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Social Problems of Cochlear Implant Patients Explained by the Social Determinants of Health: an Extended Literature Review.
No full textCochlear implants (CIs) represent a significant medical advancement; however, their success is heavily influenced by various social factors. Disparities in healthcare access and its quality, particularly in low-income or rural populations, can delay treatment, limit rehabilitation opportunities, and worsen outcomes. The high cost of implants and therapy may prevent access, especially for financially constrained families, whereas insufficient follow-up care can hinder speech and auditory development. Education access as well as quality play a crucial role in the development of CI users, especially in speech and language acquisition. However, children with CIs often face stigmatization, social isolation, and educational challenges. Parental involvement and understanding are key, but lower educational levels or misconception can impede support, further hindering cognitive and social growth in educational environments. Social and community support is vital for mental well-being, yet societal stigma and a limited understanding of CI technology often result in social exclusion or misperceptions. This lack of community integration affects personal and professional growth, affecting the overall quality of life of CI users. Economic status is directly linked to access to healthcare, with families in lower socioeconomic brackets facing greater financial strain. Limited insurance coverage or access to support programs creates treatment disparities, with fewer resources for rehabilitation and follow-up care. These financial inequalities exacerbate health outcome disparities among CI users. The neighbourhood and physical environment also significantly impact CI user outcomes. Rural or underserved areas often lack specialized care and therapy facilities, delaying CI intervention and rehabilitation. Isolated living conditions may lead to loneliness and social exclusion, compounding the challenges CI users face in their everyday lives. Overall, the challenges faced by cochlear implant users extend beyond the technology itself, deeply influenced by healthcare and education access and quality, the social and community context, economic stability, and the neighbourhood and physical environment. These social factors often contribute to significant disparities, emphasizing the need for a holistic approach to support CI users in overcoming these obstacles and improving their quality of life
Safety of Implantable Cardiac Rhythm Management Devices.
No full textLife-saving treatments, such as pacemakers (PM), implantable cardiac defibrillators (ICDs), and cardiac resynchronization therapy (CRT) devices, are used for numerous cardiac conditions. Cardiac rhythm management devices perform different functions, including monitoring for arrhythmias, bradycardia pacing, cardiac resynchronization for heart failure, defibrillation and anti-tachycardia pacing for ventricular tachyarrhythmias. Estimating the exact rate of CIED infections is challenging due to varying definitions, differences in patient populations, and the discrepancies between retrospective and prospective study rates. CIED infections typically occur through two main mechanisms. The most common is contamination of the leads or pulse generator during the initial implantation or later adjustments. Device erosion after these procedures can lead to a pocket infection, which could cause systemic infection. The second mechanism involves infection entering through the bloodstream. Medical devices, such as cardiac implantable electronic devices, have become highly interconnected. This means now CIED’s are more connected and are able to communicate with other devices or networks. This increases the risk of exploitation of cybersecurity vulnerabilities that can affect the device's function. Radiotherapy (RT) is frequently used in cancer treatment and may also be required before or after surgery as an alternative to surgical procedures. There are two types of RT: brachytherapy (internal radiation) and external beam radiation. While radiation can damage surrounding healthy tissue, it can also pose risks to cardiac implantable devices. Although ionizing radiation can harm CIED electronic circuits, and this has raised concerns about potential device malfunctions. Electromagnetic interference (EMI) could radiate from a distance or even be conducted via individuals if they are in contact with the source. Various factors could affect EMI. The programs set on these devices could influence their response to EMI. These programs include sensitivity, polarity, mode, refractory, and blanking periods. If the setting is more sensitive, the device starts to over-sense non-cardiac signals
Fahr’s syndrome manifested with neuropsychiatric symptoms: case report and literature review.
No full textEarly diagnosis of rare diseases presents numerous challenges, particularly when diagnosing the ultra-rare Fahr’s syndrome/disease, characterized by highly heterogeneous clinical manifestations. The aim of this thesis is to discuss an extremely rare clinical case where Fahr’s syndrome/disease was suspected in a patient with acute psychosis and other neuropsychiatric symptoms, and to conduct a literature review of this pathology. Methods include the clinical case description, as well as the analysis and synthesis of scientific literature. Objectives of this thesis: to present the patient’s life and medical history, psychiatric hospitalizations, the post-discharge period, assessment of mental status and physical condition, test results, treatment course and its response; to evaluate the clinical case data and substantiate suspected organic psychosis, suggesting a change in the psychiatric diagnosis if Fahr’s disease or syndrome is confirmed; to review the scientific literature on the etiology, diagnostic methods, clinical symptoms and treatment options of Fahr’s syndrome/disease; to present other clinical cases described in the literature where Fahr’s syndrome/disease manifested neuropsychiatric symptoms, and to compare them with the presented one. Conclusions. A clinical case was presented in which the patient developed psychosis of organic etiology. The diagnosis was confirmed by neuroimaging performed during the second hospitalization, when the suspicion of organic psychosis was raised by rapidly developing extrapyramidal symptoms from low doses of antipsychotics and the absence of family psychiatric history. Bilateral, symmetrical basal ganglia and cerebellar calcifications led to suspicion of Fahr’s syndrome or disease. Further evaluation is ongoing to determine whether the calcification is primary or secondary, with genetic test results awaited. The finding of basal ganglia calcification suggests it triggered psychosis, supporting a clinical diagnosis change to F06 registry pathology. Fahr’s syndrome/disease is an ultra-rare neurodegenerative condition with a broad spectrum of clinical symptoms; therefore, diagnosis requires additional tests alongside clinical assessment. Diagnostics rely on computed tomography, genetic testing for primary Fahr’s disease, and laboratory evaluation to rule out secondary causes. Treatment of Fahr’s syndrome is primarily focused on eliminating etiological factors and symptomatic management. Given the elevated risk of adverse drug reactions in Fahr’s syndrome/disease, it is recommended to avoid typical antipsychotics, reduce doses of atypical antipsychotics, and closely monitor for extrapyramidal symptoms. Comparison with other published cases revealed common features: an average age of 40–49 years, basal ganglia calcifications on neuroimaging, neurological symptoms and movement disorders, with a range of psychiatric disorders, including affective, anxiety, and psychotic, accompanied by pronounced thought and behavioral disorders
Patent law and human rights.
No full textThis Master's thesis analyzes the relationship between patent law and human rights, as well as the challenges of reconciling these two fields in the context of global technological development. It first explores the conceptual connection between patent protection and fundamental human rights—such as the right to health, access to information, privacy, and the right to benefit from scientific progress—and highlights the potential for conflicts between them. The thesis finds that while patent law aims to promote innovation, its implementation can pose risks to human rights, particularly in areas such as access to medicines, the patenting of genetic inventions, and the application of artificial intelligence. International agreements, such as the TRIPS Agreement, and the variations in their interpretation across different regions are examined in detail. Special attention is given to mechanisms like compulsory licensing, exceptions for public use, and the principle of prioritizing public interest, which can be applied to balance intellectual property protection with the safeguarding of human rights. The thesis also considers the impact of emerging technologies, such as artificial intelligence and blockchain systems, on the patent system and human rights enforcement. It concludes that current international and national legal frameworks do not always ensure a proportionate and effective reconciliation of these two domains, highlighting the need for more flexible and value-driven approaches. The study demonstrates that reconciling patent law with human rights requires not only legal but also ethical consideration, which should be reflected in both legislative processes and practical application, especially when addressing access to life-saving innovations
The effectiveness of remote training in improving the oral health knowledge of lithuanian seniors.
No full textRelevance of the problem and aim of the work. The aging Lithuanian population is facing multiple systemic diseases and deteriorating oral health care. In order to prevent oral diseases and manage systemic diseases, specific oral health care educational programs for seniors are needed. Online learning can be a more accessible form of education for seniors with physical limitations, financial difficulties or declining cognitive functions. The aim of this study is to determine whether online learning effectively improves the oral health care knowledge of Lithuanian seniors. Material and methods. Lithuanian seniors aged 65 and older were invited to participate voluntarily in the study through announcements on websites of organizations representing this group and in senior communities on Facebook. Those who consented completed a 32-question survey assessing their baseline knowledge of oral health care. Participants received links via email to educational articles from www.virtualusodontologas.lt every two weeks for two months. After the training, their knowledge was reassessed using the same survey, and participants received gift vouchers. Each correct survey answer was scored at 1 point (maximum 32 points). Data analysis was conducted using IBM SPSS Statistics 27.0.1 and Microsoft Excel 2016, with results deemed significant at p≤0.05. Results. A total of 117 seniors completed both questionnaires in the study. The average pre-training score was 11.21(±5.19), ranging from 0 to 24 points. Seniors younger than 75 years (p<0.001), with higher education (p=0.014) and those earning above €990 per month (p=0,032) achieved higher scores. Post – intervention, the average score rose by 5.82 points to 17.03 (±6.34) (p<0.001), with scores ranging from 4 to 30 points. The proportion of participants scoring above 20 points increased from 2.6% (N=3) to 33.3% (N=39) (p<0.001). Greater score improvements were observed among seniors with higher incomes (€2000 per month) (p=0.001) and those who read all educational articles (p=0.041). The most significant improvements in correct answers were related to the use of fluoride toothpaste (30.7%, p<0.001) and its recommended fluoride concentration (35.9%, p<0.001). Post-intervention, significantly more seniors reported using interdental brushes (p=0.044) and brushing their teeth twice daily (p=0.033). Conclusions. Seniors have insufficient oral health knowledge. Oral health knowledge is influenced by seniors‘ education, income and age. Online learning effectively enhances seniors‘ oral health knowledge and motivates changes in oral hygiene habits. Greater knowledge gains were observed among seniors with higher education and those who engaged fully with the educational materials. Keywords. Remote training, seniors, oral health knowledge, oral health behaviors
2024 lithuanian presidential elections: framing candidates and their programmes on "facebook" and in online news portals.
No full textEffective political communication requires both social media users and media. Politicians use social media to bring together like-minded voters, post news and positions that are relevant to them, and criticize opponents. Adding politicians’ statements and comments to media stories is useful for them as it broadens their audience and helps to develop political strategies. Active political communication is particularly important during elections. This paper analyses how the selected candidates for the 2024 Lithuanian Presidential Elections period created a personal image on their “Facebook” accounts, how they framed their programmes. It also examines how these candidates were framed by the media, on which topics they were visible, and what frames dominated during the election campaign. The aim of this Master’s thesis is threefold: (1) to analyze the communication of the presidential candidates on their “Facebook” accounts and to identify the frames they use to enhance the attractiveness of their personality and programmatic attitudes; (2) to identify the frames used by the most popular news portals in the country to highlight the personalities and programmatic attitudes of the presidential candidates; (3) to compare the frames chosen by the candidates and the ones identified by the news portals. To achieve the aim of this research work, the objectives of the work were to analyze the significance of political communication in social media and the press, to define the frames that have dominated politicians’ posts and the media. It also aims to compare how the frames chosen by candidates in their political communication differ from the frames identified in news portals, through which audiences “see” candidates and their campaign programmes. The research uses qualitative content analysis with elements of quantitative analysis, based on Frame Theory approaches. The results of the study showed that, to some extent, the portals delfi.lt and 15min.lt applied similar personality frame categories about the candidates. Among the candidates’ posts and 15min.lt, personality frames were the most prevalent, while in the case of delfi.lt the game frame was more popular. Both the candidates’ and the news portals used the issue frame the least. This research paper partially fills the research niche of the 2024 Lithuanian Presidential Elections by analyzing the politicians’ posts on “Facebook”, news media publications, and framing aspects of their personality and programmatic points
Relationship between frailty and polypharmacy in older adults. analytical research.
No full textRelevance of the problem: Polypharmacy can contribute to frailty by affecting its various components. As average life expectancy increases, the prevalence of this syndrome is rising, posing new challenges for the healthcare system. Therefore, it is essential to study the relationship between polypharmacy and frailty. Aim of the study: To determine the relationship between frailty and polypharmacy among elderly individuals. Objectives: 1. To assess the prevalence of polypharmacy among elderly individuals. 2. To assess the prevalence of frailty among elderly individuals 3. To determine the relationship between polypharmacy and frailty. Methods: A quantitative cross-sectional analytical study method was applied. Data were collected from anonymous questionnaires and medical records. The study participants included patients from the Geriatrics Center of Mykolas Marcinkevičius Hospital and seniors from community organisations. Polypharmacy was defined as the use of five or more medications. Frailty was diagnosed according to Linda Fried’s phenotypic model criteria: 0 points – no frailty, 1–2 points – pre-frailty, 3 or more points – frailty. Statistical analysis tests used: Mann-Whitney U, Student's t-test, Kruskal-Wallis H, Welch's ANOVA, Chi-square, Fisher's exact test, Spearman‘s correlation and a multivariate logistic regression model. Results: The study included 112 participants: 24 (21.43%) men and 88 (78.57%) women. It was found that polypharmacy was present in 76 (67.68%) patients: 63 (71.64%) among women and 13 (54.24%) among men. Prevalence among the youngest-old (65–74 years) was 14 (56.0%), the middle-old (75–84 years) – 32 (64.0%), and the oldest-old (≥85 years) – 30 (81.1%). Frailty was identified in 49 participants (43.75%), 49 (43.75%) were at risk of frailty and 14 (12.50%) had no signs of frailty. Prevalence among men was 12 (50.0%), among women - 37 (42.0%). Prevalence among the youngest-old was 4 (16.0%), the middle-old – 23 (46.0%), and the oldest-old – 22 (59.5%). The Fried phenotypic model score showed a statistically significant weak positive correlation (r=0.347, p<0.001) with medication count. Polypharmacy prevalence differed significantly among frailty groups (p=0.022). The odds ratio of frailty risk with ≥5 medications were 4.98 (95% CI: 1.40, 17.63), after adjustment – 2.99 (95% CI: 0.72, 12.79). For frailty, the odds ratio were 4.49 (95% CI: 1.28, 15.80), after adjustment – 0.95 (95% CI: 0.16, 3.88). Conclusions: Polypharmacy and frailty are common among older adults. A higher number of medications used is associated with an increased risk of frailty. A statistically significant association between polypharmacy and frailty was identified. Although a statistically significant relationship between polypharmacy and frailty has been identified, it is influenced by age and the number of chronic diseases
Organisational learning process from successes and failures in overcoming internationalisation barriers in lithuanian small and medium-sized enterprises.
No full text68 pages, 6 charts, 18 pictures, 125 references The main objective of this master's thesis is to determine how the organizational learning process from successes and failures in overcoming internationalization barriers in Lithuanian SMEs takes place. The thesis is divided into three main parts. Drawing on scientific literature, the first part defines the internationalization process, identifies barriers to internationalization, and outlines the characteristics of organizational learning from both successes and failures. The second part presents the research methodology employed to determine how Lithuanian SMEs engage in organizational learning from successes and failures in overcoming internationalization barriers. Based on an analysis of prior studies on internationalization and organizational learning, a qualitative research approach was selected, utilizing the Gioia method for inductive data analysis. A semi-structured interview questionnaire was developed in line with previous studies, and data were collected through interviews with seven Lithuanian SME managers and/or (co-)owners. Data collection was concluded upon reaching theoretical saturation. The third part of the thesis presents the study's results, evaluates the findings, and provides recommendations for SMEs. The study identified that the main barriers to the internationalization of Lithuanian SMEs are commercial, regulatory, and cultural dimensions. Before activating the organizational learning mechanism, Lithuanian SMEs establish key performance indicators, which are subsequently used to determine whether efforts to overcome internationalization barriers were successful or not. An integrated control system continuously interacts with these key performance indicators. Upon identifying successes or failures, SMEs activate mechanisms for adaptive learning. In the case of learning from successes, the primary goal of Lithuanian SMEs is to replicate successful practices in other markets or internal processes. In the case of learning from failures, the aim is to take rapid and adaptive action to transform failure into success and/or eliminate the factors that contributed to the failure. Having gone through the mechanisms of adaptive learning from successes and failures, Lithuanian SMEs seek to evolve their organizational processes. To ensure that acquired knowledge remains at the organizational level rather than with individual employees, they implement a standardized organizational understanding. Finally, prior to further internationalization and the inevitable encounter with new barriers, motivation strategies are developed. Based on the identification of how Lithuanian SMEs learn from their successes and failures in overcoming internationalization barriers, an inductive model of this process was developed, and recommendations for small and medium-sized enterprises were formulated accordingly. The conclusions and proposals summarize the key theoretical aspects of internationalization and organizational learning, present the results of the qualitative study, and offer directions for future research. The author believes that the inductive model presented in the study, together with recommendations for SMEs, provides an opportunity to streamline organizational learning from both successes and failures and increase the speed of overcoming barriers to internationalization
Association between physical activity levels and signs of frailty among elderly individuals.
No full textThe aim of research work: to determine the associations between the level of physical activity and the symptoms of frailty among older adults. Tasks of work: 1.To assess the physical and functional condition of older adults with frailty and to evaluate the characteristics of frailty according to Fried's criteria. 2.To evaluate the differences in physical activity, independence in daily activities, and functional capacity among elderly participants. 3.To compare the level of physical activity between healthy older individuals and those with frailty. 4.To examine the associations between the level of physical activity and symptoms of frailty. Materials and methods. Research took place at Public Institution Mykolo Marcinkevičiaus Hospital, Vilnius, in 2023 - 2025. The study included 110 subjects (ages ranging from 65 to 95 years), divided into two groups: individuals with frailty (n = 44) and group consisting of individuals without frailty (n = 66). Physical Activity Scale for the Elderly (PASE), the Fried frailty phenotype questionnaire, the Short Physical Performance Battery (SPPB), and daily activity questionnaire were used to conduct the study. Data analysis was performed using mathematical statistical analysis, Excel 19 and IBM SPSS programs. Results. The study involved 110 older adults (mean age: 81,7 ± 7,52 years), of whom 40% were diagnosed with frailty. It was observed that frailty occurred more frequently in the oldest participants, and age was significantly associated with the presence of the syndrome. A negative correlation was found between physical activity and fatigue (r = -0,414; p < 0,001), and a positive correlation between physical activity and gait speed (r = 0,472; p < 0,001) as well as handgrip strength (r = 0,498; p < 0,001). Participants with frailty demonstrated lower physical activity levels according to the PASE scale, poorer physical performance based on the SPPB, increased fatigue, slower gait speed, weaker handgrip strength, and lower scores in daily activity assessments (p < 0,001). A strong negative correlation was established between physical activity and frailty (r = -0,695). Conclusions: 1.Participants with frailty syndrome, as defined by the Fried criteria, demonstrated reduced body mass, increased fatigue, decreased handgrip strength, slower gait speed, and low physical activity levels. 2.Older adults with frailty exhibited low physical activity, decreased independence in daily activities, and limited functional capacity. While physical activity was not associated with weight loss, higher levels of activity were significantly related to reduced fatigue, faster gait speed, and stronger handgrip. 3.Individuals with frailty showed significantly lower physical activity levels compared to those in the control group. 4.A strong negative correlation was found between low physical activity levels and the occurrence of frailty symptoms. Higher physical activity levels were associated with a reduced risk of frailty
Semi-supervised learning methods to solve the tasks of analyzing medical images of computed tomography images of the pancreas.
No full textThis master’s thesis investigates semi-supervised learning methods for the identification of pa ncreatic cancer in computed tomography images. Pancreatic cancer remains one of the most chal lenging oncological diseases to diagnose, making the application of artificial intelligence for early detection highly valuable. However, the limited availability of annotated medical images const rains the development of accurate learning models. To address this, the study explores the use of semi-supervised learning techniques that can leverage both labeled and unlabeled data. The rese arch begins with a literature review, analyzing the fundamentals of semi-supervised learning, its historical development, application challenges in medical image analysis, and the key algorithms considered, the Mean Teacher method, its uncertainty-based extension, and the FixMatch appro ach. Publicly available computed tomography image datasets were also evaluated against several criteria, including clinical relevance, annotation quality, accessibility, image diversity, and comp lexity, to select the most suitable datasets for experimentation. In the experimental phase, the three selected methods were applied to pancreas segmentation tasks, aiming to assess their effectiveness under conditions of limited labeled data. All models were trained using the same network architec ture and evaluated with consistent metrics, the Dice coefficient and the 95th percentile Hausdorff Distance. The results demonstrated that all semi-supervised learning methods significantly impro ved segmentation quality. Overall, the findings confirm that semi-supervised learning presents a promising solution for enhancing medical image analysis, particularly in scenarios where annotated data are scarce