bluuebunny/crossref_metadata_2025 huggingface dataset:
Role Substitution in Preschoolers’ Play with DifferentTypes of Materials for Pretend Play
Authors: Ryabkova I.A. , Sheina E.G.
Published: April 2021

This paper is devoted to the observation of preschoolers’ free play with different types of materials for
pretend play. It is shown that role substitution varies in play with different materials. When children played
with play costumes (role markers), many of them renamed themselves; however, the roles were similar in
character and strictly related to the proposed costumes. Also, children rarely performed their role through
actions. Playing with character toys turned out to be gender specific. Boys rarely played a role, preferring a
director's position. Girls’ play was of different levels of complexity, their roles were complementary to their
toys and original in character. When children played with toys that imitate real objects (cups, swords, irons
and so on), they were less likely to rename themselves, the roles were rather similar; however, almost all
children acted from inside their roles. The most balanced environment for pretend play was the one with
open-ended materials: many children renamed themselves, and the roles were original (in fact, originality
was the highest with this type of materials), many children performed the role through play actions (this
was especially true for older preschoolers). The exception were 6-year-old children who, despite renaming
themselves, did not perform any play actions in this environment.
Intercultural Competence as a Predictor of Adaptation of Foreign Students
Authors: Gritsenko V.V. , Khukhlaev O.E. , Zinurova R.I. , Konstantinov V.V. , Kulesh E.V. , Malyshev I.V. , Novikova I.A. , Chernaya A.V.
Published: April 2021

The aim of the study is to determine the role of intercultural competence in the adaptation process of foreign students studying at Russian universities. The research is based on the author's model of intercultural competence, the main components of which are intercultural stability, intercultural interest, the lack of ethnocentrism and the management of intercultural interaction. The sample of the study consisted of 291 foreign students from Turkmenistan studying at universities in Kazan, Saratov, Penza, Rostov-on-Don, Khabarovsk, 291 students (48.5% — Women, average age is 22 years). We showed that intercultural com petence is a significant predictor in the adaptation of foreign students. We revealed different contribution of intercultural competence components to the effectiveness in the adaptation of foreign students. Among the components of intercultural competence only intercultural stability directly affects sociocultural adaptation. The absence of ethnocentrism reduces the effect of culture shock when a student enters a new cultural environment, but increases the success of his/her adaptation in this environment only together with intercultural stability. Two other components of intercultural competence: intercultural interest and the management of intercultural interaction have an impact on the successful adaptation of foreign students not directly, but through the activation of the desire to interact with Russian students and to increase the self-esteem in the effectiveness of intercultural communication with them. In turn these mediators are directly related to both psychological adaptation and intercultural stability. Thus we revealed the mechanism of intercultural competence influence on the adaptation of foreign students. The obtained results can be used to predict the adaptation of foreign students and to reduce the possible risks of their maladjustment in a new culture.
Psychological Response and Mechanisms of Adaptation to Stress Caused by Covid-19 Pandemic
Authors: Korotkova I.S. , Iakovleva M.V. , Shchelkova O.Y. , Eremina D.A.
Published: April 2021

The article presents the results of a study aimed at analyzing the emotional state of participants (levels of anxiety and depression), their psychological strategies for coping with stress, and their level of perceived stress during the COVID-19 pandemic. The online study, conducted in March-May 2020, involved 629 people aged 18—67 (М=33.27, SD=10.6). Demographic and psychosocial data of the respondents were obtained by means of a structured interview. The methods also included the Hospital Anxiety and Depression Scale (HADS), the Spielberger’s Test Anxiety Inventory (STAI), the Perceived Stress Scale (PSS), and the Ways of Coping Questionnaire (WCQ). It was found that 30.3% of the interviewed respondents had anxiety, and 4.7% had depressive symptoms that required psychological intervention. The results revealed that healthcare providers who were not directly involved in working with COVID-19 patients were less prone to depression (p<0,05) than respondents with other professions; they had a tendency to use problem-focused coping strategies and were more inclined to follow WHO guidelines for preventing the spread of COVID-19.
Theory of Mind Development in School Children with autism spectrum disorders
Authors: Turevskaya R.A. , Plenskovskaya A.A.
Published: April 2021

We present the results of an empirical study that aimed at a deeper understanding of mental states using the concept of theory of mind (ToM). A system-level approach to the study of ToM is being developed. Using a standardized version of F. Happé’s Strange Stories test we conducted a comparative study on children from the normative group (N=54) and high-functioning children with autism spectrum disorders (N=43). Both groups were divided into subgroups of 7—11 and 12—16 years old. Based on the data obtained, emotional-figurative, perceptual-figurative, and conceptual levels of representation development in the ToM system were identified. We traced the age-related dynamics of the representations in the ToM system, which is normally associated with a change in its cognitive mechanisms, the emergence of the leading level in the organization of a representative system, and the formation of conceptual representations. The disordered development of ToM in ASD children arises due to the disturbances of ToM representations differentiation, integrative processes degradation, and development asynchrony.
The Indicators of Psychological Adaptation in Patients with Cardiovascular Pathology Against the Background of Connective Tissue Dysplasia
Authors: Yavorskaya M.V. , Kravtsova N.A.
Published: April 2021

The article presents the results of a study of psychological adaptation in patients with cardiac pathology against the background of connective tissue dysplasia, conducted at the Regional Clinical Center for Specialized Types of Medical Care in Vladivostok. It was hypothesized that patients with concomitant connective tissue dysplasia will have lower adaptive capacity than patients without this syndrome. The study involved 32 girls 16–18 years old (M=16.72; SD=0.41) with cardiovascular pathology on the background of connective tissue dysplasia and 32 girls of the same age (M=16.78; SD=0.40) with cardiovascular disease without connective tissue dysplasia. To assess the severity of adaptive capabilities, the following methods were used: the Questionnaire of socio-psychological adaptation (A.K. Osnitsky, 2004), the Multi-level Personality Questionnaire "Adaptability" developed by А.G. Maklakov and S.V. Chermyanin, the Communicative Tolerance Questionnaire (V.V. Boyko), K. Ryff's scale of Psychological Well-being adapted by N.N. Lepeshinsky, the Oxford Happiness Inventory adapted by A. Lisitsina (2003). The significant intergroup differences (p<0.05) were revealed in terms of neuropsychic and emotional stability, working capacity, self-esteem, need for communication, behavioral features, experiences of psychological well-being, feelings of happiness, socialization and adaptation, motivation for activity, tolerance to adverse factors environment, as well as indicators of the communicative capabilities of the individual. The results obtained indicate reduced indicators of psychological adaptation in adolescent patients with cardiac pathology against the background of connective tissue dysplasia. These results can be used in the development of individual psychocorrectional programs to improve the social adaptation of girls with connective tissue dysplasia syndrome.
How Social Studies Teachers Choose News Resources for Current Events Instruction
Authors: CLARK CHRISTOPHER H. , SCHMEICHEL MARDI , GARRETT H. JAMES
Published: April 2021

Integrating current events and news media in the curriculum is essential to social studies teachers’ efforts to promote critical citizenship skills. In this mixed-methods study, Christopher H. Clark, Mardi Schmeichel, and H. James Garrett draw from a survey of more than one thousand social studies teachers to examine factors that influence the frequency of teachers’ current events instruction and their choices of news resources for use in their classes. They found that respondents’ ideologies influenced the number and type of sources they preferred and that teachers listed student-focused reasons like reading accessibility more than news-focused criteria like in-depth reporting as reasons for their choices. These findings have significant consequences for researchers and teacher educators who must find ways to help teachers discard assumptions that news sources are neutral or without perspective. The authors maintain that if teachers are to help students develop the ability to interpret news media within a complicated political and informational landscape, they must be better prepared to think critically about the news sources they incorporate into their lessons.
Research Implications for Computer Science Education based on Darmstadt Model
Authors: GÜLBAHAR GÜVEN Yasemin , KALELİOĞLU Filiz
Published: April 2021

The purpose of the current study is to examine published studies in computer science education in a systematic way, and to present a history of the research and new research trends in this area. This research study reports the findings of the systematic literature review according to the educational relevant areas dimension of the Darmstadt Model. The procedures of systematic text analysis were performed as a qualitative content analysis. Prior to the systematic text analysis, the primary term ‘computer science education and K-12’ was searched for along with data in the abstract, title and keyword section for publications between 2013 and 2018 in the databases and digital libraries of Academic Search Complete, Business Source Complete, Eric, Science Direct, and the IEEE Digital Library. A total of 87 articles formed the sample of the study. Although the current study was limited to the stated journal articles, it provides insight to the field by shedding light on important issues relevant to future research studies.
Ortaokul Öğrencilerinin Dijital Ayak İzi Farkındalıkları ve Yaşantılarının İncelenmesi
Authors: YILMAZ SOYLU Meryem , DEMİRÖZ Seva , AKKOYUNLU Buket
Published: April 2021

Bu çalışmanın amacı ortaokul öğrencilerinin dijital ayak izi farkındalığını sınıf düzeyi, cinsiyet, elektronik araç ve ortamlarda geçirilen süreye göre incelemektedir. Öncelikle ortaokul öğrencileri için geliştirilen dijital ayak izi ölçeği psikometrik özellikleri açısından değerlendirilerek geçerli ve güvenilir bir araç olduğu ortaya konmuştur. Daha sonra katılımcıların dijital ayak izi farkındalıkları yukarıda belirtilen değişkenlere göre incelenmiştir. Çalışma grubu 204 kız ve 189 erkek öğrenciden oluşmaktadır. Çalışma kapsamında uygulanan Dijital Ayak İzi Ölçeği’nin yanı sıra öğrencilerin cinsiyet, yaş, sınıf düzeyleri ile cep telefonu, internet, sosyal medya kullanımları ve çevrimiçi oyun oynama süreleri hakkında sorular içeren bir form verilmiştir. Sonuç olarak, Dijital Ayak İzi Ölçeği hem araştırmacılar hem de eğitimci, yönetici ve ebeveynlerin kullanımı için geçerliği ve güvenirliği olan bir araç olduğu ortaya konmuştur.
Educational Technology Research Trends in Turkey: Investigating Graduate Theses in English Language Teaching
Authors: SOLMAZ Osman
Published: April 2021

The goal of the present study is to investigate educational technology research trends across graduate thesis written in the field of English language teaching and learning between 2016 and 2020 in the context of Turkey. A total of 146 theses were examined by means of a descriptive content analysis methodology. The findings of the study demonstrated that the research focus of the theses was dominated by attitudinal studies and research exploring digital literacies and 21st century skills, while four groups of technologies were strongly prevalent across the theses, which were CALL resources in general, video-based materials, skill-based Web 2.0 tools, and learning management systems (LMS) and e-learning platforms. It was also found that the majority of researchers adopted mixed-methods approach, commonly employed survey, interview, and achievement tests as data collection tools, and frequently analyzed the data by means of quantitative analysis methods. Following the discussion of each finding within the context of both educational technology and English language teaching scholarship, the study concludes with several suggestions in the light of the results.
A Meta-Analysis of the Effects of Realistic Mathematics Education-based Teaching on Mathematical Achievement of Students in Turkey
Authors: TURGUT Sedat
Published: April 2021

The aim of the current study is to determine the effect of realistic mathematics education-based teaching on students' mathematics achievement. For this purpose, a meta-analysis method, which allows combining the results of a series of studies on a subject, was used in the study. A total of 40 scientific publications, 27 thesis and 13 articles, which are suitable for the research problem, were included in the sample of the study. The publications conducted on mathematics achievement in 2020 and earlier in Turkey were used in the study. Process effectiveness method of meta-analysis was employed in the analysis of data and Hedges’s g was used in the calculation of effect size of the study. In determination of the publication bias of the studies included in the meta-analysis, the funnel plot and Rosenthal’s Fail-Safe N-FSN statistics were examined together. In order to determine whether the distribution of the effect sizes is homogenous or not, the results of Q statistic were investigated. As a result, the effect sizes are homogeneously distributed. Therefore, fixed effect model was used. As stated in the fixed effects model, the overall effect size value is 0.760 with a 0.041 level of standard error. As a result of the study, the effect of teaching activities based on realistic mathematics education on mathematical achievement is at a positive medium level.
Bibliometric and Content Analysis of Research Trends on the Use of Serious Games to Assist People with Disabilities
Authors: KARA Nuri
Published: April 2021

The aim of this study was to indicate bibliometric results of articles on the use of serious games to assist people with disabilities and to use content analysis to conduct a methodological review of articles over the last seven years. For the bibliometric analysis, a total of 343 articles from the Web of Science database were included. For the content analysis, a total of 52 articles published between 2014 and 2020 were selected. The bibliometric results showed that serious games, disability, and rehabilitation were the most used author keywords. USA was the most cited country followed by European countries, namely England, Netherlands and Spain. Based on the content analysis results, “education” was the most commonly used field in the articles reviewed in this study. Computer games were the most commonly researched game platform. Intellectual disability was the most common kind of disability investigated. The main contribution of this study is to reveal research trends in the use of serious games to assist people with disabilities by utilizing the diversity of applied analyses.
Sınıf Öğretmenlerinin İki Dilli Sınıflarda Yaşadığı Eğitsel ve İletişimsel Problemlere İlişkin Görüşleri
Authors: PEKGENÇ Yücel , YILMAZ Fatih
Published: April 2021

Bu araştırmanın amacı; sınıf öğretmenlerinin iki dilli sınıflarda yaşadığı eğitsel ve iletişimsel sorunlara ilişkin görüşlerini belirlemektir. Araştırma, temel nitel araştırma desenine göre tasarlanmıştır. Araştırmada; Diyarbakır ilinde bulunan 8 ilkokulda görev yapmakta olan, ana dili eğitim dilinden farklı olan öğrencilerle çalışmış 20 sınıf öğretmeninden görüş alınmıştır. Araştırmada veriler yarı yapılandırılmış görüşme tekniği ile ses kaydı alınarak toplanmıştır. Verilerin analizinde betimsel veri analizi kullanılmıştır. Araştırma sonucunda; iki dilli sınıflarda temelde iletişim sorunlarının olduğu ve iki dilli öğrencilerin kendilerini ifade edememe ve telaffuzda zorlanma gibi sorunlar yaşadıkları tespit edilmiştir.
Anasınıfına Devam Eden 5-6 Yaş Grubu Çocukların Evde Oynadıkları Dijital Oyunlar ve Ebeveynlerin Davranışlarının Belirlenmesi
Authors: DARGA Hatice
Published: April 2021

Araştırmanın amacı, anasınıfına devam eden 5-6 yaş grubu çocukların evlerinde oynadıkları dijital oyunların ve ebeveynlerin davranışlarının belirlenmesidir. Araştırmada nitel yöntem kullanılmıştır. Çalışma grubu anasınıfına devam eden 5-6 yaş grubundaki çocukların toplam 52 ebeveynidir. Veri toplama aracı yarı yapılandırılmış anket formudur. Veriler içerik analizi ile çözümlenerek yorumlanmıştır. Bulgulara göre; çocuklar telefon, tablet ve bilgisayarı oyun ve video amacıyla, günlük en çok 0-1 ve 1-2 saat arasında kullanmaktadır. Çocukları ekrandayken ebeveynler en çok ev işleri yapmaktadır. Ebeveynler çocuklarına dijital ekranda kalma sürelerini günlük kullanım hakkı olarak belirlediği zaman dilimine göre yapmaktadır. Çocuklar hem birbirinden çok farklı içerikteki hem de farklı yaş ve gelişim düzeyine hitap eden birçok oyunu oynamakta ve videoları izlemektedir.
Global Commodities
Authors: Landsteiner Erich , Langthaler Ernst
Published: April 2021

Focusing on coca, coffee, gold, soy, sugar, and tea, articles in a special issue of the Austrian Journal of Historical Studies 30/3 (2019) on Global Commodities  aim at tracing the emergence of commodity chains through the expansion and contraction of commodity frontiers. Frontier shifts imply complex – and potentially conflicting – interactions shaped by as well as shaping socio-natural systems. Thus, the contributions reveal commodity chains and their frontiers to be subject to negotiations between multiple actors, both human and non-human. Each of the contributions concentrates on one or more world region(s) of frontier shifts, while taking into account the transregional, transnational, and transcontinental connections via commodity chains. Thereby, these commodity-focused histories reveal the benefit of combining global with regional or even local perspectives (Joseph, 2019).
New Museum Order
Authors: Vanden Eynde Maarten
Published: April 2021

In the framework of the 2nd Commodity Frontiers Initiative Journal with the theme of ‘Stimulants’ I could not have wished for a better-suited match to interview than Roger M. Buergel and Sophia Prinz from the Johann Jacobs Museum, which owes its existence to the coffee and cacao trade, but more importantly is unique in its endeavour to lay bare the intrinsically interwoven histories of commodities. The museum is dedicated to the global interdependencies of our life-world that become especially clear when tracing the history of important trade goods and their transport routes. Products such as coffee, cocoa, petroleum, opium, sugar, silk, watches and diamonds have had a hand in shaping our planet, impacted cultures and revolutionized societies.
Labor Commodification in the Sugarcane Plantations of Alagoas, Northeast Brazil
Authors: Queiroz Allan S.
Published: April 2021

Since the election of Jair Bolsonaro in 2018, Brazil's ruling classes - who have always disputed labor regulations and protections with the complicity of state authorities - reorganized themselves around an authoritarian project of power. This project is widely backed by agribusiness and industrialists, given Bolsonaro’s promises to boost market freedoms by reducing social and labor rights. In this article I focus on the case of the sugarcane plantations of Alagoas, Northeast Brazil, where I have been carrying out fieldwork since 2012 to explore a couple of questions around labor precarity and job formalization using oral history interviews, documents, and labor process observations. Between May and August 2019, I returned to the field to undertake exploratory fieldwork about the consequences of the labor reform in terms of the working conditions and rights of the sugarcane cutters.
An agent-based model to support community forest management and non-timber forest product harvesting in northern Thailand
Authors: Wimolsakcharoen Wuthiwong , Dumrongrojwatthana Pongchai , Le Page Christophe , Bousquet François , Trébuil Guy
Published: April 2021

Agent-based models are popular in common-pool resource management to represent complex systems and stimulate collective action and management, where they are used to evaluate scenarios of stakeholders’ choice in participatory simulations. We developed the “CoComForest” (COllaborative COMmunity FOREST management) model to support community forest management (CFM) and non-timber forest product (NTFP) harvesting in Nan Province, northern Thailand. The model was used as a computer-based role-playing game to support sharing of perceptions and knowledge among stakeholders, and in participatory simulations to explore future CFM scenarios. The Unified Modelling Language was used to build the conceptual model, subsequently implemented under the CORMAS (COmmon-pool Resource and Multi-Agent System) simulation platform. Several tests were conducted in the laboratory for verification and calibration before using this tool with 21 diverse stakeholders during a field workshop. Three different participatory gaming and simulation sessions were organized. The first one focused on the co-validation of the model with participants. They accepted most of the model functionalities and the scheduling of the rounds of play. The model was used in the subsequent two sessions to simulate the scenarios of firebreak establishment and introduction of outsiders intensively harvesting NTFPs, respectively. The results showed that the intensive harvesting practices of outsiders accelerated the depletion of resources, whereas the prevention of wildfire by establishing firebreaks could increase the resource availability in the landscape. The debriefing session at the end of the workshop focused on the analysis of simulation results and the relationships between the players’ decision-making and their actual circumstances. Individual in-depth interviews conducted after the workshop helped to evaluate the use of this model with local stakeholders. Most participants considered the model as a useful common representation of the system they manage collectively. Its use in participatory simulations facilitated communication among the stakeholders searching for an adapted and acceptable collective action plan to improve CFM at the sub-district level in order to prevent the overharvesting of NTFPs by outsiders.
Angular changes of impacted mandibular third molars and developing mandibular third molars in premolar extraction cases- A retrospective radiographic study
Authors: Velachery Shanthi , Backer Shahir , Shetty Sandeep , Parveen Katheesa , Shetty Nandish Kumar , Husain Akhter
Published: April 2021

Successful eruption of impacted third molars requires the establishment of proper mesio-distal angulation as the tooth erupts into the oral cavity. Extraction of premolars in orthodontic cases may favour the eruption of third molars.

Patients were divided into 2 categories. Category I - Radiographs of patients undergone orthodontic treatment with third molar roots formation completed and category II - Radiographs of patients undergone orthodontic treatment with third molar roots formation uncompleted. The samples consisted of 24 third molars in each category with a total of 48 samples. On pre operative and post operative OPGs linear and angular measurements were measured.

: There was statistically significant difference in the space between the anterior border of the ramus and the second molar. But there was no significant difference in the angulation of the third molars. So even if there is a gain of space for the third molars to erupt, the changes in the angulations of third molar does not favour the spontaneous eruption after the orthodontic treatment with extraction of 1 premolar.

Extraction of 1 premolar has positive influence on the space available for the third molar eruption. But there are no changes in the angulations of the third molars that would in turn help in the eruption.
Snuff dippers cancer: An enigmatic case report
Authors: Bahal Megha , Grover Gourav
Published: April 2021

Verrucous carcinoma, a very well differentiated malignant tumour of the oral cavity which has capacity to invade the underlying tissues very quickly. Very invasive as name suggests, this tumour is warty often misleads the oral physician to come upto a clear cut diagnosis. Encountering a patient of Verrucous carcinoma is often accidental as the awe astonishing fact for this tumour is that the subject would never report the chief complaint in maximum number if cases. Verrucous hyperplasia, a very common variant or antecedent of Verrucous carcinoma has almost similar biological potential as the former. This warty appearing tumour aggravates quickly in patients who have constant habit of tobacco chewing and areca nut chewing, thus its termed as Snuff Dippers Cancer.

Verrucous carcinoma (also known as Ackerman tumor) is an uncommon exophytic low-grade well-differentiated variant of squamous cell carcinoma. This neoplasm typically involves the oral cavity, larynx, genitalia, skin, and esophagus. Often the ‘bad kind’ of squamous cell carcinoma, the troubling and problematic diagnosis of this cancer makes it a physician dilemma both clinically and histopathologically.
Inter-American Development Bank Annual Report 1977
Authors:   Inter-American Development Bank
Published: April 2021

The Annual Report contains a review of the Bank's operations in 1977.
Virtual Microscopy in Undergraduate Pathology Education
Authors: Lakhtakia Ritu
Published: April 2021

Objectives: Whole-slide imaging (WSI) and virtual microscopy (VM) have revolutionized teaching, diagnosis and research in histopathology. The aims of this study were to establish the feasibility of achieving early integration of clinical reasoning with undergraduate pathology teaching on a virtual microscopy platform and, to determine its student-centricity through student feedback. Methods: Thirty-eight VM-centered clinical cases were introduced to forty-nine students in an integrated undergraduate medical curriculum. The cases were aligned to curricular objectives, reinforced the pathologic basis of disease with critical thinking and were delivered across fifteen interactive small-group sessions. A simulated cross-disciplinary integration and judicious choice of pertinent diagnostic investigations was linked to principles of management. Feedback was obtained through a mixed-methods approach. Results:  User-friendliness, gradual learning curve of VM and annotation-capacity were scored 4-5 on a Likert scale of 1-5 by 91.84%, 87.75% and 83.67% students respectively. Students agreed on content-match to the stage of learning (81.63%), theme of the week (91.84%) and development of a strong clinical foundation (77.5%). Integration (85.71%) and clinico-pathological correlation (83.67%) were strengths of this educational effort. High student attendance (~100%) and improved assessment scores on critical thinking (80%) were observed. Software lacunae included frequent logouts and lack of note-taking tools. Easy access was a significant student-centric advantage. Conclusion: A VM-centered approach with clinico-pathological correlation has been successfully introduced to inculcate integrated learning. Using the pathologic basis of disease as fulcrum and critical reasoning as anchor, a digitally-enabled generation of medical students have embraced this educational tool for tutor-guided, student-centered learning.

Keywords: virtual, digital, pathology, microscopy, medical education
Identification of Remarkable Dimensions in Management and Evaluation of Non-Communicable Disease Programmes
Authors: Vali Leila , Ataollahi Fatemeh , Amiresmaili Mohammadreza , Nakhaee Nouzar
Published: April 2021

Objectives: This study aimed to identify indicators of proper programme development in the field of non-communicable diseases through the systematic review of existing literature. Methods: In this systematic review, a search was conducted through PubMed, Scopus, EMBASE, Web of Science, Google Scholar, Cochrane Library, ProQuest and grey literature. The search was limited to literature published between January 2000 and January 2019. Results: A total of 36 articles were found relevant to the study objectives. Data were obtained through these articles based on the context, input, process and product (CIPP) model. Seven subsets for context, five subsets for input, four subsets for process and six subsets for the product were identified. Conclusion: According to CIPP subsets, indicators such as programme definition, appropriate organisational culture, structure and evaluation must be considered to develop an appropriate programme to improve health services.

Keywords: Disease Management; Program Evaluation; Health Status Indicators; Program Development.
Magnetic Resonance Imagery Findings in Androgen Insensitivity
Authors: Mukhopadhyay Indrani , Aggarwal Rohit , Mutreja Deepti , Maheswari Sujit
Published: April 2021

Androgen insensitivity syndrome (AIS) is a sex-development disorder resulting from mutations in the androgen receptor. In its complete form, patients are genetically male but phenotypically female, presenting with primary amenorrhea. We report three cases of AIS highlighting the multifaceted role of magnetic resonance imaging (MRI) for presurgical planning by evaluating location and type of gonads and detecting complications. All patients presented at the Gynaecology Out-patient Department of Command Hospital, Bangalore, India, between 2013–2016 with primary amenorrhea and MRI accurately localised testes in all; one patient had bilateral inguinal testes; two had intraabdominal testes. Intraabdominal testes were not localised on ultrasonography. MRI also depicted Sertoli cell adenomas and Wolffian duct remnants. MRI provides comprehensive imaging before surgical treatment and can, thus, be considered a ‘one-stop shop’ for AIS imaging. All patients underwent laparoscopic gonadectomy which is the standard of care, with preoperative counselling about fertility. Postoperatively, they were started on oestrogen therapy.

Keywords: Amenorrhea; Androgen Insensitivity Syndrome; Magnetic Resonance Imaging; Case Report; India.
Perception of Saudi Undergraduate Students Towards Professionalism in Medicine
Authors: AlKhater Suzan A
Published: April 2021

Objectives: Professionalism has garnered immense attention in medical education due to increased societal accountability and focus on excellence in healthcare. However, less attention has been given to identifying attitudes about professionalism in medical students who are the future advocates of the healthcare system. This study aimed to assess perceptions of Saudi undergraduate medical students towards professionalism. Methods: A crosssectional survey was carried out among second and sixth year students of the College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, in September 2018. A self-administered professionalism questionnaire was anonymously completed. Students were asked to provide their level of agreement with 18 survey items using a 5-point Likert scale. Results: Overall, 288 students participated in the study (males: 49.3% and females: 50.7%), with a response rate of 90%. The median professionalism score was high (71.0; range: 64–76) regardless of age, gender or level of education. Similar high scores were noted in the following subscales: Excellence, 20.0 (range: 18–21); Respect for Others, 17.0 (14–18); Altruism, 12.0 (10–13); Duty, 8.0 (7–9); Accountability, 7.0 (6–8) and Honour and Integrity, 8.0 (7–10). No gender differences were observed in the majority of subscales. However, males demonstrated higher scores in the Duty subscale (males: 9.0 versus females: 8.0; P = 0.026). Conclusion: Medical students demonstrated high professionalism scores. Future studies are needed to assess the impact of the course curriculum on their level of professionalism over time.
Keywords: Attitudes; Curriculum; Medical Students; Professionalism; Survey; Saudi Arabia.
Delays in Cancer Diagnosis During the Era of the Coronavirus Disease 2019 Pandemic
Authors: Al-Azri Mohammed H.
Published: April 2021

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Adaptation of the Physical Activity Neighborhood Environment Scale in Oman
Authors: Al Siyabi Huda , Mabry Ruth , Al Subhi Mosa , De Siqueira Gustavo
Published: April 2021

Objectives: This study aimed to adapt the Physical Activity Neighborhood Environment Scale (PANES), which is a 17-item tool for assessing environmental factors relevant for walking and bicycling in the community, to the Omani context. Methods: The adaptation process was conducted in three steps: (1) revision by local experts, (2) Arabic translation and cognitive testing and (3) test-retest reliability testing with a sample of 33 Omani women and men, between September 2016 and August 2017. Results: Four of the 17 items of the PANES were modified and one was removed, resulting in a 16-item PANES, Oman (PANES-O) questionnaire. The test-retest reliability scores ranged from 0.436–1.000; scores for more than half (n = 9) were almost perfect (0.8–1.0), demonstrating a good level of consistency and good psychometric performance similar to other studies. Conclusion: The PANES-O demonstrated good test-retest reliability and appears to be a promising tool for assessing environmental perceptions related to physical activity in Oman. However, construct validity should be confirmed before wider use.
Keywords: Physical Activity; Built Environment; Exercise; Health Promotion; Policy; Transportation; Urban Planning; Oman.
Stigmatisation of COVID-19 in Riyadh, Saudi Arabia
Authors: Almoayad Fatmah , Mahboub Samira , Bin Amer Lujain , Alrabiah Alaa , Alhashem Anwar
Published: April 2021

Objectives: Infectious diseases are the most common cause of disease stigmatisation, which can lead to a denial of healthcare, education, housing and employment as well as physical violence. Such stigmatisation is common during pandemics. This study aimed to examine the social stigmatisation of COVID-19 among residents of Riyadh, Saudi Arabia. Methods: A cross-sectional descriptive study was conducted in Riyadh in May 2020. Non-probability convenient sampling was used to recruit 847 participants through social media platforms, including WhatsApp. The data were analysed using descriptive statistics, the Pearson correlation coefficient and the chi-squared test were used along with a multiple linear regression model. Results: There was a high level of stigma among 21% of the participants and an intermediate level in almost 49% of the participants. Low stigma was indicated among 30% of the study’s sample. A highly significant association existed between stigma, on the one hand, and older age groups, being married and lower levels of education, on the other. Conclusion: Future awareness programmes should educate patients and their families about stigma as well as the consequences of stigmatising COVID-19. Stigma eradication policies and interventions should be implemented to avoid potentially harmful consequences for public health.
Keywords: Social stigma; COVID-19; Pandemic; Saudi Arabia.
Exploring the Use of Herbal Treatments During Pregnancy Among Saudi Women
Authors: Almoayad Fatmah , Assiri Insherah A , Almarshoud Haifa F , Safhi Atheer M , Altahan Hend M , Benajiba Nada
Published: April 2021

Objectives: Herbal treatments are commonly used by Saudi women during pregnancy. However, the inappropriate use of some herbs can have side-effects for both the mother and the fetus. Thus, a comprehensive understanding of their use during pregnancy is crucial. This study aimed to explore the use of herbal treatments by Saudi women during pregnancy using the knowledge-attitude-practice model. Methods: This cross-sectional study was conducted from September 2019 and April 2020 in Riyadh, Saudi Arabia, on a convenience sample using an online Arabic-language questionnaire. Saudi women aged between 18–58 years who were pregnant or had been pregnant and were living in the Riyadh were included. Results: A total of 400 individuals participated in this study. All participants lacked knowledge about the side-effects of herbal treatment but 63% knew about unsafe herbs in general. Most participants (66%) had a neutral attitude towards herbal treatments. Almost half of the participants (48%) did not use herbs during pregnancy and a similar number (47%) sometimes used herbal treatments during pregnancy. There was a significant positive correlation between attitude and practice and a negative correlation between knowledge and attitude as well as between knowledge and practice (P <0.0001 each). Conclusion: While the participants’ knowledge were generally poor, their attitudes and practices regarding the use of herbal treatments during pregnancy were good. It is recommended that more efforts be made by healthcare providers to target attitudes towards herbal treatments by providing accurate knowledge and reinforcing healthy practices among Saudi women.
Keywords: Herbal Medicine; Pregnancy; Health Knowledge, Attitudes, Practice; Saudi Arabia.
A Secondary Spontaneous Pneumothorax in a Patient with COVID-19
Authors: Al Alawi Abdullah M , Al Naamani Zakariya
Published: April 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, represents an unprecedented global threat. We report a 78-year-old male patient who presented to the Emergency Department at a tertiary care hospital in Muscat, Oman, in June 2020 with a one-day history of right chest pain and severe breathlessness. The patient was an ex-smoker and known to have idiopathic pulmonary fibrosis (IPF) with two previous pneumothoraces in the left lung. On presentation, the patient was breathless with an oxygen saturation of 90% on room air. Chest X-ray demonstrated bilateral lung infiltrates and right-sided pneumothorax. The patient tested positive for SARS CoV 2. A chest drain was placed which resulted in good resolution of the pneumothorax. The patient’s condition improved remarkably and he was discharged after 17 days of hospitalisation. To the best of the authors’ knowledge, this was the first case of pneumothorax reported in a patient infected with COVID-19 who was known to have underlying IPF.
Keywords: Spontaneous Pneumothorax; Pulmonary Fibrosis; SARS Coronavirus; Oxygen; Pleurodesis; COVID-19; Case Report; Oman.
Bioinformatic analysis of the whole genome sequences of SARS-CoV-2 from Indonesia
Authors: Ulfah Maria , Helianti Is
Published: April 2021

Background and Objectives: In first May 2020, Indonesia has been successfully submitted the first three full-length sequence of SARS-CoV-2 to GISAID database. Until September 10th , 2020, Indonesia had submitted 54 WGS. In this study, we have analyzed and annotated SARS-CoV-2 mutations in spike protein and main proteases.
Materials and Methods: The Whole Genome Sequence (WGS) of Indonesia were obtained from GISAID data base. The 54 data were taken from March to September 10th, 2020. The sequences corresponded to Spike Protein (SP), 3-chymotrypsin like protease (3CLpro), and papain like protease (PLpro) were selected. The Wuhan genome was used as reference.
Results: In total WGS from Indonesia, we found 5 major clades, which dominated as G clade, where the mutation of D614G was found. This D614G was identified as much as 59%, which mostly reported in late samples submitted. Beside D614G mutation, we report three unique mutations: A352S, S477I, and Q677H. Besides, some mutations were also detected in two domains that were expected to be conserved region, the main viral proteases: PLpro (P77L and V205I), 3CLpro (M49I and L50F).
Conclusion: The analysis of SARS-CoV-2 from WGS Indonesia showed a high genetic variation. The diversity in SARSCoV-2 may epidemiologically enhance virulence and transmission of this virus. The prevalence of D614G over the time in different locations, indicating that changes in this mutation may related to host infection and the viral transmission. However, some mutations that have been reported in this study were not eligible for the most stable conformation.
Coexistence of aminoglycoside resistance genes in CTX-M-producing isolates of Klebsiella pneumoniae in Bushehr province, Iran
Authors: Latifi Behrouz , Tajbakhsh Saeed , Ahadi Leila , Yousefi Forough
Published: April 2021

Background and Objectives: Increasing the rate of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae has given rise to a major healthcare issue in clinical settings over the past few years. Treatment of these strains is hardly effective since the plasmid encoding ESBL may also carry other resistance genes including aminoglycosides. The current study aimed to evaluate the prevalence of ESBL-producing K. pneumoniae and investigate the coexistence of Cefoxitamase-Munich (bla ) with aminoglycoside-modifying enzyme (AME) genes, aac(3)IIa as well as aac(6′)Ib, in CTX‑M‑producing K. pneumoniae isolated from patients in Bushehr province, Iran.
Materials and Methods: A total of 212 K. pneumoniae isolates were collected and confirmed using polymerase chain re‑ action (PCR) of the malate dehydrogenase gene. Isolates were screened for production of ESBL. Phenotypic confirmatory test was performed using combined disk test. The genes encoding CTX-M groups and AME genes, aac(3)IIa and aac(6′)Ib, were investigated by PCR.
Results: The ESBL phenotype was detected in 56 (26.4%) K. pneumoniae isolates. Moreover, 83.9% of ESBL-producing isolates carried the genes for CTX-M type β-lactamases, which were distributed into the two genetic groups of CTX-M-1 (97.8%)- and CTX-M-2 (2.1%)-related enzymes. Notably, among K. pneumoniae isolates containing the blaCTX‑M gene, 68.08% of isolates harbored AME genes. In addition, the coexistence of bla in 46.8% of CTX-M-producing K. pneumoniae isolates.
Conclusion: This study provides evidence of a high prevalence of AME genes in CTX-M- producing K. pneumoniae iso‑ lates; therefore, in the initial empirical treatment of infections caused by ESBL-KP in regions with such antibiotic resistance patterns, aminoglycoside combination therapy should be undertaken carefully.
Evaluation of latent tuberculosis infection in liver transplant recipients
Authors: Ahmadinejad Zahra , Mokhtaryan Maryam , Salami Arezoo , Talebian Monavar , Irajian Hamideh , Ghiasvand Fereshteh
Published: April 2021

Background and Objectives: Tuberculosis is one of the main reasons for mortality in liver transplant recipients. Since Iran is considered as a tuberculosis-endemic country, the present study aims to evaluate the outcome of latent tuberculosis infection in transplant recipients after liver transplantation.
Materials and Methods: The present analytical cross-sectional study was performed on transplanted patients in Imam Khomeini Complex Hospital in Tehran Iran from 2006 to 2016. All patients with positive tuberculin skin test were enrolled. Variables including demographic information, therapeutic and outcome data were gathered and analyzed.
Results: Among 675 transplant recipients, 100 patients had positive tuberculin skin test (14.8%). Sixty seven percent of recipients were men and the mean age was 72.67 ± 1.3 years. All patients' received Isoniazid prophylaxis before transplantation. The mean duration of anti- tuberculosis prophylaxis before and after transplant were 2.7 ± 1.9 and 3.6 ± 5.5 months, respectively. Tuberculosis has not been occurred in none of these patients after a mean follow up time of 45.21 ± 3 months. During the study period, four subjects infected by Mycobacterium tuberculosis, while their skin test was negative before transplant.
Conclusion: According to our study, tuberculin skin test is a reliable and sensitive test for diagnosis of latent tuberculosis in liver transplant candidates. Isoniazid prophylaxis is well tolerated in patients with end stage liver diseases and liver transplant recipients.
Exploring clinically isolated Staphylococcus sp. bacteriocins revealed the production of amonabactin, micrococcin, and α-circulocin
Authors: Kassem Mohamed Ali , Saafan Amal Eissa , Bayomy Faten , El-Gendy Ahmed Osama
Published: April 2021

Background and Objectives: Bacteriocins are considered alternative non-conventional antimicrobials produced by certain bacteria with activity against closely related species. The present study focuses on screening, characterization, and partial purification of bacteriocins produced by Staphylococcus sp. isolated from different clinical sources such as pus and blood.
Materials and Methods: A total of 100 Staphylococcus isolates were screened for bacteriocin production using spot on lawn assay and agar diffusion method against five indicator bacteria. Bacteriocins from five selected highly active isolates were subjected to proteinase-K enzyme, different pH, and heating at different temperatures, and investigated the stabilities of their antimicrobials. Two selected isolates, MK65 and MK88, were molecularly identified by 16S rRNA gene sequencing, explored for the presence of 18 bacteriocin genes, and liquid chromatography-high resolution electrospray ionization mass spectrometry (LC-HRESIMS) was used to identify their different metabolites.
Results: Twenty isolates exhibited inhibitory effect against at least one indicator bacteria. Micrococcus luteus ATCC 4698 showed the highest sensitivity to such bacteriocins. Proteinase K, acidic pH, and heating at 100°C triggered marked activity inhibition. However, amylase enzyme, alkaline pH, and heating at 80°C caused trivial effects. Four out of eighteen bacteriocin genes were detected using PCR. Fermentation, partial purification, and LC-HRESIMS of total protein extracts of two selected isolates, MK65 and MK88, revealed the production of different antimicrobial peptides.
Conclusion: To the best of our knowledge, this is the first study to report the production of micrococcin and α-circulocin from Staphylococcus aureus MK65 and the production of amonabactin from Staphylococcus epidermidis MK88.
The piriformis abscess: a case-based review
Authors: Salehi Mohammadreza , Ghiasvand Fereshteh , Feizabadi Mohammad Mehdi , Zarei Mohammad , Ayoobi Yazdi Niloofar , Alijani Neda , Qaempanah Mehdi , Seyedpour Simin
Published: April 2021

This study reports a 43 years-old man diagnosed with piriformis pyomyositis. A literature review was conducted by searching MEDLINE via Pubmed for English language case reports, published from 8 th December 2019 to 20th January 2020. Patients' symptoms, laboratory tests, imaging, treatment, and other comorbidities were evaluated. Thirty-two cases diagnosed with piriformis pyomyositis, of which 21 patients developed piriformis abscess (including one new patient added by us) of which 52.4% were female, and the mean age was 26.98 ± 17.5. The most common manifestations were fever, lower back pain, and limited ambulation with increased ESR, CRP, or leukocytosis. Staphylococcus aureus was the most prevalent (57.14%) pathogen isolated. The authors suggested gynecologic manipulations, muscle overuse, and other co-infections as probable risk factors. However, we fail to find any association between these factors and abscess formation (p>0.05). Piriformis abscess should be regarded as a probable diagnosis in patients with gluteal pain, fever, and limited ambulation that have raised inflammatory markers or leukocytosis. MRI and CT scans are beneficial in diagnosing pyomyositis in early-stage. Full recovery is expected with timely antibiotic and surgical treatments.