced an acute worsening of aggression, self-injury, and other catatonic symptoms with escalating dosages of antipsychotic treatment, which occurred before inpatient admission. All patients experienced resolution of physical aggression toward self and/or others, experienced improvement in their communicative abilities, and were able to return home or enter residential level of care upon discharge. Conclusions: Given the limited availability of ECT and the unclear utility of lorazepam for hyperactive catatonia in autism, the use of long-acting benzodiazepines and/or midazolam infusion may offer a safe and readily available treatment alternative.