Metacognitive Abilities within Personal Narratives of Inpatients with Schizophrenia: Associations with Clinical Insight and Drug Compliance

Psychiatric nurses face many challenges in providing effective care for patients with schizophrenia who have poor insight. The understanding of metacognitive functions in schizophrenia may form a richer idea of why some patients deny illness and decline treatment, and may allow for further consideration of effective psychiatric care.  This study aimed to assess the metacognitive abilities within personal narratives among inpatients with schizophrenia and to investigate its relationship with clinical insight and drug compliance. The study followed a cross- sectional descriptive correlational research design. It was conducted on 65 male inpatients with schizophrenia, at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. Indiana Psychiatric Illness Interview was used to elicit a narrative of self and illness, the narratives of the study subjects were rated using the metacognitive assessment scale concurrently with the assessment of clinical insight and drug compliance. The results revealed a statistical significant positive correlation between metacognitive abilities, clinical insight and drug compliance. It was concluded that poor insight and drug non-compliance might be significantly improved when considering the metacognitive measures.  Recommendations encompassed that metacognitive assessment should be integrated in psychiatric care of inpatients with schizophrenia. A form of integrative psychotherapeutic intervention that could promote insight and drug compliance through stimulating metacognitive abilities should be developed in patients with schizophrenia. Replication of the study is also required on more diverse and larger groups of patients. Keywords: Metacognitive abilities, Narratives, Schizophrenia, Clinical Insight, Drug compliance. DOI: 10.7176/JEP/10-1-1

Central Venous Oxygen Saturation as a Predictor of the Outcome of Weaning From Mechanical Ventilation

Weaning from mechanical ventilation represents a corner stone of management of critically ill patients. Successful weaning represents a great achievement in patient's critical course in the ICU. This makes the process of weaning one of the most difficult steps in ICU care, for those reason, such a study was done to create a new thinking about the predictors that facilitate patient weaning from mechanical ventilator. The aim of this study is to evaluate the central venous saturation as a predictor of the outcome of weaning from mechanical ventilation. Cohort, unicentric, clinical study research design was utilized in the current study. Sample consists of one hundred and twenty patients over a one year period, all patients passed the first SBT (spontaneous breathing trial) and weaned successfully from mechanical ventilation were extubated after undergoing a two-step weaning protocol (measurements of predictors followed by a T-tube trial). Extubation failure was defined as the need of re-intubation within 48 hrs. The weaning protocol evaluated hemodynamic, ventilation parameters, arterial and venous gases during mechanical ventilation (Immediately before T-tube trial), and at the 30th min of spontaneous breathing trial. Findings of this study show that re-intubation rate was 30%. Analysis by logistic regression revealed that central venous saturation was the only variable able to discriminate outcome of extubation. Reduction of central venous saturation by >5% was an independent predictor of re-intubation, with odds ratio of 52.6 (95% confidence interval =16.34–169.42), a sensitivity of 87%, and a specificity of 90%. Reduction of central venous saturation during spontaneous breathing trial was associated with extubation failure and could reflect the increase of respiratory muscles oxygen consumption. Results of the present study indicated that central venous saturation was an early and independent predictor of extubation failure and may be a valuable accurate parameter to be included in weaning protocols. Keywords: Central Venous Saturation - Mechanical Ventilation - Extubation

Staged inset of free flaps for complex microsurgical head and neck reconstruction to ensure total flap survival

IntroductionMicrosurgical reconstruction of complex head and neck defects often requires reliable tissue in multiple spatial configurations to achieve good functional and aesthetic outcomes. In addition to robust perforators, flap inset and wound closure require great caution to minimize complications especially in the presence of trismus with limited space for inset. This report describes the technique and results of our staged approach to flap inset which increases the chance of total flap survival in complex head and neck reconstructions.MethodsFrom February 2010 to August 2016, a total of 53 patients were identified via a retrospective chart review. Patients who were suspected to have a high risk of vascular compromise and subsequently underwent complex head and neck reconstruction with staged inset of anterolateral thigh (ALT) flaps were included. The flap was inset only partially at the recipient site initially with fewer sutures. At a second stage, after neovascularization from surrounding tissue was established, the flap was partially elevated, divided and mobilized on its own pedicle for definitive inset.ResultsFiftyâ one patients had complete survival of flaps and had uneventful postoperative course. Six cases required immediate reâ exploration to release wound tension or reposition the pedicle. Of these, 4 flaps were salvaged, 2 failed due to small perforators despite anastomosis revision. The flap survival rate was 96.2% and the average time between 2 stages was 24â days (range, 21â 28).ConclusionStaged flap inset can improve free flap survival in complex head and neck reconstructions.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146598/1/micr30370.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146598/2/micr30370_am.pd

Relationship between Perceived Stress, Psychological Wellbeing and Emotional Competence among Baccalaureate Nursing Students: an Egyptian Sample

Nursing education is acknowledged as one of the stressful and emotionally demanding profession. Stress among nursing students is an inevitable issue that might lead to poor psychological wellbeing. Having a good emotional competence helps university nursing students to decrease their stressand enhance their psychological well-being. Aim: this study was aimed to determine the relationship between the perceived stress, psychological wellbeing and emotional competence among baccalaureate nursing students. Design: A descriptive correlational research design was used in this study. Baccalaureate nursing students who were enrolled at Psychiatric Nursing and Mental Health coursewere the study subjects. Their number amounted 135 students. Four tools were used namely; Bio-socio demographic data structured interview schedule, Ryff’s Psychological Wellbeing (RPWB) scale, The Emotional Skills/Competence questionnaire and Perceived Stress Scale (PSS).Results:A positive significant relation between the students’ psychological well-being and their Emotional competence was noted and there was a negative significant correlation between them and students’ perceived stress.It can be concluded that nursing students have high level of stress and their emotional skills/competence in addition to their psychological well-being can help them to decrease their level of stress. Implementation of emotional hygiene program, to teach the nursing students to care for their own emotions and didn’t leave them injured or untreated is recommended. Key words: Stress, Psychological well-being. Emotional competence, Nursing students. DOI: 10.7176/JHMN/68-09 Publication date: November 30th 201

Case report: tracking data from foraging hawksbill turtles in the northern Red Sea

Background: Hawksbill turtles (Eretmochelys imbricata) are Critically Endangered throughout their global range, and concerningly little is known about this species in the Red Sea. With large-scale coastal development projects underway in the northern Red Sea, it is critical to understand the movement and habitat use patterns of hawksbill turtles in this environmentally unique region, so that effective conservation strategies can be implemented. We satellite tagged three hawksbill turtles, one 63 cm curved carapace length adult male captured near Wahlei Island, one 55 cm turtle captured in the Gulf of Aqaba, and one 56 cm turtle suffering from a floating syndrome which was captured at Waqqadi Island, rehabilitated, and released at Waqqadi Island. Turtles were tracked for 156, 199, and 372 days between October 2020 and November 2021. Results: We calculated the home ranges and core use areas of hawksbill turtles using kernel-density estimations and found that each turtle showed high fidelity to their foraging sites. Home ranges calculated with GPS-derived locations ranged between 13.6 and 2.86 km2, whereas home ranges calculated with Argos-derived locations ranged from 38.98 to 286.45 km2. GPS-derived locations also revealed a higher proportion of time spent in coral and rock habitats compared to Argos, based on location overlap with the Allen Coral Reef Atlas. We also found that turtles were making shallow dives, usually remaining between 0 and 5 m. Conclusions: While the number of tracked turtles in this study was small, it represents an important contribution to the current understanding of spatial ecology among foraging hawksbill turtles globally, and provides the first-ever reported hawksbill turtle tracking data from the Red Sea. Our results suggest that protecting coral reef habitats and implementing boating speed limits near reefs could be effective conservation measures for foraging hawksbill turtles in the face of rapid coastal development

Security of Tenure in Egypt: Policies and Challenges

This thesis explores a set of urban laws and policies adopted in the past decade in Egypt regarding their possible effect on security of tenure as an element of the right to housing. The past decade has witnessed a legislative focus on formalizing tenure rights coupled with policies aiming at redevelopment of informal settlements, infrastructure projects and lately a goal of eliminating unplanned areas by 2030. This research attempts to untangle what these laws and policies could mean for a country with 40% of its housing being informal. It builds on a rich literature on titling programs in developing countries to offer a deeper understanding of the limitations of such programs and their effect on the informal security of tenure and perceived security. The thesis relied on semi structured interviews with experts and stakeholders and content analysis of laws, reports, and court decisions to investigate how Egypt fares regarding internationally accepted indicators of security of tenure. The findings suggest a lack of institutional competency to carry out titling procedures and a possibly negative effect on perceived tenure. The results show good achievements on structural indicators and access to justice in cases of loss of tenure but raise concerns regarding their application on the ground

The realization of time metaphors and the cultural implications : An analysis of the Quran and English Quranic translations

The aims of this paper were to contrast English usages of 'time' metaphors with Quranic Arabic realizations and their representations in three English Quranic translations. Three noted translations of the Quran were used, namely, those done by, Pickthall, Yusuf Ali and Asad ('Quran Search,' 2007). Using the cognitive theory of metaphor as a framework (Lakoff & Johnson, 1980), these translations were examined and contrasted, in order to distinguish the version that corresponded the most accurately with the conceptual metaphors found in both languages. If the examined conceptual metaphor was not realized in either language, changes to the meaning of the Quran were taken into consideration. Finally, historical, social and religious aspects were examined in order to determine the cause of certain conceptual metaphor realizations in both or one of the languages. Materials taken from Lakoff & Johnson (1980b), Lakoff (1994), Kövecses (2002), and Kövecses (2006) gave insight into the social-historical reasons behind the metaphor realizations in English while Quranic references and hadiths, or Prophetic narrations, were considered when examining the Quran. Two conceptual metaphors were tentatively concluded to be universal and two other metaphors were realized differently on the basis of differing cultural values. Culture in this context referred to the 'mental representations' of certain phenomena of a culture through the language (Kövecses, 2006, p.135). The translations done by Yusuf Ali and Pickthall were considered to be more literal and thus more accurate renderings of metaphors in the Quran, within the cognitive theory of metaphor framework, while Asad's translations were considered to be less accurate, containing, on the whole, more paraphrasing and individual interpretation. It was pointed out, however, that this is a sample study that cannot entirely represent the complete works of the authors mentioned. It was suggested that more studies need to be conducted in order to conclusively establish these findings

Scaffold-geführt Rekonstruktion des Kiefers durch axiale Vaskularisation mittels eines arterio-venösen- Schleifen Modells.

Background and Objectives Reconstruction of large and complex bone segments is one of the most challenging problems facing modern clinical practice. In order to diminish the donor site morbidity associated with autogenous bone transfer, synthetic biomaterials are being used nowadays to regenerate lost bone due to disease or trauma. The majority of currently applied regenerative medicine approaches rely on extrinsic vascularization, which could not be applied to reconstruction after cancer ablation. Our objective was to investigate the feasibility of regenerating a critical size mandibular defect in a goat using an axially vascularized synthetic bone substitute. Confirming the feasibility would help introducing regenerative medicine to reconstruction after cancer surgery. Materials and Methods This study is an experimental pilot study introducing the concept of axial vascularization of bone substitutes to regenerate a critical size mandibular defect in a large animal model (goat). In this study we used the facial vessels to create an arterio-venous loop in order to vascularize a biphasic ceramic scaffold. The scaffold was charged with platelet rich plasma and bone morphogenic proteins in order to augment osteogenesis. After a 6 months- follow up period, the new bone formation and vascularization were assessed through radiological (CT), biomechanical (3 points bending), and histological studies. Results and Observations We were able to demonstrate the technical feasibility of creating a local vascular axis through arterio-venous anastomosis within a synthetic bone substitute to regenerate a critical size mandibular defect. About 80% of the volume of the resected segment was regenerated. The biomechanical test showed that the mandible broke at a force of 1662.19 Newton. The histological study confirmed bone regeneration and adequate vascularization of the scaffold. Conclusions We were able to demonstrate for the first time through long-term follow up, radiological, histological, and biomechanical studies the feasibility of regenerating a critical size mandibular defect in a large animal using an axially vascularized bone substitute. The regenerated bone was mature, adequately vascularized and functionally competent. Further upgrading of this model by inducing a large segmental and possibly irradiated mandibular defect would be helpful to put the model in a real challenge and a very similar condition to clinical scenarios.Hintergrund und Ziele Die Rekonstruktion großer und komplexer Knochendefekte ist eine der anspruchsvollsten Fragestellungen in der heutigen klinischen Praxis. Um das Problem der Hebemorbidität eines autogenen Knochenersatz zu umgehen, werden heutzutage synthetische Biomaterialien verwendet. Die meisten der heutigen Ansätze basieren dabei auf einer extrinsischen Blutversorgung. Dieses Verfahren ist jedoch bei der Rekonstruktion nach Tumorentfernung nicht immer anwendbar. Ziel unserer Arbeit war die Evaluation eines axial und somit intrinsisch vaskularisierten synthetischen Knochenersatzes an einem Großtier-modell. Der Erfolg dieses Konzeptes erlaubt der Wiederherstellung von ausgedehnten, mandibulären Knochendefekten nach onkologischer Resektion. Material und Methoden Bei der vorliegenden Pilot-Studie wurde das Konzept des axial vaskularisierten synthetischen Knochenersatzes an einem Großtier-Modell (Ziege) untersucht. Hierbei wurde eine arterio-venöse Schleife basierend auf die Arterie und die Vene Fazialis zentral in ein biphasisches Keramik-konstrukt eingebracht, welches durch Zugabe von thrombozytenreichem Plasma (PRP) und Knochenwachstumsproteinen (BMP) zur Osteogenese angeregt wurde. Nach einer Beobachtungsintervall von 6 Monaten erfolgte die Charakterisierung der Knochenneubildung und-vaskularisation mit Hilfe von Computertomographie (CT) sowie durch biomechanische und histomorphologische Verfahren. Ergebnisse und Beobachtungen Die technische Eignung der axialen Vaskularisation eines synthetischen Knochenersatzes mittels einer arterio-venöser Schleife konnte beim Großtier-Modell bestätigt werden. Hierbei wurde ca. 80% des Knochenvolumens regeneriert. Die biomechanische Untersuchung hat einen Brechpunkt von 1662.19 Newton und somit eine gute Stabilität nachgewiesen. Die histomorphologische Untersuchung bestätigte die Wiederherstellung des Knochens sowie auch die reichende Vaskularisation des Konstrukts. Praktische Schlussfolgerung In der vorliegenden Arbeit wurde die Eignung das axial vaskulariserten, synthetischen Knochenersatzes bei der Wiederherstellung eines kritischen mandibulären Defektes erstmalig nachgewiesen. Der wiederhergestellte Knochen war voll entwickelt, ausreichend vaskularisiert, und funktionsfähig. Erweiterung dieses Modells durch Vergrößern bzw. Verstrahlen des mandibulären Defektes kann den klinischen Szenarios ganz gut ähneln