Single Case Research Articles

Attitude Estimation From Vector Measurements: Necessary and Sufficient Conditions and Convergent Observer Design

The paper addresses the problem of attitude estimation for rigid bodies using (possibly time-varying) vector measurements, for which we provide a <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">necessary and sufficient</i> condition of distinguishability. Such a condition is shown to be strictly weaker than those previously used for attitude observer design. Thereafter, we show that even for the single vector case the resulting condition is sufficient to design almost globally convergent attitude observers, and two explicit designs are obtained. To overcome the weak excitation issue, the first design employs to make full use of historical information, whereas the second scheme dynamically generates a virtual reference vector, which remains non-collinear to the given vector measurement. Simulation results illustrate the accurate estimation despite noisy measurements.

Challenging the Chatbot: An Assessment of ChatGPT's Diagnoses and Recommendations for DBP Case Studies.

Chat Generative Pretrained Transformer-3.5 (ChatGPT) is a publicly available and free artificial intelligence chatbot that logs billions of visits per day; parents may rely on such tools for developmental and behavioral medical consultations. The objective of this study was to determine how ChatGPT evaluates developmental and behavioral pediatrics (DBP) case studies and makes recommendations and diagnoses. ChatGPT was asked to list treatment recommendations and a diagnosis for each of 97 DBP case studies. A panel of 3 DBP physicians evaluated ChatGPT's diagnostic accuracy and scored treatment recommendations on accuracy (5-point Likert scale) and completeness (3-point Likert scale). Physicians also assessed whether ChatGPT's treatment plan correctly addressed cultural and ethical issues for relevant cases. Scores were analyzed using Python, and descriptive statistics were computed. The DBP panel agreed with ChatGPT's diagnosis for 66.2% of the case reports. The mean accuracy score of ChatGPT's treatment plan was deemed by physicians to be 4.6 (between entirely correct and more correct than incorrect), and the mean completeness was 2.6 (between complete and adequate). Physicians agreed that ChatGPT addressed relevant cultural issues in 10 out of the 11 appropriate cases and the ethical issues in the single ethical case. While ChatGPT can generate a comprehensive and adequate list of recommendations, the diagnosis accuracy rate is still low. Physicians must advise caution to patients when using such online sources.

Debriefing, a dialogical space for the development of reflective thinking in nursing.

To understand the pedagogical elements necessary for the debriefing to favor the development of reflective thinking. A single case study developed at the Centro de Simulación en Salud of the Escuela de Enfermería of the Universidad de Costa Rica in October 2018. Data were collected through interviews, observation and document analysis. For data analysis, the strategy of theoretical propositions and the construction of explanation technique were used. The data originated two categories: 1) pedagogy of the organization, addressed elements thought by the professor to facilitate the dialogue; 2) facilitation pedagogy, brought elements from the dialogue itself that enrich the discussion, mobilize the group, provoke reflection and engagement. It is essential to include the following as pedagogical elements in order to favor the development of reflective thinking: prior planning, adequate environment, systematization, pedagogical training in facilitating debriefing, openness to dialogue, pedagogical respect, valorization of positive aspects, patience, and motivation.

Combination of Transcranial Direct Current Stimulation and Action Imitation Training in Post- Stroke Aphasia Rehabilitation: Implications from a Single Case Study.

Background. One of the most used non-invasive brain stimulation (NIBS) techniques in aphasia rehabilitation is Anodal Transcranial Direct Current Stimulation (A-tDCS). Its application is supported by the fact that brain plasticity, when facilitated by language intervention, can be improved by non-invasive brain stimulation. The effects of neuromodulation combined with various language and communication therapies have led to promising results in the rehabilitation of patients presenting with acquired aphasia. An Action Observation Therapy such as IMITAF seems to contribute to improvements in language skills, mainly in naming. This experimental clinical protocol aims to investigate the rehabilitative potential of A-tDCS on perilesional areas, combined with computerized neuropsychological training. Method. Participant: Mr. V., 66-year old right-handed male, Italian native speaker. The patient suffered an ischemic stroke due to left carotid artery dissection which resulted in right hemiparesis, mixed transcortical aphasia, characterized by non-fluent speech and dysarthric and disfluent speech. Treatment: The subject underwent unipolar montage stimulation, with anode placed in F5 and intra-cephalic reference on Fp2. For safety reasons, a stimulation intensity of 1.5 mA was applied for 20 minutes once a day in combination with IMITAF level I, which required the subject to repeat bisyllabic words. Procedure: The stimulation protocol lasted a total of 4 weeks and was divided into 2 different modes. Clinical Training: 40-minute treatments (no.10 sessions) and involved the combined administration of a-tDCS (20-minute online mode) and 40-minute training. Home-Based Training: 40-minutes trainig carried out at the patient’s home, via PC (no. 8 sessions). Results. Mr. V. completed the protocol treatment sessions without reporting any adverse effects, such as scalp redness, tingling or headache. The results showed an improvement in the auditory/visual comprehension of words/sentences after A-tDCS and Action Observation Therapy, which has maintained one month after treatment. Conclusions. Together with IMTAF neuropsychological training, the constant and repeated use of A-tDCS, on the perilesional areas, contributed to improvements in language skills thus promoting an overall recovery of communicative skills in an individual with chronic post-stroke non-fluent aphasia.

Sleep and fatigue management strategies: How nurses, midwives and paramedics cope with their shift work schedules-a qualitative study.

To understand the benefits and challenges of shift work, and the coping strategies used by nurses, midwives and paramedics to manage the impact of shift work on sleep and fatigue from shift work. A single case study with embedded units. Twenty-seven participants were interviewed exploring their shift work experiences, coping strategies used to improve sleep, and what their recommendations are for improving shift work management. Interviews were completed between November and December 2022. Participants enjoyed the lifestyle, flexibility and financial rewards offered by working shift work. However, fatigue and sleep deprivation undermined these benefits, as it impacted their ability to enjoy social and family events. There were also concerns of long-term health consequences of shift work and delivery of care. Changes to rostering practices and sleep and shift work education were common recommendations. This study provides insights on how healthcare professionals manage sleep and fatigue due to shift work and the inadequate support. There is absence of adequate policies, processes and training at an organizational, academic and personal level on how to best manage sleep and fatigue when working shift work. Future research is needed to explore how to equip healthcare shift workers with the skills to successfully manage their schedules to mitigate the negative impact that poor sleep and fatigue has on the health and safety of themselves and their patients. Understanding the specific challenges of shift work and how workers manage their shift work schedules is critical for improving the health and safety of themselves and their patients. This study identified that there is insufficient training regarding sleep and shift work management strategies, potentially leading to occupational health and safety concerns. Further education and training to equip staff with the necessary information, training and guidance to staff on how to reduce fatigue risk is required. This study involved healthcare shift workers in semi-structured interviews. Data gathered from a previous survey that participants were involved in helped shape the interview topics and the study design.

Clinical and genetic profile of patients with dystonia: An experience from a tertiary neurology center from India

BackgroundThe genetics of dystonia have varied across different ethnicities worldwide. Its significance has become more apparent with the advent of deep brain stimulation. ObjectiveTo study the clinico-genetic profile of patients with probable genetic dystonia using whole exome sequencing (WES). MethodsA prospective, cross-sectional study was conducted from May 2021 to September 2022, enrolling patients with dystonia of presumed genetic etiology for WES. The study compared genetically-determined cases harboring pathogenic/likely-pathogenic variants (P/LP subgroup) with the presumed idiopathic or unsolved cases. ResultsWe recruited 65 patients (males, 69.2%) whose mean age of onset (AAO) and assessment were 25.0 ± 16.6 and 31.7 ± 15.2 years, respectively. Fifteen had pathogenic/likely-pathogenic variants (yield = 23.1%), 16 (24.6%) had variants of uncertain significance (VUS), 2 were heterozygous carriers while the remaining 32 cases tested negative (presumed idiopathic group). The P/LP subgroup had a significantly younger AAO (16.8 ± 12.3 vs 31.3 ± 17.0 years, p = 0.009), longer duration of illness (10.9 ± 10.3 vs 4.8 ± 4.3 years, p = 0.006), higher prevalence of generalized dystonia (n = 12, 80.0% vs n = 10, 31.3%, p = 0.004), lower-limb onset (n = 5, 33.3% vs n = 1, 3.1%, p = 0.009), higher motor (p = 0.035) and disability scores (p = 0.042). The classical DYT genes with pathogenic/likely pathogenic variants included 3 cases each of TOR1A, and KMT2B, and single cases each of SGCE, EIF2AK2, and VPS16. Non-DYT pathogenic/likely-pathogenic cases included PINK1, PANK2, CTSF, POLG, MICU1, and TSPOAP1. ConclusionsThe yield of WES was 23.1% among cases of probable genetic dystonia. Pathogenic or likely pathogenic variants in TOR1A, KMT2B, and SGCE genes were commoner. The absence of family history emphasizes the importance of accurate assessment of clinical predictors before genetic testing.

TREINAMENTO DE HABILIDADES SOCIAIS E ESTRESSE NA UNIVERSIDADE: UM ESTUDO DE CASO

ABSTRACT The application of Social Skills Training in the university context can be effective in reducing the stress perceived by students. Therefore, the objective of this article was to describe, in the format of a single case study, the therapeutic process of a Social Skills Training carried out with a Psychology student, also presenting data regarding the effectiveness of the intervention. Pre- and post-test assessments were performed using the following instruments: Social Skills Inventory 2 (IHS2-Del-Prette), Perceived Stress Scale (PSS-14), interviews and field diary. It was possible to verify the improvement of social skills such as refusing and making requests, dealing with criticism and exposing displeasure and requesting a change in the other’s behavior, and reduction of stress levels based on qualitative and quantitative data, with maintenance of these results in the follow-up of six weeks. It was concluded that the Social Skills Training carried out enabled the participant to improve her university experience.

Role of Laghumasha Taila Nasya Karma in Avabahuk with special reference to frozen shoulder single case study

Role of Laghumasha Taila Nasya Karma in Avabahuk with special reference to frozen shoulder single case study

From ejection fraction, to myocardial strain, and myocardial work in echocardiography: Clinical impact and controversies.

Enhancing an echocardiographic tool, aimed to detect even subtle left ventricular (LV) systolic function abnormalities, capable of obtaining both early diagnosis and risk prediction of heart disease, represents an ambitious, attractive, and arduous purpose in the modern era of cardiovascular imaging. Ideally, that tool should be simple, reliable, and reproducible, in order to be concretely applied in routine clinical practice. Importantly, that technique should be physiologically plausible and useful both at the population-level, as well as in the individual subject. For a long time, LV ejection fraction (EF) has been considered the first-line parameter for assessing LV global systolic function, strictly related to the prognosis, at least in some settings. However, LV EF limitations are well-known, even though frequently overemphasized, including its load-dependency. Therefore, myocardial strain techniques have been proposed, deemed able to disclose even subtle early LV function anomalies. Nevertheless, many disadvantages of myocardial strain have been reported as well. More recently, myocardial work (MW) analysis has been introduced as a new echocardiographic tool for the evaluation of LV global systolic function, attempting to overcome EF and strain disadvantages. However, MW has shown many limits as well. Notwithstanding, LV EF still remains a landmark functional classification marker for heart failure and cardiac oncology, allowing reliable fast reassessment of LV function changes during patient management, in order to guide treatment in individual cases as well. Notably, global longitudinal strain and MW parameters seem to show better meaningful results at the population-level, but controversial clinical impact, major limitations, wide cut-offs spread and overlap, when the single value needs to be applied to the single case. Taking into account the recent literature-based evidence, the scope of the present narrative critical review is trying to delineate the different types of information given by the described LV global systolic function parameters, both at the population-level and in the individual case, in order to trace a comparative analysis of advantages and limitations in clinical practice.

The Stakeholders’ Attitudes on the Transition from Knowledge-Based Curriculum (KBC) to a Competence-Based Curriculum (CBC) in Selected Secondary Schools in Kampala District

The study investigated the Stakeholders’ attitudes on the transition from knowledge-Based Curriculum (KBC) to Competence-Based Curriculum (CBC) in selected Secondary schools A and B found in Kampala District. The implementation of CBC was driven by the need for Uganda to move away from rote memorisation and focus on practical skills and knowledge that will be useful in the workforce. The study was guided by curriculum implementation theory by Gross et al (1971). The study adopted a qualitative research approach that analysed the case of CBC from the subjective point of view while involving the study participants’ opinions. The study followed the Interpretivist paradigm which enabled participants to create and construct their social reality in line with the study. The study also adopted a single case study research design in order to get an in- depth understanding of the stakeholders’ attitudes on the transition from KBC to CBC. A sample of 23 participants including a UNEB official (U), Headteachers (H), Teachers (T) and Students (S) were selected purposively and used for the study. This enabled the researcher to gather qualitative responses, from the best- fit participants whose responses were relevant to the study. The study employed the use of the interviews to one UNEB Official, two headteachers and eight teachers and focus group discussions to twelve students while using a group of six students from each school to collect data. Through triangulation the methods enabled the researcher to collect in-depth subjective reality which was analysed using thematic analysis. The findings of the study indicated that; to a greater extent stakeholders had a positive attitude towards the transition from KBC to CBC. This is because CBC had led to development of skills and it is more practical compared to KBC. However, the findings of the study also revealed a negative attitude of stakeholders on a transition from KBC to CBC while stressing that, CBC is expensive and time for preparation was not enough. The study recommended the government of Uganda through the MoES to; train teachers so as to equip them with the necessary skills of teaching and assessment methods, facilitate schools with enough educational facilities and materials to use and continuously monitor, supervise and evaluate CBC practices in schools.

How industry integration improves the eco-efficiency of the textile industry: The case of Qun-yi village in China

During the formulation of policies related to China's Rural revitalization strategy in recent decades, industries (e.g., the textile industry) with high environmental restoration costs and low added value of social and economic benefits have been transformed or phased out to achieve eco-efficiency. In the policy implementation, a new self-organized social network of village committees, entrepreneurs, enterprises and villagers has been established to support village-level self-organization. Aiming to explore the nexus of industry integration and eco-efficiency for industry development in rural areas, we conducted a longitudinal single case study Qun-yi Village. In the evolution process from 1995 to 2022, the textile industry integration process of the Village was divided into three periods. We found that first comprehensive industrial integration characterized by increasing complex industry structures and blurred industry boundaries, has greatly improved eco-efficiency by reducing economic and environmental restoration costs and increasing output value. Second, a successful village-level self-organization featured by strong village committee leadership, participation of actors and perceived benefits significantly facilitate and moderate the process of industrial integration aiming for high eco-efficiency. This study provided important theoretical and policy insights into the industrial integration for high eco-efficiency in rural areas in developing countries from the perspective of village-level self-organization.

The impact of the Rijksstudio on the museum business model as tool for value creation

The diffusion of sophisticated and at the same time accessible technologies has led to a paradigm shift in the traditional ways of creating value in cultural heritage, imposing a change in the business models of organizations in the sector and in particular museums. With the aim of conducting an exploratory analysis to understand how digitization has influenced the change in cultural business models, this research focused on the Rijksstudio platform, designed and implemented by the Rijksmuseum in Amsterdam in order to generate new ways of relating to users and visitors. The authors chose to adopt a qualitative single case study approach and the evidence obtained was classified using Ramaswamy and Ozcan’s Co-Creation Framework (CCF) to understand how the museum redesigned its digital service through a value co-creation approach capable of generating a high degree of interaction with its target audience.

Essentials for Digitalizing Maintenance Activities in SMEs

Numerous research has for long studied the challenges and opportunities within digitalization of Small and Medium-sized Enterprises (SMEs). While SMEs are financially limited compared to larger organization, previous research has succeeded in identifying potential focus areas that allow SMEs to participate in the industrial progression. Among these, pragmatic research on exploitation of existing resources have been highlighted. Therefore, this paper intends to report the findings of a single case study in a Danish SME, where the objective is to understand how technological sub-factors influence the prototyping of digital initiatives for advancing maintenance activities. The study begins with mapping the maintenance activities, along with the IT infrastructure. From here, relevant data is analyzed to understand their shortcomings, where the most dominant relates to how technicians report service orders. The paper concludes by identifying two sets of three technological sub-factors that strongly influence the digitalization of the case company's maintenance activities.

Surgical management of renal calculi in cases of crossed renal ectopia: A rare case series

Crossed renal ectopia is a rare congenital malformation. Only 36 cases of crossed renal ectopia with calculus have been recorded in literature, even a few cases of urolithiasis in them have been surgically managed. The majority of cases in literature have been published as single case reports. We conducted a retrospective study of all the crossed renal ectopia cases admitted and managed in our department in the past 2 years. Among them, only one was without fusion. Youngest patient was 32-year-old male with crossed left kidney with calculus in the left kidney. Both the patients underwent retrograde intrarenal surgery (RIRS). Oldest patient was 80-year-old female with a right crossed kidney with pelvic calculus, who underwent open pyelolithotomy. Post-operative period was uneventful in all cases with complete stone clearance. Patients undergoing RIRS had less post-operative pain and were discharged early compared to open pyelolithotomy. RIRS is a safe and effective modality of treatment and can be considered as the first choice for the management of calculus in crossed renal ectopia in properly selected cases. However, in cases of huge stone burden and difficult anatomy, laparoscopic/open pyelolithotomy is still an attractive option for clearing the stone in a single setting, even though it has comparatively more morbidity and longer hospital stay.

Primary Hyperparathyroidism in Young and Adolescents: Alike or Unlike Adult Hyperparathyroidism? - A Series from South India.

Primary hyperparathyroidism (PHPT) is a common endocrine condition but rare in the pediatric and adolescent populations. The presentations can be unique, accounting for significant morbidity in the case of untimely detection. To study surgically treated pediatric PHPT retrospectively. Surgically treated children of PHPT up to 20 years of age between 2010 to 2022 were analyzed. All of them were operated on by an endocrine surgeon and team. There was a total of 712 parathyroidectomies over 12 years, out of which there were 52 children (7.3%) had PHPT at less than 20 years of age. This group included 32 male children. The mean age was 16.1 years, including 7 cases of neonatal severe HPT. Multiple Endocrine Neoplasia type 1 was confirmed in 12 children. Presentations were more severe like bone pain (35.13%), renal stones (27.02%), incidental asymptomatic detection (18.9%), failure to thrive (10.8%), and pancreatitis (8.1%) as compared to adults. Mean serum calcium was 12.9 mg/dl (highest-14.1, N-8.8-10.8 mg/dl), mean parathormone levels were 386.91 pg/ml (N-10-65) and vitamin D levels ranged from 2.9-22.8 ng/ml. Localization was done with ultrasound and 99mTc- SESTAMIBI scans. Mean serum calcium levels in NSPHPT were 28.6 mg/dl (N-8.8-10.8 mg/dl). There were a total of 45 cases (6.32%) of PHPT less than 20 years of age, excluding the cases of NSPHPT. All children underwent parathyroidectomy, with 14 cases having an additional thymectomy, 2 cases with thyroidectomy, and a single case of hemithyroidectomy. The cure rate was 97.3%, while one baby with NSPHPT had persistent disease (postop PTH-110 pg/ml). The uniglandular disease was seen in 54.05% and the rest had a multiglandular disease. Adults accounted for 559/660 cases with 80% uniglandular disease. All cases had a postoperative histopathological confirmation with an average follow-up of 1 year. Childhood PHPT has a few features same as the adult population. Symptomatic presentations like adults, though pancreatitis and fatigue were more commonly seen as compared to bone pain. Calcium, phosphorus, and parathormone levels were comparable. Uniglandular involvement was seen just like the adult population. There are a few others that make them a distinct subtype like their symptoms of bone pain and being more common among boys. One-fourth of them had MEN1. Fewer cases in this age group make them unique.

Coronectomy of impacted mandibular third molars: a clinical and radiological retrospective case series study with 2-9 years of follow-up.

Impacted mandibular third molars occasionally are in intimate relation to the inferior alveolar nerve (IAN). Coronectomy has been proposed as a good alternative to prevent injury of the IAN. The present study evaluates the clinical and radiological outcomes of impacted mandibular third molars presenting radiographic signs associated with a high risk of IAN injury, and which were treated with the coronectomy technique. A retrospective case series evaluated the outcomes of coronectomies of impacted mandibular third molars. The inclusion criteria were: available preoperative, immediate postoperative and two-year panoramic radiographs, preoperative cone-beam computed tomography (CBCT), and a complete case history. The clinical evaluation comprised intraoperative complications (mobilized fragments of root and damage to adjacent structures), short-term complications (sensory alterations and postoperative infection), and long-term complications (infection or oral exposure). The IAN position with respect to the roots, root shape, eruption status, third molar position, radicular-complex migration and bone above roots were radiographically evaluated as well. Approximately a total of 2000 mandibular third molars were removed from 2011 to 2022. Of these, 39 molars in 34 patients were partially extracted using the coronectomy technique. The mean age was 36 years (range 22-77), and the mean follow-up was 28 months (range 24-84). There were two short-term postoperative infections. One of them was resolved through reintervention to remove the roots after antibiotic treatment, while the other required hospital admission and removal of the roots. One case of short-term transient lingual paresthesia was also recorded. Two long-term oral exposures were detected, and the root fragments had to be extracted. There were no permanent sensory alterations. In our case series of 39 impacted mandibular molars in intimate contact with the IAN and treated with the coronectomy technique, the number of complications was low (two infections and a single case of transient lingual paresthesia), and no permanent sensory alterations were observed. Prospective studies, especially randomized clinical trials, are needed to compare this technique with conventional extraction.

Impact of long wave diathermy and DAPRE technique intervention on hamstring injury: A single case study

Impact of long wave diathermy and DAPRE technique intervention on hamstring injury: A single case study

Prioritized Max-FlowLoc for Evacuation Planning

From different disasters such as earthquakes, flooding, landslides, hurricanes, blizzards, etc., thousands of people have lost their lives and millions of people have to be rescued each year. To reduce the losses from different disasters, appropriate emergency plannings are essential. The allocation of facility in an appropriate location of prioritized network are evenly used in such plannings. The prioritized maximum flow problem is to obtain the maximum flow in a network by taking a predetermined leaving pattern at the sources and/or reaching pattern at the sinks. But placing the facility on an arc, which is a very important task to supply the basic needs of the evacuees, reduces the arc capacity so that the maximum flow value in the network may be reduced. Here, we introduce the prioritized maximum static and dynamic flow location (FlowLoc) problems in a single source and multi-sink network. The mathematical models are given for both single and multi facility problems. The polynomial time algorithms are presented in single facility cases. After proving the $\mathcal{NP}$-completeness, the polynomial-time heuristics are presented for optimal or near optimal solutions in case of multi-facility cases.

Early support for the development of the prenatal child and its family in pedagogical practice. Individual case study

The article addresses the problem of early support for the development of a child in the prenatal period and its family experiencing an unfavorable prenatal diagnosis. The intensive development of medicine and prenatal diagnostics is an inspiration and challenge for researchers and practitioners dealing with the earliest period of human life. Interest in the situation of parents experiencing an unfavorable diagnosis of their unborn child is constantly growing, and research explorations imply considerations on the practical dimension of the issue and solutions that could be part of the activities of educators. The article describes the activities and results undertaken as part of my own pedagogical practice in the area of early support for the development of the prenatal child and his family. The leading research strategy was a single internal case study, which resulted from the research goal of comprehensively describing the phenomenon with full consideration of the situational context. The conclusions and results obtained constitute an incentive for further exploration of the issue and the development of pragmatic solutions in the practice of systemic activities supporting early child and family development.

Diversity Communication of Interreligious Harmonization: A Case Study of Rama Agung Village, Bengkulu Utara Regency, Indonesia

Indonesia is known as a country that has many tribes, cultures, races, religions, and codes of conduct of the people. But the exciting thing is that the complexity of diversity does not divide Indonesia. Rama Agung Village, Bengkulu Utara Regency, was designated as a Religious Harmony Village in Bengkulu Province in 2018 by the Minister of Religious Affairs of the Republic of Indonesia. Upon launching the minister of religion, the Governor of Bengkulu designated it as a Miniature Village of Religious Harmony in Bengkulu Province. This is in line with the decision of the Regent of Bengkulu Utara in 2021, which established Rama Agung Village as a Religious Tourism Village. In this position, religious and cultural tolerance becomes important as the main indicator that can reduce points of conflict between individuals, social classes, and society. This tolerance was formed not on the basis of an accident. Still, the similarity of struggle that gave birth to valuable lessons bound in the points and points of Pancasila elaborated in the State Constitution and actualized in everyday life. This research design uses qualitative methods with a single instrumental case study approach. Data collection will be collected through interviews and document review. The results showed that the harmonization that occurs in Rama Agung village is currently maintained because of the value of harmony instilled by the community in interreligious life, namely open communication between fellow believers, mutual respect for other religious celebrations, and the rules of other religions.