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From Rupture to Refuge The Coordinates of Contemporary Refugee Narratives
No full textFrom Rupture to Refuge is a wide-ranging study of both contemporary refugee fiction and memoir. From international best-selling novels such as Khaled Hosseini’s The Kite Runner and Christi Lefteri’s The Beekeeper of Aleppo, to memoirs by Zoya Phan and Clemantine Wamariya, it follows refugees as they narrate their experiences and memories of homeland, war, escape, camp, and finally finding refuge.
Tracing literary connections between this wide body of 21st Century writing, the book provides an overview of a genre of writing and a detailed textual analyses of thematic and poetic intersections. It also introduces the concept of ‘narrative displacement’, uncovering the ways in which refugees are discursively displaced from their own tales as well as being displaced spatially. Sloane argues that in writing and recording, refugees replace themselves at the centre of their own life stories
Hemichorea-Hemiballismus as A First Presentation of Diabetes: Basal Ganglia Involvement and Hba1c Threshold
Get PDFWe report a case of a 72-year-old woman who presented with a one-week history of abnormal, involuntary movements in her left upper limb. These movements were persistent throughout the day, occurring during both activity and sleep, and had progressively increased in intensity since onset. She also experienced weakness in the affected arm. Her past medical history included hypertension, managed with Amlodipine 5 mg once daily. On examination, she exhibited continuous, involuntary, flinging movements of the left arm, consistent with hemiballism. The rest of her neurological examination was unremarkable, and cerebellar signs could not be assessed due to the involuntary movements. Her blood pressure on admission was 202/81 mmHg. Random blood glucose was 27 mmol/L, with ketones at 0.8 mmol/L and serum osmolality at 285 mOsm/kg. She was managed as a case of hyperosmolar hyperglycemic state. Investigations showed an HbA1c of 18.6%. A head computed tomography (CT) revealed no intracranial abnormalities, while magnetic resonance imaging (MRI) showed tiny hypodensities in the left ganglio-capsular region and small hypointensities in the right ganglio-capsular area and this not stroke. Treatment with Risperidone successfully resolved the chorea. Her blood pressure and blood glucose were optimized, and she was discharged in stable condition. Hemichorea-hemiballismus as the first presentation of diabetes is extremely rare. Most case reports indicate an HbA1c of 12% or higher can be associated with hyperglycemia-induced hemichorea-hemiballismus (HIHH). Further research is needed to clarify the mechanisms underlying HIHH and to determine a definitive HbA1c threshold
A Contemporary Multifaceted Insight into the Association Between Diabetes Mellitus and Diverticular Disease: An Update About Geriatric Syndrome
Get PDFIntroduction: Diverticular disease, once considered a rare geriatric gastrointestinal condition, has now become a prevalent disorder associated with increased morbidity and healthcare costs. The spectrum of complications from diverticular disease ranges from incidental findings to more serious issues such as bleeding and diverticulitis. Symptomatic diverticular disease represents a significant economic burden in the western world. Diabetes mellitus is a major global health issue. As global aging accelerates, geriatric syndromes such as diabetes mellitus (DM) and diverticular disease (DD) are becoming increasingly prevalent. Understanding their interplay is critical, particularly within the geriatric population. Both conditions are linked to lifestyle, dietary habits, and changes in gut physiology. Additionally, age-related alterations in the gut microbiome and immune system make this association more complex, contributing to morbidity and healthcare burdens in older adults. The primary aim of this review is to provide an update on the association between diabetes mellitus and diverticular disease. Methods: This narrative review explores the association between diabetes mellitus and diverticular disease. Relevant articles were identified by searching major databases. Results: Risk factors for diverticular disease include insulin resistance, diabetes mellitus, smoking, non-alcoholic fatty liver disease, lack of physical activity, a low-fibre diet, and a high-carbohydrate diet. These risk factors are also associated with the development of diabetes mellitus. Major population studies indicate that diabetes can either increase the risk of diverticular disease or have a neutral impact. A complication of diabetes mellitus includes impaired intestinal peristalsis and enteric nervous system dysfunction, which can ultimately lead to the formation of intestinal diverticula. High-calorie foods low in fibre are a staple in the diets of many type 2 diabetes mellitus patients, contributing to gut dysbiosis. A detrimental consequence of dysbiosis is a breach in the protective intestinal barrier, which promotes the development of diverticulosis. Conclusions: Diabetes mellitus may be associated with diverticular disease, and the risk factors that contribute to diabetes mellitus can also be linked to diverticular disease. Further studies are needed to explore the complex relationship between diabetes mellitus and diverticular disease
Vitamin D supplements and effect on glycemic control and lipid profile in individuals living with diabetes: a retrospective study
Get PDFAbstract
OBJECTIVE: Diabetes Mellitus (DM) is a global concern with a high prevalence among the Saudi population. Uncontrolled diabetes is associated with serious medical complications and an increase in mortality and morbidity. Vitamin D deficiency may have the potential to decrease insulin sensitivity and alter lipid metabolism. This study aimed to assess the impact of vitamin D supplements on glycemic control and lipid profile among individuals living with diabetes in Saudia Arabia. MATERIALS AND METHODS: This retrospective study recruited 254 individuals with diabetes. The medical records were searched for age, gender, HbA1c, fasting blood glucose (FBG), Vitamin D and lipid profiles. The population records were extracted in two intervals: before taking vitamin D supplements and three months after receiving supplements. Paired t-test and confidence intervals were used to compare HbA1c, FBG, vitamin D, and other extracted variables between intervals. Vitamin D levels were compared between genders in each interval. RESULTS: The supplementation of vitamin D leads to improvement in vitamin D from a mean of 45.4 to 65 (normal reference range 50-150). Supplementation of vitamin D showed significant improvement in HbA1c, FBG, all parameters of lipid profile, renal and liver function and hemoglobin (p < 0.001) when t-test was used and confidence interval calculated. CONCLUSIONS: Vitamin D plays a potential role in insulin sensitivity and lipid metabolism. Therefore, maintaining optimal level of vitamin D through its supplements or sun exposure might help to improve heath and decrease complications especially in individuals with diabetes
Mastermind and Expert Mind: A Qualitative Study of Elite Quizzers
No full textQuizzing is an enduringly popular pastime, yet quiz has received little attention in the expertise literature. Some elite quizzers stand out even among their peers, leading us to ask how expert quizzers develop their prodigious knowledge. Quizzing takes many forms, including general knowledge quizzes, websites such as Sporcle, games like Trivial Pursuit, and broadcast quiz shows, suggesting that the cognitive and motivational drivers of quiz excellence may be multifaceted and vary according to challenge. We investigated this domain using the Grounded Expertise Components Approach (GECA), which starts by characterizing those active in a domain through a broad survey. In order to scope out the areas such a survey should cover, qualitative semi-structured interviews were conducted with seven expert quizzers, either winners of UK TV shows or professional quiz setters. Data were analyzed using inductive thematic analysis. Seven themes were generated, six of which are discussed in this paper. “Levels of Expertise” provided support for a range of performance levels within quiz, with suggestions as to how to benchmark these levels, as well as discussing gender inequalities in the domain. “Thirst for Knowledge” related to an enthusiastic interest in facts, with a corresponding sponge-like ability to acquire incidental information driven by curiosity and engagement, and an appetite for cognitive challenge. By contrast, “Quiz Preparation” explored the use of deliberate (and/or purposeful) practice to plug gaps in knowledge. “Immersion” reflected the continued engagement in quiz which kept the quizzers at the top of their game. “Motivation” discussed the intrinsic and extrinsic motivational drivers for both starting quizzing and then maintaining a high level of involvement. Finally, “Characteristics” related to how individual differences in the patterns of cognitive and other traits may underlie quiz preferences. The findings informed the construction of a Stage 1 GECA survey of quizzers (results to be reported elsewhere), as well as signaling some of the most important underlying cognitive and motivational factors involved in the development of quiz expertise
Narrative Review on the Management of Neck of Femur Fractures in People Living with HIV: Challenges, Complications, and Long-Term Outcomes
Get PDFNeck of femur (NOF) fractures are a critical orthopaedic emergency with a high morbidity and mortality prevalence, particularly in people living with Human Immunodeficiency Virus (PLWHIV). A combination of HIV infection, combined antiretroviral therapy (cART), and compromised bone health further increases the risk of fragility fractures. Additionally, HIV-related immune dysfunction, cART-induced osteoporosis, and perioperative infection risks further pose challenges in ongoing surgical management. Despite the rising global prevalence of PLWHIV, no specific guidelines exist for the perioperative and post-operative care of PLWHIV undergoing NOF fracture surgery. This narrative review synthesises the current literature on the surgical management of NOF fractures in PLWHIV, focusing on pre-operative considerations, intraoperative strategies, post-operative complications, and long-term outcomes. It also explores infection control, fracture healing dynamics, and ART’s impact on surgical outcomes while identifying key research gaps. A systematic database search (PubMed, Embase, Cochrane Library) identified relevant studies published up to February 2025. Inclusion criteria encompassed studies on incidence, risk factors, ART impact, and NOF fracture outcomes in PLWHIV. Data were analysed to summarise findings and highlight knowledge gaps. Pre-operative care: Optimisation involves assessing immune status (namely, CD4 counts and HIV-1 viral loads), bone health, and cART to minimise surgical risk. Immunodeficiency increases surgical site and periprosthetic infection risks, necessitating potential enhanced antibiotic prophylaxis and close monitoring of potential start/switch/stopping of such therapies. Surgical management of neck of femur (NOF) fractures in PLWHIV should be individualised based on fracture type (intracapsular or extracapsular), age, immune status, bone quality, and functional status. Extracapsular fractures are generally managed with internal fixation using dynamic hip screws or intramedullary nails. For intracapsular fractures, internal fixation may be appropriate for younger patients with good bone quality, though there is an increased risk of non-union in this group. Hemiarthroplasty is typically favoured in older or frailer individuals, offering reduced surgical stress and lower operative time. Total hip arthroplasty (THA) is considered for active patients or those with pre-existing hip joint disease but carries a higher infection risk in immunocompromised individuals. Multidisciplinary evaluation is critical in guiding the most suitable surgical approach for PLWHIV. Importantly, post-operative care carries the risk of higher infection rates, requiring prolonged antibiotic use and wound surveillance. Antiretroviral therapy (ART) contributes to bone demineralisation and chronic inflammation, increasing delayed union healing and non-union risk. HIV-related frailty, neurocognitive impairment, and socioeconomic barriers hinder rehabilitation, affecting recovery. The management of NOF fractures in PLWHIV requires a multidisciplinary, patient-centred approach ideally comprising a team of Orthopaedic surgeon, HIV Physician, Orthogeriatric care, Physiotherapy, Occupational Health, Dietitian, Pharmacist, Psychologist, and related Social Care. Optimising cART, tailoring surgical strategies, and enforcing strict infection control can improve outcomes. Further high-quality studies and randomised controlled trials (RCTs) are essential to develop evidence-based guidelines
Beyond the UN: the Feasibility of Conducting Peace Enforcement Operations in the Grey Zone of Cyberspace
Get PDFWar has been an inevitable consequence of human existence since time immemorial. Peace, however, has been described as a more modern invention. The United Nations have conducted successive generations of peace operations for 75 years, but the rise in intrastate conflicts, irregular warfare, and the resulting loss of the state monopoly of violence is challenging these responses. In addition, it is now assured that modern conflicts will have a cyber component, characteristically taking place in an area of normative uncertainty referred to as the grey zone, below the threshold of conventional warfare and unbound by International Humanitarian Law. These operations pose a threat to international peace and security, and therefore civilians should have the same rights and protections in cyberspace as they would during a kinetic conflict. But while the boundaries of war and peace are unclear, there is unlikely to be a peace for the UN to keep. Cyber peacekeeping has been proposed as the solution, and prior examinations have identified a requirement to ascertain the feasibility of carrying out the proposals in practice, as well as enforcing these types of operations without the consent of the belligerent parties. This thesis addresses that knowledge gap and contributes to scholarship by finding that the provision of peacekeeping in cyberspace has limited feasibility and practicality when considered as a UN function. Instead, delivery goes beyond the role of the UN and must be conducted in stabilisation terms while conflict and sub-threshold activities continue. This multi-faceted approach must incorporate the civil sector, NGOs, and the private sector organisations with responsibility for global infrastructure and services that citizens rely on, in order to achieve long-term success and stability. In addition, peace in these terms must be considered as more than an absence of war; states will not cede the tactical advantages that cyber power brings to grand strategy, and therefore a feasible peace process requires a concerted effort to address the underlying causes of conflict in digital terms, such as poverty, inequality, and political oppression, alongside an international commitment to the promotion of human rights and dignity. The significance of this research is that prior findings have been confirmed and new contributions have been made to the research area
Précis of The Psychology of Creative Performance and Expertise
Get PDFThe study of expertise has recently moved into an exciting phase. While previous research had a narrow
focus on deliberate practice versus innate aptitude, recent multifactorial models of expertise development
have breathed new life into contemporary research. Reflecting these opportunities, the Psychology of
Creative Performance and Expertise explores our understanding of the wide range of factors contributing to
greatness in creative domains. With the intention of expanding the conversation around expertise, the book
transcends traditional fields such as chess, sports, and music, exploring the intersection of expertise with
creativity and the performing arts. The applied chapters therefore cover more unfamiliar fields, including
extreme-memory athletes, dance, creative writing, acting, art, and STEM, as well as the more conventional
domains of mind games and music. Each applied chapter explores the psychological and opportunity factors
that shape success within these domains, offering a close look at how creative experts develop, thrive, or
falter. In other dedicated chapters, the book also examines the facilitators of creative performance, including
aesthetic sensitivity, creativity, and mental imagery, as well as the obstacles to performance such as burnout,
procrastination, and gender-related challenges. The exploration concludes by engaging with pressing issues
facing expertise, including the effect of artificial intelligence (AI). Addressing a gap in the market for an
approachable guide to the multidimensional complexities of expertise development, this book is suitable as a
resource for final-year undergraduate and postgraduate students across a range of disciplines. However,
given that the book uniquely synthesizes material from the creativity, gifted and talented, and expertise
literatures in a number of unfamiliar domains, it should provide fresh insights for newcomers and seasoned
scholars alike
Impact of clinical pharmacist video-based education on self-care and glycemic control in Sudanese adults with type 2 diabetes: A pre-post interventional study
Get PDFBackground: Diabetes affects various body systems, increasing the risk of complications.
Objectives: This study assessed the impact of clinical pharmacist-associated education on diabetes self-care practices and glycemic control in Sudanese individuals with Type 2 Diabetes Mellitus (T2DM).
Design and methods: This quasi-experimental study with no control group recruited 110 adults with T2DM from a diabetes clinic over 12 months using simple random sampling. We collected data through interviews and calls. Participants received 12 educational videos covering diabetes management. The intervention was video-based and delivered over 5 months. We analyzed data using SPSS version 28.
Results: The mean age of participants was 56.2 ± 10.3 years. Self-care practices significantly improved over time. Fasting blood glucose (FBG) levels decreased by 16.7 mg/dL at 6 months (p = 0.009) and 41.9 mg/dL at 12 months (p < 0.001). Two-hour postprandial glucose levels dropped by 18.7 mg/dL at 6 months (p = 0.006) and 61.8 mg/dL at 12 months (p < 0.001). HbA1c levels decreased by 1 % at6 months (p < 0.001) and 1.9 % at 12 months (p < 0.001). The effect size (Cohen’s d) was increased from 0.26 at 6 months to 0.74 at 12 months. Similarly, it was increased for 2hrsPPG from 0.2 at 6 months to 0.74 at 12 months. For HbA1c, it was increased from 0.62 at 6 months to 1.25 at 12 months, indicating clinically meaningful improvement in long-term glycemic control following the pharmacist intervention. LDL decreased by 9.2 mg/dL at 12 months (p < 0.001), and HDL increased by 5.5 mg/dL at 12 months (p = 0.002). Changes in BUN and serum creatinine were insignificant.
Conclusion: Clinical pharmacist education improved diabetes self-care practices and metabolic outcomes, including glycemic control and lipid profiles, demonstrating its role in achieving therapeutic goals for patients with T2DM
