Reworking the postmodern understanding of reality through fantasy in M. Night Shyamalan’s Lady in the Water (2006) and Neil Jordan’s Ondine (2009)

In the two feature films Lady in the Water (2006) and Ondine (2009), M. Night Shyamalan and Neil Jordan, respectively, present us with two grounded-in-reality fairy tales whose two male protagonists come in close contact with two mythical water creatures – encounters that positively reshape their perspective on reality through the use of fantasy. Shyamalan relates the story of an emotionally wrecked middle-aged man who rescues a ‘narf’ (a water nymph in an unoriginated ancient bedtime story) from the pool of the dreary building he is superintending, while Jordan follows the ordeal of a struggling Irish fisherman who accidentally fishes a ‘selkie’ (a Celtic seal-like water creature that has the power to assume full human form on land by shedding its seal skin). The two films negotiate the problematic connection between the fantastic and the real, and question the postmodern concept of representations masking an absence of solid reality as proposed by Jean Baudrillard. The paper focuses on tracing the ontological and linguistic role of fantasy in relation to reality and delineates how acts of storytelling and representation can refashion the human psyche’s perception of reality in a postmodern world by analysing the narrative and psychological means by which this relation is constructed in Shyamalan’s and Jordan’s films. The main argument of the paper is to explore how employing metafictional narrative techniques and reworking the psyche’s ties to fantasy can offer the postmodern individual a more enabling understanding of themselves and their reality

Nurses’ Perceived Factors of Reluctance to Implement the Bowel Regimen Protocol in Intensive Care Units

Aims: To identify nurses’ perceived factors of reluctance to implement the bowel protocol in the ICUs. Background: However, Bowel regimen protocol of patients in the intensive care unit is safe, feasible, and beneficial, its’ implementation as part of routine nursing clinical care can be challenging. Study design: Descriptive cross-sectional design. Methods: A cross-sectional survey of 64 nurses who were working in intensive care units and meet the inclusion criteria was conducted between April 2017 and February 2018.  The survey instrument was a semi-structure interview questionnaire developed by the researchers based on the related literature. Results: The mean age of studied nurses was 29.12± 6.41. The most frequently nurses’ perceived factors of reluctance to deliver bowel regimen were the busy shift (93.8%), limited staff & lack of supervision (92.2 %), the low priority of bowel care (90.6%) when considered against other demands of the highly technical intensive care units, unclear order from the doctors (89.06%)., forgetfulness and lack of education and awareness(92.2 %). Conclusion: This study provides an understanding of the perceived factors of reluctance to deliver bowel regimen for critically ill patients. Implications for Nursing Management: Nurse Managers could deal with factors of reluctance to deliver bowel regimen protocol in the ICUs and develop new strategies to overcome these factors Keywords: critical care; intensive care; bowel care DOI: 10.7176/JHMN/73-10 Publication date: April 30th 202

Multi-factorial Etiology of Gallbladder Cancer: A USA Case-Control Population Study

https://openworks.mdanderson.org/sumexp21/1121/thumbnail.jp

Flavones composition and therapeutic potential of Dodonaea viscosa against liver fibrosis

Dodonaea viscosa (L.) Jaeq (Sapindaceae) is used in traditional medicine for the treatment of hemorrhoids, ulcer, and pains of hepatic or stomach origin. The current study was designed to investigate the phytochemical constituents of the plant and evaluate its activity against liver fibrosis induced by carbon tetrachloride (CCl4) in rats.   The phytochemical analysis has afforded one flavanone; 5,7-dihydroxy flavanone (pinocembrin) (1) and eight flavones. The compounds were isolated and elucidated as; 5,7-dihydroxy-3,6,4'-trimethoxyflavone (santin) (2), 5,7,4'-trihydroxy-3-methoxy flavone (kaempferol 3-O-methyl ether) (3), 3,4',5-trihydroxy-7-methoxy flavone (kaempferol 7-O-methyl ether) (4), 3',4',5,7-tetrahydroxy-3-methoxy-flavone (quercetin 3'-O-methyl ether) (5), 3,3',4',5,7-pentahydroxyflavone (quercetin) (6), 5,7,4'-trihydroxy-3,6-dimethoxy flavone (7), 5,7-dihydroxy 3,6,3',4'-tetramethoxy flavone (8), and isorhamnetin-3-O-robinobioside (9).. In vitro screening of ethanol extract, fractions of toluene and ethyl acetate, the flavanone and major flavone compounds as antioxidants was carried out. In addition, D. viscosa ethanol extract and two fractions were examined in vivo against liver fibrosis induced by CCl4 in rats. The evaluation was done through measuring hepatic oxidative stress markers; malondialdehyde (MDA), glutathione (GSH) and superoxide dismutase (SOD). The work was extended to measure serum protein content and liver function enzymes; aspartate and alanine aminotransferases (AST and ALT), alkaline phosphatase (ALP­) and gamma glutamyl transferase (GGT). Liver histopathological analysis was done for results confirmation. In conclusion, among the isolated flavones, compounds 3, 4, and 8 were isolated for the first time. The ethanol extract and compound of 6, 5 followed by 7 exhibited the strongest antioxidant activities. Treatment with D. viscosa extract and its fractions attenuates the increments of MDA, AST, ALT, ALP, GGT, total protein and increased GSH and SOD levels. The ethanol extract showed the most potent effect. The data confirmed the rationale for the traditional use of D. viscosa extracts to hepatic disorders. Further studies are needed in order to evaluate the isolated flavones as protective agents against liver injury and for their clinical application

Flavones composition and therapeutic potential of Dodonaea viscosa against liver fibrosis

Dodonaea viscosa (L.) Jaeq (Sapindaceae) is used in traditional medicine for the treatment of hemorrhoids, ulcer, and pains of hepatic or stomach origin. The current study was designed to investigate the phytochemical constituents of the plant and evaluate its activity against liver fibrosis induced by carbon tetrachloride (CCl4) in rats.   The phytochemical analysis has afforded one flavanone; 5,7-dihydroxy flavanone (pinocembrin) (1) and eight flavones. The compounds were isolated and elucidated as; 5,7-dihydroxy-3,6,4'-trimethoxyflavone (santin) (2), 5,7,4'-trihydroxy-3-methoxy flavone (kaempferol 3-O-methyl ether) (3), 3,4',5-trihydroxy-7-methoxy flavone (kaempferol 7-O-methyl ether) (4), 3',4',5,7-tetrahydroxy-3-methoxy-flavone (quercetin 3'-O-methyl ether) (5), 3,3',4',5,7-pentahydroxyflavone (quercetin) (6), 5,7,4'-trihydroxy-3,6-dimethoxy flavone (7), 5,7-dihydroxy 3,6,3',4'-tetramethoxy flavone (8), and isorhamnetin-3-O-robinobioside (9).. In vitro screening of ethanol extract, fractions of toluene and ethyl acetate, the flavanone and major flavone compounds as antioxidants was carried out. In addition, D. viscosa ethanol extract and two fractions were examined in vivo against liver fibrosis induced by CCl4 in rats. The evaluation was done through measuring hepatic oxidative stress markers; malondialdehyde (MDA), glutathione (GSH) and superoxide dismutase (SOD). The work was extended to measure serum protein content and liver function enzymes; aspartate and alanine aminotransferases (AST and ALT), alkaline phosphatase (ALP­) and gamma glutamyl transferase (GGT). Liver histopathological analysis was done for results confirmation. In conclusion, among the isolated flavones, compounds 3, 4, and 8 were isolated for the first time. The ethanol extract and compound of 6, 5 followed by 7 exhibited the strongest antioxidant activities. Treatment with D. viscosa extract and its fractions attenuates the increments of MDA, AST, ALT, ALP, GGT, total protein and increased GSH and SOD levels. The ethanol extract showed the most potent effect. The data confirmed the rationale for the traditional use of D. viscosa extracts to hepatic disorders. Further studies are needed in order to evaluate the isolated flavones as protective agents against liver injury and for their clinical application

Assessment of Knowledge, Attitude and Practice of Molar-Incisor Hypomineralisation among a Group of Egyptian Dentists (Observational Cross-Sectional Study)

Abstract: Introduction: Molar Incisor Hypomineralisation (MIH) is one of qualitative DED. MIH is increasing dramatically in the new generations, which is considered to be challenging for the majority of dentists. MIH was found to be prevalent in 14.2% of the world\u27s population, with the high incidence 18% in South America and the least (10.9%) in Africa. This study was carried out to assess the knowledge, attitude, and practice of graduated Egyptian dentists\u27 group regarding MIH condition and compare the outcome information among different dental specialists. Material and methods: A google based questionnaire based on previously validated published papers distributed electronically through different social media by direct message or public social media link. Eligibility criteria including Graduated Egyptian licensed dentists excluding students, interns and other medical specialties. Model answer prepared by researchers in 3 rounds based on most recent published papers. Results: 416 participants enrolled in this study with response rate reach to 16.7% for direct message and 1.4% for public share link. 79.1% of PDs, 45.8% of GPs and 45.0% of other specialties are familiar with both MIH condition and terminology. A prevalence of 10-20 % was notice by participants during their practice (21.9% PDs, 22.0% GPs and 22.2 other specialties). Most of participants believe that there is a lack of information regarding MIH between Egyptian dentists. The majority of the participant used Full coverage for posterior teeth and composite resin for anterior teeth as treatment choice. 53.1% of PDs are encountered MIH in monthly bases. Conclusion: MIH is a clinical problem that Egyptian dentists well recognize and frequently encounter in clinical practice. There is a need to include MIH in academic curriculum to increase the awareness regarding the condition and clinical management

CARD15/NOD2, CD14 and Toll-like 4 Receptor Gene Polymorphisms in Saudi Patients with Crohn’s Disease

Crohn’s disease (CD) is a multifactorial disease with a genetic component and an observed association with genes related to the innate immune response. Polymorphisms in the CARD15/NOD2 gene, in addition to functional variants of the toll-like receptor-4 (TLR4) and CD14 genes, have been associated with the development of Crohn’s disease. There is no information about the frequency of these polymorphisms in the Saudi population. We examined the frequency of the three major CARD15/NOD2 risk alleles (Leu1007fsinsC, Arg702Trp, and Gly908Arg) and the TLR4 (Thr399Il) polymorphism as well as a functional polymorphism in the promoter of the CD14–159C/T in 46 Saudi CD patients and 50 matched controls. Genotyping was performed by allele-specific PCR or by restriction fragment length polymorphism (PCR-RFLP) analysis. The mutant genotype frequencies of the Leu1007fsinsC, Arg702Trp and Gly908Arg in the patient group were 6.5, 21.7 and 6.5%, respectively, compared with frequencies of 0, 4 and 2%, respectively, in the control group. There were 15 patients who carried the mutant alleles for all three CARD15/NOD2 variants, Leu1007fsinsC, Arg702Trp and Gly908Arg, while none of the control candidates carried the three alleles. This genetic study provides evidence that the three major CARD15/NOD2 variant alleles and the CD14 –159C/T polymorphism are associated with Crohn’s disease (CD) susceptibility in the Saudi population; however, there is no evidence that the TLR4 (Thr399Il) or CARD15/NOD2 polymorphisms can be considered risk factors for Crohn’s disease

Obesity Early in Adulthood Increases Risk but Does Not Affect Outcomes of Hepatocellular Carcinoma

Despite the significant association between obesity and several cancers, it has been difficult to establish an association between obesity and hepatocellular carcinoma (HCC). Patients with HCC often have ascites, making it a challenge to accurately determine body mass index (BMI), and many factors contribute to the development of HCC. We performed a case–control study to investigate whether obesity early in adulthood affects risk, age of onset, or outcomes of patients with HCC

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely