Iris Publishers- Open access Journal of Textile Science & Fashion Technology | Added Value of Barki Wool Comparing to Merino for Woven Fabrics Properties

 

Authored by Marwa A Ali*

Abstract

Barki wool as a coarse wool is considered one of the existing materials in the Egyptian environment, which its different properties have not exploited properly yet, especially the mechanical. Where only the defects of its own are seen like fiber wrinkling, harshness and irregularity of micron, so its usage only limited on the handmade carpet or the weft yarns that used in the mechanical floor coverings. The research is aiming to study the difference properties between Barki wool as a local material and Merino wool as an imported material, improving properties and utilizing of local wool properties to make multi-uses fabrics which different from its usual uses. Barki and Merino wool blended with woolen polyester, two ratios were used of Barki/polyester (30:70)% and (45:55)% to produce samples, and one ratio was used of Merino/polyester (45:55)% for comparing, all produced samples were weaved by twill 2/2 weave structure. The produced samples were evaluated by mechanical and physical properties, statistically was analyzed by variance analysis (ANOVA) with General Linear Model (GLM) of SAS and differences between means were tested using Duncan’s multiple range test. It was concluded that the blending ratios of wool and polyester to produce the samples significantly affected on all physical and mechanical properties for samples. In addition, the values of mechanical properties of samples produced from Barki wool increased, while the values of the physical properties of samples produced from Merino wool increased.

Keywords: Coarse; Barki wool; Woven fabric; Merino wool; Mechanical properties

Introduction

In Egypt, there is a significant increase in the total amount of wool produced during the last 10 years from 4530 tons in 2003 to 12500 tons in 2013 [1]. Barki sheep breed is one of the three major sheep breeds in Egypt. Its predominant distribution is the northwestern coastal zone (NWCZ) of Egypt [2]. Barki sheep has a white body and a brown or black head, the color of the head may extend to cover the neck; a white color of head may be rarely. Its legs are usually colored or spotted [3]. Barki wool is processed into low quality woolens and blended with other types of wool [4].

Barki fleece wool was subdivided into three grades; 13.4% fine, 72% medium and 14.6% strong. Grades of wool subjectively are varying according to the fiber handlings harshness and fineness that lead to improved quality during industrial processes. However, it was suggested the fine wool grade to produce apparel and knitted yarns. Mostly, the difference of longitudinal micron of wool fibers is the main factor to reject the local wool by manufacturers, therefore, most of their products are used by the lower class of society or desert residents [5,6].

Generally, Wool fiber has a good thermal insulation either in state of wet or with moisture regains at a certain temperature and relative humidity. Whereas, it is absorbing more moisture than cotton, before becoming saturated, and causing the sensation of wet cling on the skin [7].

Many times, it was needed to mix between different materials to obtain the specific properties. Blended yarn has several types of fibers (two or more constituents) blended, which is completely unique [8]. The blended spinning technique depended on the fiber length (staple length) of material in case of natural material such as cotton and wool [9].

Polyester is one of the most common man-made fibers; it is cheap and has easy-care and excellent washing properties and wearing appearance. So, it was used in textile industries to improve the durability and uniformity. When polyester is proposed to contact with skin in a cloth, it is usually treated to improve its wicking ability. Blending wool fiber and polyester fiber had improved moisture management properties compared to fabrics in wool fiber without blending [7]. Adding the polyester fibers to coarse and fine Barki wool grades led to improve yarn strength properties [10].

Merino Sheep is one of the oldest and strongest breeds during the summer and freezing winter around the world. Now, it was breed mainly in New Zealand and Australia. Merino Sheep produces the finest and smoothest fibers comparing with all wools; it is the perfect performance fabric for the 21st Century. The Merino wool fabrics were produced with different weights began from 150 g/m2 for very light fabrics to 250 g/m2 for heavy fabrics. The garment wool fabric was used the weight between 140- 195 g/m2. Merino wool characterized with light weight, odor buildup resistance, easy washable, quick drying, durability, long lasting and give UV protection when untreated by chemical processes reach to about 50% comparing other materials [11,12].

Polyester wool blended fabric leads to pilling tendency, this property related to different parameters of textile like fiber properties, yarn & fabric structure, finishing processes and blended ratio between the materials. The finer fibers have a lower pilling than coarser fibers. In addition to, the plain-woven structure has less percentage of pills comparing to twill and satin woven structures, which due to the higher intersections for plain structure [13].

The research aims to study the properties of produced multiuses fabrics with coarse Egyptian Barki wool that blended with woolen polyester, other than floor coverings. In order to improve the added value for its properties and higher the economic value for local wool. Moreover, the quality of produced Barki/polyester fabrics was evaluated by comparing with the most used and widespread wool Merino/polyester with similar to one of the two ratios used for Barki/polyester and the same weave structure for all produced samples.

Materials and Methods

Materials

Barki wool was collected from the Mariout Research Station, belonging to the Desert Research Center, Egypt, during the shearing season 2015. The wool was graded subjectively by visual assessment on a sorting table to separate the fine wool fleeces. Then, they were carried out the scouring and carding processes for fine Barki wool fleeces, Barki wool was used in this search classified as fine wool as shown in Table 1.

Merino350® wool is an imported textile material that used in the clothing industry, it was used the medium grade of Merino. Woolen polyester is a common material used when blended with wool. The two materials were brought from Misr Spinning and Weaving Company, Al-Mahalla Al-Kubra, Egypt.

Methods

Two samples of woven fabrics were produced from Barki wool blended with woolen polyester in the spinning step with different ratios as (45:55) % and (30:70)%. One sample produced from Marino wool blended with woolen polyester by (45:55)% ratio, all produced blends manufacture by semi-worsted system into yarns. All produced samples fabric weaved by inversed twill 2/2woven structure; Table 2 presents the specification of produced samples.

The sample weaved from Merino wool that the most common among the different types of wool in global blended with woolen polyester. It has been produced with a blended ratio similar to one of the two blended ratios of Barki wool with woolen polyester, as well as one fabric weave structure used for all samples produced to help in evaluating for the different properties between the two types of wool.

Evaluation tests

All produced samples were evaluated by mechanical and physical properties; they were put in the standard atmospheric conditions for 24 hours before testing according to ISO-139.The tests which carried out on produced samples as follows; tensile strength &elongation of fabrics according to ASTM-D5035-11, stiffness resistance according to ASTM-D1388-96,abrasion resistance by loss in weight indication according to ASTM-D4158-08, shrinkage of fabric AATCC 135, pilling test fabric was estimated by ICI pill box tester, fabric thickness according to ASTM-D1777-96, air permeability according to ASTM-D737-96, water permeability was measured according to ASTM-D 461, and electrostatic charges were determined according to ASTM-D 4238 and the test was performed using FMX-003TM Electrostatic field meter, there are three grades for evaluating the static electricity on the surface of various materials as shown in Table 3./p>.

Statistical analysis

The test results were statistically analyzed by analysis of variance (ANOVA) with General Linear Model (GLM) of SAS (2001) [15] and differences between means were tested using Duncan’s multiple range test [16]. The significance level was set at P = 0.05 and P = 0.01. In addition to, it was pointed to order of the bestproduced samples by radar chart area.

Results and Discussion

The various results were presented for the mechanical and physical properties of the produced samples, and the difference between the properties of wool types used were cleared.

Effect the ratio and types of wool on the mechanical and physical properties

Tensile strength and elongation properties: Figure 2 shows that the tensile strength for warp and weft yarn direction, the samples that produced with Barki/polyester gave high value of tensile strength comparing with the sample produced from Merino/polyester, especially in warp direction that affected with the weft yarns. Also, the increasing of polyester ratio in the produced samples led to increase in the value of strength, this is due to the tenacity of polyester material and this result is agreed with previous investigations [17,18], and the density of warp yarns in these two samples also affected on them as a high strength. It was reported by Helal, et al. that an increase of polyester ratio from 25% to 35% or 40% led to a slight increase in yarn elongation. However, differences were not significant [10].

The elongation is varying between the produced samples as shown in Figure 3. The samples produced with Barki/polyester achieved higher elongation value than the sample produce Merino/ polyester especially in weft direction; this is may be due to the yarn count of Barki wool yarns and high fiber diameter of its grades.

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Iris Publishers- Open access Journal of Addiction and Psychology | Cognitive Neuroscience Contribution to Police Officer Fitness for Duty Assessment: 2 Case Examples

 

Authored by Stephen E Berger*

Abstract

It is essential that the public has confidence that police officers are Fit for Duty. Of course, that starts with being physically fit to perform the demands of their jobs. However, it is also essential that they are of sound mind also – that they are Fit for Duty. The assessment begins during the initial hiring process. In the United States, each individual state sets the standards that police officers have to meet to be considered Fit for Duty. There will be individual differences among the various police organizations in each state. Thus, not only will state police departments have their standards, counties, cities and other jurisdictions will have their standards. In assessing a police officer’s quality of mind, cognitive neuroscience has much to contribute. This article presents two different police officers who were assessed for Fitness for Duty. One was referred by the officer’s own Department due to questionable actions on the job. The other officer self-referred after suffering a head injury, and after taking actions that the officer thought was inappropriate. Data from the cognitive neuropsychological evaluations of each officer are presented. There is an emphasis on the results from the Rorschach, as the differences between those profiles were remarkably divergent, yet each officer was having problems conforming their behavior to proper standards, but each of them for different reasons. The analyses of their psychological assessments demonstrate how cognitive neuroscience can be applied to assessing police officers’ psychological fitness for duty.

Introduction

It challenges credulity to imagine a civilized society without a police force. It would be lovely if all citizens obeyed laws and did not commit crimes. That state of human development and functioning has clearly not occurred yet. Therefore, society is dependent upon some kind of police force to enforce the laws and provide protection for citizens. Obviously, the police force itself must be law abiding and competent to provide professional, police services. Consequently, police officers must be physically, intellectually, emotionally, and characterologically capable of enforcing and abiding by the laws.

To that end, societies must assess whether officers are capable and competent of performing their job duties. This paper focuses on the intellectual and emotional capabilities of police officers. To help ensure that police officers have the intellectual and emotional capability of performing their jobs, laws are enacted to provide a legal mechanism for assessing the intellectual and emotional capa bility of police officers. The task of assessing Fitness for Duty is a reflection of the concept of whether a given employee is capable, physically, intellectually and emotionally of satisfactorily performing their job. Thus, assessments of applicants for a job as well as reassessments of current employees occur frequently.

Legal Foundations for Police Officer Fitness for Duty Evaluations

The assessment of a police officer’s Fitness for Duty is encoded in American Law. Specifically, a police officer may be discharged for cause [1,2]. For example, cause is defined in the State of Illinois as a “substantial shortcoming recognized by law and public opinion as a good reason for termination,” and a “substantial shortcoming which renders the employee[’]s continuance in office in some way detrimental to the discipline and efficiency of the service” [2,3]. In an illustrative recent (2016) Illinois Appeals Court ruling [4], the Court stated, “There is a well-defined and dominant public policy in Illinois in favor of a disciplined and efficient police force comprised of officers who are fit for duty.” See, e.g., (policy in favor of ensuring public safety and maintaining a reliable, responsible police force) [5].

Since the two case examples provided here occurred in the State of California, some relevant aspects of California law are provided here. Under California Government Code section 12940(f) (2), covered employers may require that an employee undergo a medical or psychological examination or make medical or psychological inquires of employees that are “job related and consistent with business necessity” [6]. Under California Government Code section 12940(f)(2), covered employers may require that an employee undergo a medical or psychological examination or make medical or psychological inquires of employees that are “job related and consistent with business necessity” [7]. In regard to California, California Government Code Section 1031 (8) mandates that all peace officers in California “[b]e found to be free from any physical, emotional or mental condition which might adversely affect the exercise of the powers of a peace officer” [8].

Psychological Assessment of Fitness for Duty

The history of the application of testing instruments being used for selection of employees and personnel can be traced to World War I where the use of the Army Alpha (literate version) and Army Beta (illiterate version), spearheaded by psychologist Robert Yerkes and six others, sought out to systematically classify individuals for roles based on their mental aptitude [9,10]. Given the perceived efficiency that this process provided during World War I for recruits, private industry and organizations began to apply similar models to streamline employee selection based on various criteria unique to their organizations. According to the literature, use of testing measures within organizational structures taps the following areas, or combination of areas: intellectual/aptitude tests, psychomotor abilities, employment specific knowledge (i.e. work sample), vocational inclination, and personality [11].

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Iris Publishers- Open access Journal of Addiction and Psychology | De-Escalation as a Therapeutic Strategy for Dual Diagnosis Patients in Psychiatry

 

Authored by Ambros A Uchtenhagen*

Abstract

Schizophrenic patients with a substance abuse condition present one of the highest risks for violent behaviour. The traditional safety measures used in psychiatry are still in force but challenged by a trend to avoid all involuntary action, in respect of patient autonomy. There is an urgent need to develop strategies to cope with this situation, which is especially difficult to cope with in case of first encounters with dual diagnosis patients in psychiatry. The risk for open aggressiveness is difficult to assess and to manage in first encounters, avoiding an escalation and working a deescalation strategy. The strategy described in this paper is based on a distinction of the different types of first encounter and on general rules.

Introduction: What is the Problem?

Research evidence shows that the risk for violent behaviour in schizophrenic patients is high (high suicide rates and high rate of injury to others after discharge [1,2]. These risks are highest in case of concomitant substance abuse, especially multiple substance abuse, well documented since decades [3], and confirmed recently [4]. The type and extent of risk in first encounters with unknown patients is difficult to assess if no anamnestic data are available. Special attention has been given to methods how to predict violence including «imminent violence» [5,6].

Traditional psychiatry usually recurred to enforced interventions, in the interest to prevent violent behaviours and to protect staff. At present, the trend to refrain from involuntary and enforced interventions, in the light of respecting human rights and especially patient rights, is a challenge to such practices. The search for adequate rules how to cope with such risks is under way, as a part of general therapeutic recommendations [7], or as a research effort to learn from surveys how the encounters work in practice [8].

However, violence in psychiatry is an important topic. A European Research Group is dedicated to the study of it, with 70 member scientists and practitioners and 135 member societies from 17 countries [9]. Annual congresses with attendants from 36 countries are a platform to present and discuss all relevant aspects of the topic [10]. The most frequently used measures to prevent harm from violent behaviour are physical restraint (17%), seclusion (15%) administering medications (14%) [9]. Involuntary admissions to psychiatry are still as high as 20% of all admissions, in a high-income country with adequate service provision [11].

Confronted with this situation, medicine including psychiatry partly decides to refrain completely from any involuntary interventions in practice (no enforced admissions, no closed wards, no enforced treatment, discharge on demand e.a.). Given the aggressive potential of many dual diagnosis patients, such a policy has the consequence that other organisations and third parties (family, neighbors, concerned citizens, police, social services, courts e.a.) take over to prevent and restrict aggressive behaviour. In the worst case, this is done without professional involvement for diagnosis, prevention and therapy. The respective persons have no patient status, are dealt with as healthy offenders, no therapeutic efforts are made to reduce the safety risks.

The intention of this paper is to describe a procedure how to avoid the potential risk of violent behaviour in first encounters with dual diagnosis patients, using de-escalation approaches.

Typology of First Encounters with Dual Diagnosis Patients

The most difficult can be involuntary (enforced) encounters, because the negative feelings from being subject to enforcement, its circumstances, the humiliation and the futility of resistance add to the aggressive potential of the condition. Careful symptom observation and control is needed. No inquisitive questioning; empathic questions should convey genuine interest in what happened and what it means, as an invitation to share the frustrating experience. Explain your thoughts and the options you have, preferably before acting. Try to avoid anything that might lead to an escalation of negative feelings and tension.

The sitution is quite different in case of an opportunistic encounter, when the patient makes no attempt at resistance to enforcement, thereby avoiding the unpleasant aspects. It may be due to realistic insight, or else to a need to save time before taking an opportunity to react, or to a feeling of weakness or inability to come to a decision how to react. Whatever the motivation may be, try to acknowledge the non-resistance, help the person to clarify the reasons for it and then to cooperate in finding out what is best for him /her. At the same time, keep an eye on a hidden aggressive tension.

An encounter on a third-party initiative may be complicated by the nature of and the relation to that party. Many special issues have to be taken up. Has the person a realistic knowledge of the third party’s motivation, or are there negative phantasies or even paranoid ideas at work? Are there problems with partner, in the family, at the workplace, with other people that could have contributed to an appeal to psychiatry? Meaning well, protecting the patient against him/herself, or with an intention to get rid of him/her? When is it the right time to discuss a participation of the third party in that clarification process?

Finally, there are encounters on the patient’s initiative. Ignorant of his/her motivation and intention, an inadequate procedure may cause a withdrawal or else provoke an escalation. In any case there is a need to decide if the patient may go without intervention or if he/she presents a risk to be prevented and how. The responsibility for this decision and all the consequences is high. Imagine a person is afraid of its own aggressive feelings and seeks help to dominate them, is disappointed or humiliated or infuriated by the psychiatrist’s attitude and reaction, turns away in anger and what should be prevented is happening. Or else the psychiatrist underestimates the patient, is preoccupied by something else or wants to avoid the responsibility by taking the initiative for an intervention, unwelcomed by the patient and causing resistance and eventually aggressive behaviour. The risk for either case can best be reduced by following some general rules of procedure.

General Rules for Risk Avoidance

Empathy: be aware of your own feelings, prejudices, fears, in order not to let them guide you in a premature way. Listen to the patient, your questions should carefully try to clarify what you observe and hear. Explain what you say, your impression, your ideas about what could be done, make proposals and listen to what the patient has to say.

Fear management: do not play the hero, profit from the presence of other persons who could eventually assist you when it comes to violent behaviour. You will feel more secure, your decisions will be less influenced by concerns about your own safety. The patient will anticipate the assistance which in turn will help him to control his/ her behaviour. You may send third parties away to demonstrate trust in the patient’s self-control, if your relationship has developed to a stage where such trust is perceived to be realistic.

Mediation: Try to consider and, to the extent possible, to involve in due time all parties that are involved directly or indirectly, in order to know about their positions, attitudes, past experience etc. with the patient. In case of joint meetings, try to start out with empathy and neutrality, before coming to conclusions and plans for further procedure. All parties must have their say but discourage attempts from anyone to dominate.

Be prepared: opportunities to test your behaviour in such encounter situations, to train it with the help from more experienced colleagues, are helpful. A range of psychotherapy methods, such as Motivational interviewing, Early intervention methods, Systemic therapy, Behavioural therapy, Contingency management, Assertive community treatment e.a. work on an understanding of the therapeutic process useful for confrontations in first encounters. A dutch project has developed a method for assessing stages and profiles of encounters with dual diagnosis patients, in order to have a better starting point for interventions [12].

Conclusion

Preventing harm from aggressive behaviour of patients against staff, other patients and themselves is a major problem in present psychiatry and expected by society. All staff must be prepared to cope with it and to know how to act when confronted with potential violence, especially in case of first encounters with dual diagnosis patients.

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Iris Publishers- Open access Journal of Archives in Neurology & Neuroscience | Spontaneous Regression of Intraprocedural Carotid Stent Thrombosis Achieved Using Antiplatelet Agents

 

Authored by Jei Kim*

 

Abstract

Background and Purpose: The natural process of and treatment plan to prevent intraprocedural carotid stent thrombosis progression have not been clearly described.

Summary of case: We report the case of a 63-year-old male in whom successful regression of an intraprocedural carotid stent thrombus without clinical aggravation was achieved with antiplatelet agent use during and after stent placement.

Conclusion: The present case illustrates the regression process of an intraprocedural carotid stent thrombosis following the administration of antiplatelet agents during and after the intervention.

Keywords: Carotid stent; Thrombosis; Regression; Antiplatelet agent

Introduction

Acute thrombosis is an uncommon complication during carotid stent intervention.1 In some patients, an intraprocedural carotid stent thrombosis occurs immediately after stent deployment and can lead to a fatal iatrogenic stroke.2 A clear treatment plan to prevent further thrombus progression has not been established to date. We report a patient with successful regression of an intraprocedural carotid stent thrombus without clinical aggravation who received antiplatelet agents during and after intervention.

Case Presentation

A 63-year-old male arrived at emergency room due to altered comprehension and communication, and motor weakness on the left side of his face and extremities (grade II) that was noted approximately 2 hours before he arrived at the hospital. On the arrival in emergency room, his total National Institute of Health Stroke Scale score was nine. Magnetic resonance imaging performed at the emergency room revealed an ischemic lesion in the right frontal cortex. Perfusion-weighted imaging showed delayed perfusion in the right parietal and temporal cortices. The patient underwent intra-arterial thrombectomy to restore right hemisphere perfusion.

On initial angiography, the right internal carotid artery was not visualized below its origin. (Figure 1A) After removal of a thrombus using a suction catheter, the occlusion was recanalized, but severe and focal narrowing at the stenotic lesion was still visualized (Figure 1B). A bare metal carotid stent was deployed inside the focal stenotic lesion. Then, a thrombus lodged in the middle cerebral artery was removed by using a suction catheter twice and by single use of a retractable stent through the carotid stent.

Even though right middle cerebral artery recanalization was successful, 66% stenosis persisted inside carotid stent due to intraprocedural carotid stent thrombus (Figure 1C). To prevent further stenosis progression, a glycoprotein IIb/IIIa antiplatelet agent (tirofiban, 0.5 mg) was infused inside the carotid stent. The intra-arterial thrombolysis and carotid intervention were completed after no further progression of the thrombus occurred over a 30-minute period. Immediately after the intervention, the patient received oral aspirin (300 mg) and clopidogrel (280 mg). He was maintained on a daily regimen of aspirin (100 mg) and clopidogrel (75 mg). follow-up of magnetic resonance imaging performed 1 day after intra-arterial thrombectomy revealed that only the frontal lobe lesion was denser (Figure 1).

Even though right middle cerebral artery recanalization was successful, 66% stenosis persisted inside carotid stent due to intraprocedural carotid stent thrombus (Figure 1C). To prevent further stenosis progression, a glycoprotein IIb/IIIa antiplatelet agent (tirofiban, 0.5 mg) was infused inside the carotid stent. The intra-arterial thrombolysis and carotid intervention were completed after no further progression of the thrombus occurred over a 30-minute period. Immediately after the intervention, the patient received oral aspirin (300 mg) and clopidogrel (280 mg). He was maintained on a daily regimen of aspirin (100 mg) and clopidogrel (75 mg). follow-up of magnetic resonance imaging performed 1 day after intra-arterial thrombectomy revealed that only the frontal lobe lesion was denser (Figure 1).

Six days after intra-arterial thrombectomy, the patient showed improvement, with partial communication and comprehension and grade III motor weakness in the left extremities. At 31 days, the patient could name items and repeat words in the language function test, and he was able to move his left extremities with grade IV motor power.

Discussion

The present case demonstrates the 10-day regression process of an intraprocedural carotid stent thrombosis after using intravenous and oral antiplatelet agents. Even though intraprocedural carotid stent thrombosis is a rare complication of carotid stent intervention, it is important to delineate a clear treatment plan to prevent further thrombus progression.

The causes of intraprocedural carotid stent thrombosis are not well understood. In percutaneous coronary intervention, intraprocedural thrombosis occurs in just 0.7% of patients but is frequently observed on the edge of the plaque.3 In the present patient, the occlusion by the thrombus also formed on the edge of the carotid plaque, and the intraprocedural carotid stent thrombosis formed inside the carotid stent at the plaque edge. The unstable status of the plaque could have facilitated the formation and progression of the intraprocedural carotid stent thrombus.

The antiplatelet agents aspirin and clopidogrel are often prescribed before and after carotid intervention to prevent thrombus formation inside a carotid stent.4 However, the present patient could not start antiplatelet agents before the intervention because he was initially schedule to undergo intra-arterial thrombolysis to recanalize the right middle cerebral artery. After detection of the intraprocedural carotid stent thrombosis, intravenous antiplatelet agent (glycoprotein IIb/IIIa inhibitor) was administered, and it effectively prevented further thrombus progression during the intervention. Immediate loading and maintenance of two oral antiplatelet agents according to the guideline effectively prevented further progression, and the thrombus regressed without clinical aggravation.

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Iris Publishers- Open access Journal of Advances in Cancer Research & Clinical Imaging | Narrative Based Medicine for healthcare professionals and cancer patients

 

Authored by Valerio Ferro Allodola*

Evidence Based Medicine and Narrative Based Medicine

Unlike the Evidence Based Medicine (EBM) approach, which tends not to consider the particularity of the subject, understood as unicum, in recent years a new “sensitivity” has spread in the Medical Faculties of many countries - European and non-European - and a different way of understanding medical-health practice: Narrative Based Medicine (NBM). This supports the need for social and health workers to learn to pay attention to patient stories and understand their emotional experience, but also to reflect on themselves, their emotions in confronting the disease and how they affect perceptions and on clinical practice. Rita Charon, director of magazine “Literature and Medicine” (Columbia University, USA) and leading exponent of the Narrative Medicine movement, supports the relevance, in the training of health professionals, of the narrative element, defined as a set of listening skills , analyze, interpret, share stories. The narration of one’s illness, if on the one hand, helps the patient to rationalize and put order in the chaos of emotions he is experiencing, to transfer anxieties, fears, fears, to acquire greater self-control and to find meaning in his own experience of illness, on the other hand helps doctors to grow in humanity, to the exercise of analysis and self-criticism, avoiding the risk that compressed emotions may turn into a cynical detachment or reappear, later, in the form of frustration, burn -out, etc. Narrative appears on the scene when medicine, having reached extraordinary technological development goals, seems to lose its effectiveness precisely in the relationship with the patient and, consequently, in the identification and management of those states of suffering that are not pathology but they are no longer health, building a bridge between science and the worlds of life [1]. Narrative Medicine stimulates not only a process of existential and relational anamnesis of the patient’s experience, but also the co-construction between doctor and patient of the meaning of the patient’s experience and the progressive opening of biomedicine to the contributions of complementary medicines, in addition to growth a fruitful dialogue with pedagogy, sociology, psychology and anthropology. The narrativity in medicine is acquiring a role of increasing importance as a method to investigate and make hypotheses, as an investigation to collect new data, as a theory that acts as a meeting point between professionals who start from different conceptual settings and thinking traditions [2].

In recent years, various theoretical approaches in the psychopedagogical field have underlined the importance of tools such as narration and autobiography for the construction of the Self. When the person narrates himself and his personal history, he gives greater significance to his actions and presents himself to others, in the way he deems most appropriate for a specific implementation. In this way, defining his future self, he organizes his own conduct. Talking about EBM or NBM therefore means passing through different ways of defining the body, disease, malaise, care, function of care, quality of care etc., It means going through two different “epistemologies”[3-6]. The emergence of narrative-based medicine, often in controversy as opposed to evidence-based medicine, cannot fail to be a sign of cultural change within the system of investigation, diagnosis and treatment of biomedicine. There are three fundamental aspects that provide for NBM:

1. The observation of the subjectivity of the disease that leads the whole meeting of the patient in his reality;

2. The interaction between malaise (illness) and physiology (disease), for example through links with the psych immune system, which requires the overcoming of organic-systemic, organic-functionalist, normative functionalist and conflictual models, using the construction of a point of sociological, relational and connectionist view, able to modify the cultural settings of health / disease;

3. The emergence of a new post-modern medical epistemology of re-appropriate greeting, by patients, with greater attention to people and their identity, including genetics.

4. Here then the training - both initial and ongoing - occupies a particular place especially for operators in support of care, for doctors in particular, urged to take on the problems of their patients not only in a strictly biological key, but also falling into the meaning that the disease has not only for the patient, but also for his family.

As Bonadonna [7] states, “modern doctors like ‘ancient’ doctors must know that patients are not a mere collection of symptoms and signs of disease, of organic and psychological dysfunctions; they are first and foremost human beings, apprehensive, lost and hopeful, eager for comfort, help, reassurance. It is therefore essential to balance health science with a strong recovery of the art of healing. The doctor must be able to master technology and not become a slave to it. Medicine is an art that never ends. “NBM - of course - does not want to replace itself or be an alternative to EBM. In an article in the British Medical Journal - more than a decade ago - Greenhalgh & Hurwitz [8] said: “Why study the narratives? In the diagnostic meeting, the description is the phenomenal form in which the patient experiences health; encourages empathy and promotes understanding between the doctor and the patient; allows the construction of clues and analytical categories useful for the therapeutic process; suggests the use of a holistic method. In research, narrative medicine helps to develop a patient-centered agenda and generate new hypotheses”. The NBM is therefore, first of all, a “proposal” of approach; the result of a co-construction work between patient and professional in which the latter tries to grasp not only the causes but also the reasons and the experience of the disease. Furthermore, narrative medicine can improve the quality of care especially for the following reasons:

1. allows you to get closer to the “reasons” of the patient, facilitating the exercise of empathy;

2. by comparing the point of view of the various operators, it facilitates team building, reducing inefficiencies and errors;

3. helps to reflect on oneself, on daily clinical practice, promoting self-care, preventing burn-out and constantly reconfiguring one’s professional epistemology.

Finally, narrative medicine produces sustainability. Through a “cognitive listening” [9], not conditioned by early starting hypotheses, reflection on the said / unspoken, the written / unwritten, helps to understand the patient’s point of view, improving the care style. Any relationship interrupted due to a lack of humanity and competence between the therapist and the patient is, moreover, an anomaly of quality and an unsustainable waste for Health [10].

Methodologies and Tools of NBM

Starting from the assumption that the doctor and the health professional must combine two requisites, namely the technical skills (expertise) and the relational ones, in the contexts of the care, therefore, dialogic, narrative and reflective competence take on importance. The guiding idea of the training training projects is to trigger in the operators a path of reflective practice on their knowledge, on their idea of health, on the contrast/complementarity between evidence-based knowledge (EBM) and on the narration of experiences and of life prospects (NBM). The centrality of the operator in the educational relationship (educating to a lifestyle) and in the care relationship (taking charge of) then becomes the meaning of both prevention and treatment. But this passes through the enhancement of [narrative] and reflective strategies that allow the operator to enter into a relationship with his own thinking and with his own “submerged” heritage of knowledge that reflects his personal and professional history. It is through this personal “personal knowledge” that he acts as an educator. The ‘unmasking’ of the operator’s implicit representations and ideas, therefore - activated in moments of specific training through narrative workshops and reflective practice - is the expression of how health professionals “see themselves, their task, their degree of abstraction or involvement, the preferential ways of relating and reflective awareness that accompany the personal knowledge of the profession” [11].

As regards the “repertoire of instruments”, typical of NBM, are: observation, “cognitive listening” and transcription of patient stories by healthcare professionals;

1. reflective practice, activated by specific self-reflection narrative workshops, aimed at promoting “transformative learning” [12]. It is possible to use films or film sequences to stimulate reflection (eg in the case of cancer patients, for the doctor and the health professional, a training course can be envisaged starting from the film “Wit”, by Mike Nichols, USA, 2001).

2. shared and consensual reading of patient and professional diaries;

3. The parallel folder or “parallel chart” (where all other information, moods and thoughts not foreseen in a medical chart are transcribed) [13].

Why Narrative Medicine can help Healthcare Professionals and Cancer Patients

The storytelling can certainly represent, as evidenced by the scientific literature that has deepened it, an added value for the understanding of patients, an understanding that transcends the “data” and the “symptom” and deepens it from the point of view of the illness, for the realization of the diagnosis and the formulation of the therapy. This is also a valuable opportunity to give voice to those who normally do not have them, even though they are in fact the protagonist, that is, to the patient, or to those around them (caregivers). In addition, this way of remembering one’s own care experience is for the patient, as well as being more accessible than the drafting of a scientific article that provides for the processing of data on his own case history, an opportunity for immediate meeting and comparison with other operators, because filtered by one’s sensitivity. The basic concept is that of “attention” to the other not only as a body carrying symptoms and pathologies or as a set of organs on which to intervene, but as a person carrying “experiences” and emotions (illness). In order to be practiced, illness requires two fundamental tools: time and attention. Time, however, must be managed and not wasted. As pointed out by Hayden White in 1981, the narrative can be considered as “the solution of the problem of how to translate knowledge into saying, modeling human experience in a form that is assimilable to meaning structures that are generally human rather than specifically cultural. We may not be able to fully understand the specific thought patterns of another culture, but we have relatively less difficulty understanding a story from another culture, however exotic this culture appears to us. As Gadamer [14] reminds us, clinical practice is based on a dialogical dimension that is realized in a discourse on the patient and on the disease that does not want to be just an explanation, but that is also an understanding and production of intersubjective meaning. We can say that the Narrative Medicine moves in two directions: towards the patient, with collective or individual contexts in which to narrate and towards the operator, who experiences the narration of the self and builds a repertoire of narrative experiences. It is not possible to work with the history of the other without first analysing one’s own. Narrative Medicine “stimulates, not only a process of existential and relational anamnesis of the patient’s experience, but also the co-construction between doctor and patient of the meaning of the experience of the disease. The narrative forces you to bend over the patient’s emotional world in a logic of sharing, which refers not to the diversity of the roles of the patient, but to the common human dimension of existence. The treatment process then becomes a construction of meanings and clinical practice becomes aware of its own educational dimension, full of implications on the ethical level” [15].

In fact, the narrative activity on “clinical cases” generates theories from practice and allows the meeting in the care relationship of “two stories”, contextualising them in a “therapeutic relationship”. The narrative experience allows us to work on our learning by transforming it. Transforming, Freeman [16] reminds us, means that we have to give up old values, habits, skills and beliefs to make room for new ones. To indicate this process, Freeman uses the term “de-learning”. This is declined into “learning to take responsibility for cognitive acts and care choices and choose whether to adhere exclusively to a quantitative epistemology (EBM), which measures effectiveness and performance, or whether to adhere to a constructivist epistemology (NBM) that acts as selfregulation”[ 17].

Conclusion

Disease has two faces: on the one hand it expresses itself in an “objectified body”, it can be described through rigorous experimental and quantitative research strategies, removed or modified with technical interventions, on the other it is a subjective experience lived by the individual and his family and by the doctor himself, which can be known through equally rigorous qualitative research strategies and understood through reflective methodologies that can influence the prognosis and the course (e.g. taking charge) [18]. Attention to the patient’s illness - especially cancer patient - attributes value to symptoms in the personal context, as a subjective feeling of feeling good / bad. In particular of “perceived quality of life”. Talking about health means “understand the meaning of particular or daily events, the consequent adaptations or mismatches activated and the desires and expectations of a subject who finds himself inserted in a given environment. Speaking of health, ultimately, means talking about the life of persons, not only for what they are but, above all, for how the life is perceived and lived” [19].

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Iris Publishers- Open access Journal of Advances in Cancer Research & Clinical Imaging | Where Is the Genesis of Pancreatic Cancer? What is the Cause & Is There a Cure?

 

Authored by Robert O Young*

Mini Review

The Universal Origin of Acute Interstitium Inflammatory Pancreatic Disease [AIIPD], Pancreatic Cancer [PC] or Pancreatic Ductal Cell Adenocarcinoma [PDCA].

Pancreatic cancer [PC] or Pancreatic Ductal Cell Adenocarcinoma (PDAC) is the fourth most common cause of cancer-related death in the United States, exhibiting the lowest five-year survival rate among all cancerous conditions. More than half of pancreatic cancer patients are diagnosed at a late stage, for which the fiveyear survival rate is 3% [1]. This poor outcome is mainly due to the asymptomatic early stages of pancreatic cancer and the consequent late diagnosis when the cancerous condition and/or tumor is untreatable [2,3]. In order to increase the overall survival rate of patients with pancreatic cancer, as well as to decrease the cancer acidic burden of the interstitial fluids, it is necessary to perform early non-invasive, non-surgical, non-radioactive L.I.F.E. testing [Living Interstitium Fluid Environmental Testing], for accurately measuring the chemistry, including the pH of the interstitial fluids of the Interstitium of the pancreas and ALL other organs, glands and tissues. The L.I.F.E. testing will provide a non-invasive tool for prevention and early detection for AIID, PC, and PDAC and all other organs, glands or tissues at risk and for monitoring the efficacy of the any cancerous therapy [4]. PDAC is inherently linked to the unique physiology and microenvironment of the exocrine pancreas where dynamic changes in the interstitial fluids of the Interstitium [extracellular fluids] and intracellular pH (pHe/pHi) arise.

Specifically, the exocrine pancreas secretes substantial amounts of sodium bicarbonate [NaHCO3-] into the pancreatic ductal lumen (Figure 1) to buffer metabolic and dietary acids, including hormonal acids; when stimulated by post-prandial acidic waste (glucose, lactic acid, uric acid, nitric acid, etc.), luminal [NaHCO3-] reaches 150 mm. Secretion of base or alkalinity across the apical membrane is coupled to the extrusion of an equal amount of metabolic and/or dietary acids across the basolateral membrane, thereby acidifying the pancreatic interstitial fluids of the pancreatic Interstitium. Even though this may appear as a localized acidic condition it is not. Decompensated acidosis of the interstitial fluids of the Pancreatic Interstitium is a systemic condition and therefore will affect the health and well-being of every organ, every gland and every tissue of the human body. Thus, pancreatic epithelium and stromal cells are exposed to a milieu of spatially and temporally declining acidic pH fluids, with episodes of substantial acidity of the interstitial fluids of the Interstitium that surround every epithelial cell and every cell of the human body traveling through every organ, gland and tissue. In other words, cancer is a systemic acidic condition of the interstitial fluids of the Interstitium and not a localized metastatic acidic condition. This is why L.I.F.E. Testing is so critically important in the prevention and treatment of ANY diseased condition [4]. Epithelial cells of the pancreatic ducts are therefore challenged to maintain an alkaline pH constancy despite the vast base or sodium bicarbonate fluxes as the body desperately attempts to restore and alkaline pH or the alkaline design of the interstitial fluids of the Interstitium compartments at a pH of 7.365. The ideal pH of the Blood Plasma, Interstitial fluids of the Interstitium organ and Intracellular fluids is at 7.365. An acidic microenvironment [the interstitial fluids of the Interstitium] drives all cancerous progressions by saturating pancreatic cells with excess toxic acidic waste creating a higher risk for other organs, glands and tissues to become effected eventually leading to a so-called metastatic cancerous condition, even though the acidic condition of the Interstitium is systemic and negatively effecting every cell in the human body [4]. Decompensated acidosis of the interstitial fluids of the Interstitium [Ideal pH of the interstitial fluids is 7.365 dropping to 7.2 in a cancerous condition] triggers cellular mutations and breakdown and the disease progression to an acute or chronic inflammatory condition and finally to a cancerous acidic condition [5]. Current research efforts to improve AIIPD, PC and PDAC treatment and diagnosis do not take into account the unique pancreatic alkaline pH landscape of the Interstitium, despite the fact that acidosis of the interstitial fluids of the Interstitium is the universal origin of all inflammatory and cancerous conditions, including AIIPD, PC and PDAC [5] (Figure 2).

The prevention of Acute or Chronic Interstitium Inflammatory Pancreatic Disease, AIIPD, PC and PDAC or the reversal of AIIPD, PD, PDAC can be achieved by the following the steps below:

1. Open and clear the channels of elimination [urination, defecation, perspiration and respiration] in order to eliminate toxic acidic waste from the interstitial fluids of the Interstitum throughout the body [6].

2. Hyper-perfuse sodium bicarbonate and potassium bicarbonate into the blood which will push the excess alkalinity into the interstitial fluids of the Interstitium [7].

3. Reduce ALL acidic contributing factors of toxic metabolic, dietary, respiratory and environmental waste [lifestyle, including diet] that are being pushed out into the compartments of the Interstitium that hold acidic waste [6].

4. Restore alkalinity of the interstitial fluids of the Interstitium with an alkaline lifestyle, including diet, alkaline infusions of sodium and potassium bicarbonate and specific alkaline supplemental support products which can be taken orally, rectally, through the pores of the skin and through respiration [www.drrobertyoung.com][6,7].

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