"It doesn't exist…": negotiating palliative care from a culturally and linguistically diverse patient and caregiver perspective.

BACKGROUND: The end of life represents a therapeutic context that acutely raises cultural and linguistic specificities, yet there is very little evidence illustrating the importance of such dynamics in shaping choices, trajectories and care practices. Culture and language interplay to offer considerable potential challenges to both patient and provider, with further work needed to explore patient and caregiver perspectives across cultures and linguistic groups, and provider perspectives. The objective of this study was to develop a critical, evidence-based understanding of the experiences of people from Culturally and Linguistically Diverse (CALD) backgrounds, and their caregivers, in a palliative care setting. METHODS: A qualitative study, using semi-structured interviews to explore key experiences and perspectives of CALD patients and caregivers currently undergoing treatment under oncology or palliative care specialists in two Australian hospitals. Interviews were digitally audio recorded and transcribed in full. A thematic analysis was conducted utilising the framework approach. RESULTS: Sixteen patients and fourteen caregivers from a range of CALD backgrounds participated in semi-structured interviews. The research identified four prevalent themes among participants: (1) Terminology in the transition to palliative care; (2) Communication, culture and pain management; (3) (Not) Talking about death and dying; and, (4) Religious faith as a coping strategy: challenging the terminal diagnosis. CONCLUSIONS: CALD patients and caregivers' experiences are multifaceted, particularly in negotiating linguistic difficulties, beliefs about treatment, and issues related to death and dying. Greater attention is needed to develop effective communication skills, recognise CALD patients' particular cultural, linguistic and spiritual values and needs, and acknowledge the unique nature of each doctor-patient interaction

Poverty among households living in slum area of Hlaing Tharyar Township, Yangon City, Myanmar

Background: Slums can be regarded as physical manifestations of urban poverty. Although the world has made dramatic improvement in reducing poverty since 1990, poverty still persists at an unacceptable level. Although current situations highlights the importance of slum areas to be given priority in poverty alleviation, there are limited data on poverty level among people living in urban slums of Myanmar.Methods: A cross-sectional study was conducted among households living in slum areas of Hlaing Tharyar Township, Yangon City, Myanmar during 2016. Multi-staged systematic random sampling and face-to-face interview were applied in selecting the samples and collecting the data, respectively. The new global poverty line (1.9 USD per person per day) was used as a threshold in determining the poverty. Chi-squared test and multivariate logistic regression analysis were utilized in data analysis.Results: Altogether 254 participants were recruited after getting informed consent. The occurrence of poverty among households was 54.3% (95% CI: 48.2%, 60.5%). Head counts of poverty among study population was 58.8%. The education status of household’s head, size of household and the presence of less than 15 years old children in the household were detected as significant determinants of being poor household.Conclusions: Poverty among households living in slum area of Hlaing Tharyar Township, Yangon City was high. Measures to alleviate poverty in urban slums should be intensified. Education level of household’s heads should be improved. Family planning or birth spacing programme should also be strengthened, especially in urban slums.

Factors Associated With Prolonged Length of Stay for Elective Hepatobiliary and Neurosurgery Patients: A Retrospective Medical Record Review

Background: Patients with prolonged length of hospital stay (LOS) not only increase their risks of nosocomial infections but also deny other patients access to inpatient care. Hepatobiliary (HPB) malignancies have some of highest incidences in East and Southeast Asia and the management of patients undergoing HPB surgeries have yet to be standardized. With improved neurosurgery techniques for intracranial aneurysms and tumors, neurosurgeries (NS) can be expected to increase. Elective surgeries account for far more operations than emergencies surgeries. Thus, with potentially increased numbers of elective HPB and NS, this study seeks to explore perioperative factors associated with prolonged LOS for these patients to improve safety and quality of practice. Methods: A retrospective cross-sectional medical record review study from January 2014 to January 2015 was conducted at a 1250-bed tertiary academic hospital in Singapore. All elective HPB and NS patients over 18　years old were included in the study except day and emergency surgeries, resulting in 150 and 166 patients respectively. Prolonged LOS was defined as above median LOS based on the complexity of the surgical procedure. The predictor variables were preoperative, intraoperative, and postoperative factors. Student\u27s t-test and stepwise logistic regression analyses were conducted to determine which factors were associated with prolonged LOS. Results: Factors associated with prolonged LOS for the HPB sample were age and admission after 5　pm but for the NS sample, they were functional status, referral to occupational therapy, and the number of hospital-acquired infections. Conclusion: Our findings indicate that preoperative factors had the greatest association with prolonged LOS for HPB and NS elective surgeries even after adjusting for surgical complexity, suggesting that patient safety and quality of care may be improved with better pre-surgery patient preparation and admission practices

On minimizing coding operations in network coding based multicast: an evolutionary algorithm

In telecommunications networks, to enable a valid data transmission based on network coding, any intermediate node within a given network is allowed, if necessary, to perform coding operations. The more coding operations needed, the more coding resources consumed and thus the more computational overhead and transmission delay incurred. This paper investigates an efficient evolutionary algorithm to minimize the amount of coding operations required in network coding based multicast. Based on genetic algorithms, we adapt two extensions in the proposed evolutionary algorithm, namely a new crossover operator and a neighbourhood search operator, to effectively solve the highly complex problem being concerned. The new crossover is based on logic OR operations to each pair of selected parent individuals, and the resulting offspring are more likely to become feasible. The aim of this operator is to intensify the search in regions with plenty of feasible individuals. The neighbourhood search consists of two moves which are based on greedy link removal and path reconstruction, respectively. Due to the specific problem feature, it is possible that each feasible individual corresponds to a number of, rather than a single, valid network coding based routing subgraphs. The neighbourhood search is applied to each feasible individual to find a better routing subgraph that consumes less coding resource. This operator not only improves solution quality but also accelerates the convergence. Experiments have been carried out on a number of fixed and randomly generated benchmark networks. The results demonstrate that with the two extensions, our evolutionary algorithm is effective and outperforms a number of state-of-the-art algorithms in terms of the ability of finding optimal solutions

Osteonecrosis of the Maxilla and Mandible in Patients with Advanced Cancer Treated with Bisphosphonate Therapy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139939/1/onco0911.pd

A Fly in the Ointment: Evaluation of Traditional Use of Plants to Repel and Kill Blowfly Larvae in Fermented Fish

Introduction: In rural areas in Laos, fly larvae infestations are common in fermenting fish. Blowflies (Chrysomyamegacephala, Diptera: Calliphoridae) are attracted to oviposit (and/or larviposit) onto fermenting fish which results ininfestations with fly larvae. Knowledge of traditional use of plants to repel larvae during the production of fermented fish iscommon and widespread in Lao PDR. Research Questions: How effective are the most salient species in repelling, and killing fly larvae in fermenting fish? Material and Methods: The three plant species most frequently reported to repel fly larvae during an ethnobotanical surveythroughout Lao PDR were tested for repellence and larvicidal activity of fly larvae infesting fermented fish. The lethality andrepellence of Tadehagi triquetrum (L.) H. Ohashi (Fabaceae), Uraria crinita (L.) Desv. ex DC. (Fabaceae) and Bambusa multiplex(Lour.) Raeusch. ex Schult. & Schult. f. (Poaceae) were tested in an experimental design using fermenting fish in Vientiane,Lao PDR. Results: The repellent effect of fresh material of T. triquetrum and U. crinita, and the larvicidal effect of fresh B. multiplex, issignificantly more effective than that of dried material of the same species, and the total effect (repellence and larvicidaleffect combined) for each of the three species was significantly more effective for fresh than for dry material. Fresh materialof T. triquetrum, U. crinita, or B. multiplex added on top of the fermenting fish repelled 50%, 54%, 37%, and killed 22%, 28%,and 40% of fly larvae. The total effect was not significantly different per species at 72%, 82%, and 77%, respectively. Discussion and Conclusions: The three most salient species are effective in repelling and killing fly larvae in the productionof fermented fish, and may be essential to augment food safety during traditional fermentation in open jars

Identification of new sources of resistance to dry root rot caused by Macrophomina phaseolina isolates from India and Myanmar in a mungbean mini-core collection

Dry root rot (DRR), caused by Macrophomina phaseolina, is a prevalent disease of mungbean in Myanmar, and an emerging problem in South Asia. The pathogen is a polyphagous necrotroph, survives in the soil for many years that results disease mitigation difficult. Managing DRR in mungbean through an integrated approach has been suggested, and the use of resistant varieties is one of the economical methods. The present study aimed to identify sources of resistance against DRR from a mungbean mini-core collection and to characterize the associated M. phaseolina isolates from India and Myanmar. Evaluation of the 296 mungbean mini-core accessions against the isolate MP1 by paper towel method identified 29 accessions with DRR resistance (disease scores: ≤ 3), and 18 of them with the consistent resistance in the repeated experiment. During the screening of 18 resistant accessions in the glasshouse, nine accessions were found DRR resistance in repeated sick pot experiments with ≤10% disease incidence. A subset of 30 accessions was selected from the mini-core collection based on their in vitro DRR reactions. These accessions were evaluated for DRR resistance in the field in Yezin, Myanmar in 2018 and 2019. Out of the 30 accessions, ten accessions were found DRR resistance with ≤10% disease incidence in both years of evaluations. Pooled analysis of percent disease incidence data of 15 accessions common in both glasshouse and field revealed the stability of accessions VI001509AG, VI001244AG, and VI001400AG for DRR resistance across years and locations. The three resistant accessions along with a susceptible check VC693088 were re-evaluated by paper towel method against nine additional M. phaseolina isolates from India (MP3-MP11). The accessions VI001509AG and VI001400AG were resistant to all nine isolates, while accession VI001244AG was resistant to MP5, MP6, and MP7 isolates. These accessions could be used in mungbean DRR resistance breeding programs