bluuebunny/crossref_metadata_2025 huggingface dataset:
PARADIGMAS DA EXTENSÃO RURAL EM QUESTÃO:
Authors: RAPHAEL FERNANDO DINIZ  , ANTONIO NIVALDO HESPANHOL
Published: January 2024

Em um contexto marcado pela reinserção da extensão rural na agenda política do Estado brasileiro, buscou-se realizar no presente artigo uma análise histórico-crítica e teórico-metodológica da trajetória da política extensionista a partir das transformações ocorridas nos princípios ético-filosóficos que orientaram os serviços de extensão rural no país. Para isso, procedeu-se a uma revisão bibliográfica acerca do processo de institucionalização, crise e renovação da extensão rural no Brasil ao longo da segunda metade do século XX e início do XXI. As reflexões e análises construídas evidenciaram que as mudanças verificadas nas diretrizes e orientações operacionais da política extensionista no país se deram em função da conjuntura político-econômica e socioambiental das realidades nacional e internacional, possibilitando diferenciar seus discursos em três concepções: a política extensionista como fábula, como perversidade e como possibilidade, que esteve ora a serviço das forças sociais dominantes, ora em atenção às demandas dos grupos sociais subalternizados.
Treino funcional orientado para a tarefa Sit-to-Stand, numa criança com status pós-síndrome de Guillain Barré: estudo de caso
Authors: Couras Diogo , Martins Maria Elisabete
Published: January 2024

Introdução: A Síndrome de Guillain Barré (SGB) é uma doença autoimune que afeta o sistema nervoso periférico e, carateriza-se por uma paralisia ascendente simétrica, hiporreflexia ou arreflexia. Na população pediátrica, estima-se uma taxa de incidência de 0,4-0,6/100 000, que embora inferior à população adulta, é considerada a causa mais comum de paralisia flácida aguda. O tratamento da SGB é caracterizado por tratamento farmacológico e Fisioterapia. A intervenção do Fisioterapeuta é crucial nas diferentes fases da doença, tanto na prevenção de complicações secundárias, como na maximização da funcionalidade e na autonomia funcional, decorrentes dos défices neurológicos residuais. Objetivos: Descrever a aplicação de um plano de intervenção centrado no treino funcional dirigido para a tarefa motora Sit-to-Stand (STS) e analisar os resultados obtidos na mobilidade funcional e nas Atividades de Vida Diária (AVDs). Material e Métodos: O caso em análise refere-se a uma criança do sexo feminino, de 9 anos de idade, com o diagnóstico médico de status pós-síndrome Guillian-Barré, ocorrido no dia 20 de janeiro de 2023, do qual resultou um quadro de tetraparésia. Apresenta os seguintes problemas: restrição na prática dos hobbies (dançar e brincar com os amigos e com o animal de estimação), dificuldades nas AVDs (vestir/despir e higiene pessoal), por limitações na mobilidade funcional (no leito, nas transferências, no desempenho do Sit-to-Stand e da marcha), devido a défice no controlo postural e no equilíbrio, presença de dor neuropática e mecânica à extensão de ambos os joelhos, fraqueza muscular nos membros superiores e inferiores e na Core. Resultados e Discussão: Após 60 sessões de fisioterapia, foram observados resultados na intensidade da dor, de 8/10 para 0/10 na escala Wong-Baker e no equilíbrio, que se refletiram no desempenho das 4 fases do STS e das AVDs. Verificou-se uma melhoria de 5/56 para 14/56 na Escala de Equilíbrio Pediátrica (EEP), no tempo da execução do teste Five Times Sit-to-Stand, e na Medida de independência funcional (MIF) que passou de 88 para 44 segundos e de 67/126 para 84/126, respetivamente. Os resultados obtidos revelaram-se positivos tanto a nível da mobilidade funcional, como no desempenho das AVDs.
الإنتقاء التقني في التصميم الداخلي المعاصر: دراسة حالة متحف شنغاهاي للعلوم والتكنولوجيا
Authors: Mohamed Jarallah Tawfik  , Marwah Mohammed Abdulabbas
Published: January 2024

يتطلب كل تصميم داخلي في مجاله التقني بما يتضمنه من الفضاءات الداخلية انتقاء تقنيا وتصميماً خاصاً لعناصره التكوينية  التي تكون مبنية على قواعده  التصميمية المترابطة الأمر الذي يتطلب دراسة  آلية  الانتقاء التقني التي تعمل على مبدأ التوافق في أدائها الوظيفي والجمالي، كما أن البيئة التصميمية لفضاء المتحف تتضمن أيضاً دراسة المصمم الى الانتقاء الفكري التقني عبر الدراسة  المحددة  لمدد زمانية معينة بحيث يبين من خلالها دراسة الانتقاء التقني وذلك بإعتماد المدارس الفنية والتصميمية مما يشكل جانب جذب مهم  للمشاهدين عند إيجاد حالة من التكامل والانسجام ذات الانتقاء التقني بما يتضمنه من دور واضح  في إدراك  البيئة التصميمية وعليه، فقد تم صياغة مشكلة الدراسة البحثية بالتساؤل الآتي: ما هي قواعد الانتقاء التقني التي تعتمد  في التصميم الداخلي المعاصر لمتحف شنغاهاي للعلوم والتكنولوجيا؟ بينما تسهم  أهمية البحث في دراسة قواعد الانتقاء التقني التي تعتمد في التصميم الداخلي المعاصر فضلا عن دراسة مراحل التصميم الداخلي التي تجري في عقل المصمم الداخلي التي  يجب ان تكون مبنية على وفق  مفاهيم وقواعد ذات انتقاء  تقني مدروس في حين يهدف البحث الحالي الى التعرف على قواعد الانتقاء التقني التي تعتمد في التصميم الداخلي المعاصر (لمتحف شنغاهاي للعلوم والتكنولوجيا)، كما تضمنت الدراسة البحثية محاورالإطار النظري وكذلك إجراءات البحث والمتمثلة بمنهجية البحث المعتمدة المنهج الوصفي (دراسة حالة) وأخيراً تضمن الدراسة البحثية استخلاص أهم النتائج والاستنتاجات والتوصيات والمقترحات  المستقبلية.
Knowledge and Attitudes of Students About Water Pipe Smoking at Technical Institute / Alsuwayra in Middle Technical University
Authors: Jawad Ahmed K. , Khaleefah Jasim A. , Ammar A. Okab
Published: January 2024

Water pipe (WP) is also referred to as Narghile, Hubble-bubble, Ghoza, and Hookah, depending on the country. Water pipe tobacco smoking is a type of tobacco consumption that involves smoking flavored or unflavored tobacco via a single or multi-stemmed instrument. The objective of the study knowledge and attitudes about water pipe (shisha) smoking. A descriptive cross-sectional study design (mixed methods design) was carried out at the technical institute –Suwaira. Included (240) students. The sampling technique was a random sample, and data was collected using an interview with students, from December 2021 to March 2022. Results of the study show demographic characteristics of students' age groups (21-24) years (50.0%), type of smoking (21.2%) of smoking both (cigarettes and water pipes), the overall level of knowledge to study sample about waterpipe smoking was intermediate knowledge (67.1%). The conclusions of the study show a majority of participants were smoking (52.1%), and most of them were smoking both (Cigarettes, Water pipes). Knowledge of students about waterpipe smoking was more (Yes) responses are harmful to health, the overall level of knowledge about waterpipe smoking was intermediate and poor knowledge. The study recommends great interest to the Ministry of Health and the consideration of the adjustment of strategies to improve knowledge, change attitudes, and correct the misconceptions about the habit of WPS, especially among students in colleges and universities.
تأثير رأس المال الاجتماعي في الاداء الوظيفي من خلال الدور الوسيط لتبادل المعرفة: دراسة تحليلية في وزارة الثقافة والسياحة والآثار
Authors: Rana Diaa Abdel Baqi  , Sawsan Jawad Hussein  , Marwa Mustaph Al-Roubaie  , Jafar Ahmad Alserhan
Published: January 2024

هدف البحث الى اختبار تأثير رأس المال الاجتماعي والمتمثل بـ (الهيكلي، العلائقي، والادراكي) في الاداء الوظيفي من خلال الدور الوسيط لعمليات تبادل المعرفة (تبرع وجمع المعرفة) في وزارة الثقافة والسياحة والاثار. ولتحقيق اهداف البحث فقد تم استخدام المنهج الوصفي والتحليلي من خلال توزيع استمارة استبانة على الموظفين العاملين في ديوان الوزارة، إذ وزعت 300 استمارة استبانة على وفق العينة العشوائية البسيطة وكانت نسبة الاستجابة (92%) إذ بلغت الاستبانات الصالحة للتحليل الاحصائي (278) استمارة. نمذجة المعادلة الهيكلية مع ايموس AMOS v.28 تم استخدامها لبناء انموذج وتحليل العلاقات الارتباطية فضلا عن برنامج SPSS v.28. توصل البحث الى مجموعة من النتائج ومنها وجود علاقات ارتباط وتأثير ذات دلالة معنوية بين رأس المال الاجتماعي، تبادل المعرفة، والاداء الوظيفي، فضلاً على ان تبادل المعرفة يتوسط ايجابيا العلاقة بين رأس المال الاجتماعي والاداء الوظيفي. وتمثلت اهم التوصيات في تصميم استراتيجيات تهدف الى تشجيع موظفي الوزارة على الانخراط في انشطة التفاعل الاجتماعي وتبادل المعرفة لتحسين الاداء الوظيفي.
تعزيز جودة الخدمة من خلال سلوك المواطنة التنظيمية: دراسة استطلاعية في دائرة بلدية الدورة
Authors: Eman Yassein Ahmed  , Amer Abdul Latif Al-Amri  , Noor Bassim Abd  , Jafar Ahmad Alserhan
Published: January 2024

يتضمن هذ البحث تحليل تأثير سلوك المواطنة التنظيمية لموظفي الاتصال بالزبائن على جودة الخدمات المقدمة لهم. على وفق لذلك، إذ تم اعتماد المنهج الوصفي التحليلي لتأثير OCB لموظفي الاتصال بالزبائن على جودة الخدمة في البلدية. تم اختيار عينة عشوائية تتألف من (194) فرداً من العاملين في الادارة العليا والوسطى والتنفيذية، الإداريين والمشرفين على الانشطة الخدمية في كافة اقسام البلدية. التي تمثل جزءاً من مجتمع البحث البالغ عدده (437). وكانت استمارة الاستبيان هي الأداة المخصصة لجمع البيانات. وقد تم استخدام الاساليب الاحصائية مثل المتوسط، الانحراف المعياري، معامل الارتباط لسبيرمان وتحليل الانحدار الخطي البسيط لتحليل البيانات.  حيث اثبتت نتائج التحليل الكمي باستخدام قيمة معامل الارتباط (R2) لاختبار الفرضيات وجود أثر معنوي لأبعاد سلوك المواطنة التنظيمية في جودة الخدمة. إذ إن الاهتمام بسلوك المواطنة التنظيمية كان بمستوى متوسط مع ضعف في تطبيق بعض ابعاد (OCB) التي ادت الى خلل في جودة الخدمات التي يتم تقديمها للمواطنين.  وعليه يقترح هذا البحث تحفيز العاملين وتشجيعهم على أداء العمل بسلوكيات المواطنة التنظيمية ودفعهم نحو الابداع في الدور الإضافي.
إمكانية استخدام أنموذج مضاعف الربحية في تقييم الأسهم العادية: دراسة تطبيقية في سوق العراق للأوراق المالية
Authors: Ayman Jadoua Faisal Al-shammari  , Shatha Abdul-Hussein Jabr  , Abbas Hashem Muhalhal  , Bader S. S. Hamdan
Published: January 2024

يتمثل هدف البحث في عرض لمفهوم نموذج مضاعف الربحية ودراسة مدى امكانية هذا النموذج P/E في قياس القيمة الحقيقية للأسهم العادية بعّده من النماذج المهمة في مساعدة المستثمرين في معرفة الفرق بين القيمة السوقية للأسهم العادية والقيمة الحقيقية، ولإثبات فرضية البحث تم اختيار عينة البحث لقطاع المالي واختيار مجموعة من المصارف المدرجة في سوق العراق للأوراق المالية والمتكونة من ثلاثة عشر مصرفاً للمدة الممتدة (2015-2019).
إذ توصلت نتائج البحث إلى قدرة نموذج مضاعف الربحية في تفسير القيمة الحقيقية للأسهم العادية لعينة البحث والخاصة بالبيئة العراقية، كما توصلت النتائج إلى أن القيم جميعا التي تم قياسها على وفق نموذج البحث كانت أكبر من القيمة السوقية وهذا يساعد المستثمرين من زيادة فرصتهم في تحقيق أرباح أعلى، وكذلك يدل على أن هناك ضعف في كفاءة السوق.
La contabilidad como medio de prueba para acreditar la prescripción de la renta presunta que se deriva del registro de una deuda inexistente
Authors: Malvárez Pascual Luis A.
Published: January 2024

En el presente trabajo se analizan las consecuencias de la aplicación de la presunción que permite derivar una renta del descubrimiento del registro contable de una deuda inexistente. En particular, se analiza la reciente jurisprudencia que ha considerado que la contabilización no controvertida de dicha deuda en un periodo prescrito es un medio de prueba válido para que el contribuyente pueda demostrar que la renta presunta se debe imputar también a dicho periodo prescrito.
Testimonios
Authors: Felipe Mejía Adán
Published: January 2024

"Exhumaciones" por Adán Felipe Mejía. Artículos periodísticos del autor donde refiere alguna anécdota o experiencia del ingenio de aquellos escritores con quienes alternó en las redacciones o en los círculos literarios; pero en cada caso logró ofrecer una veraz estampa, que no se sabe si admirar por la originalidad de la observación que revela, o por la maestría del estilo.
Algunas de las Exhumaciones que se publican en la presente edición de Fénix son las siguientes:  Cesar Vallejo, meditaba un negocio lucrativo... , Chocano se afeitaba con autógrafos... ,  Percy Gibson, jugador de bolero... , Clovis, un caso de constancia...
The impact of social stigma perceived by adolescents in the Early Adolescents using Community Child Centers. on their adaptation to school life and depression.
Authors:   Korea Youth Counselling Association, Lee Yong-Hee
Published: January 2024

This study aimed to investigate the impact of social stigma perceived by early adolescents using Community Child Centers on their adaptation to school life and depression. For this purpose, a survey was conducted on 320 middle school students among youth who used local children's centers in Busan and Gyeongnam. The collected questionnaires were analyzed through correlation analysis and regression analysis using the SPSS statistical program. As a result of the analysis, first, it was found that there was a significant relationship between the independent variables and dependent variables set in this study. This means that adaptation to school life and level of depression may vary depending on the social stigma perceived by early adolescents using Community Child Centerss. Second, the sub-factors of social stigma perceived by early adolescents using Community Child Centers were found to have a significant impact on the sub-factors of school life adjustment. This is an important result that shows that in our society, a sense of social stigma exists against early adolescents who use Community Child Centers, and that awareness of this stigma has a negative impact on adolescents' adaptation to school. Third, the sub-factors of social stigma perceived by early adolescents using Community Child Centers were found to have a significant impact on depression. This indicates that social stigma has a negative effect on depression in adolescents, either directly or indirectly, and that they can be affected by social stigma to a greater extent than adults. In summary, the stigma perceived by adolescents using Community Child Centers was found to have a negative impact on their adaptation to school life and depression. Therefore, this suggests that efforts should be made to ensure that Community Child Centers, which are mainly used by poor children and adolescents, not only expand the quantity of services and programs, but also prevent social stigmatization during the service process.
The Effects of Smartphone Overdependence on Aggression in Adolescents: The Mediating Effect of Grit
Authors:   Korea Youth Counselling Association, Park Bong-Hwan
Published: January 2024

The purpose of this study was conducted to test mediating effects of grit in the relationship between smartphone overdependence and aggression in adolescents. The data of 2,275 in the Year 4 of the Korea Children and Youth Panel Survey (KCYPS) 2018 were analyzed. The analyzed data was subjected to technical statistical analysis, reliability analysis, correlation analysis and regression analysis using the SPSS 25.0 program. The results of this study are as follows. First, smartphone overdependence and Aggression showed a positive correlation, grit and Aggression showed a negative correlation. The purpose of this study was
conducted to test mediating effects of grit in the relationship between aggression and smartphone addiction in adolescents. These results discussed practical interventions in the development of educational programs and promotion activities that Considering grit, can be mediated by trigger and protect factors to lower overuse of smartphone overdependence and level of aggression.
The Effect of Short-Term Mindfulness-Based Group Therapy on Social Anxiety and Self-Esteem
Authors:   Korea Youth Counselling Association, Hong Young-Keun
Published: January 2024

The purpose of this study was to investigate the effects of short-term mindfulness-based group therapy (SMGT) on social anxiety and self-esteem in adults. The study was conducted in Busan, South Korea, and recruited 16 adults through the counseling center at OO University. The participants were randomly assigned to either an experimental group or a control group. The experimental group participated in 5 weeks of weekly 2-hour SMGT. The control group did not receive any treatment. To measure the effects of the intervention, the participants completed pre-tests, post-tests, and follow-up tests at baseline, immediately
after the intervention, and 5 weeks after the intervention. The Mindfullness Scale(MS) was used to measure mindfulness, the Rosenberg Self-Esteem Scale (RSES) was used to measure self-esteem, the Social Phobia Inventory (SPIN) was used to measure social anxiety, and the Fear of Negative Evaluation Scale (FNE) was used to measure the fear of negative evaluation. The results showed that SMGT was associated with significant improvements in mindfulness and self-esteem. However, there was no significant improvement in social anxiety. The study's implications were discussed at the end.
Beyond body and mind: psychology and the unity of the human person in Aquinas
Authors: Udoh Anthony Athanasius
Published: January 2024

Abstract
Human persons are at once simple and complex: simple, because they possess a unified and indivisible essence in the form of the soul; and, complex, since this immaterial soul is conjoined to a material body, accounting for the human whole. This paper highlights the nature of this union and explores the psychology of the human person based on Thomistic philosophical tradition. Our thesis is that Aquinas’s hylomorphism, which counters in advance the claims of Descartes on human identity, offers a comprehensive understanding of the human person and provides a robust foundation that understands the human person as transcending the limitations of body and mind, and this has implications for philosophical, psychological and scientific enquiries.
The high-resolution Global Aviation emissions Inventory based on ADS-B (GAIA) for 2019–2021
Authors: Teoh Roger , Engberg Zebediah , Shapiro Marc , Dray Lynnette , Stettler Marc E. J.
Published: January 2024

Abstract. Aviation emissions that are dispersed into the Earth's atmosphere affect the climate and air pollution, with significant spatiotemporal variation owing to heterogeneous aircraft activity. In this paper, we use historical flight trajectories derived from Automatic Dependent Surveillance–Broadcast (ADS-B) telemetry and reanalysis weather data for 2019–2021 to develop the Global Aviation emissions Inventory based on ADS-B (GAIA). In 2019, 40.2 million flights collectively travelled 61 billion kilometres using 283 Tg of fuel, leading to CO2, NOX and non-volatile particulate matter (nvPM) mass and number emissions of 893 Tg, 4.49 Tg, 21.4 Gg and 2.8 × 1026 respectively. Global responses to COVID-19 led to reductions in the annual flight distance flown and CO2 and NOX emissions in 2020 (−43 %, −48 % and −50 % respectively relative to 2019) and 2021 (−31 %, −41 % and −43 % respectively), with significant regional variability. Short-haul flights with durations < 3 h accounted for 83 % of all flights but only for 35 % of the 2019 CO2 emissions, while long-haul flights with durations > 6 h (5 % of all flights) were responsible for 43 % of CO2 and 49 % of NOX emissions. Globally, the actual flight trajectories flown are, on average, ∼ 5 % greater than the great circle path between the origin and destination airports, but this varies by region and flight distance. An evaluation of 8705 unique flights between London and Singapore showed large variabilities in the flight trajectory profile, fuel consumption and emission indices. GAIA captures the spatiotemporal distribution of aviation activity and emissions and is provided for use in future studies to evaluate the negative externalities arising from global aviation.
Evaluation of hydrological models on small mountainous catchments: impact of the meteorological forcings
Authors: Evin Guillaume , Le Lay Matthieu , Fouchier Catherine , Penot David , Colleoni Francois , Mas Alexandre , Garambois Pierre-André , Laurantin Olivier
Published: January 2024

Abstract. Hydrological modelling of small mountainous catchments is particularly challenging because of the high spatio-temporal resolution required for the meteorological forcings. In situ measurements of precipitation are typically scarce in these remote areas, particularly at high elevations. Precipitation reanalyses propose different alternative forcings for the simulation of streamflow using hydrological models. In this paper, we evaluate the performances of two hydrological models representing some of the key processes for small mountainous catchments (< 300 km2), using different meteorological products with a fine spatial and temporal resolution. The evaluation is performed on 55 small catchments of the northern French Alps. While the simulated streamflows are adequately reproduced for most of the configurations, these evaluations emphasize the added value of radar measurements, in particular for the reproduction of flood events. However, these better performances are only obtained because the hydrological models correct the underestimations of accumulated amounts (e.g. annual) from the radar data in high-elevation areas.
An ensemble-based approach for pumping optimization in an island aquifer considering parameter, observation and climate uncertainty
Authors: Coulon Cécile , White Jeremy T. , Pryet Alexandre , Gatel Laura , Lemieux Jean-Michel
Published: January 2024

Abstract. In coastal zones, a major objective of groundwater management is often to determine sustainable pumping rates which avoid well salinization. Understanding how model and climate uncertainties affect optimal management solutions is essential for providing groundwater managers with information about salinization risk and is facilitated by the use of optimization under uncertainty (OUU) methods. However, guidelines are missing for the widespread implementation of OUU in real-world coastal aquifers and for the incorporation of climate uncertainty into OUU approaches. An ensemble-based OUU approach was developed considering parameter, observation and climate uncertainty and was implemented in a real-world island aquifer in the Magdalen Islands (Quebec, Canada). A sharp-interface seawater intrusion model was developed using MODFLOW-SWI2 and a prior parameter ensemble was generated containing multiple equally plausible realizations. Ensemble-based history matching was conducted using an iterative ensemble smoother which yielded a posterior parameter ensemble conveying both parameter and observation uncertainty. Sea level and recharge ensembles were generated for the year 2050 and were then used to generate a predictive parameter ensemble conveying parameter, observation and climate uncertainty. Multi-objective OUU was then conducted, aiming to both maximize pumping rates and minimize the probability of well salinization. As a result, the optimal trade-off between pumping and the probability of salinization was quantified considering parameter, historical observation and future climate uncertainty simultaneously. The multi-objective, ensemble-based OUU led to optimal pumping rates that were very different from a previous deterministic OUU and close to the current and projected water demand for risk-averse stances. Incorporating climate uncertainty into the OUU was also critical since it reduced the maximum allowable pumping rates for users with a risk-averse stance. The workflow used tools adapted to very high-dimensional, nonlinear models and optimization problems to facilitate its implementation in a wide range of real-world settings.
Sensitivity of cross-sectional compliance to manufacturing tolerances for wind turbine blades
Authors: Maes Vincent K. , Macquart Terence , Weaver Paul M. , Pirrera Alberto
Published: January 2024

Abstract. Wind turbine blades are complex structures and, despite advancements in analysis techniques, differences persist between predictions of their elastic response and experimental results. This undermines confidence in the ability to reliably design and certify novel blade designs that include self-regulating features like bend–twist coupling. To address these discrepancies, this study investigates the influence of manufacturing tolerances on the compliance properties of blade cross-sections, focusing specifically on a previously disregarded feature: the trailing edge bondline. To conduct this investigation, the validated cross-sectional modelling tools BECAS and VABS are used to demonstrate that even small geometric variations can have significant influence on cross-sectional stiffness properties. The results are further examined and substantiated through the utilisation of 3D finite element models, adopting both shell and solid elements. We reaffirm that an accurate geometric representation of the cross-section is necessary to adequately capture the shear flow within it and assure accurate predictions on cross-sectional stiffness properties, providing updated guidelines for designers in industry.
Fulminant Hepatic Failure as the Initial Presentation of Hodgkin's Disease and Liver Transplantation: A Case Report.
Authors: Saldaña-Ruiz Mauricio Alejandro , Ortiz-Alonso Federico , Sandoval-González Adriana Carolina , Tapia-Brito Liliana Sayuri , Lozano-Galván Laura Carolina , Ramírez-Pintor Karla Monserrat
Published: January 2024

BACKGROUND: Hodgkin's lymphoma (HL) or Hodgkin's disease is a B-cell neoplasm, characterized by affecting the lymph nodes or extranodal lymphoid tissue. Includes two distinct entities: classical HL (95%) and lymphocyte-predominant nodular HL. This disease presents as cervical and intrathoracic lymph node growth in 60-90%, however, presentation due to liver infiltration is extremely rare. Around 30% of patients manifest the disease with a picture of general malaise based on fever, night sweats, weight loss and chronic pruritus.
THE CASE: We present the case of a 13-year-old female, who started with an insidious condition that evolved to fulminant hepatic failure of unknown etiology (Table 1), it was decided to perform an orthothopic liver transplant, the histopathological analysis of the explant and a lymph node reported mixed cellularity Hodgkin's disease. Subsequently, the hematology service requested a lumbar puncture, with no evidence of infiltration. It was decided to initiate six cycles of chemotherapy with BEACOPP scheme, evolving without complications and achieving a complete response eleven months later; currently, she has been free of disease for three years.
CONCLUSION: The cause remains unknown for this disease, so an early diagnosis and having different treatment options are the key points to combat this disease. Even though having a diagnosed neoplasm is a contraindication for receiving a liver transplant at present, the diagnosis was not available at that time, and because of her clinical situation, she met the criteria for liver transplantation. In the future, it could be essential to individualize each case to weigh the risks and benefits of carrying out the transplant or not.
Mitigating Physician Emigration in Nigeria by Improving the Internship Experience
Authors: Daniel Faithful Miebaka , Essien Emmanuel Aniekan , Gbuchie Monica Anurika , Ukoaka Bonaventure Micheal , Emeruwa Victoria Ezinne
Published: January 2024

Nigeria faces a critical shortage of health workers, exacerbated by a growing of physician emigration. This study explored the negative internship experiences that drive Nigerian interns to migrate abroad, with a focus on the COVID-19 pandemic's impact. Interns cite excessive workload and burnout, lack of professional development opportunities, challenging work environment, and mistreatment as key reasons for considering emigration. The COVID-19 pandemic has exacerbated these challenges, leading to shortages of personal protective equipment, limited screening services, and poor hazard allowances. The paper emphasizes the importance of adopting policies that make destination countries attractive to emigrating interns. These includes creating a supportive work environment with fair compensation, professional development opportunities, and adequate resources to retain interns in the country. It also highlights the significance of addressing mistreatment and bullying in the workplace. Collaboration between healthcare organizations, policy reforms, and increased healthcare financing are suggested as potential strategies to mitigate the brain drain and ensure a sustainable healthcare system in Nigeria. Improving internship conditions and addressing the shortcomings of managing the COVID-19 pandemic are essential to retaining Nigerian doctors and combatting physician emigration. This requires a coordinated effort from healthcare systems, policymakers, and stakeholders.
Outcomes and Complications of Percutaneous Nephrolithotomy (PCNL) at Al-Ribat Urology Center (Omer Sawi Hospital)
Authors: Jaber Amin Mohammed Hammad , Hassan Mohammed Hussam Eldein , Ahmed Hussain Mohammed , Hassn Hassan Ishag , Ibrahim Magbol Mustafa Altayeb , Saeed Sami El Arbab
Published: January 2024

BACKGROUND: Percutaneous nephrolithotomy generally is safe, effective, and associated with a few but specific complications. However, the definition of complications of PCNL and their management still lacks consensus. PCNL is the first-line approach for large, multiple, and inferior calyx renal stones according to the European Association of Urology (EAU) guidelines. We aimed to evaluate the Technique, Outcome, and Complication of percutaneous Nephrolithotomy at Al-ribat Urology Center (Omer Sawi Hospital).
METHODS: A prospective, institutional-based cross-sectional study was used to investigated all patients presented to the study area with renal stones during the period from November 2019 to January 2020 in Al-Rebat Hospital. . A total of 28 patients were enrolled using multi-stage sampling.  The researcher completed a validated questionnaire consisting of several sections to assess outcomes and complications of percutaneous nephrolithotomy.
RESULTS: the study assessed the outcome of PCNL among 28 patients. The study found that the mean size of stones recorded was 1.25 cm, and the stones were on the left and right kidneys in 53.6%, and 46.4% respectively. Stones present by a percentage of 10.7%,28.6%, and 53.6% in the upper and lower calyx and pelvis respectively. The stones were rounded in 78.6% and staghorn in 21.4%. the stone was single in 53.6% and multiple in 46.4%. all operations were done under fluoroscopy guidance. Patients were supine in 25% and prone in 75% of the operations. The mean operative time was 27.9 minutes calculated from puncture time does not include retrograde and positioning. In addition to that 57.1% of the patients had nephrostomy tubes and double J. 92.9% of the patients were stones-free at the end of the operation. Injury to the surrounding organs did not occur. Mild bleeding occurs in 10.7% of the patients, in which blood transfusion was necessary. Extravasation of fluid occurs in 10.7%. Fever occurs in 42.9%. Most of the patients stay for 1 day postoperatively 57.1%.
CONCLUSION: This study demonstrated that PCNL is a safe elective, minimally invasive surgical modality with good outcomes and lower incidences of major complications.
Knowledge, Attitude, And Factors Affecting Human Papilloma Virus Vaccine Uptake Among Female Undergraduate Students In Public Tertiary Institutions In Lagos State Nigeria.
Authors: Okoka Elile Monisola , Odeyemi Joshua Olufisayo , Olu-Ajayi Mariam Ajoke
Published: January 2024

BACKGROUND: Human Papillomavirus is responsible for about 99% of all cervical cancers. Cervical cancer remains a leading cause of morbidity and mortality in women from Low and middle-income countries. Vaccination against human papillomavirus (HPV) is an effective way to prevent the disease, however, uptake remains low in Nigeria. This study aimed to assess the knowledge, attitudes, and factors affecting Human papillomavirus vaccine uptake among female undergraduate students in public tertiary institutions in Lagos State, Nigeria.
METHODS: This was a descriptive cross-sectional study. A multistage sampling method was used to select 355 female undergraduate students from Lagos State University and the University of Lagos. Data was gathered using a self-administered structured questionnaire. Data analysis was done using Epi info version 7 statistical software and Chi square was used to test for statistical significance.
RESULTS: There were 355 respondents giving a response rate of 100%. The responders' average age was 23 years old. 63.4% and 61.3% had heard about cervical cancer and cervical cancer screening respectively. Only 27.6% had heard of Human Papilloma virus vaccine. While most of the respondents (53.8%) had poor overall knowledge of cervical cancer, majority had a positive attitude towards cervical cancer prevention and screening (80.8%). Only 1.1% of the respondents had received the HPV vaccine, and a lack of awareness about the vaccine was the most commonly reported barrier to uptake (64.7%). Also, only 3.7% had ever done a cervical cancer screening and the most commonly reported reason was “Fear of bad result”(31%). There was no association between overall knowledge of cervical cancer and uptake of cervical cancer screening (p=0.08).
CONCLUSION: In conclusion, despite the positive attitude towards cervical cancer prevention and screening, HPV vaccine uptake remains low among young women in this population, and knowledge about the vaccine is lacking. Increasing awareness of the link between HPV and cervical cancer and promoting the vaccine as a safe and effective method of prevention, may help to increase uptake.
Orthopaedic Surgery in the Metaverse: Current Data on Virtual-Reality Based Training
Authors: Tingey Mitchell T. , Taylor Parker R.
Published: January 2024

BACKGROUND: Immersive, realistic, and low-risk training has long been ideal for skill-based disciplines such as surgery. Recent advances in virtual reality technology have led to development of surgical training software with the goal to provide experience without risk. The aim of this review is to summarize the current data for virtual reality-based orthopaedic surgery training to evaluate how beneficial the technology may become in educational circumstances.
METHODS: A literature review was completed analyzing eight randomized controlled trials completed between 2019 to 2022 to evaluate the effect of virtual reality on orthopaedic surgery education for medical students and residents. Each trial included groups of learners that were trained on a specific procedure with standard methods (“control”) or virtual reality software (“VR group”). Subjects were then evaluated on completion of procedures with real-life models. Procedures included total hip arthroplasty (n=2), tibial intramedullary nail (n=2), slipped capital femoral epiphysis pinning (n=2), and unicompartmental knee arthroplasty (n=2). The primary metrics assessed were time to complete procedure and objective assessment scores. Secondarily survey results were evaluated regarding subjects’ perceived utility of virtual reality in orthopaedic surgery training.
RESULTS: 168 subjects (medical students n=68, residents n=100) were included across the 8 different trials. All trials included at least one objective assessment and it was found that overall, the VR group performed 19.9% better than control group on average (19.875 ± 18.324, 95% CI). Seven of the trials reported time to complete procedure, in which it was found that overall VR group completed the procedures 12% faster than control group on average (12 ± 10.988, 95% CI). Subjective measures showed that over 70% of subjects found the VR learning to be at least “helpful” or “useful”.
CONCLUSION: Early studies of the emerging field of virtual reality in surgical training are promising. When looking at objective measures and time to complete procedures, VR trained learners perform as well, if not better, than standard method learners. Inclusion of virtual reality-based practice in medical school curricula and residency training may lead to less surgical errors, increased knowledge of procedures, and more efficient learning in real-life scenarios. This potential impact extends beyond well-resourced institutions, as VR technology can provide a cost-effective and accessible alternative for surgical training in low-income and low-resource areas of the world, democratizing access to high-quality medical education. Continued research on translation into clinical practice is warranted, with the potential to bridge educational disparities and improve surgical outcomes on a global scale.
Cross Sectional Study on Various Menstrual Hygiene Products Used Among College Going Students of Central Gujarat, India
Authors: Bavadiya Bhoomi , Thakur Dhruvi
Published: January 2024

BACKGROUND: In recent years, there has been significant progress in raising awareness about menstruation in Indian society, primarily through educational initiatives and various communication channels. However, one critical aspect that often remains overlooked is menstrual hygiene products. This study aims to bridge this knowledge gap by conducting a quantitative assessment of students' preferences, their level of knowledge, reliability ratings, and acceptability of various menstrual hygiene products. Additionally, the secondary objective is to identify the common challenges and discomforts frequently experienced by women when using these hygiene products.
METHODS: This study takes on a descriptive approach, primarily focusing on assessing the knowledge, attitudes, and practices related to menstrual hygiene products among young females. Data for this study was collected through online questionnaires and meticulously organized in Excel sheets for comprehensive analysis.
RESULTS: Our research involved 186 medical students, the majority of whom displayed a good understanding of menstrual hygiene products and their usage. It is noteworthy that 75% of the students reported facing issues while using these products. However, these challenges did not significantly disrupt their daily activities, indicating their resilience and adaptability in managing these difficulties.
CONCLUSION: Disposable pads emerged as the favored menstrual hygiene product among the participants due to their convenience, hygiene, comfort, and high absorption capacity. Nevertheless, it is crucial to acknowledge that users of disposable pads often encounter issues such as skin irritation, leakage, unpleasant odors, and a potential risk of infection. This underscores the need for continuous efforts to improve product design and education surrounding menstrual hygiene to ensure the well-being and comfort of women.
Impact of USMLE Step 1 Transition to Pass/Fail Scoring System on Medical Students' Anxiety, Sleep Quality, and Burnout
Authors: AlDoori Lana , Zaki Peter G. , Joshi Vivek
Published: January 2024

BACKGROUND: Originally designed to evaluate the application of foundational scientific knowledge in clinical contexts, the United States Medical License Exam Step 1 evolved into a comparative tool for assessing candidates' educational foundations. This transition heightened the pressure on medical students to excel in the exam. In response, collaborative efforts involving the National Board of Medical Examiners prompted a significant change from reporting scores to a pass/fail system. However, the true impact of this shift remains insufficiently explored. This study aims to assess the emotional toll - encompassing burnout, anxiety, depression, and sleep quality - experienced prior to taking the Step 1 exam. Additionally, it aims to uncover potential gender-based disparities in perceived stress, anxiety, and depression.
METHODS: The study encompasses the entirety of third-year medical students at Drexel University College of Medicine, who were invited to participate in a comprehensive survey. Drawing from retrospection, the survey relies on self-reported data regarding anxiety, depression, sleep quality index, and burnout levels. Data compilation was anonymized and executed through the Qualtrics platform.
RESULTS: A total of 102 medical students completed the survey, with a 97% pass rate for the USMLE Step 1. Despite their excellent performance, 75% of students reported inadequate sleep quality, and 68% exhibited mild to moderate anxiety levels. Among them, a higher percentage of females (83%) experienced mild to moderate anxiety compared to their male counterparts (50%). Furthermore, 66% of students felt that their commitment to education exceeded what was reasonable for their well-being.
CONCLUSION: The transition from traditional scoring to a pass/fail system was ostensibly intended to enhance the mental well-being of medical students. Nevertheless, our findings underscore that students continue to grapple with heightened levels of stress, anxiety, and burnout during the pivotal month leading up to the Step 1 examination.
Use of Stent in Choledochocholedochostomy for Pediatric Liver Transplantation Secondary to Hepatoblastoma: A Case Report
Authors: Saldaña-Ruiz Mauricio Alejandro , Rendón-Saldívar Mauricio Linnery , Sánchez-Maldonado Héctor Fernando , Álvarez-Treviño Guillermo Alberto , Ortiz-Alonso Federico
Published: January 2024

BACKGROUND: Hepatoblastoma is a malignant tumor with an insidious clinical presentation, however, it is characterized by an increase in abdominal circumference. In addition, there is PRETEXT staging based on the degree of liver involvement, which ranges from I to IV, of these, for stage IV the treatment of choice is liver transplantation. In addition, the use of stents in the the choledocho – choledochostomy has been tried to reduce post-transplant complications, with variable results.
THE CASE: A 18-month-old female with a diagnosis of PRETEXT IV hepatoblastoma and a history of receiving 11 cycles of chemotherapy (CTX) with SIOPEL-3HR scheme, subsequently initiates protocol to receive liver transplantation for being an ideal candidate and PRETEXT IV staging, received from a related living donor. During surgery, it was decided to place a biodegradable stent to perform the choledocho – choledochostomy. She also had hemorrhagic shock grade IV secondary to blood loss, which was successfully resolved. In her first two days post-transplantation she presented adequate flows by Doppler ultrasound and liver enzymes with a downward trend, which remained with the same trend, and she was discharged on day 26 post-transplantation. The following month, she received a cycle of adjuvant CTX with SIOPEL-3HR scheme, without complications. One month later she presented cholestasis and jaundice, so the stent was removed. Currently free of disease, functional graft, and adequate psychomotor development.
CONCLUSION: Although the use of a stent was intended to prevent complications such as biliary obstruction, since it is the most feared complication during liver transplantation, this was not the case of the patient, so it could be considered that it continues to be a controversial technique. Also, the use of chemotherapy after transplantation is important to be free of disease since clinical studies have shown an increase in patient survival.
Antibiotic Use Awareness and Practices in the Indian Community During Later Stages of COVID-19 Pandemic: A Cross-Sectional Survey
Authors: Ghosh Hiyanoor , Gupta Kanchan
Published: January 2024

BACKGROUND: Irrational prescription of, and self medication with antibiotics is a rampant problem in LMIC'S like India. The prescription of antibiotics for symptoms similar to Covid-19 infection has aggravated the problem of antibiotic overuse, further worsening antimicrobial resistance. This study aims at understanding not only the extent of overuse, but also the social patterns and causes of overprescription or self medication of antibiotics in India.
METHODS: A cross-sectional survey of the knowledge, attitude and practices on antibiotic use was conducted from September to October, 2022, using a Google form questionnaire. A virtual snowball technique was used to recruit respondents.  
RESULTS: A total of 309 responses were received (56% female and 44% male). 59.5% of the respondents were between 15 to 30 years. Surprisingly, inspite of a majority of respondents (around 70%) having a health sciences background, 67.8% of respondents falsely believe that antibiotics speed up recovery from most coughs and colds. 94.8% of respondents had used antibiotics in the last one year.17.2% of respondents had taken antibiotics without the prescription of a doctor. The most common antibiotic used on prescription and self medication was Azithromycin. Only 20.7% of respondents took antibiotics on suspicion of having Covid-19, with the most common one being Azithromycin.
CONCLUSION: The study brings to light trends in the awareness and usage of antibiotics with greater emphasis on the Indian medical community. The findings of this study can be used to formulate a more effective Antimicrobial Stewardship Programs to curb antibiotic overuse. The use of antibiotics for self-limiting indications like cough, cold and sore throat needs to be restricted through stricter regulations. The study highlights that a greater knowledge on antibiotic use does not necessitate better attitude towards their cautious and rational use, nor does it guarantee a supportive attitude towards regulations on antibiotic dispensing. In spite of it's significant cardiovascular adverse drug reactions, Azithromycin was found to be the most commonly used antibiotic in our study. Relatively lower rate of self-medication with antibiotics was seen in our study, which might be due to a greater percentage of respondents with a healthcare background, thus exhibiting positive behavior practices on antibiotic use.
Incidentally Found Rectal Carcinoid Tumor in a 46-Year-Old Female: The Potential for Complications and the Importance of Screening Guidelines
Authors: Lapides Rebecca , Shah Akash , Bal Shubhneet , Ramapriya Vidhun
Published: January 2024

BACKGROUND: Carcinoid tumors are rare neuroendocrine tumors that can be found in the gastrointestinal tract as well as other areas throughout the body. The neurosecretory nature of these tumors can have implications for other chronic diseases that patients may have, including diabetes and hypertension. Certain treatments that may be implemented for patients that have carcinoid tumors, such as somatostatin analogs and Everolimus, can also alter blood glucose control. This highlights the importance of diagnosing and treating carcinoid tumors as early as possible to avoid complications associated with metastasis and more intense treatment. With more advanced disease, clinicians should consider the possible effects of carcinoid tumors and their treatments on other chronic conditions as they manage the patient. For gastrointestinal carcinoid tumors, colonoscopy screening guidelines are incredibly important to counsel patients on, as resection can yield a complete cure for carcinoid tumors when they are found at an early stage.
THE CASE: We describe the case of an incidentally diagnosed rectal carcinoid tumor in a 46-year-old female patient with a history of type 2 diabetes mellitus and hypertension. This tumor was discovered on colonoscopy, which had been delayed due to complications following a surgical procedure that the patient had recently undergone.
CONCLUSION: Carcinoid tumors are quite rare, however, the incidence of neuroendocrine tumors, including gastrointestinal carcinoid tumors, is growing. Thus, it is important to consider the implications of such tumors on pre-existing chronic conditions, such as diabetes and hypertension. Also, more research efforts should be directed towards standardizing the treatment protocol for such tumors, specifically rectal carcinoid tumors, and counseling patients on the importance of screening guidelines. When rectal carcinoid tumors are caught early, complete surgical resection can be curative, which is ideal. However, with more advanced disease, symptoms of the tumor itself as well as necessary treatments can impact other chronic conditions, possibly requiring modifications to a patient’s prior medication regimen. Fortunately, the carcinoid tumor in the described patient was not advanced enough to cause significant alteration in her other chronic conditions, however, this case is still a great example of how carcinoid tumors can arise asymptomatically, which is why it is important for the astute clinician to counsel on screening recommendations. This emphasizes the importance of using a team-based approach to ensure that the carcinoid tumor is diagnosed and adequately treated without significantly affecting other conditions so that patients can achieve optimal outcomes for each condition being managed. It also highlights the crucial importance of screening guidelines so that conditions can be caught early to mitigate downstream consequences.