bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting Peace through Tourism
Authors: Wijayawickrama Erangi
Published: July 2021

This paper discusses the relationship between peace and tourism and the way how tourism leads to peace. Tourism doesn’t have a direct link with peace. But in several ways, tourism open paths to way for peace. Tourism should be designed and conducted properly to proceed and to maintain peace in society. Tourism in itself is a complex phenomenon. There are many benefits of the tourism industry. Of them implementing peace can be identified as one benefit. Peace means the absence of violence. In society, we can identify the structural violence which happens due to a lack of economic, social, political imbalance in many ways. The main reason for the structural violence is poverty. By implementing the tourism industry in society, it can be used to eliminate poverty by increasing economic development. Then indirectly Tourism has made the path for peace. Tourism is an extremely complex phenomenon through which identities and worldviews are continuously being represented, consumed, reconfirmed, negotiated and modified. This article describes separately peace, tourism and the relationship between tourism and peace. Tourism means a trip or a visit to an unknown place or a new place from the home place. By that tourists will meet different cultural people, and will understand the diversity of cultures as well as will learn the importance of respecting the diversity. This phenomenon also helps to share love and harmony with culturally different people. It will be an initiating point to begin peace in the world.
Transovarial effect of novaluron: persistence and residual effects on Stephanitis pyrioides (Hemiptera: Tingidae)
Authors: Joseph Shimat V.
Published: July 2021

Stephanitis pyrioides (Scott) (Hemiptera: Tingidae) is an important insect pest of azaleas, Rhododendron Linnaeus spp. (Ericaceae), in the United States of America. Because neonicotinoids, insecticides traditionally used against S. pyrioides, pose a risk to pollinators and natural enemies, nursery growers have reduced neonicotinoid use and are seeking alternative management options. Novaluron, an insect growth regulator, elicits a transovarial effect by reducing the viability of eggs after exposure to S. pyrioides adults. However, stability and persistence of transovarial effects on adults following exposure are not clear. The objectives of this study were to determine (1) the persistence of the transovarial effect of novaluron for up to three weeks after a single adult exposure and (2) the residual activity of aged novaluron residues eliciting a transovarial effect against S. pyrioides after a single application. Stephanitis pyrioides density was significantly lower in the novaluron-treated adults than in the nontreated controls for up to 21 days. The novaluron residues deposited on azalea foliage aged up to 32 days significantly reduced the number of S. pyrioides nymphs compared to that of the nontreated control. There was no significant difference in the number of nymphs among the 7-, 17-, and 32-day-old novaluron treatments relative to the nontreated control.
Bilateral occlusive retinal vasculitis associated with primary sclerosing cholangitis
Authors: Ansari Abdus S. , Bertalot Catrin , Mathews Divya , Mathews John P.
Published: July 2021

We present the case of a 46-year-old man who presented with bilateral panuveitis and occlusive retinal vasculitis 6 months after being acutely admitted with abnormal liver function and diagnosed with primary sclerosing cholangitis (PSC). Initial investigations by the medical and ophthalmic departments including all autoimmune investigations were within normal parameters. Of particular interest was the high likelihood of inadvertent androgenic-anabolic steroid self-suppression of disease. As a lifelong bodybuilder, the patient had been taking oral and intramuscular steroids for years. He became symptomatic upon cessation of these recreational medications. There remains a significant paucity of information describing the relationship between uveitis and PSC. Given the poorly understood aetiology of this rare cholestatic disease, we review the current literature and highlight the diagnostic and therapeutic challenges for such a patient. PSC may predispose patients to an occlusive panuveitis with androgenic-anabolic steroids suppressing ocular autoimmune disease.
Topiramate-induced acute bilateral angle closure glaucoma confirmed by ultrasound biomicroscopy
Authors: AlNaqeeb Osama , Aljohani Saud , Alshehri Abdulaziz
Published: July 2021

Topiramate is a sulfamate-substituted monosaccharide used in the treatment of epilepsy and migraines. This case report demonstrates a 29-year-old female who complained of severe bilateral loss of vision 14 days after using topiramate for her migraine. On initial examination, visual acuities were counting fingers in both eyes. Intraocular pressures were 55 mmHg and 58 mmHg in the right and left eyes, respectively. Anterior segment examination showed bilateral conjunctival chemosis, mild corneal edema, and markedly shallow anterior chambers with closed angles on gonioscopy. Ultrasound biomicroscopy revealed bilateral anterior rotation of ciliary body with choroidal effusion. Topiramate was immediately discontinued, topical and systemic anti-glaucomatous treatment was administered. After 1-week follow-up, the patient had fully recovered.
CHARGE syndrome
Authors: Galvez-Ruiz Alberto , Galindo-Ferreiro Alicia , Lehner Anthony J.
Published: July 2021

CHARGE syndrome is a genetic disorder comprising the following clinical features: coloboma, heart defects, choanal atresia, retardation (of growth and development), as well as genitourinary and ear abnormalities. This syndrome is caused by mutations in the CDH7 gene, located on chromosome 8 (8q12). We present two new gene mutations in two patients with CHARGE syndrome, not previously reported in the scientific literature. Both of these patients clearly demonstrate the difference in the clinical expression of this syndrome, with patient 1 having a greater clinical severity compared to patient 2. We conclude that although in the scientific literature to date there is no clear correlation between a patient's genotype and phenotype expression, we can assume from the cases we present that a correlation does in fact exist. Specifically, missense mutations (as in case of patient 2) are associated with milder clinical expression, whereas mutations which result in truncation of the CDH7 protein (as in the case of patient 1 having a nonsense mutation) may be associated with a more severe clinical expression.
Corneal biomechanical properties in hyperthyroidism and thyroid eye disease
Authors: Razeghinejad M. Reza , Farsiani Amir R. , Salout Ramin , Owji Naser , Masoumpour Masoumeh , Kharmandar Alireza , Zamani Mohammad
Published: July 2021

PURPOSE:

The purpose of this study is to compare the corneal biomechanical properties of hyperthyroids without ophthalmopathy (HWO), thyroid eye disease (TED), and euthyroid participants.

METHODS:

In this prospective comparative study, one eye per patient included in the analysis and according to exclusion criteria, 38 eyes of 40 HWO patients, 31 eyes of 40 TED patients, and 150 eyes of 160 age- and sex-matched euthyroid participants were enrolled. All participants were evaluated by an endocrinologist and oculoplastic surgeon for evaluation of thyroid function and orbitopathy, respectively. Measurements of corneal biomechanical properties were performed using ocular response analyzer and Corvis ST tonometers.

RESULTS:

In the HWO group, applanation-1 length (A1 L), applanation-2 velocity (A2V) (P < 0.001), and corneal resistant factor (P = 0.043) were higher than the control group and corneal hysteresis (CH) was lower (P = 0.018). In the TED group, A1 L, A2V (P < 0.001), and highest concavity radius (HCR) (P = 0.027) were higher than the control group, and the CH (P = 0.007) and highest concavity deformation amplitude (HCDA) (P = 0.001) were lower. Furthermore, the level HCDA in the TED group was lower than HWO group (P = 0.011). The level of upper scleral show and palpebral fissure had a negative correlation with CH and HCDA. The amount of exophthalmos level had a positive correlation with HCR.

CONCLUSION:

Corneal biomechanical properties in the HWO and TED groups were different from the normal euthyroid individuals and may be taken into account in managing situation like glaucoma and refractive surgeries.
Pediatric spectacle prescription
Authors: Malaika Rawan , Raffa Lina , Algethami Mohammed , Alessa Sara
Published: July 2021

PURPOSE:

This study aims to understand the approach to prescribing spectacles for children and the interpretation of refractive errors among ophthalmologists/optometrists in Saudi Arabia.

METHODS:

A cross-sectional survey was conducted between September and November 2018 using a database of online registrants for ophthalmologists and optometrists practicing in Saudi Arabia. The survey included 10 multiple-choice questions designed to elicit information about how ophthalmologists and optometrists deal with commonly encountered case scenarios covering different practical aspects of pediatric refraction. The responses were compared using the proportion of pediatric clientele received in the respondents' practices (Group A: <25%, Group B: 25%) and drawing upon concepts from the published literature.

RESULTS:

One hundred and three participants, including ophthalmologists, specialists/registrars, and optometrists from across Saudi Arabia, participated in this survey. Approximately 25% were classified as Group A. Large discrepancies were observed between the participants' responses and actual practices based on guideline recommendations. Responses varied significantly between Groups A and B on certain issues pertaining to pseudomyopia (P < 0.001), anisometropia (P = 0.033), and high astigmatism (P = 0.023).

CONCLUSION:

Practice patterns regarding pediatric spectacle prescription varied among ophthalmologists and optometrists in Saudi Arabia. The approach to managing refractive errors in children was better among ophthalmologists/optometrists servicing a larger pediatric clientele, suggesting the need to increase awareness among all groups of ophthalmologists/optometrists.
Optical coherence tomography analysis of surgical outcomes of combined hamartoma of retina and retinal pigment epithelium
Authors: Gupta Rajan , Ayachit Apoorva , Joshi Shrinivas , Nayak Sameera , Sahoo Niroj K. , Sacconi Riccardo , Singh Sumit R. , Muftuoglu Ilkay K. , Querques Giuseppe , Chhablani Jay
Published: July 2021

PURPOSE:

To evaluate the surgical outcomes in combined hamartoma of retina and retinal pigment epithelium (CHRRPE) using optical coherence tomography (OCT).

METHODS:

This was a retrospective interventional study, in which medical records of 12 eyes with CHRRPE that underwent vitrectomy and membrane peeling at three tertiary vitreoretinal institutes were reviewed. Preoperative and postoperative color fundus photographs and OCT were reviewed for each follow-up visit.

RESULTS:

Five out of 12 eyes had a good visual outcome (equal or more than 2 lines gain in visual acuity), four had stable visual outcome (<2 line gain), and three had poor visual outcome (loss of visual acuity). Preretinal fibrosis preoperatively was seen in 80% of cases with good outcomes as compared to 50% and 0% of cases in the cohorts with stable and poor outcomes, respectively. Preoperatively all 5 cases with good visual outcome had Grade 4 epiretinal membrane (ERM), while only 1 case with stable and poor visual outcome had grade 4 ERM and the rest had Grade 3 ERM. Maxi peaks were seen in 80%, 50%, and 0% of cases preoperatively in the three cohorts, respectively. Hyperreflectivity of inner retinal layers preoperatively was evident in all cases having good visual outcomes, in 75% of cases with stable visual outcomes, and in 33% of cases with poor outcomes.

CONCLUSION:

Surgical intervention in CHRRPE with preretinal fibrosis seems to be beneficial. The visual recovery as defined by conventional predictors in cases of surgical removal of ERM fails to explain the visual outcome in CHRRPE.
The validity of diabetic retinopathy screening using nonmydriatic fundus camera and optical coherence tomography in comparison to clinical examination
Authors: Aljefri Sarah , Al Adel Fadwa
Published: July 2021

PURPOSE:

To evaluate the use of non-mydriatic fundus camera as a screening modality for diabetic retinopathy in a sample of population in Riyadh, Saudi Arabia.

METHODS:

Patients coming, from April 2015 till September 2018, for their diabetic check up at the diabetic center clinics in King Abdul-Aziz University hospital were screened using a non-mydriatic fundus camera (NMFC). Photos were graded by retina specialist and compared to the findings of dilated fundus examination (DFE) by retina specialists.

RESULTS:

The grading results of NMFC and DFE were compared and the overall sensitivity and specificity for detection of diabetic retinopathy within one grade of retinopathy was 98.7% and 80% respectively. The sensitivity for detection of sight threatening conditions such as proliferative diabetic retinopathy, severe non-proliferative diabetic retinopathy, and diabetic macular edema (by Ocular Coherence Tomography) was found to be 86.7%, 90.3% and 100% respectively; while the specificity was found to be 96.5%, 93%, and 100% respectively.

CONCLUSION:

Non-mydriatic fundus camera has a high sensitivity and specificity in screening for diabetic retinopathy. It is a great screening tool, which is user friendly and can be operated by trained nurses in primary clinics during patient's regular routine diabetic checkups. It aids in early detection of sight threatening conditions which need urgent referral to ophthalmologists.
Congenital bilateral upper lid eversion
Authors: Almajed Faten , Alsulaiman Hamad M. , AlMadhi Nada , Schellini Silvana A. , Sesma Gorka
Published: July 2021

We report two healthy Saudi newborns with congenital bilateral upper lid eversion evolving with good outcome using conservative treatment. The current literature including epidemiology, clinical characteristics, possible etiologic factors, and treatment was reviewed.
Topical Oral Melatonin Application Could Potentially Reduce the Risk of Orthodontic Appliance-Induced Periodontal Deterioration
Authors: Balaji Thodur Madapusi , Jagannathan Raghunathan , Murukesan S. , Rajendran Swaminathan , Sridhar Lakshmi Priya , Varadarajan Saranya , Rajendiran Deepika
Published: July 2021

Introduction:

Although patients derive numerous aesthetic and functional benefits by wearing orthodontic appliances, they also undergo some adverse changes in the oral cavity such as chronic generalized marginal gingivitis and localized gingival enlargements that can be concerning. Salivary changes following placement of fixed orthodontic appliances have been documented by numerous research papers.

The Hypothesis:

Melatonin in the form of an orabase gel with 1% to 2% concentration applied daily topically on the gingival tissues throughout the orthodontic treatment phase could boost the salivary antioxidant levels, neutralize the nickel and chromium toxicity, potentially attenuating inflammation, and fibrotic enlargements of the periodontal tissue.

Evaluation of the Hypothesis:

Testing the abovementioned hypothesis will involve a randomized double-blinded clinical trial with a placebo and test orabase gel with 1% to 2% melatonin as an active drug agent. Testing and validating the proposed hypothesis will throw open a new vista in using melatonin as a topical adjuvant in orthodontic appliance wearers.
Comparison of Commercially Available 0.12% And 0.2% Chlorhexidine Mouthrinses on Plaque and Gingiva
Authors: Swarnalatha C. , Suresh Babu J. , Almansour Nada Nasser , Almalaq Saleh Ali , Alnasrallah Fahad Abdulrahman , Alshammari Tayf Naif Radhi , Alshammari Mohammad Saafaq , Nayyar Abhishek Singh
Published: July 2021

Introduction:

Regardless of potent anti-microbial and anti-plaque properties of Chlorhexidine (CHX), its widespread and comprehensive uses are restricted by local side effects which are mostly dose dependent. Thus, by understanding the properties and limitations of the CHX molecule, consideration has been given to CHX with lower concentrations, though, this, may produce an impact on its activity emphasizing the need for further clinical trials. The present study was, thus, designed to assess and compare the efficacy of commercially available 0.12% (Periogard) and 0.2% (Hexidine) of CHX mouthrinses on dental plaque and gingiva over a period of eight weeks.

Materials and Methods:

A randomized control, triple blind parallel clinical trial was designed among ninety-nine subjects. The study subjects were randomly distributed into three groups with random allocation of mouthrinses to each group. Plaque and gingival indices were recorded by using Plaque and Gingival indices were recorded by using Turesky, Gilmore and Glickman’s modification of Quigley Hein Plaque Index and Loe and Silness Gingival Index. Statistical analysis was done using IBM SPSS Statistics for Windows version 21 (IBM Corp, Armonk, USA). Wilcoxon matched pairs signed rank test was applied to compare reduction in mean plaque scores and mean gingival scores at different time intervals while pair-wise comparison in between the groups was done by using Mann-Whitney U test. P < 0.05 was considered as statistically significant.

Results:

Both the 0.2% and 0.12% CHX mouthrinses were effective in controlling plaque and gingivitis over a period of eight weeks. These mouthrinses exhibited significant decreases in mean plaque and gingival scores during baseline to 4th week examination, however, a significant rise in mean plaque and gingival score was noted again from 4th week to 8th week examination.

Conclusion:

The study concluded that lower concentrations of CHX (0.12%) are as effective as 0.2% of CHX, thereby, use of lower concentrations of CHX can be recommended.
The Effect of Home Visit on Anxiety of Mothers with Preterm Infant Discharged from Neonatal Intensive Care Unit
Authors: Beigy Somayeh , Salmani Naiire , Khodayarian Mahsa
Published: July 2021

Context:

After being discharged from hospital, most preterm infants need to receive treatments such as gastric gavage, oxygen therapy, apnea control, and medication. Mother's unpreparedness to care for their infants causes anxiety for them.

Aims:

The purpose of the present study was to investigate the effect of home visit on anxiety of mothers having preterm infant discharged from neonatal intensive care unit (NICU).

Settings and Design:

This was a experimental control group study on 50 mothers with preterm infant discharged from NICU of Shahid Sadoughi Hospital, an educational hospital with 30 beds in a city in the west of Iran in 2019.

Subjects and Methods:

Participants with a convenience sampling were randomly assigned in the experimental and control groups. In the experimental group, home visit was done on the 3rd and 5th days after discharging the infants, and the mothers received necessary instructions proportional to their needs. Data collection tools included demographic information and Spielberger State-Trait Anxiety Inventory.

Statistical Analysis Used:

The findings were analyzed by SPSS 20 software using Kolmogorov–Smirnov, independent t-test, and Chi-square.

Results:

The mean ages of the participants in the intervention and control groups were 30.59 ± 6.38 and 28.67 ± 5.05 years, respectively. There was no significant difference between the mean obvious and hidden anxiety in the two groups (P > 0.05) before the intervention. However, after the intervention, the mean obvious and hidden anxiety in the experimental group was lower than the mean of the control group, and this difference was significant (P < 0.001).

Conclusions:

Home visit is effective in decreasing anxiety in mothers of preterm infant who have been discharged from NICU.
A Rare Bleeding Disorder with an Expensive Factor Defect
Authors: Sudarsanan Harish , Kamalarathnam C. N.
Published: July 2021

A 14-day-old baby girl was admitted with fever, profuse bleeding from umbilicus, and encephalopathy. Neuroimaging showed intracranial bleed and coagulopathy remained uncorrected with fresh frozen plasma. Coagulation profile characteristically demonstrated prolonged prothrombin time, international normalized ratio, and normal activated partial thromboplastin time. Factor VII assay was done which showed very low levels of Factor VII. Factor VII deficiency or Alexander disease, an autosomal recessive disorder, is the most common among rare bleeding disorders with a global prevalence of 1/5, 00,000. Defect can be either quantitative or qualitative. Clinical manifestations range from severe to nonsevere. Severe forms manifest in newborns with intracranial bleed. It is the least common presentation. Recombinant Factor VII remains the most effective therapy but is currently unavailable and very expensive even for the affordable considering short half-life of 4–6 h. Prenatal diagnosis with genetic testing remains the only promising preventive strategy.
Oral Mucosal Lesions in Newborns
Authors: Cruz Poliana Valdelice , Bendo Cristiane Baccin , Bouzada Maria Cândida Ferrarez , Machado Márcia Gomes Penido , Martins Carolina Castro
Published: July 2021

Background:

An increase in prematurity and low birth weight (LBW) has been observed worldwide, to which several factors may be associated. This cross-sectional study aimed to evaluate the relationship between gestational age and LBW with oral mucosal lesions in newborns, maternal health conditions, newborn health conditions, and socioeconomic levels.

Materials and Methods:

The sample was comprised of 431 pairs of mothers-newborns born from a high and medium complexity hospital (CAAE nº: 57295316.3.0000.5149). Maternal health conditions and childbirth information were collected through the medical records and mothers answered a questionnaire on socioeconomic indicators. Oral mucosal lesions were evaluated by oral clinical examination. Gestational age and birth weight were analyzed, together with oral mucosal lesions and related factors, through bivariate and multivariate logistic regression models (α = 5%).

Results:

Prematurity and LBW were associated with Epstein pearls (odds ratio [OR]: 1.7; 95% confidence interval [CI]: 1.03–3.0; OR: 1.8; 95% CI: 1.1–3.2, respectively) and mucocele (OR: 4.6; 95% CI: 1.3–16.1; OR: 3.7; 95% CI: 1.1–13.1, respectively), but not ankyloglossia (OR: 1.0; 95% CI: 0.5–2.1; OR: 0.7; 95% CI: 0.3–1.6, respectively) or breastfeeding (OR: 0.5; 95% CI: 0.1-2.1; OR: 1.9; 95% IC: 0.2–15.6, respectively).

Conclusion:

Preterm and LBW newborns were more likely to have Epstein pearls and mucocele than full terms. Breastfeeding and ankyloglossia were not associated with prematurity and LBW.
Shock Index and Modified Shock Index among Survivors and Nonsurvivors of Neonatal Shock
Authors: Bhat Ramitha R. , Batra Prerna , Harit Deepika
Published: July 2021

Background:

Neonatal shock is associated with high mortality and morbidity. Shock index (SI), a ratio of heart rate (HR) to systolic blood pressure (BP), has been evaluated as a simple tool for early predictor of mortality in adult as well as pediatric patients.

Objective:

The objective of this study was to compare SI and modified SI (MSI) among survivors and nonsurvivors of neonatal shock and healthy controls.

Materials and Methods:

HR and BP were measured in neonates presenting with clinical shock at 0, 2, and 6 h after admission and in healthy controls. SI and MSI were calculated and compared between three groups.

Results:

The mean (standard deviation) SI was significantly higher at 2 and 6 h of admission (2.57 [0.54] vs. 2.93 [0.78], P = 0.029; 2.42 [0.41] vs. 3.04 [0.91], P = 0.0005) among nonsurvivors of neonatal shock as compared to survivors. MSI was also significantly raised at both 2 and 6 h of admission in nonsurvivors (3.32 [0.64] vs. 3.78 [1.05], P = 0.03; 3.16 [0.63] vs. 4.10 [1.85], P = 0.005).

Conclusions:

SI and MSI are significantly higher in nonsurvivors of neonatal shock than survivors and healthy controls. These metrics can be used as bedside tools for early identification of at-risk neonates with shock.
Basic behavior guidance techniques
Authors: Segarra-Ortells Cristina , Leyda-Menéndez Ana Maria , Ribelles-Llop Marta , Gavara-Navarro María Jose , Marqués-Martínez Laura
Published: July 2021

Background:

Over the last 20–30 years social trends, educational and parenting patterns, and the ethical and legal factors guiding them have led to the revaluation and even abandonment of some traditionally used behavior guidance techniques (BGTs).

Aims:

To profile the professionals providing specialized pediatric treatments in Spain and understand changes in their preferences and use of basic BGTs, and the evolution of these preferences.

Settings and Design:

A cross-sectional, descriptive, and correlational study was designed.

Methods:

One hundred and twenty-six dentists completed a previously validated survey.

Statistical Analysis:

Descriptive statistics and Chi-square tests were performed to analyze the questionnaire data.

Results:

The most common BGTs were “Tell/Show/Do” (98%) and positive reinforcement (92.1%), and the most abandoned BGT was: “hand-over-mouth” (15%), because it was rejected by parents and because of potential legal problems and psychological consequences for the patients. Of note, 37% of the professionals allowed the patient's parents to be present during the treatment.

Conclusions:

There has been a notable decrease in the use of certain BGTs in Spain, especially hand-over-mouth and voice control, because they are becoming less socially acceptable as the way society relates to and educates children changes.
Cold abscess of dental origin in a 7-year-old child
Authors: Ganesh Mayuri , Priya V Krishna , Banu M Divya , Shilpa G , Challa Santosh Kumar , R Krishna Murthy V V V
Published: July 2021

Abscess related to an infected tooth is mostly associated with pyogenic infection, but sometimes, it can be asymptomatic and indicate a chronic condition. This case report shows cold abscess with a draining sinus due to dental origin. A 7-year-old female patient complained of pain with respect to grossly decayed tooth and recurrent swelling with no response to medications. After investigations and management of the lesion, it was concluded as abscess due to chronic granulomatous infection. Cold abscess is a classical manifestation of tuberculosis with no signs of inflammation. More than 60% of cases of this pathology occur in patients below 15 years old. It needs various clinical, histopathological, and laboratory investigations. Although rare, it should be considered as a differential diagnosis when no improvement occurs postroutine therapy to prevent serious complications. Furthermore, various precautions should be taken by the clinicians to prevent cross-infection.
Рациональные гипергеометрические тождества
Authors: Sarkissian Gor Alfredovich , Spiridonov Vyacheslav Pavlovich
Published: July 2021

Рассмотрен специальный сингулярный предел $\omega_1/\omega_2 \to 1$ для модулярного квантового дилогарифма Фаддеева (гиперболической гамма-функции) и соответствующих гиперболических интегралов. Это приводит к новому классу гипергеометрических тождеств, связанных с двусторонними суммами интегралов типа Меллина-Барнса от специальных произведений символов Похгаммера.
Максимальная монотонность оператора Немыцкого
Authors: Tolstonogov Alexander Alexandrovich
Published: July 2021

В сепарабельном гильбертовом пространстве рассматривается семейство максимально монотонных операторов с областями определения, зависящими на отрезке числовой прямой от времени. Рассматривается также пространство интегрируемых с квадратом функций, определенных на этом отрезке, со значениями в указанном гильбертовом пространстве. Исходя из семейства максимально монотонных операторов, на пространстве интегрируемых с квадратом функций строится оператор суперпозиции - оператор Немыцкого. При достаточно общих предположениях доказывается максимальная монотонность оператора Немыцкого. Дается конкретизация этого результата применительно: к семейству максимально монотонных операторов, наделенных псевдорасстоянием по А. А. Владимирову; к семейству субдифференциальных операторов, порожденных собственной выпуклой зависящей от времени полунепрерывной снизу функцией; к семейству нормальных конусов движущегося выпуклого замкнутого множества.
Граф Шура-Вейля и теорема Тома
Authors: Vershik Anatolii Moiseevich , Tsilevich Natalia Vladimirovna
Published: July 2021

В работе определяется градуированный граф, названный графом Шура-Вейля, который естественно возникает при одновременном рассмотрении алгоритма RSK и классической двойственности между симметрической и полной линейной группами. В качестве одного из первых применений этого графа мы даем новое доказательство полноты списка дискретных неразложимых характеров бесконечной симметрической группы.
Use of telehealth and outcomes before a visit to the emergency department: a cross-sectional study on walk-in patients in Switzerland
Authors: Mettler Annette C. , Piazza Livio , Michel Janet , Müller Martin , Exadaktylos Aristomenis K. , Hautz Wolf E. , Sauter Thomas C.
Published: July 2021

AIMS OF THE STUDY
An increasing number of patients are using telehealth before contacting the healthcare system. If we are to optimise future telehealth strategies and adequately respond to patient needs, we need to know more about the frequency and characteristics of telehealth use. Our objectives were (i) to investigate whether patients use telehealth before consulting the emergency department (ED), (ii) to compare patients with and without use of telehealth, and (iii) to investigate adherence, confidence and satisfaction.

MATERIALS AND METHODS
A survey was conducted among ED walk-in patients at a tertiary university hospital in Switzerland. Eligible patients were questioned about their use of telehealth before current presentation, during 30 shifts from 23 October to 15 December 2019.

RESULTS
A total of 183 (43.9%) of 417 surveyed patients used telehealth, with the telephone being the most commonly used modality, especially among elderly patients. Patients using telehealth were more likely to be male (53.5%, p = 0.001) and were similar in age to non-users. Telehealth users tended to be better educated. Telehealth was predominantly used for semi-urgent non-traumatic diseases that did not lead to hospitalisation. All age groups expressed satisfaction with telehealth, trusted the recommendations and adhered to them. The main reason for "non-use" of telehealth was lack of knowledge.

CONCLUSIONS
Lack of knowledge about telehealth opportunities and barriers in specific patient groups should be addressed to include all patients, and thus to exploit telehealth’s many advantages.
Acute toxicity study of the ethanolic extract of Eleutherine bulbosa Urb in Wistar rats
Authors: Wati Helmina , Muthia Rahmi , Kartini  , Setiawan Finna
Published: July 2021

Introduction: Eleutherine bulbosa Urb is a plant species with medicinal properties, including anti-inflammatory, widely relied upon in traditional practices. For this reason, the present research was intended to assess and, thus, ensure the safety of this plant for conventional medicinal purposes using a toxicity test study.    
Methods: The acute toxicity test of the ethanolic extract of E. bulbosa Urb (EEEB) used the method adopted from the Organization Economic Cooperation and Development (OECD) guidelines 425 for testing Wistar rats.    
Results: During 14 days of the acute toxicity study, there were no significant changes in rat weight, no mortality, and no signs of toxicity after the oral EEEB administration at 2000 mg/kg body weight (bw). The limit test showed that the LD50 of EEEB was higher than 2000 mg/kg bw.
Conclusion: EEEB has low toxicity because its LD50 is higher than the limit test results.
The comparison of the actual cost to case-mix of type 2 diabetes mellitus inpatient in Pandan Arang Boyolali hospital
Authors: Negara Sri Bintang Sahara Mahaputra Kusuma , Octavia Devi Ristian , Utami Primanitha Ria
Published: July 2021

Aim: The objective of this study was to determine the conformity of diabetes mellitus (DM) actual cost with the rate of Indonesia Case-Based Groups (INA-CBGs) among Universal Health Coverage (Jaminan Kesehatan Nasional - JKN) and non-JKN patients diagnosed with DM.     

Methods: This retrospective cross-sectional study was observational and analytic. It recruited DM inpatients with or without JKN. The data were analysed to identify the total actual cost of DM management among inpatients.     

Results: The results showed that the average cost for treating inpatient with diabetes mellitus at classes 1, 2, and 3 was IDR 2,677,003±906,406, IDR 2,881,023±851,483, and IDR 2,323,768±802,828, respectively. A positive difference of 378,509,126 was found between the actual cost and the INA-CBGs rate in 101 patients. There was a discrepancy between the real cost and the INA-CBGs rate for all treatment classes and the treatment levels. Factors influencing the real cost of treatment for DM were the length of stay and the severity level.
Correlation between the level of knowledge of drug managers and drug management in several primary health centres in Malang regency
Authors: Hariadini Ayuk Lawuningtyas , Ishmah Nur , Pramestutie Hananditia Rachma
Published: July 2021

Background: Drug management is one of the primary health centre management activities that aims to ensure the continuity and affordability of pharmaceutical preparations.   

Aim: This study aims to determine the relationship between the level of knowledge of drug managers and drug management in several primary health centres of Malang regency.   

Method: The study was observational analytic using questionnaire instruments to analyse the level of knowledge of drug managers and three checklists to analyse drug management through three indicators of drug management: (1) conformity of stock to the national formulary, (2) conformity of stock to the disease patterns, and (3) the percentage of expired drugs.   

Result: There was no significant relationship between the level of knowledge and the first (p = 0.842), second (p = 0.236), and the third indicator (p = 0.361).   

Conclusion: Not all drug lists in the national formulary are required by each primary health centre. The inventory is adjusted to the consumption and epidemiology.
The effect of stress level on the therapeutic outcomes of type 2 diabetes mellitus at the regional public hospital of West Nusa Tenggara province
Authors: Nopitasari Baiq Leny , Nurbaety Baiq , Jaya Made Krisna Adi
Published: July 2021

Introduction: Diabetes Mellitus (DM) is a complex chronic disease that requires ongoing medical care with a multifactorial risk reduction strategy beyond glycemic control. Self-management, education, and support are essential to prevent acute complications and reduce the risk of long-term complications. Stress levels may affect fasting blood glucose (FBG) and 2-hours postprandial blood glucose (2HPPBG).    

Objectives: This study aims to determine the effect of stress levels on the therapeutic outcomes of type 2 DM patients at the regional public hospital of West Nusa Tenggara province.  

Methods: This observational, cross-sectinal research was carried out on a sample of 37 patients using the Perceived Stress Scale (PSS). Data analysis used a linear regression test.  

Results: The results showed that stress had a significant effect on FBG (p=0.038) and 2HPPBG (p=0.001) levels.
A pharmacoeconomic study: cost-utility analysis of modern wound dressings vs conventional wound dressings in patients with diabetic foot ulcer
Authors: Rahmawati Cyntiya , Nopitasari Baiq Leny
Published: July 2021

Introduction: Duration of treatment and outcome of therapy of diabetic foot ulcers are some of the factors that affect the quality of life and will require higher medical costs.
Aim: This study aimed to choose an alternative wound dressing that provides the best utility at the most cost-efficient.   
Methods: The research method used was pharmacoeconomics with a patient’s perspective.   
Results: The results showed the mean cost of modern wound dressings per visit was IDR 347,131, while that of conventional wound dressings was IDR 47,140. The quality of life with modern vs conventional wound dressing was significantly different (p < 0.05). The incremental cost utility ratio (ICUR) value was IDR 22,813 per quality of life (QoL).    
Conclusions: This study showed that modern wound dressings provide a higher quality of life at a higher cost. Indeed, it cost more than IDR 22,813 to change from conventional to modern wound dressings and increase 1 unit of quality of life, but patients obtained an additional 13.15 quality of life.
The impact of pharmacist shortage on the inventory management of medicines at primary healthcare centres in East Java, Indonesia
Authors: Rahem Abdul , Athiyah Umi , Setiawan Catur Dian , Hermansyah Andi
Published: July 2021

Background: Pharmacists are the only people authorised to manage the medicines inventory. However, in the case of pharmacist shortage, other personnel may take over this function. This is particularly the case in most primary healthcare centers (puskesmas) in Indonesia.   

Aim: To compare the outcome of medicine inventory management between pharmacists and non-pharmacists in primary healthcare centres (PHCs).   

Methods: A survey of 146 puskesmas in East Java was conducted involving 73 pharmacists and 73 non-pharmacist staff. This study was conducted from July to January 2020. Each respondent completed a questionnaire focusing on the inventory aspects of medicine management.   

Results: Purchasing accuracy is higher for pharmacists (90%) than for non-pharmacists (68%). Pharmacists manage the inventory more efficiently with only 2% of the drugs expired and wasted while non-pharmacist staff wasted 16% of the drugs and 18% of the drugs expired.   

Conclusion: The role of pharmacists in medicine inventories is vital as they carry out more efficient and accurate medicine management.
Medical quest as a method of distance simulation training
Authors: Khodus S. V. , Oleksik Vladimir S
Published: July 2021

A study was conducted among 76 students who passed the Olympiad competitions on practical medical skills in an innovative remote format. The data obtained indicate the effectiveness of distance simulation training, which was evaluated by students answering test questions before and after passing the competition task, as well as by evaluating the actions of students during the remote passage of the simulation scenario. The proposed method of remote simulation allowed to increase the quality of knowledge of certain issues of emergency medical care.
Simulation training during the COVID-19 pandemic
Authors: Smirnova E. A. , Tarasova G. N. , Leshchenko M. A. , Makarenko A. S.
Published: July 2021

The need for rapid re-profiling of specialists, changes in the logistics of providing medical care in the context of a pandemic dictate the widespread introduction of simulation technologies in the educational process. The paper considers possible changes in the format of simulation training, taking into account the peculiarities of the epidemiological situation.
Workplace training (in situ) — modern technology of training and assessment of medical personnel
Authors: Ripp E. G. , Ripp T. M. , Parmon E. V.
Published: July 2021

The article shows the need to include team simulation trainings directly at the workplace in the curriculum of existing medical institutions.
Modern technologies in teaching obstetrics. About students' attachment to simulation training
Authors: Soshnikov A. V. , Gorokh O. V. , Katkova N. Yu.
Published: July 2021

The authors of this article describe the experience of applying of simulation technologies in the curriculum in a medical university. The article discusses the methodology of practical training in obstetrics on the platform of a simulation center. The article also presents the results of the study that reveals students ' opinion about the role of the medical simulation training and its place in the educational process.
Gender Representation in English Textbooks: A Study about Public Middle Schools in Punjab
Authors: Malik Dr.Muhammad Abid , Rind Dr. Irfan Ahmad , Qayyum Abdul
Published: July 2021

This paper investigates gender representation in grade 6, 7 and 8 English textbooks used in public schools in Punjab. For a comprehensive analysis, both textual contents and pictures were analyzed using quantitative and qualitative techniques. The findings show that the female character were under-represented and misrepresented. Not even a single chapter was titled after any female character. Even in the text, they were heavily outnumbered, and generally shown in stereotypical and traditional roles. Shockingly, not even a single female character was portrayed positively. They were mostly shown in a neutral way. The same pattern was observed in the pictures. In spite of the fact that national education policies and curriculum frameworks emphasize heavily on gender parity, the textbooks appear to have failed to incorporate it. This study suggests that textbooks should contain gender parity and represent women in a respectful way so that the students may pick those values and inculcate them.
Use of Non-verbal Communication in Pedagogic Practices at Public High Schools in Lahore
Authors: Rasul Dr. Irfana , Dr. Muhammad Nadeem  , Ms Ayesha Afzal
Published: July 2021

It was a descriptive research which studied the use of non-verbal communication in the pedagogic practices at secondary school level in Lahore. The study was conducted to examine the practices of teachers’ non-verbal communication used in conjunction with verbal communication in actual classroom setting by teachers which affected the participation and performance level of learners. It investigated the students’ understanding, interpretation of and attitude towards non-verbal communication used by teachers and identified the existing barriers for the use of non-verbal communication strategies to improve students’ learning. The non-verbal communication was restricted to five factors—physical appearance, facial expressions, eye contact, spatial distance and paralinguistic. The study was limited to the subject of English (compulsory) at the female secondary schools in public sector. The sample comprised of 1200 students and 40 teachers from female public high schools of Lahore (Punjab), Pakistan. The study recommended that all female teachers at secondary level schools should be provided an orientation in non-verbal communication which would help them to use these skills in their teaching methodologies. While recognizing the importance of non-verbal communication, the curriculum planners and policy makers should take practical steps to make it a part of teacher education programs for the training of prospective teachers. Moreover, an awareness among students shall be created on how to interpret and reflect upon the teachers’ non-verbal communication signals during teaching-learning process.
Keywords: Non-verbal, physical appearance, eye contact, paralanguage, body movements, facial expressions, gestures, high school, interaction
National Identity Perceptions of the Turks of Kosovo and North Macedonia: How Identity Turns into a Shield When Denied?
Authors:   Dicle University, Öztürk Ümit
Published: July 2021

Turks of Kosovo and North Macedonia have become members of a nation that has turned into a minority in terms of population and influence both after the dissolution of the Ottoman State and after the dissolution of Yugoslavia. The aim of the study is to determine the identity perceptions of the Turks of Kosovo and North Macedonia. Within the scope of the study, a number of questions were asked to the participants regarding their identity definitions and perceptions by means of semi-structured interview technique. Participants' responses were discussed with a phenomenological approach and qualitative analysis. It was observed from the findings that Turks of Kosovo and North Macedonia experience nationalist feelings with a very high consciousness. They oppose the understanding of Turkishness as an ethnic identity. According to the majority, Turkish identity should be understood as a national identity built on the basis of religion and culture. And it is far from seeking ethnic ties or genealogy. In addition, some participants stated that although they defined themselves with Turkish identity in the past, nowadays they define themselves as Albanian. This situation can be explained as an alienation from the Turkish identity arising from different reasons; such as assimilation and denial. However, some of the participants dealing with questions such as “How can you call yourself a Turk? Is there any Turk left here after the Ottoman Empire? in daily life, state that they defend themselves by making reference to ethnic and ethnocentric implications. Because in such situations where identity is denied, identity turns into a shield.
The Narrative of Hybrid Identity in the Third Space: A Postcolonial Critique of The Reluctant Fundamentalist by Mohsin Hamid
Authors: Malik Moazzam Ali , Ahmed Shiraz , Ehtsham Muhammad
Published: July 2021

The study aims at analyzing the construction and the working of hybrid identity in The Reluctant Fundamentalist. The review of the literature discusses how postcolonial identity research has undergone a paradigm shift in recent times. Among the modern postcolonial critics like Bhabha (1994) and Spivak (2013), 'colonizer' and 'colonized' are dynamically dependent on each other for their subjective constructions. The identities of the 'colonizer' and the 'colonized' are not autonomous; rather, they have mutually exclusive identities—a structuralist stance taken by the earliest postcolonial theorists. Instead, such identities of 'colonizer' and 'colonized' are transcultural and fluid in nature and can negotiate themselves 'in the third space of enunciation' for 'new' forms of 'social collectives' (Bhabha, 1994). This aspect of hybrid identities provides the framework for our research. So, the study, through the textual analysis of The Reluctant Fundamentalist, has applied Bhabha's (1994) concept of 'hybridity' to unearth different aspects of Changez's identity in the wake of changing geopolitical and global scenario after the 9/11 event. The study ends on a note that there is a further need to develop the concept of hybrid identity so that it might enlighten us more about the role of 'cultural materials' in constructing such identities.
A Qualitative Understanding of Doctoral Students’ Experience of Embodiment
Authors: Waheed Syed Abdul
Published: July 2021

Human beings exist in the world ‘bodily’ and their existence is inexorable. International doctoral students’ understanding of themselves and their perspectives of the learning environment is through their embodiment. The purpose of the present research was to understand doctoral students’ embodiment experiences in relation to a culturally and academically diverse university environment. This understanding was gained through the phenomenological lense of qualitative research. For this purpose, thirteen doctoral students were selected through maximum variation sampling from the Austrian public sector universities located in different states. They were doing doctoral studies in various physical and social sciences at different stages of their dissertation. The understanding of the phenomenon was sought through semi-structured interviews. The interviews were recorded, transcribed and analyzed by coding the text and categorizing it into themes that emerged while frequently reading the transcripts. The emerging themes include ‘stress and anxiety, ‘confidence and motivation’ and ‘physical fatigue and exertion’. Most of the students experienced ‘confidence’, ‘encouragement’, ‘depression’, ‘nervousness’, ‘homesickness’, ‘stress’ and ‘frustration’ when asked about ‘lived body’ or corporeality. The study has implications in understanding doctoral students’ ‘bodily’ existence in the universities.