Mediation in literacy : language, technology, and modality.

The issue of difference in writing, both in terms of language diversity and modalities, has received increasing attention in the context of new developments in technologies, increasing global migration, and intensified intersections of cultural and linguistic practices accompanying these changes. Theories of language and modality are trying separately to develop ways to best respond to the challenges and opportunities brought about by these changes. Responding to scholars’ recent calls for bridging the gap between studies of multilingualism and those of multimodality, this dissertation offers an approach that, instead of separating the study of modality and languages, questions such a tendency to not only create dichotomies between these two, but also to assume the stability and discrete character of various modes and languages. I argue that dominant, additive models of multimodality and multilingualism deemphasize understandings of languages, modalities, and technologies as material social practices in a complex communicative ecology, thereby implying what Brian Street calls “an autonomous” model of multimodality and multilingualism. Going beyond the abstract notions of language and modality as stable and discrete, this dissertation urges us to see the material-social practice of language as always already multimodal, while also being part of the ecology of multimodal semiotic practices. This dissertation has been divided into five chapters. Chapter One introduces issues of multilingualism and multimodality and provides a brief theoretical background to analyze dominant assumptions about language and modality. Chapter Two interrogates social theories of agency and mediation, both humanist and anti-humanist and develops an alternative understanding of mediation based on cultural materialist theories of practice and new materialism. I discuss how theories of Bourdieu, Giddens, and Pennycook help us see seemingly isolated acts as parts of a nexus of sedimented practices, whereas Latour’s call to pay attention to non-human agents and mediation as translation makes us see how durability and change in practices do not depend only on human agents and social structures, but equally on the “missing masses.” Chapter Three and Chapter Four take up the theoretical insights from the previous chapters, arguing that major theories of multilingualism and multimodality retain some residues of monolingualism and monomodality either in assuming the discrete and stable character of languages and modes or in assuming individual users as stable and free-floating agents. In an attempt to overcome these monolingualist and monomodalist tendencies, these two chapters call for paying attention to the full panoply of (f)actors affecting semiotic negotiations of our students rather than romanticizing the agency of users in an attempt to debunk monolinugualist/monomodalist ideology. Chapter Five develops an alternative, integrated way of viewing translingual and transmodal relations. This chapter ends with a demonstration of how shifting our theoretical orientation challenges not only the norm of existing pedagogical practices of segregating codes (linguistic or other semiotic), but also revises some of the multilingual and multimodal pedagogies advocated in recent studies

Access to free health-care services for the poor in tertiary hospitals of western Nepal: a descriptive study

Background: Nepal is an underdeveloped country in which half of the total health expenditure is from out-of-pocket payments. Thus, the Government of Nepal introduced universal free health-care services up to the level of district hospitals, and targeted these services to poor and marginalized people in regional and subregional hospitals. The aim of this descriptive study was to explore the implementation and utilization of free health-care services by the target population (poor and marginalized people) in two tertiary-care hospitals in western Nepal, one with a social care unit (Western Regional Hospital) and one without a social care unit (Lumbini Zonal Hospital). Methods: Medical records maintained by the two hospitals for one Nepali calendar year were collected and analysed, along with information from key informant interviews with staff from each hospital and patient exit interviews. Results: Utilization of free health-care services by poor and marginalized people in the two tertiary-care hospitals was suboptimal: only 8.4% of patients using services were exempted from payment in Western Regional Hospital, whereas it was even fewer, at 2.7%, in Lumbini Zonal Hospital. There was also unintended use of services by nontarget people. Qualitative analysis indicated a lack of awareness of free health-care services among clients, and lack of awareness regarding target groups among staff at the hospitals. Importantly, many services were utilized by people from rural areas adjoining the district in which the hospital was situated. Conclusion: Utilization of free health-care services by the target population in the two tertiary-care hospitals was very low. This was the result of poor dissemination of information about the free health-care programme by the hospitals to the target population, and also a lack of knowledge regarding free services and target groups among staff working in these hospitals. Thus, it is imperative to implement educational programmes for hospital staff and for poor and marginalized people. Unintended use of free services was also seen by nontarget groups; this suggests that there should further simplification of the process to identify target groups

STUDY OF THE COMPUTED TOMOGRAPHY MEASUREMENT OF DIAMETER OF ABDOMINAL AORTA IN NEPALESE

Background: The diameter of abdominal aorta (DAA) has its own importance in human body in diagnosing several abdominal aortic diseases. Its size is the diagnostic parameter for the abdominal aortic aneurysm which is the localized dilation of the abdominal aorta. Methods: The DAA of Nepalese was measured according to age and sex at three different levels, just superior to the celiac axis, at renal pedicle level and just superior to bifurcation by using Computerized Tomography (CT) scan. Also the DAA of the normal people was compared to those having hypertension, alcohol consumption and smoking habit. Study Sample: Altogether, 125 patients were included who came to Tribhuvan University Teaching Hospital (TUTH), Maharajgung, Kathmandu, Nepal for abdominal CT scan. Among them 100 are normal population and 25 are the victim of hypertension, alcohol consumption and smoking habit. Results: The findings revealed that the DAA in most of the observed patients is less than the aneurysm limit i.e. smaller than 30mm except in one male patientof age 72 years. Conclusion: It is concluded that the diameter of abdominal aorta increases with ages and is pronounced more in Nepalese male population than in female. It is also higher in patients of both sexes having hypertension and smoking habit. KEYWORDS: Bifurcation; Celiac axis; CT scan, DAA; Renal pedicle level

Role of Ultrasound Scan in Non-Traumatic Acute Abdomen Presenting in Surgery Department of a Tertiary Care Center

Introduction: An acute abdomen is defined as a clinical condition characterized by severe abdominal pain developing suddenly over several hours or less. Ultrasonography (USG) helps the managing surgeons arrive at early diagnosis and rule out alternative diseases, thus reducing negative laparotomy rate. This study analyzed the diagnostic yield of USG in patients with non-traumatic acute abdomen presenting to Surgery department via Emergency department/outpatient department of a tertiary hospital. Methods: This cross-sectional observational study included 110 patients with non-traumatic acute abdominal pain who were sent for USG examination. The percentage concordance of USG diagnosis with the final diagnosis at discharge was determined in terms of sensitivity, specificity, positive and negative predictive values for acute abdomen. Results: Of 110 patients, correct clinical diagnosis was made in 83 patients (75%) while USG made a correct diagnosis in 101 patients (91%). Hence, with the help of USG, accuracy of diagnosing cause of acute abdomen increased by 16 %. The sensitivity and specificity of USG in diagnosis of acute appendicitis were 87.7% and 98.3% respectively. Conclusion: USG is easily available and non-invasive modality without radiation exposure and requiring minimal patient preparation. USG should, therefore, be an important routine diagnostic investigation in patients presenting with acute abdomen

STUDY OF THE COMPUTED TOMOGRAPHY MEASUREMENT OF DIAMETER OF ABDOMINAL AORTA IN NEPALESE

Background: The diameter of abdominal aorta (DAA) has its own importance in human body in diagnosing several abdominal aortic diseases. Its size is the diagnostic parameter for the abdominal aortic aneurysm which is the localized dilation of the abdominal aorta. Methods: The DAA of Nepalese was measured according to age and sex at three different levels, just superior to the celiac axis, at renal pedicle level and just superior to bifurcation by using Computerized Tomography (CT) scan. Also the DAA of the normal people was compared to those having hypertension, alcohol consumption and smoking habit. Study Sample: Altogether, 125 patients were included who came to Tribhuvan University Teaching Hospital (TUTH), Maharajgung, Kathmandu, Nepal for abdominal CT scan. Among them 100 are normal population and 25 are the victim of hypertension, alcohol consumption and smoking habit. Results: The findings revealed that the DAA in most of the observed patients is less than the aneurysm limit i.e. smaller than 30mm except in one male patientof age 72 years. Conclusion: It is concluded that the diameter of abdominal aorta increases with ages and is pronounced more in Nepalese male population than in female. It is also higher in patients of both sexes having hypertension and smoking habit. KEYWORDS: Bifurcation; Celiac axis; CT scan, DAA; Renal pedicle level

Knowledge and Perception of Public Towards Medico Legal Autopsy in Nepal

Introduction: Autopsy is an important tool to determine the cause of death. This study was conducted with the objectives to assess the knowledge and perception of Nepalese people towards medico legal autopsy. Methods: It was a questionnaire based cross sectional study performed among the general public of Nepal. A standard pretested questionnaire was used to collect the responses on knowledge and perception of the people about medico legal autopsy. Independent samples t-test was used to compare the mean score of knowledge among the various groups. P value of < 0.05 was considered significant. Results: Mean age of the respondents was 29.06 years (SD = 10.50) and 72.31% were male (n = 188, N = 260). Mean score of knowledge was 6.65 (SD = 1.76) out of a total ten. The score was significantly higher (p = 0.02) among the respondents whose relatives had undergone an autopsy than those whose were not. It was comparable among the educated and uneducated groups.  A total of 75.77% respondents (n = 197, N = 260) would not reject the autopsy of their relatives. Conclusion: People lack knowledge mostly in basic elements of medico legal autopsy. Most of the people showed positive perception towards autopsy and those who were negative, feared of disfigurement of the bodies after an autopsy

Clinical profile of patients with acute coronary syndrome in Lumbini Medical College and Teaching Hospital: A prospective study

Background: The clinical profile among patients with acute coronary syndromes (ACS) is not well studied in this western part of Nepal where Lumbini Medical College and Teaching Hospital (LMCTH) is situated. Cardiovascular disease is now the most common non communicable disease killing thousands of people worldwide. The trend of incidence is increasing in the developing countries including Nepal. Objective: To obtain the clinical profile of patient presenting with ACS in LMCTH. Material and Method: This is a prospective study carried out in LMCTH in the department of Internal Medicine April 14, 2013 to October 14, 2013. Patients were diagnosed to have ACS based on their clinical findings, Electrocardiogram (ECG) and Troponin test. Those with non-cardiac chest pain were excluded. A detail history and all the data pertaining to the patient were noted analyzed in a systematic way. Results: A total of 40 patients with ACS presented during the study period in LMCTH. The mean age of presentation was 67±18 years. Thirty out of those constitute male (75%). Six patients (15%) died during the study period. Seventeen (42.5%) presented with central chest pain, 13(32.5%) presented with left sided chest pain, 4(10%) presented with acute shortness of breath. Four (10%) patient presented in the state of cardiogenic shock and 2 (5%) presented with the Ventricular tachycardia (VT) as their complication. 6 (15%) had unstable angina (UA), 14 (35%) had Non ST elevation Myocardial Infarction (NSTEMI) and 20 (50%) had ST elevation Myocardial Infarction (STEMI). Of the total 20 (50%) patient who had STEMI, only four of them underwent thrombolysis. Anterior wall MI was the most common wall involved. Circadian variation study showed peak incidence of acute coronary syndrome during the early morning hours.  Mean duration of symptoms before presentation to the hospital facility was 4 days. Mean hospital stay was 5±2 days. Conclusion: Cardiovascular disease is common in this Western part of Nepal. STEMI was the commonest presentation and the incidence was more among the male and the elderly patients

Diagnostic yield of percutaneous computed tomography guided core needle biopsy of lung lesion and its complications in tertiary hospital

Background: Early diagnosis of lung cancer can reduce its mortality and morbidity. Minimally invasive image guided percutaneous core needle biopsy can obtain tissue sample for diagnosis and staging of lung cancer, which is crucial for correct management of lung lesions. Common complications of lung biopsy include pneumothorax, parenchymal haemorrhage and haemoptysis. The study was aimed to determine diagnostic yield and complications of the percutaneous computed tomography (CT) guided core needle biopsy of lung lesion in tertiary hospital.Methods: Hospital based prospective study was performed in 40 patients in Tribhuvan University Teaching Hospital. CT guided biopsy of lung lesions was performed with 18-gauge semi-automated biopsy instrument. The complications following the biopsy were recorded and correlated with different factors using chi-square test. Histopathology report were obtained to measure the diagnostic yield.Results: Among 40 patients who underwent guided lung biopsy, histopathology showed definitive diagnosis in 37 patients; 31 malignant and 6 benign lesions. Parenchymal haemorrhage, pneumothorax and haemoptysis were seen in 13, 8 and 5 respectively; however, none required active intervention. Emphysema in traversing lung and numbers of pleural punctures used were predictive factors of complication (p value <0.05).Conclusions: The study showed percutaneous image guided core needle biopsy has high diagnostic yield with fewer complication rates and is thus recommended for routine biopsies of lung lesions

A Cross-Sectional Study on Empathy and its Association With Stress in Medical Students

Introduction: Empathy is the cornerstone of the doctor-patient relationship and a crucial quality associated with better patient compliance and clinical outcomes. This study aims to assess the level of empathy and its association with the level of stress in 3rd and 4th year medical students Methods: This cross-sectional study was conducted in Kathmandu Medical College after taking ethical approval from the Institutional Review Committee and informed written consent from all the participants. The respondents completed a structured questionnaire including demographic profile, Jefferson Scale of Empathy-Student Version, and Perceived Stress Scale. Data were entered and analyzed in Statistical Package for the Social Sciences version 20. Results: A total of 255 questionnaires were obtained with a response rate of 85.2%. The mean empathy score was 101.79 (SD  =  11.26) and the mean perceived stress score was 18.55(SD = 5.56). There was a statistically significant negative correlation between empathy and stress (p-value &lt;0.01) and similar negative correlations were seen in sub-group analysis. Female students had higher empathy scores compared to their male counterparts (p-value &lt;0.01). Fourth-year students reported lower empathy scores than third-year students (p-value &lt;0.05).  Conclusion: Stress was found to be a significant determinant of empathy among medical students. Medical educators must be aware of this and should try to incorporate means to alleviate stress in medical education. Furthermore, effective stress management techniques to preserve empathy in medical students with a view to improve clinical competency and achieve optimum patient care needs to be studied

Does access to microfinance matter for rural women?

Due to the unavailability of financial services, the lack of products, and the cost of credit, many low-income households struggle to manage their savings and invest in, and expand, small businesses. Women, as well as poor and deprived groups, are unable to manage inputs and technologies to make their farms more productive. To boost local entrepreneurship, the Improved Seeds for Farmers’ Programme (KUBK-ISFP) set out to establish 30 financial institutions to increase women’s financial inclusion. Membership of a microfinance cooperative has been found to improve women’s empowerment and the livelihoods of poor farmers