Philosophy

‘There are No Such Great Philosophies’: Contested Meanings of Toasebio Parish in Jakarta

'THERE ARE NO SUCH GREAT PHILOSOPHIES' CONTESTED MEANINGS OF TOASEBIO PARISH IN JAKARTA Juneman Abraham1 1 Bina Nusantara University, Psychology Department, Jakarta, Indonesia,  ABSTRACT This present study aims at exploring the meaning of the building of Santa Maria de Fatima Catholic Church (abbreviated as: SMFCC) or Toasebio Parish located in District Glodok, Jakarta, Indonesia. The author exposes in advance the meaning of the physical elements of the building SMFCC as understood by history writers and building experts. These meanings are not inseparable from the elements of human activities in the building. Through qualitative methods and literature review, the author describes in the Results section, how those meanings can be further interpreted through the existing studies and expressions of the SMFCC Parish Head. It is found that these meanings are contested − from the direction of religious faith and of culture − but complete our understandings of the church which is well-known as an Indonesian cultural heritage and dominated by Chinese and pastors from Europe. Keywords: meaning, church, cultural heritage, Jakarta INTRODUCTION A church building that becomes a melting pot of various cultures must have great potential as a place of meaning contestation. This is because culture and religion contain systems of meaning and even mutually pervasive; in other words: culture is religious, and religion is cultural [1]. Morgan elaborated further, as follows: "Whereas culture and religion are convergent expressions of meaning, anthropology and theology must be understood to be disciplines addressed to the systematics of meaning, and, ..., the analysis of meaning will inevitably involve an analysis of the symbol as meaning bearer" [1, p. 371]. The present study has the same spirit as Morgan's proposition, and aims to illustrate the meanings contained in the Santa Maria de Fatima Catholic Church (SMFCC), located in Jakarta, Indonesia capital city. In the handbook of Church History of Saint Maria de Fatima, the origins of SMFCC are presented [Toasebio, Sejarah singkat Gereja Saint Maria de Fatima, (n.d.)]. We mention [erratum: It is mentioned] that the original building SMFCC already existed since the early 19th century in the form of a house with Chinese architecture. Attributes that characterize this house were: First, luxury and grandeur, nobility, characterized by male and female lion statues on the right and left in front of the building. That said, originally in its vast yard there was also a sapodilla tree and a high-floor joglo pavilion and the land was surrounded by a high walled wall [2]. Second, on the roof, peaks look sticking out. Third, on the edge of the roof, there is a combination of red yellow-gold and green-leaves with flower ornaments and fruits (symbols of peace and prosperity) and writing in Chinese characters. Fourth, on the edge of the roof of the main building there were four Chinese writings, namely 'Hok Shau Kang Ning' (front side) which means 'house or place of peace', 'Hok Chia Phin An' (back side) meaning 'one family would be safe and wealthy', 'Nan An Shien' (the left side) which is thought to be one of the areas in China from the homeowner's family, as well as 'Chuan Chau Fu' (right-hand side) hypothesized as the surname of the owner. The building element that makes it function as a church is a large cross on the roof of the main building, an 'Gereja Katolik Santa Maria de Fatima' inscription mounted above the main door of the church, the bell tower standing on the right side of the front of the church, and the Maria de Fatima Hill on the left front of the church. The altar of this church comes from the place of family prayer. In 1972 the Church of Santa Maria de Fatima was officially recognized and protected by the Law as National Cultural Heritage, and on 29 March 1993, it was officially declared as a Jakarta Provincial Heritage Building with the Decree of the Governor of Jakarta PRE-PRINT VERSION 2 no. 457/1993 (Komsos Paroki Toasebio, as cited in [Berto, Paroki Toasebio, gereja inkulturasi, 2017, ]). In 1950, three Jesuit priests (two from Austria and one from Netherlands) who came from mainland China, followed by Pastor Wilhelmus Krause Van Eiden SJ (1953), a state law expert, bought a plot of land in Toosebiostraat area (now: Jalan Kemenangan III) to establish churches, dormitories and schools for Overseas Chinese. The land was purchased from a Kapitan (a name for a Chinese descendant of the Dutch colonial period) surnamed Tjioe [2, p. 8]. In 1954, when Father Matthias Leitenbauer SJ arrived in Jakarta, the land and buildings on it officially belonged to the church. Land payments were collected from pastors' funds by providing oneyear foreign language courses in Toasebio and the Catholic community in Austria. Because many of the people spoke only Mandarin, the Chinese Pastor, Father Joannes Tcheng Chao Min SJ, was assigend in. On September 14, 1955, Toasebio Station was promoted to become a Parish, the Saint Maria de Fatima. Starting from the request of the Xaverian Missionary Society (SX) to the Archbishop of Jakarta, Mgr. Adrianus Djajasepoetra SJ, in order to work in the Archdiocese of Jakarta, the Bishop offered the Toasebio Parish to the Xaverian Society. On November 1, 1970, the Toasebio Parish was handed over to Father Pietro Grappoli SX, which was subsequently replaced by Father Otello Pancani SX [2, p. 10]. During the activity of Father Otello, there were: the extensive renovation of the Church building, the replacement of floors and ceilings and the arrangement of the site for the Maria de Fatima statue − from Ortisei (Northern Italy) − and the Sacred Heart of Jesus statue. On the idea of Father Otello, a wood was carved depicting Jesus on a cross flanked by two criminals. The carving was sent from Italy and installed in the days of Pastor Liliano SX. The carving was mounted over the front of the altar. On March 10, 1989, Father Josep Bagnara SX was appointed Archbishop of Jakarta, Mgr. Leo Soekoto SJ, as the Head of Parish of Toasebio SMFCC. Since Father Josep's work, it is held six times per week the Holy Mass (i.e. once on Saturday afternoon, and 5 times on Sunday). Among the mass schedules, there is also a sacred Mass in Chinese, which is held every Sunday at 4:00 pm. In the Toasebio Parish 50 Year Book [2, p. 3-4], Father Josep Bagnara pointed out that SMFCC (a.k.a. Toasebio) at Glodok sub-district, Tambora, is the most crowded area in Jakarta. In that year, 2015, Toasebio Catholics numbered approximately 4500 people. In the same book, Archbishop Malcolm Ranjith as Apostolic Nuncio, the Vatican's Ambassador to Indonesia delivered the message, "I wish Santa Maria parish could produce a few saints even for public veneration one day. That would be the challenge.... We ought to remember that it is really the Lord who has made this Our Lady of Fatima parish grow that way. For, 'unless the Lord builds the house, in vain do its builders toil,' says the psalmist [Ps. 127:1]". Thamrin and Arifianto, experts on buildings, wrote their analyses on SMFCC as follow: "The process of building this church utilizes existing buildings without changing the existing structure so it still looks authentic .... The application of Chinese cultural diversity in the interior design of this church looks at aspects of shape, use of materials, and colors in buildings, layout space, space-forming elements, transition elements, space fill elements, and aesthetic elements .... The shape of this church building which was originally a symmetry-looking residence is preserved to this day and is one of the distinctive Chinese cultural characteristics that lead to a life which is balanced .... This church has a roof in the shape of ren zi xuan shan which is generally used in residential buildings. At the end of the roof of the building has a swallow's tail which is commonly used in palace buildings, pagoda, and noble house .... The right and left of the church building is escorted by a pair of cion sai (rock lion). The male is on the left with his right claw on the ball symbolizing the unity of the whole country, and the female on the right with her left paw stroking the lion who symbolizes the source of happiness .... At the front wall of the church, there are ornamental motifs, i.e. the peony flower motif symbolizes honor, and meanders symbolize longevity, as well as geometric patterns or diaper patterns. The existing geometric pattern in the form of a circle is the symbol of heaven, and a box is the symbol of the earth, so it is placed at the top of the wall. The combination of these decorations shows the position of homeowners who expect happiness in a balanced life .... The use of red in this area 3 shows the degree of sanctity, as the center of church activity in proclaiming the good news.... Sedilia of the priests is an extension of the scholar's seat during the Ming dynasty." [4] Parish of SMFCC (Toasebio) from 1955 to 1970 (for 15 years) was served and led by Jesuit (Society of Jesus) priests. The ministry's work was continued by the Xaverian Missionary Society (SX) and assisted by CDD speakers to serve Chinese-speaking people. Until 2018, the SX Society has been instrumental in developing the Toasebio Parish for 48 years (1970-2018). Today the Toasebio Parish is led by Father Fernando Abis SX (since 2015). It is interesting to know his perspective on the SMFCC building; whether there is any compatibility, contradiction, or 'revision' to what has been suggested by the history writers and the building experts as mentioned above. When compared to Coomans' investigations, the interesting thing found throughout this study is that almost no SMFCC priests are "actively involved in the debate about sacred art and architecture" [5, p. 91], at least in terms of documentation that SMFCC owns. This also prompted the author to conduct an interview with the Head of the SMFCC Parish. MATERIALS AND METHODS This present study uses qualitative method and literature review. Data was collected from the present Head of the SMFCC Toasebio Parish, Father Fernando Abis SX, by conducting an indepth interview on Wednesday, April 4, 2018 (Fig. 1). Interview data was then compared with findings from both from internal documents of SMFCC. and from scientific journals. RESULTS The 1950s' atmosphere of building and rebuilding (renovation) SMFCC in Chinatown of Jakarta may not be much different from building a Christian church in China at the beginning of the 20th century. Among the challenges is that in addition the church building must be recognizable as a church, should also be practical, beautiful, and suitable for worship [5]. In relation to the practicality dimension of SMFCC (Fig. 2-4), Father Fernando Abis said that, in a church, there is indeed no virtue of any culture, including Chinese culture, above others. The uniqueness of the SMFCC, which is the maintenance of the Mandarin background of the majority of Chinese descendants, should be seen as 'the winning of the needs of the people'. The Catholic Church wants all cultures to get 'their own home' in the church, where people feel accepted as they are, so they are driven to accept others as they are as well. The context of the need for the establishment of the SMFCC Parish (originally: Toasebio Statio Station) was as a special treatment place for Chinese descents so they could be protected from a less conducive atmosphere in those days, where "Chinese ethnicity is separated from the host community" [6, p. 2] and culminated in the New Order Era where the three pillars of Chinese culture, namely the Chinese-language press, Chinese high schools, and Chinese ethnic organizations were eliminated from Indonesia [6]. The use of Chinese language was not supported since 1966. In the early days of SMFCC, the longtime Father in China came to SMFCC and used Chinese language and culture to serve and develop the 'alienated' and 'solidarity-needy' Chinese people in Jakarta. SMFCC formed a group of Mandarin that existed until now. People who can not speak Indonesian can comfortably pray according to their conscience and comprehension in Mandarin. Not surprisingly, on the basis of this practical dimension, Father Fernando Abis stated, 'There are no such great philosophies, indeed. In fact, there is no intention of the form of the church and its parts to carry a particular message. The synthesis of elements of the church is dominated by practical actions, the contribution of some aspirant people, who follow the spiritual appetite of the majority of Chinese Catholics.' [Father F. Abis 2018, pers.comm., 4 Apr] The form of the church is an expression of the taste of the local community in a given time and arranged in such a way that supports the sense of security, majesty, beauty, and prayerfulness. 4 In the aspect of beauty, a French Jesuit handbook (as cited in [5, p. 104]) conveyed, "Inscriptions of happiness and longevity... and all other familiar things to a Chinese would create a sympathetic atmosphere and attract him to a church" although this is criticized for not conforming to the "comforting theory of pain, which Christ came to teach". In this connection, Father Fernando Abis emphasized the phrase 'ens bonum, verum et pulchrum convertuntur' which according to him means: goodness, truth, and beauty are mutually supportive, substituting, and convertible. The beautiful has no faults. The beautiful is a gift from God. The truth must be beautiful. The beautiful must be good. For example, the pulpit in the SMFCC contains elements of carvings that are the encounter between Chinese art and Balinese art. The overall aesthetic of SMFCC is a bonum, because the beautiful, harmonious impression of this church makes SMFCC a reasonable, comfortable place of prayer, which gives an atmosphere of prayer for people, making people feel 'at home'. It was stressed by Father Fernando Abis, that carvings, sculptures, etc., are symbols that show the true faith (verum) in depth. In the context of SMFCC, one should not misunderstand an important thing: The element of diversity, inculturation, and cultural encounter within the SMFCC is inappropriate when positioned as a conductor to complete faith. It is not the diversity that is the basis of the development of faith. Rather, the opposite. It is faith that brings appreciation for diversity. For by faith, brotherhood and love are measured. Faith is the basis for respecting all cultures and all ways of prayer with any symbol, structure, or passion. Therefore, in the SMFCC, people are not exclusive; they can meet believers of any tribe. In the aspect of fitness for worship/liturgy, Coomans [5] had pointed to the fact that Papal Encyclical Letters of Maximum Illud and Rerum Ecclesiae provide an endorsement of the inculturation of the church with the local culture. Since the priests of SMFCC are dominated by priests from outside Indonesia (Austria, Italy, Spain, etc.) − where this condition differs from most of the Catholic churches in Jakarta nowadays − it can be assumed that a special adaptation of priests, especially Westerners, is required. Except for pastors who have worked in mainland China, at least they have to learn indigenous actuality, ranging from material conditions, climate, and Chinese culture. In relation to this, Father Fernando Abis emphasized that "Any artifact of any culture which is a symbol of spiritual relationships (the sign of faith, the grace of God), which supports the heart-directedness to God, shows prayer and unity (i.e. mutually recognizes and respects) in faith (as the tradition inherited from Christ), is lawful, in the sense that it can be used as far as it takes, as long as it is free of superstition." [Father F. Abis 2018, pers.comm., 4 Apr]. He took the example in the SMFCC context, the Tabernacle ("A cupboard or boxlike receptacle for the exclusive reservation of the Blessed Sacrament" [Catholic Dictionary. Tabernacle, 2018, ]) presumably in the past was the most valuable jewelry store of a housewife. In addition, the place for reading scriptures uses Chinese noble home materials, whether former doors or other materials, which was then accommodated and matched to the need of the church. Father Fernando Abis also compared with the term 'basilica'. According to him, in the original meaning, it is a large house king residence, the place for his relatives and general people, which could be used to gather. Basilica is a general term that then has a spiritual connotation, which is a church building. However, the principle in general terms and spiritual terms are actually the same. CONCLUSIONS This present study assumes that culture and religion are inseparable in explaining meanings. A prominent finding of this study is that the cultural encounter between priests and people as well as between church citizens and cross-cultural objects is interpreted differently − but complementary in perfecting our understanding of the parish − by history writers, building experts and parish leader. The historians the construction experts made cultural symbols of the architecture of the church building as a 'foreground', a material for the primary collective representation analysis. In contrast, the Parish Head, Father Fernando Abis SX, performed a sort of "desecularization − from above" [7] in its loosest sense, by making theological faith an 5 unwavering basis of all interpretations of the SMFCC's physical atmosphere and its community activities. Architectural philosophies and cultural interpretations are placed as the 'background' in the Father's narrative; a more or less natural thing, considering his position as a church leader. BIBLIOGRAPHY [1] J. Morgan. Religion and culture as meaning systems: a dialogue between Geertz and Tillich. The Journal of Religion, vol. 57, issue 4, October (1977), 363-375. [2] A.T. Gunarta, R. Glen, K.A. Kusumawati, A.J. Teddy. Buku kenangan 50 tahun Paroki Santamaria de Fatima 1955-2015, Paroki Santamaria de Fatima, Jakarta (2015) 1-120. [4] D. Thamrin, F. Arifianto. Keragaman budaya Tionghoa pada interior Gereja Katolik (Studi kasus: Gereja Santa Maria De Fatima di Jakarta Barat). Dimensi Interior, vol. 9, issue 1, June (2011), 1-12. [5] T. Coomans. A pragmatic approach to church construction in Northern China at the time of Christian inculturation. In: "The handbook 'Le missionnaire constructeur'", 1926. Frontiers of Architectural Research, vol. 3, issue 2, June (2014), 89-107. [6] L. Suryadinata. Kebijakan Negara Indonesia terhadap Etnik Tionghoa: dari asimilasi ke multikulturalisme?. Antropologi Indonesia, vol. XXVII, issue 71, May (2003), 1-12. [7] V. Karpov. Desecularization: a conceptual framework. Journal of Church and State, vol. 52, issue 2, July (2010), 232-270. Fig. 1 - Juneman Abraham (the author) with Father Fernando Abis SX, the Head of Toasebio/SMFCC Parish, after an interview session Fig. 2 - Toasebio Parish SMFCC (a day before Chinese New Year). Source: Fina, WhatsApp Group PASKA Ricci on 15 February 2018 Fig. 3 - Toasebio Parish [Fina, 15 Feb 2018] Fig. 4 - Toasebio Parish [Fina, 15 Feb 2018]


Philosophy

Vulnérabilité des femmes enceintes en éthique de la recherche: un problème sémantique

SN Abtroun. Can J Bioeth / Rev Can Bioeth. 2019, 2(2):11-14 Canadian Journal of Bioethics Revue canadienne de bioéthique 2019 SN Abtroun. Creative Commons Attribution 4.0 International License ISSN 2561-4665 COMMENTAIRE CRITIQUE / CRITICAL COMMENTARY (ÉVALUÉ PAR LES PAIRS / PEER-REVIEWED) Vulnérabilité des femmes enceintes en éthique de la recherche : un problème sémantique Sihem Neïla Abtroun1 Résumé Abstract Ce commentaire s'intéresse à la notion de vulnérabilité appliquée aux femmes enceintes en recherche clinique. L'utilisation de cette notion, liée à un problème sémantique, soulève un enjeu éthique et participe à l'exclusion quasi systématique de cette frange de la population du processus de recherche. This commentary explores the notion of vulnerability applied to pregnant women in clinical research. The use of this notion, related to a semantic problem, raises an ethical issue and participates in the quasi-systematic exclusion of this sub-population from the research process. Mots-clés Keywords éthique de la recherche, femmes enceintes, vulnérabilité, stigmatisation, recherche clinique research ethics, pregnant women, vulnerability, stigmatization, clinical research Introduction La vulnérabilité des femmes enceintes, dans le domaine de la recherche, est sujette à controverse du fait de la définition même du terme " vulnérabilité " : il s'agit d'un paradigme qui existe entre certains textes de régulations de la recherche qui ont évolué et ne catégorisent pas les femmes enceintes comme vulnérables, et la réalité du milieu de la recherche qui les exclut continuellement du fait de la simple perception de cette frange de la population comme vulnérable [1-4]. À l'instar du conseil des organisations internationales des sciences médicales (CIOMS), l'Énoncé de Politique des Trois Conseils, deuxième édition (EPTC2) - a qui régit la recherche avec des participants humains au Canada - ne catégorise pas les femmes enceintes comme une population vulnérable, mais l'attention particulière qui leur est portée pourrait participer à leur perception comme des personnes vulnérables et porter à confusion [5,6,7]. Bien qu'il n'existe pas de définition uniformisée du concept de vulnérabilité, il en existe diverses compréhensions et appréhensions par les chercheurs en recherche clinique qui l'utilisent abusivement pour exclure les femmes enceintes. Il est aussi important de souligner que dans d'autres textes règlementaires à l'international, comme les textes législatifs régissant la recherche en France [8] ou le Code of Federal Regulations aux ÉtatsUnis [9], aussi bien que dans la littérature biomédicale [4], les femmes enceintes sont encore clairement qualifiées de " vulnérables ". On comprend donc que cette notion de vulnérabilité et le problème sémantique qu'elle soulève sont fortement ancrés dans la pratique en recherche et plus particulièrement en recherche clinique. On s'intéressera donc dans ce commentaire à la notion de vulnérabilité des femmes enceintes selon deux conceptions : la première, aisément réfutable, liée à la capacité décisionnelle et la seconde liée au risque de tort potentiel. On conclura par le fait que la compréhension erronée de la notion de vulnérabilité et son application aux femmes enceintes ont participé à leur exclusion systématique de la recherche, d'où la nécessité de se libérer de la vision surprotectrice et contre-productive de la vulnérabilité supposée des femmes enceintes et ainsi promouvoir leur participation à la recherche. Femmes enceintes : participantes vulnérables Comme nous l'avons souligné précédemment, il existe plusieurs conceptions de la vulnérabilité. Les plus répandues sont la vision nord-américaine où la vulnérabilité est liée à une altération de la capacité décisionnelle et la vision internationale à prédominance européenne liée au risque de tort couru par le participant. Au Canada, selon l'EPTC2, " la vulnérabilité résulte souvent d'une capacité décisionnelle limitée ou d'un accès limité à des biens sociaux comme des droits, des opportunités de développement et du pouvoir " [7]. Tout en sachant que l'EPTC2 ne qualifie pas les femmes enceintes de vulnérables per se, nous utiliserons sa définition dans un premier temps pour pouvoir analyser cette conception souvent utilisée à tort de la vulnérabilité chez la femme enceinte [5,7]. Cette conception de la vulnérabilité est aisément réfutée, car dans le cas des femmes enceintes, le fait d'avoir été fécondé et donc de porter un être vivant en elle ne modifie pas leur pouvoir décisionnel ni leur statut socioéconomique. Ainsi, si cette définition de la vulnérabilité proposée par l'EPTC2 est appliquée stricto sensu à la femme enceinte, elle renverrait donc à une notion erronée. En ce qui concerne cette sous-population féminine, il n'existe pas de problème de compréhension ni de limitation de ressource ou d'accès ; sachant qu'il existe des situations où les femmes peuvent être désavantagées, du fait d'inégalités de genres et socioculturelles, indépendamment de leur statut de gestation [10]. Cette définition apparait donc comme obsolète et ne saurait être appliquée aux femmes enceintes. Cependant, Basaia décrit la femme enceinte comme vulnérable du point de vue psychologique, à cause des changements liés à la grossesse, mais qui " conserve toutes ses aptitudes qui la maintiennent libre de ses choix " reprenant le concept de " personne vulnérable, mais capable " [8]. Cette description problématique de la femme enceinte " vulnérable, mais capable " pourrait potentiellement contribuer à son exclusion systématique, mais aussi celle de l'ensemble des femmes en s'inscrivant dans une version paternaliste extrême, certes peu probable, où toutes femmes subissant des variations physiologiques seraient exclues. van der Zande et collègues ont quant à eux analysé " la vulnérabilité des femmes enceintes en recherche clinique ". Ils ont identifié quatre notions de vulnérabilité pour la femme enceinte : 1) la difficulté à obtenir un consentement éclairé, qui ne peut être appliqué dans ce cas ; 2) une susceptibilité accrue à la coercition par le fait d'être induit en erreur en mettant le bien-être Abtroun 2019 Page 12 éventuel du foetus avant leur propre bien-être ; 3) la vulnérabilité propre du foetus comme un participant inapte ; et enfin 4) une augmentation du risque lors de la recherche par manque de données scientifiques concernant les femmes durant la grossesse. Les auteurs ont finalement réfuté les trois premières visions et ont conclu que la vulnérabilité de la femme enceinte est due au manque de savoir scientifique concernant cette sous-population qui entraine un risque plus élevé par rapport aux autres participants à la recherche [4]. Si plusieurs visions en recherche clinique contribuent à la catégorisation des femmes enceintes comme vulnérables, la plus répandue actuellement serait peut-être celle liée au fait d'un risque possiblement plus élevé lors de leur participation aux processus de recherche [2,3,11-13]. Cette conception de la vulnérabilité répond à la vision internationale de la vulnérabilité liée aux risques potentiels auxquels s'exposent potentiellement les participants. Ainsi, Hurst définit la vulnérabilité comme " un risque accru de subir un tort et qui peut exister ponctuellement ou durablement, face à toutes sortes de torts, pour différentes raisons " [12, p.1057]. Tout en évoquant la multifactorialité de la vulnérabilité, celle-ci pourrait alors s'appliquer aux femmes enceintes de différentes façons. Tout d'abord, elles font face à des modifications physiques et physiologiques de leurs corps qui s'apprêtent à faire grandir un être en elles ainsi qu'à des modifications psychiques : les émotions par rapport à leurs foetus existent dès le début de la grossesse. À cela sont associées une responsabilité accrue et une protection instinctive de la future mère envers son enfant à venir. Enfin, le foetus représente une entité propre exposée à des risques malformatifs et abortifs, et il est aussi appelé à être individu vivant (enfant puis adulte) qui pourrait subir les conséquences de la recherche, avec comme une ombre noire qui plane les réminiscences des dérives de la recherche liées à la thalidomide ou au distilbène. Dans le milieu de la recherche clinique, la santé physique et psychologique de la femme enceinte est souvent mise au second plan par rapport à la santé du foetus. Selon la conception traditionnelle de la grossesse, il y aurait une dichotomie entre le foetus et la femme gestante (la mère) qui peut parfois mener à la priorisation du foetus au détriment de la mère [2,14]. Toutefois il semble que l'on devrait considérer la femme enceinte et son foetus comme un couple indissociable et interconnecté ; une modification de l'état de l'un a inévitablement des répercussions sur l'autre, qu'il soit bénéfique ou non [1]. On peut imaginer, par exemple, qu'une participation à une recherche clinique qui améliorerait la santé du foetus et de l'enfant à venir améliorera par conséquent la santé psychologique et la qualité de vie future de la mère. De la même manière, les risques ainsi que les éventuelles répercussions à court et long terme pour la femme gestante seule, le couple mère-foetus et l'enfant à venir sont incontestables. Mais si la femme enceinte appartient à une sous-population à risque accru, cela signifie-t-il nécessairement que ce groupe est vulnérable et doit être surprotégé? Sachant que cette catégorisation pourrait conduire à son exclusion en se basant sur une vulnérabilité plus " hypothétique " que réelle [5]. En réponse à van der Zande et collègues [4], Krubiner et Fraden [14] ont relevé le fait que les femmes gestantes représentent une partie importante des soins thérapeutiques administrés dans les différentes sociétés, mais leur exclusion de la recherche biomédicale perpétue " un cercle vicieux " qui induit un manque de connaissance et donc leur exclusion systématique. Le point le plus pertinent étant que les femmes enceintes doivent " être protégées durant la recherche et non pas de la recherche elle-même " [14]. Le statut des femmes enceintes en recherche est qualifié de " vulnérabilité paradoxale " [13] car la majorité des médications prescrites aux femmes durant la grossesse ne sont pas agréées pour être utilisées chez les femmes enceintes [3-4]. Dans certains cas, seul l'état de grossesse induit une iniquité face à la participation potentielle des femmes enceintes à la recherche. Ainsi à travers l'exemple allemand, Wild [2] illustre parfaitement ce concept : bien qu'il n'existe pas de législation précise régulant la recherche sur les femmes enceintes en Allemagne, leur vulnérabilité est largement acceptée. Elle rapporte plusieurs cas où les femmes enceintes sont exclues catégoriquement de la recherche clinique. Un des exemples les plus parlants est celui du ministère de la santé allemand qui, en 2009, a publié que des essais cliniques en vue de l'approbation d'une vaccination contre la souche H5N1 n'ont pas été conduits sur les femmes enceintes pour raisons éthiques. L'auteure note que " les raisons éthiques " ne sont ni spécifiées ni explicitées, mais résultent de stéréotypes [2]. Il est évident que considérer les femmes gestantes comme vulnérables restreint la conduite d'essais cliniques qui permettraient pourtant d'augmenter les données scientifiques probantes les concernant. L'existence de telles données améliorerait leur participation aux processus de recherche [3] alimentant un puits sans fin. Une mesure de protection qui, en finalité, entraine une exclusion. Par conséquent, l'utilisation et la perception mêmes du terme de " vulnérabilité " pour décrire la population des femmes enceintes est inadéquat. Il pose un problème sémantique réel, car il fait référence dans le domaine de la recherche soit à une possible incapacité décisionnelle qui est généralement absente dans ce cas, soit à un risque incommensurable par le seul fait que la femme est gestante. Ainsi, la femme qui était une participante compétente et potentielle perd cette possibilité par le seul fait de porter un foetus et nécessite donc une protection accrue qui finit par l'exclure quasi systématiquement de la recherche. Femmes enceintes : participantes particulières Prenons l'exemple des textes de régulation de la recherche qui ne considère pas les femmes enceintes comme vulnérables per se [5-7,15]. Ainsi, L'EPTC2 ne catégorise pas les femmes enceintes comme vulnérables, mais requiert à travers l'article 4.3 que " les femmes ne doivent pas être indûment exclues de la recherche uniquement en raison de leur capacité de procréer ou parce qu'elles sont enceintes ou qu'elles allaitent. [...] À moins qu'il n'y ait une raison valable de le faire, les chercheurs ne devraient pas exclure les femmes de la recherche en raison de leur capacité de reproduction ou parce qu'elles sont enceintes ou parce qu'elles allaitent " [7], et cela tout en tenant compte des risques et des bénéfices de leur participation. Cette conception de participante particulière est confortée par le Conseil des organisations internationales des sciences médicales (CIOMS) qui, en 2016, a affirmé que " les femmes enceintes ne doivent pas être considérées comme des personnes Abtroun 2019 Page 13 vulnérables simplement en raison de leur état. Toutefois, des circonstances particulières, telles que les risques pour le foetus, peuvent justifier la mise en place de mesures de protection spéciales. " [6] Cependant, bien que L'EPTC2 et le CIOMS, dans la ligne directrice 19, encouragent la participation des femmes enceintes à la recherche, ils soulèvent la difficulté de son application concrète dans le milieu de la recherche. Par exemple, le CIOMS met en avant le bénéfice personnel de la femme et de son foetus : si le bénéfice de la recherche est sociétal et non individuel, les femmes enceintes ne pourront y participer que si le risque est minime, ceci met clairement en évidence le problème de l'évaluation éthique du bénéfice-risque ; bien qu'il tente d'apporter des solutions et préconise d'inclure les femmes gestantes " uniquement après un examen rigoureux des meilleures données pertinentes possibles " [7,15]. Ces données probantes étant le plus souvent insuffisantes, le CIOMS tout comme l'EPTC2 dans l'application de l'article 4.3 (cité ci-dessus), s'en remet aux chercheurs et aux comités d'éthique [6,7], qui ont tendance à être surprotecteurs [1,9]. Mais cette surprotection des femmes et de leur foetus ne doit pas participer à leur exclusion systématique. Comment alors résoudre ce dilemme? Est-il lié au terme lui-même de vulnérabilité ou à son signifié? Même si la femme enceinte est potentiellement exposée à plus de risque dans la recherche du fait du manque de connaissances, sa protection doit s'affranchir de cette vision paternaliste historique et par conséquent ne pas considérer l'utilisation du terme de vulnérabilité pour les femmes enceintes. Si les femmes enceintes ne doivent pas être catégorisées comme vulnérables, elles sont des participantes particulières et le risque potentiel encouru nécessite une évaluation éthique plus raisonnable et plus prudente pour leur inclusion dans la recherche, mais ce postulat est valable pour tout participant à la recherche. Afin de promouvoir la participation des femmes enceintes à la recherche, van der Graaf propose de s'appuyer sur un système de santé apprenant ce qui répondrait aux attentes cliniques et de développement de la recherche, ce qui permettrait de dépasser les mécanismes surprotecteurs liés à une surestimation des risques par la communauté de la recherche [15]. Cependant un tel système ne permettrait que d'améliorer des protocoles existants, mais ne permettrait pas nécessairement le développement de nouveau traitement. Par exemple : il est évident que pour une condition comme l'hypertension gravidique et la prééclampsie, l'étude continue des données permettrait d'améliorer la santé de la mère et de l'enfant par une amélioration de la démarche diagnostique et thérapeutique, mais il serait tout de même difficile d'inclure des femmes enceintes pour tester de nouveaux médicaments. Quel que soit le domaine de recherche, il s'agit plus d'une évaluation éthiquement acceptable du risque encouru pour la santé physique et psychologique de la future mère et de la santé du foetus et/ou de l'enfant à venir, que de vulnérabilité telle que perçue dans ce milieu. En considérant les principes éthiques de base de la recherche, soit la bienfaisance et la non-malfaisance, la considération et l'évaluation du risque - même si celui-ci est plus élevé pour les femmes enceintes - ne doivent pas signifier pour elles systématiquement leur non-inclusion ou leur exclusion des processus de recherche. Conclusion Il serait préférable de supprimer le terme " vulnérabilité ", utilisé à tort pour les femmes enceintes, et de les considérer certes comme une sous population à part entière en tenant compte de leurs particularités physiques et psychologiques, mais sans surprotection. La femme enceinte est certes une participante particulière, cependant la grossesse n'est pas un état débilitant, mais un cycle immuable de la vie humaine qui permet de perpétuer l'humanité. Ainsi les femmes enceintes doivent être incluses dans la recherche en tenant compte des différents enjeux éthiques sans stigmatiser ou surprotéger cette frange de la population par rapport à une autre. Comme tout participant, elle peut faire face à des situations ou contextes augmentant sa vulnérabilité, mais cela est indépendant de son statut gestationnel. Une vision éthique acceptable serait plutôt de promouvoir leur inclusion et de leur offrir une information plus détaillée : des risques encourus à court et long terme pour elles et leur foetus et surtout des bénéfices potentiels et attendus de leur participation à la recherche pour la sous-population des femmes enceintes, de la population des femmes et de la société en général. Un défi futur et peut-être utopique en éthique de la recherche serait donc d'abolir définitivement le terme sémantiquement problématique de vulnérabilité pour les femmes enceintes. Remerciements Acknowledgements L'auteur tient à remercier Bryn Williams-Jones pour ses précieux commentaires. Elle remercie également les éditeurs et l'évaluateur externe pour leurs critiques constructives et leurs suggestions enrichissantes. The author would like to thank Bryn Williams-Jones for his valuable and helpful comments. She also thanks the editors and the external evaluator for their constructive critique and enriching suggestions. Conflit d'intérêts Conflicts of Interest L'auteur est éditrice pour la Revue canadienne de bioéthique. Son directeur de recherche est Bryn Williams-Jones, éditeur en chef de la revue. The author is editor for the Canadian Journal of Bioethics. Her PhD supervisor is Bryn Williams-Jones, Editor-in-chief of the journal. Responsabilités des évaluateurs externes Peer-reviewer responsibilities Les évaluations des examinateurs externes sont prises en considération de façon sérieuse par les éditeurs et les auteurs dans la préparation des manuscrits pour publication. Toutefois, être nommé comme examinateur n'indique pas nécessairement l'approbation de ce manuscrit. Les éditeurs de Revue canadienne de bioéthique assument la responsabilité entière de l'acceptation finale et la publication d'un article. Reviewer evaluations are given serious consideration by the editors and authors in the preparation of manuscripts for publication. Nonetheless, being named as a reviewer does not necessarily denote approval of a manuscript; the editors of Canadian Journal of Bioethics take full responsibility for final acceptance and publication of an article. Édition/Editors: Patrick Gogognon & Aliya Affdal Abtroun 2019 Page 14 Évaluation/Peer-Review: Samia Hurst Affiliations 1 Programmes de bioéthique, École de santé publique, Université de Montréal, Montréal, Québec, Canada Correspondance / Correspondence: Sihem Neïla Abtroun,  Reçu/Received: 27 Feb 2018 Publié/Published: 11 Mar 2019 Les éditeurs suivront les recommandations et les procédures décrites dans le Code of Conduct and Best Practice Guidelines for Journal Editors de COPE. Plus précisément, ils travaillent pour s'assurer des plus hautes normes éthiques de la publication, y compris l'identification et la gestion des conflits d'intérêts (pour les éditeurs et pour les auteurs), la juste évaluation des manuscrits et la publication de manuscrits qui répondent aux normes d'excellence de la revue. The editors follow the recommendations and procedures outlined in the COPE Code of Conduct and Best Practice Guidelines for Journal Editors. Specifically, the editors will work to ensure the highest ethical standards of publication, including: the identification and management of conflicts of interest (for editors and for authors), the fair evaluation of manuscripts, and the publication of manuscripts that meet the journal's standards of excellence. Références 1. Lyerly AD, Little MO, Faden R. The second wave: Toward responsible inclusion of pregnant women in research. International Journal of Feminist Approaches to Bioethics. 2008;1(2):5-22. 2. Wild V. How are pregnant women vulnerable research participants? International Journal of Feminist Approaches to Bioethics 2012;5(2):82-104. 3. Schonfeld T. The perils of protection: vulnerability and women in clinical research. Theoretical Medicine and Bioethics 2013; 34(3):189-206. 4. van der Zande ISE, van der Graaf R, Oudijk MA, van Delden JJM. Vulnerability of pregnant women in clinical research. Journal of Medical Ethics 2017; 43(10):657-63. 5. Johnson LSM. When hypothetical vulnerability becomes actual: research participation and the autonomy of pregnant women. Dans: Baylis F, Ballantyne A, rédacteurs. Clinical Research Involving Pregnant Women. Cham : Springer International Publishing; 2016:161-78. 6. World Health Organization, Council for International Organizations of Medical Sciences. International Ethical Guidelines for Health-Related Research Involving Humans. Genève: CIOMS; 2016. 7. CRSH, CRSNG, IRSC. Chapitre 4. Justice et équité dans la participation à la recherche. Énoncé de politique des trois Conseils : Éthique de la recherche avec des êtres humains. Ottawa; 2014. 8. Basaia A. Protection de la femme enceinte dans la recherche biomédicale. La Revue Sage-Femme 2014;13(1):611. 9. Protection of Human Subjects. 45 CFR 46. US Government; 2018. 10. Macklin R. A global ethics approach to vulnerability. International Journal of Feminist Approaches to Bioethics. 2012;5(2):64-81. 11. Sheppard MK. Vulnerability, therapeutic misconception and informed consent: is there a need for special treatment of pregnant women in fetus-regarding clinical trials? Journal of Medical Ethics 2015;42(2):127-31. 12. Hurst S. Protéger les personnes vulnérables : une exigence éthique à clarifier. Revue Médicale Suisse 2013;9:1054-1057. 13. Den hollander Geerte C., Browne J l., Arhinful D, van der Graaf R, Klipstein-Grobusch K. Power difference and risk perception: mapping vulnerability within the decision process of pregnant women towards clinical trial participation in an urban middle-income setting. Developing World Bioethics. 2016;18(2):68-75. 14. Krubiner CB, Faden RR. Pregnant women should not be categorised as a "vulnerable population" in biomedical research studies: ending a vicious cycle of "vulnerability." Journal of Medical Ethics. 2017;43(10):664-5. 15. van der Graaf R, van der Zande ISE, van Delden JJM. How the CIOMS guidelines contribute to fair inclusion of pregnant women in research. Bioethics. 20 Oct 2018 [Epub].


Philosophy

International Journal of Medicine Research 114 International Journal of Medicine Research ISSN: 2455-7404; Impact Factor: RJIF 5.42  Volume 1; Issue 2; May 2016; Page No. 114-117 An expert system for nausea and vomiting problems in infants and children Samy S Abu Naser, Abed ELhaleem Ahmad El-Najjar Faculty of Engineering & Information Technology, Al-Azhar University, Gaza, Palestine Abstract Infants and children are suffering from a lots of nausea and vomiting problems. Doctors, usually face various difficulties dealing with these problems because of their similarities. In this paper, we present an expert system to help users in getting the correct diagnosis of problems of nausea and vomiting in infants and children (Gastro-esophageal reflux, Gastroenteritis, Systemic Infection, Bowel obstruction, Tumors, A bleeding disease, tonsillitis, and Hepatitis pharynx). Furthermore, this expert system provide information about the disease and how to deal with it. SL5 Object expert system language was used to design and implement this expert system. Keywords: Artificial Intelligence; Expert Systems; SL5 Object; Nausea; Vomiting; infants and children 1. Introduction Nausea and vomiting are general in children, and are frequently element of a mild, short-lived illness, normally caused by a viral infectivity. Even though the majority of children get better from nausea and vomiting without any extravagance, it is significant to recognize when to seek out assistant if the child does not get better [3,4]. Spitting up in infants (gastroesophageal reflux) is covered separately. For vomiting, nausea, stomach disorders endured by several children one cause for entering the food or polluted air way [30, 31]. Vomiting happens when nerves in the body or brain detect a trigger, for instance food poisoning, specific infections or drugs, or movement. Nausea typically, but not at all times, takes place prior to vomiting. Younger children might not be capable of identifying nausea, while they may grumble of a stomach ache or have other wide-ranging grievances. Vomiting frequently has an advantage because it gives a way for the body to dispose probably hurtful materials. But, medicines and techniques to persuade vomiting (e.g. syrup of ipecac, placing a finger in the throat) are not any more suggested, even if an infant or child has ingested a dangerous materials. In this situation, it is better to right away request emergency medical support [32]. Fig 1: a child 2. Expert system language Expert Systems language is a set of programs which allow the building of an expert system through the creation of knowledge and rules [11, 14] see figure 2 for details. Expert systems have three essential components 1. User interface: presents questions to the user and accepts inputs from them. 2. Knowledge base: contains data, facts, rules and objects in a specific knowledge domain. The knowledge base obtained from the human expert is prepared by a knowledge engineer as most human experts are not skilled in computer programming. 3. Inference engine: this is software that matches the users input with data contained in the knowledge base to reach appropriate answers. This is done using inference rules e.g. IF conditions THEN statements ELSE statements rules. Fig 2: Component of the expert systems The proposed Expert System for Nausea and Vomiting in Infants and Children Diagnosis was implemented using SL5 Object language which stands for Simpler Level 5 Object expert system language [2]. It is a forward chaining expert system that can make inferences about facts of the world using rules, objects and take appropriate actions as a result. The SL5 Object language is implemented in Delphi Embarcadero RAD Studio XE6 [2]. SL5 Object language is easy for the knowledge engineer to build the expert system and for the end users when they use it. International Journal of Medicine Research 115 3. Literature Review There are many expert system that were designed to diagnose diseases [15, 29]. But there is no specialized expert system for diagnosis of the Nausea and Vomiting in Infants and Children available. Although it's linked to several human diseases such as: Diabetes, bacterial, Ear, Eye, Mouth Problems [1, 6, 8, 15, 29]. Talayeh developed an expert system for diabetes diagnosis [13]. MYCIN is a famous expert system for diagnosing bacterial infections [24]. Some of these Expert Systems are specialized in one specific disease and other in a few diseases. However, the current proposed expert system is specialized in the diagnosis of Nausea and Vomiting in Infants and Children. 4. Materials and Methods The proposed expert system perform diagnosis for the Nausea and Vomiting in Infants and Children by asking questions that requires True/False answers. The proposed expert system will ask the user to choose the correct answer in each frame. At the end of the diagnosis session, the proposed expert system provides the proper diagnosis of the problem and offer a recommendation of the symptoms to the users. Figure 3 shows the first screen of the expert system session. Figure 4 shows an example of True/False question and Figure 5 shows how the expert system displays the diagnosis of the problem and the recommendation for treating the patient. Fig 3: shows first screen of the expert system session Fig 4: shows an example of TRUE/FALSE question type Fig 5: The expert system displays the diagnosis of the problem and the recommendation for treating the patient. International Journal of Medicine Research 116 5. Knowledge Representation The main sources of the knowledge for this expert system are Physician and specializes websites for Nausea and Vomiting in Infants and Children. The collected knowledge have been transformed into SL5 Object Knowledge base syntax: Facts, Rules and Objects. Currently the expert system has 11 rules which cover Nausea and Vomiting in Infants and Children. The core cause of the Nausea and Vomiting in Infants and Children may be by a problem in a different part of the body. In numerous cases, physician may not discover a cause for the ache. When a cause is recognized, general explanations take account of [3, 5, 30, 34,].  This is most likely spitting up a general occurrence for infants on formula. Not widespread is a lactose intolerance or milk allergy.  This form of vomiting may be from a obstruction at the end of the stomach named as pyloric stenosis.  Child may have an obstruction of the intestines identified as intussusception.  Vomiting and diarrhea may be from viral gastroenteritis or maybe from a trouble with aformula.  Infant or child could be on the edge of dehydration. 5.1 Causes of nausea and vomiting in children and infants  Allergies, are general causes of vomiting and feeling to the occurrence of the child to definite foods.  Food poisoning, in this situation go along with by stints of vomiting, diarrhea and stomach spasm.  Overeating, in some situations, children lean to eat a vigorous meal.  Brain disorder, if there exists an Astound to the brain, or due to the existence of a tumor near the spinal cord vomiting happens.  Intestinal obstruction, this case happen for babies, one of the rare situation not go with by diarrhea or fever.  Meningitis 5.2 Causes of nausea and vomiting in children  Inflammation of the intestines and bowel viral  Inflammation of the intestines and colon bacterial  Food poisoning  Pelvic  Peritonitis  Pharyngitis  Pneumonia  Harsh cough 5.3 Nausea and Vomiting in Infants and Children As much as it hurt to observe the child vomits, causing the situation of vomiting serious apprehension him/her, Vagaye suspicious state of the body to get rid of upset stomach things, frequently accompanied by vomiting, diarrhea, but when it occurs without an accompanying symptom of a further fear and may need intervention therapeutically offer on doctor to study the actions one's can take when your child is vomiting. Here are the top causes of vomiting in children: If the child vomiting take care of feeding him fluids to avoid dehydration and avoid the risk of solids, does not provide for your child and a full meal after vomiting, and bitch about dairy products. Vomiting in children is often caused by a viral infection, the situation has sometimes identified as stomach flu, or gastroenteritis. Typically accompanied by diarrhea case, even though there is no treatment for the problem, but the good side is that the situation stabilizes on its own within a few days. Attention of feeding the child fluids to avoid the risk of drought. Allergies, are common causes of vomiting and sensitivity to the presence of the child toward certain foods. If your child is in the weaning phase and try out new foods are possibly to cause him/her eaten sensitivity, such as eggs, or soy, or dairy products, or shellfish, or peanuts. If the cause of vomiting is a sensitive cases will steady on its own, and it is sensible to keep away from this food. Food poisoning, in this case accompanied by bouts of vomiting, diarrhea and stomach spasm. The situation may be caused by bacteria, or not cooked the meat well, or some dairy products and fatty cream, or eating foods that has been expired for a long period of time. Overeating, in some cases, children tend to eat a hearty meal, and may be of junk food that causes disruption to the digestive system. Anxiety and stress, emotional stress can lead to an imbalance in the digestive system, resulting in nausea or vomiting or diarrhea. This condition occurs for adolescents often not for children. Brain disorder, if there were a shock to the brain, or due to the presence of a tumor near the spinal cord vomiting occurs. Intestinal obstruction, this situation occur for babies, one of the rare cases not accompanied by diarrhea or fever. Home procedures to deal with vomiting:  Do not give the child a meal after vomiting only after 3060 minutes to give the stomach enough time to recover.  Start with small amounts of fluids after the stomach break, and better to give the child water or natural juices, not ready-made. Your child does not force on fluid intake, simply eat two tablespoons or 3, and wait 5 minutes and then resume fluid intake.  Avoid solids, do not provide your child a full meal after vomiting, and avoid dairy products.  Avoid the causes of vomiting such as strong odors such as onions or perfume may aggravate symptoms. 6. Conclusion In this paper, a proposed expert system was presented for aiding Physicians in diagnosing patients with possible Nausea and Vomiting in Infants and Children. Nausea and Vomiting in Infants and Children patients can get the diagnosis faster and more accurate than the traditional diagnosis done by physicians. This expert system does not require rigorous training to be used; it has a straightforward and user friendly interface. It was developed using SL5 Object expert system language. The results of the preliminary testing of the expert system showed potential. 7. Future Work This expert system is considered to be a base of future ones; more Nausea and Vomiting in Infants and Children are planned to be added to the expert system and to make it more accessible to users from anywhere at any time. 8. References 1. Abu Naser SS, Akkila AN. A Proposed Expert System for Skin Diseases Diagnosis. INSInet Publication. Journal of Applied Sciences Research. 2008; 4(12):1682-1693. International Journal of Medicine Research 117 2. Abu Naser SS. SL5 Object: the Simpler Level 5 Object Expert System Language, International. Journal of Soft Computing, Mathematics and Control (IJSCMC). 2015; 4(4):25-37. 3. Mayo Clinic, . Date visited 303-2016. 4. Family Doctor,  health-tools/search-by-symptom/mouth-problems-infantschildren.html, Date visited 30-3-2016. 5.  mAccessed 30 March 2016. 6. Abu Naser SS, Ola AZ. An expert system for diagnosing eye diseases using Clips. Journal of Theoretical and Applied Information Technology, 2008, 4-10. Available:  Vol4No10.pdf 7. Abu Naser SS, Baraka M, Baraka AA. Proposed Expert System For Guiding Freshman Students In Selecting A Major In Al-Azhar University, Gaza. Journal of Theoretical and Applied Information Technology. 2008; 4(9):889-893. Available:  research-papers/Vol4No9/15Vol4No9.pdf 8. Abu Naser SS, Kashkash K, Fayyad M. Developing an Expert System for Plant Disease Diagnosis. Journal of Theoretical and Applied Information Technology. 2008; 1(2):78-85.  jai.2008.78.85 9. Wikipedia,  Accessed 30 March 2016. 10. Abu Naser SS, ALmursheidi SA. Knowledge Based System for Neck Pain Diagnosis, World Wide. Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(4):12-18.Available: . com/vol%202/issue%204/pdf/13.2.pdf 11. Durkin J. Expert Systems: Design and Development, ISBN 0-02-330970-9, Prentice Hall, Englewood Cliffs, NJ, 1994. 12. Giarratano J, RileyG. Expert Systems: Principles and Programming, Fourth Edition. Boston MA, Thomson/PWS Publishing Company, 2004. ISBN: 0534937446. 13. TalayehTabibi. An Expert System for Diabetes Diagnosis, American Academic & Scholarly Research Journal, 2012. 14. Russell S,Norvig P. Artificial Intelligence: A Modern Approach, Prentice Hall, Englewood Cliffs, NJ, Second Edition, 2002. ISBN 0-13-103805-2. 15. Abu Naser SS, El-Hissi H, Abu-Rass M, El-Khozondar N. An expert system for endocrine diagnosis and treatments using JESS. Journal of Artificial. Intelligence, 2010; 3(4):239-251. 16. Abu Naser SS, Al-Dahdooh R, Mushtaha A, El-Naffar M. Knowledge Management in ESMDA: Expert System for Medical Diagnostic Assistance, AIML Journal. 2010, 2002. 17. Abu Naser SS, Alhabbash M. Male Infertility Expert system Diagnoses and Treatment, American. Journal of Innovative Research and Applied Sciences. 2016; 2:4. 18. Abu Naser SS, Mahdi A. A proposed Expert System for Foot Diseases Diagnosis, American. Journal of Innovative Research and Applied Sciences. 2016; 2(4). 19. Abu Naser SS, AlDahdooh R. Lower Back Pain Expert System Diagnosis and Treatment. Journal of Multidisciplinary Engineering Science Studies. (JMESS) 2016, 2-4. 20. Abu Naser SS, Hamed AM. An Expert System for Mouth Problems in Infants and Children. Journal of Multidisciplinary. Engineering Science Studies (JMESS), 2016, 2-4. 21. Abu Naser SS, Abu Hasanein H.Ear Diseases Diagnosis Expert System UsingSL5 Object. World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(4):41-47.  22. Azaab S,Abu Naser SS, Sulisel O.A proposed expert system for selecting exploratory factor analysis procedures. Journal of the college of education. 2000; 4(2):9-2. 23. Randolph A. Miller et al. INTERNIST-1 An Experimental Computer-Based Diagnostic Consultant for General Internal Medicine, New England Journal of Medicine, 1982; 307:468-76. 24. Buchanan BG, Shortliffe EH. Rule Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic Programming Project. Reading, MA: Addison-Wesley, 1984, ISBN 978-0-201-10172-0. 25. Yoon YR, Brobst P, Bergstresser, Peterson L. ComputerBased Medical Systems, Proceedings of Third Annual IEEE Symposium on, 1990; 3(6):306-312. 26. Wollina U. Common skin diseases: uncommon presentations. Clinics in Dermatology, 2005; 23(5):443445. . 2005. 01. 001. 27. Abu Naser SS, El Haddad I. An Expert System for Genital Problems in Infants, World Wide. Journal of Multidisciplinary. Research and Development (WWJMRD). 2016, 2-5. 28. Abu Naser SS, Bastami B. A Proposed Rule Based System for Breasts Cancer Diagnosis. World Wide. Journal of Multidisciplinary. Research and Development (WWJMRD). 2016, 2-5. 29. Abu Naser SS, Shaath M. Expert System Urination Problems Diagnosis. World Wide. Journal of Multidisciplinary Research and Development (WWJMRD). 2016, 2-5. 30. Abu Naser SS, Hilles M. An Expert System for Shoulder Problems Using CLIPS. World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016, 2-5. 31. Nausea and Vomiting, Date visited 15-4-2016. 32. Nausea and Vomiting, , Date visited 15-4-2016. 33. Nauseaand Vomiting,  /adventures-in-vomiting, Date visited 15-4-2016. 34. Nausea and Vomiting,  /English/health-issues/conditions/abdominal/Pages/ Treating-Vomiting.aspxm, Date visited 15-4-2016. 35. Nausea and Vomiting, , Date visited 15-4-2016.


Philosophy

International Journal of Medicine Research 83 International Journal of Medicine Research ISSN: 2455-7404; Impact Factor: RJIF 5.42  Volume 1; Issue 2; May 2016; Page No. 83-86 An expert system for men genital problems diagnosis and treatment Samy S Abu Naser, Mones M Al-Hanjori Faculty of Engineering & Information Technology, Al-Azhar University, Gaza, Palestine Abstract Male genital problems and injuries may occur quite simply because of the scrotum and penis are not protected like other organs. Genital problems and injuries normally happen through: recreational activities (like Football, Hooky, biking, basketball), workrelated tasks (like contact to irritating chemicals), downhill drop, and sexual activity. A genital injury frequently causes harsh pain that typically disappear fast without causing enduring harm. Home handling is generally all that is required for trivial problems or injuries. Pain, inflammation, staining, or rashes that are coexist with other symptoms might be a source for concern. Genital problems in men is one of the most common problems which requires fast intervention. In this paper we present an expert system that help men diagnose their genital problems and give them the proper treatment. SL5 Object expert system language was used to design and implement this expert system. Keywords: Artificial Intelligence, Expert Systems, SL5 Object language, Men Genital Problems. 1. Introduction There may be many medications to treat sexual problems in males, depending on the causes. Problems that result from trauma, infections, as well as a simple irritation often cured by treatment or for a long time. In other cases, male sexual problems cannot be cured, but treatment can successfully reduce or eliminate symptoms. This applies to many diseases, through sexual contact are often dealing with transmitted diseases with medicine, but also some other issues that can be treated with drugs or surgery. While it may be impossible to completely heal every problem of the males, treatment options can be successful. One should consult his doctor to find the most effective treatment for a certain problem [1, 2]. Figure 1 shows male reproduction system. Fig 1: Male reproduction system [1] 1. Expert systems Expert systems is a branch of artificial intelligence that have had the majority of impact, especially in medicine, finance, telecommunications, customer service, transportation, aviation, and more lately, written communication. Artificial intelligence systems based on expert systems by using technologies such as machine learning, natural language processing, speech recognition and machine vision, all of which are central to highly developed systems [16, 17, 19]. 2.1 Advantages of Expert Systems  Expert advice available on the system all the time  Expert knowledge of a human expert is attained before he/she passes away  Can be employed as to train staff to enhance their expertise  Put together rational decisions without human emotions  They do not get tired like human  Give answers efficiently without the need of more staff  Use natural language interface to make them user friendly 2.2 Limitations of Expert Systems  Covers a specific field of knowledge  Good expert system may require lot of effort and cost International Journal of Medicine Research 84  Expert systems are not as good as human experts.  Expert systems do not learn from mistakes properly  Dubious to come up with creative solutions 2.3 Definition of expert systems: The expert system is a rather popular term that describes computer program, which came to the throne and individual performance or association that owns the expert knowledge and understanding in this field [19]. Today, as a rule, known as artificial intelligence, expert systems has a long history dating back to the 1970s. But, of course, such a system will integrate knowledge that contains an experience that has been collected and inference engine a set of rules for applying the knowledge base for the exact condition to explain the program. They can improve complex expert systems with the additions to the knowledge base or the group regulations. Expert Systems have a good role in the field of financial service systems, healthcare, manufacturing, and video games [17, 19]. 2. Knowledge Representation The main sources of the knowledge to this rule expert system for men genitals problems diagnoses from [1, 5, 8, 9, 14]. The collected knowledge was converted in to Sl5 Object knowledge base (facts, rules and objects) syntax [7]. Currently, our expert system has 13 rules. This expert system can help the user with the following men genital problems.  Sexually transmitted infections Sexually transmitted infections are infections that one may get by having sex with a person who is infected. These infections are typically passed from one person to another through vaginal contact, but they may also be passed through oral sex or skin-to-skin contact. Sexually transmitted infections can be caused by viruses (hepatitis B, herpes, HIV and the human papilloma virus) or bacteria (chlamydia, gonorrhea).  Urinary tract infection A urinary tract infection is an infection in the kidneys, the bladder and the urethra. As blood pour through the kidneys, waste is removed and stored in the bladder as urine.  Yeast infection Vaginal yeast infections are attributable to a fungus known as Candida albicans. Yeast are small organisms that usually exist in a few numbers on the skin and within the vagina. The acidic environment of the vagina keep out yeast from increasing. If the vagina has less amount of acid, a lot of yeast may grow and cause a vaginal infection.  Genital warts Genital warts are small, flat, flesh-colored bumps. Genital warts are attributable to a lot of types of human papilloma virus. Human papilloma virus is associated with cancer of the vulva, anus and penis; however, it does not usually lead to cancer.  Syphilis Syphilis is a severe infection conceded from one person to another during sexual contact. The main cause of it is bacteria. One can get syphilis by touching the blood or sores of a person who has syphilis, particularly sores on the person's mouth, penis, vagina or anus.  Prostate cancer Prostate cancer is when abnormal cells develop in the prostate gland. Prostate cancer is one of the mainly widespread types of cancer in men. A good number of types of prostate cancer develop gradually, but several types can be aggressive. This means the cancer grows rapidly and can proliferate to other parts of the body. As soon as cancer spreads, physicians state that the cancer has "metastasized."  Prostatitis Prostatitis is an irritation of the prostate gland. Prostatitis might be easily mystified with other infections in the urinary tract. When one think he has prostatitis, he should see his doctor.  Testicular torsion Testicular torsion happens when the spermatic string becomes twisted. This stops the blood supply to the testicles.  Testicular cancer Testicular cancer starts in one or both of the testicles. The testicles are situated in the scrotum, the skin that hangs up beneath the penis. Hormones and sperm are developed in the testicles.  Varicose veins Varicose veins are veins that are distended and protuberance above the surface of the skin. They may be twisted and are frequently blue or dark purple. Varicose veins are most generally found on the legs or feet, but they might be found on the groin. 3. Literature Review Many expert systems have been designed [6, 10, 13, 15, 18, 20, 39] to help facilitating diagnosing and managing a lot of diseases and medical problems which considered as a part of applying Artificial Intelligence and computer science in order to help doctors, hospitals and health care facilities decision making to enable them to offer their health services in the correct way. One Expert System was found for diagnosing genital problems in infants [32]. However, our expert system diagnosing genital problems in men and recommend the proper treatment. 4. Materials and Methods The proposed expert system perform diagnosis in men genital problems by asking questions that requires True/False answers. The proposed expert system will ask the user to choose the correct answer in each screen. At the end of the diagnosis session, the proposed expert system provides the proper diagnosis of the problem and present a recommendation for the treatment to the users. Figure 2 shows the first screen of the expert system session. Figure 3 shows how the expert system displays the diagnosis of the problem and the recommendation for treating the patient. International Journal of Medicine Research 85 Fig 2: First screen shot of the expert system diagnosis session Fig 3: Shows the expert system diagnosis and recommendation 5. Conclusion In this paper, we presented an expert system that consists of facts, rules, and objects to help men in diagnosing their genital problems, and help in giving them the proper recommendations for the treatment of the problems they have. The diagnosis is faster and more accurate than conventional diagnosis. This expert system does not require intensive training in order to be ready for use, because it is easy and user friendly. SL5 Object expert system language was used to design and implement the proposed expert system. 6. References 1. , Date visited 15-5-2016. 2. , Date visited 15-5-2016. 3. , Date visited 15-5-2016. 4.  m, Date visited 15-5-2016 5. , Date visited 15-5-2016 6. Abu Naser SS, Akkila AN. A Proposed Expert System for Skin Diseases Diagnosis. INSInet Publication, Journal of Applied Sciences Research. 2008; 4(12):16821693. 7. Abu Naser SS. SL5 Object: the Simpler Level 5 Object Expert System Language, International Journal of Soft Computing, Mathematics and Control (IJSCMC). 2015; 4(4):25-37. 8. . Date visited 1-5-2016. 9. , Date visited 15-5-2016. 10.  .htm 11. Abu Naser SS, Ola AZ. An expert system for diagnosing eye diseases using Clips. Journal of Theoretical and Applied Information Technology, 2008; 4(10). Available:  International Journal of Medicine Research 86 12. Abu Naser SS, Baraka M, Baraka AA. Proposed Expert System For Guiding Freshman Students In Selecting A Major In Al-Azhar University, Gaza, Journal of Theoretical and Applied Information Technology. 2008; 4(9):889-893. Available:  13. Abu Naser SS, Kashkash K, Fayyad M. Developing an Expert System for Plant Disease Diagnosis, Journal of Theoretical and Applied Information Technology. 2008; 1(2):78-85. Available:  14. Wikipedia, , Accessed 30 April 2016. 15. Abu Naser SS, ALmursheidi SA. Knowledge Based System for Neck Pain Diagnosis, World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(4):12-18. Available :  16. Durkin J. Expert Systems: Design and Development, ISBN 0-02-330970-9, Prentice Hall, Englewood Cliffs, N.J, 1994. 17. Giarratano J, Riley G. Expert Systems: Principles and Programming, Fourth Edition. Boston, MA, Thomson/PWS Publishing Company, 2004. ISBN: 0534937446. 18. Talayeh Tabibi. An Expert System for Diabetes Diagnosis. American Academic & Scholarly Research Journal. 2012. 19. Russell S, Norvig P. Artificial Intelligence: A Modern Approach, Prentice Hall, Englewood Cliffs, NJ, Second Edition, 2002. ISBN 0-13-103805-2. 20. Abu Naser SS, El-Hissi H, Abu-Rass M, El-Khozondar N. An expert system for endocrine diagnosis and treatments using JESS, Journal of Artificial Intelligence, 2010; 3(4), 239-251. 21. Abu Naser SS, Al-Dahdooh R, Mushtaha A, El-Naffar M. Knowledge Management in ESMDA: Expert System for Medical Diagnostic Assistance. AIML Journal. 2010. 22. Abu Naser SS, Kashkash K, Fayyad M. Developing an Expert System for Plant Disease Diagnosis, Journal of Theoretical and Applied Information Technology. 2008; 1:(2). 23. Abu Naser SS, Alhabbash M. Male Infertility Expert system Diagnoses and Treatment, American Journal of Innovative Research and Applied Sciences. 2016; 2:(4). 24. Abu Naser SS, Mahdi A. A proposed Expert System for Foot Diseases Diagnosis, American Journal of Innovative Research and Applied Sciences. 2016; 2:(4). 25. Abu Naser SS, AlDahdooh R. Lower Back Pain Expert System Diagnosis and Treatment, Journal of Multidisciplinary Engineering Science Studies (JMESS), 2016; 2(4). 26. Abu Naser SS, Hamed AM. An Expert System for Mouth Problems in Infants and Children, Journal of Multidisciplinary Engineering Science Studies (JMESS), 2016; 2(4). 27. Abu Naser SS, Abu Hasanein H. Ear Diseases Diagnosis Expert System Using SL5 Object. World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(4):41-47.  28. Azaab S. Abu Naser SS, Sulisel O. A proposed expert system for selecting exploratory factor analysis procedures. Journal of the college of education. 2000; 4(2):9-2 29. Buchanan BG, Shortliffe EH. Rule Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic Programming Project. Reading, MA: AddisonWesley, 1984. ISBN 978-0-201-10172-0. 30. Yoon YR, Brobst P, Bergstresser, Peterson L, ComputerBased Medical Systems, Proceedings of Third Annual IEEE Symposium on, 1990; 3-6:306-312. 31. Wollina U. Common skin diseases: uncommon presentations. Clinics in Dermatology, 2005; 23(5):443445. Doi: 10.1016/ j.clindermatol. 2005. 01. 001. 32. Rubin A. Design of an expert system and its application to dermatopathology, 2007; 21(3):269-274. D O I: 10.1 1 1 1 /j.1 3 6 5 -25 5 9.1992.tb00386.x, http:// dx.doi.org/ 1 0. 1 1 11/ j. 13652559.1992.tb00386.x 33. Thomas A, Quirina V, Steven F, Feldman R, Sara Q. Treating Skin Disease: SelfManagement Behaviors of Latino Farm workers. Journal of Agromedicine. 2006; 11(2):27-35, DOI: 10.1300/J096v11n02-06. 34. Abu Naser SS, Shaath M. Expert System Urination Problems Diagnosis. World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(5). 35. Abu Naser SS, Bastami BA. Proposed Rule Based System for Breasts Cancer Diagnosis. World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(5). 36. Abu Naser SS, Hilles M. An Expert System for Shoulder Problems Using CLIPS. World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(5). 37. Abu Naser SS, El Haddad IA. An Expert System for Genital Problems in Infants, World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(5). 38. Abu Naser SS, Alawar MW. An Expert System for Feeding Problems in Infants and Children, International Journal of Medicines Research (IJMR), 2016; 1(2). 39. Abu Naser SS, El-Najjar AA. An Expert System for Nausea and Vomiting Problems in Infants and Children, International Journal of Medicines Research (IJMR), 2016; 1(2).


A lot of infants have significant food-related problems, as well as spitting up, rejecting new foods, or not accepting to eat at specific times. These issues are frequently ordinary and are not a sign that the baby is unwell. According to the National Institutes of Health, 25% of generally developing infants and 35% of babies with neurodevelopmental disabilities are tormented by some sort of feeding problem. Some, for example rejecting to eat specific foods or being overly finicky, are momentary and don’t cause any health dangers.
          This paper proposes an expert system that can be used to successfully diagnose Feeding problems in infants and children. The suggested systems were found to be beneficial approach in addition to existing impartial ones. So far as the authors are aware, this is the initial effort of using an expert system in attaining good performance in a real world application. This expert system was designed and implemented to help parents diagnose these problems and get a recommendation of how to deal with infants and children.

Philosophy

International Journal of Medicine Research 79 International Journal of Medicine Research ISSN: 2455-7404; Impact Factor: RJIF 5.42  Volume 1; Issue 2; May 2016; Page No. 79-82 An expert system for feeding problems in infants and children Samy S Abu Naser, Mariam W Alawar Faculty of Engineering & Information Technology, Al-Azhar University, Gaza. Abstract A lot of infants have significant food-related problems, as well as spitting up, rejecting new foods, or not accepting to eat at specific times. These issues are frequently ordinary and are not a sign that the baby is unwell. According to the National Institutes of Health, 25% of generally developing infants and 35% of babies with neurodevelopmental disabilities are tormented by some sort of feeding problem. Some, for example rejecting to eat specific foods or being overly finicky, are momentary and don't cause any health dangers. This paper proposes an expert system that can be used to successfully diagnose Feeding problems in infants and children. The suggested systems were found to be beneficial approach in addition to existing impartial ones. So far as the authors are aware, this is the initial effort of using an expert system in attaining good performance in a real world application. This expert system was designed and implemented to help parents diagnose these problems and get a recommendation of how to deal with infants and children. Keywords: Feeding assessment, Feeding problems, Food aversion, Food refusal, expert systems 1. Introduction Infancy feeding problems are projected to happen in up to 25% of generally developing children and in up to 35% of children having neurodevelopmental disabilities. One familiar definition of feeding problems is the incapability or refutation to eat specific foods. Problems with feeding can lead to important unconstructive nutritional, developmental and psychological sequelae. Since the harshness of these sequelae is connected to the age at onset, level and interval of the feeding problem, before time identification and administration are significant. The purpose of this paper is to provide guidelines to recognize feeding problems in the first three years of life; to present a newly developed instrument to assess the presence of feeding problems and watch the effects of management; and to explain basic management methods that may get rid of or enhance feeding dysfunction [1, 4]. Many of infants have significant food-related problems, as well as spitting up, rejecting new foods, or not accepting to eat at specific times. These issues are frequently ordinary and are not an sign that the baby is unwell. According to the National Institutes of Health, 25% of generally developing infants and 35% of babies with neurodevelopmental disabilities are tormented by some sort of feeding problem. Some, for example rejecting to eat specific foods or being overly finicky, are momentary and don't cause any health dangers [7, 8]. Nevertheless, problems for instance food allergies, vomiting, and constantly rejecting foods and liquids may designate and fundamental medical condition. It can have unpleasant effects on an infant's health and may need medical attention. Swallowing disorders, medically identified as dysphagia, may happen at dissimilar stages throughout the infant's swallowing progression, and consist of [12, 34, 40].  Oral Phase: The oral stage is incorporated of sucking, chewing, and moving foods and/or liquids to the throat.  Pharyngeal Phase: The pharyngeal phase is when the infant starts to swallow and move food down the throat, yet closes off the throat to prevent it from going into the airway, which keeps out choking.  Esophageal Phase: The esophageal phases contains calming and contraction the openings of the esophagus and pushing food into the stomach 2. Expert System Language Expert Systems language is a group of programs that aid the knowledge engineer in building expert system through the creation of knowledge (rules and facts). See figure 1 for details. An expert system is typically consists of at least three main components [14, 15, 17].  Knowledge Base The knowledge base is a collection of rules and facts derived from the human expert. Rules typically takes the form: IF <antecedent> THEN <consequent> The antecedent is the condition that must be satisfied. When the antecedent is satisfied, the rule is triggered and is said to "fire". The consequent is the action that is performed when the rule fires.  Inference Engine The inference engine is the main processing element of the expert system. The inference engine select rules from the agenda to fire. If no rules found in the agenda, the inference engine must get information from the end user to be able to add more rules to the agenda. It uses knowledge base, in order to conclude situations. It is responsible for collecting the data from the end user, by asking questions and applying it wherever necessary. International Journal of Medicine Research 80  User Interface A user interface is the technique the expert system interacts with the end user. These can be through dialog boxes, command prompts, forms, or other input methods. Fig 1: Components of Expert Systems The proposed Expert System for Feeding Problems in Infants and Children diagnosis was designed and implemented using, CLIPS Language [15]. CLIPS is a public domain software tool for building expert systems. The name is stands for "C Language Integrated Production System [15]. 3. Materials and Methods. The proposed expert system will ask the user a number of questions about the signs and symptoms of the patient and at the end of the session the diagnosis and the recommendation for taking care of the patient. 4. Literature Review There is no dedicated expert system for feeding problems in infants and children in the literature; however, there are a good number of medical expert systems that were designed to help with diagnosing diseases such as: Foot problem, Male fertility problems, Ear problems, Hearing Problems, neck pain problems, low back pain problems, eye problems, and endocrine problems [5, 6, 11, 13, 16, 18, 33]. 5. Knowledge representation The main source of the knowledge for this expert system are physicians and specialized websites. The captured knowledge have been converted into CLIPS Knowledge base syntax (facts and rules). Here is a brief identification of feeding problems in infants and children problems that the expert system can help the user with. 5.1 Symptoms of Infant Feeding Problems Infants with feeding problems may show a few symptoms, but signs and symptoms may vary according to every person and the brutality of the feeding issues. General signs and symptoms of infant feeding problems comprise [35, 36].  Semi-circled the back and body whilst feeding  Meticulousness or shortage of attentiveness during feeding  Rejecting to eat food and drink fluids  Rejecting various textures of food  Extremely lengthy feeding times  Chewing problems  Difficulty with bottle and/or breast feeding  Coughing during feeding times  Extreme drooling  Complexity in coordinating breathing with eating and drinking  Augmented nasal staleness throughout meals  Husky, or breathy sound quality  Rescreening spitting up and/or vomiting  Frequent pneumonia or respiratory infections  Slow weight gain or development Infants having feeding problems may as well be at risk for: Dehydration, aspiration, chronic lung disease, or poor nutrition. 5.2 Diagnosis of Infant Feeding Problems When a baby is having complexity with feeding, it's significant to call the pediatrician right away. Although feeding problems are frequently insignificant, it's essential to seek medical action in case there is a fundamental medical matter. The pediatrician will usually begin by testing the infant and addressing and diagnose any medical clarifications for the feeding complication, including, if applicable, the attendance of excessive reflux or metabolic disorders. A pathologist who specializes in take cares of infants and children with feeding and swallowing disorders may as well test out the baby's symptoms, and if appropriate, recommend a pathology early involvement [37, 40]. 5.3 Treatment Options for Infant Feeding Problems Treatment differs very much depending on the reason and signs of the feeding matters. The following are amongst a few handling options for babies with feeding problems [38-40].  Medical treatment.  Feeding therapy.  Nutritional modification.  Encouraging an increased approval of new foods and textures.  Food temperature and texture modification.  Postural or positioning modifications.  Behavior administration techniques.  Mouth training to make the mouth muscles stronger  Tongue movement and chewing training  Encouraging various types of foods, as well different textures  Assist with sucking improvement  Changing food textures and liquid thickness to make sure secure swallowing In urgent situation cases involving feeding disorders, hospitalization may be essential. The baby may as well require feeding tube while there in order to take in enough nutrition. Nevertheless, the majority of cases of infant feeding problems are deal with before hospitalization. As said earlier, nutritional therapy and/or regular meetings with baby's doctor are enough to assist with feeding. A team approach between parents, caregivers, baby's pediatrician, and professionals International Journal of Medicine Research 81 such as dietitians, therapists, and speech pathologists is often the main optimal way to overcome these problems. In some instances, an infant may be placed on a precise diet and approved nutritional supplements, the majority often when they are underweight, undergoing treatment, and experiences developmental delays [39]. 5.4 Causes of Infant Feeding Problems The following are a few causes of feeding and swallowing disorders in infants [40]. 1. Medical Causes of Infant Feeding Problems  Traumatic birth injuries that lead to neurological disorders, such as cerebral palsy  Cleft lip and/or cleft palate  Autism  Neck and head abnormalities  Premature birth  Low birth weight  Respiratory problems  Heart disease  Gastrointestinal disorders  Medications that decrease appetite 2. Non-medical Causes of Infant Feeding Problems Non-medical reasons that may affect a baby's feeding patterns include [38]. The baby may be stressed or scared about something  The baby isn't receiving enough attention or emotional care from parents and/or loved ones (feels alone, anxious)  The baby simply does not like the tastes, smell, and/or texture of certain foods 5.5 Infant Feeding Problems Prognosis and Long-term Outlook When the feeding problems are addressed as early as the baby begins to show signs of feeding problems, for example losing weight and rejecting to eat, the prognosis is generally favorable and is typically resolved within short period of health conditions or effect. When the baby left untreated, nonetheless, infant feeding problems may guide to a myriad of problems, including delayed physical development, delayed mental development, learning disorders, and more. Actually, these developmental delays may stay within infant through childhood and into and through maturity. Once specific foods with high nutritional value is not a part of a growing infant's diet, there is a possibility that oral motor development will be delayed, which in turn can guide to more delays, such as speech problems, slow growth, cognitive matters, and behavioral disorders [1, 4]. 6. Conclusions In this paper we proposed an expert system that can be used to successfully diagnose feeding problems in infants and children. The suggested system was found to be beneficial approach in addition to existing impartial ones. So far as the authors are aware, this is the initial effort of using an expert system in attaining good performance in a real world application. This expert system was designed and implemented in CLIPS language to help parents diagnose their infant and children problems and get a recommendation of how to them. 7. References 3.  5-5-2016 4.  5-5-2016 5.  issues/miscellaneous_disorders_in_infants_and_young_ children/feeding_problems.html 5-5-2016 6.  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Developing an Expert System for Plant Disease Diagnosis, Journal of Theoretical and Applied Information Technology. 2008; 1(2):78-85. Available:  14. Wikipedia,  Accessed 30 March 2016. 15. Abu Naser SS, ALmursheidi SA. Knowledge Based System for Neck Pain Diagnosis, World Wide Journal of Multidisciplinary Research and Development (WWJMRD). 2016; 2(4):12-18. Available :  16. Durkin J. Expert Systems: Design and Development, ISBN 0-02-330970-9, Prentice Hall, Englewood Cliffs, N.J, 1994. 17. Giarratano J, Riley G. Expert Systems: Principles and Programming, Fourth Edition. Boston, MA, Thomson/PWS Publishing Company, 2004. ISBN: 0534937446. 18. Talayeh Tabibi. An Expert System for Diabetes Diagnosis, American Academic & Scholarly Research Journal. 2012. 19. Russell S, Norvig P. Artificial Intelligence: A Modern Approach, Prentice Hall, Englewood Cliffs, NJ, Second Edition, 2002. ISBN 0-13-103805-2. International Journal of Medicine Research 82 20. 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