Recurrent gallstone ileus: case report and literature review

The gallstone ileus is a rare complication of cholelithiasis and it represents the 1-4% of small intestinal mechanical obstruction. Gallstone is generally wedged in the terminal ileum, even if unusual locations have been described. The literature reports a very high morbidity and mortality, often because misdiagnosis or delayed diagnosis. There is no unique opinion in literature about the choice between one-stage and two-stage surgery. We report a clinical case that summarizes the diagnostic and therapeutic difficulties of gallstone ileus.

Whipple’s disease infection surgical treatment: presentation of a rare case and literature review

The Whipple’ Disease (W.D.) is a very rare disease with an incidence of 1 per 1.000.000 inhabitants; it is a systemic infection that may mimic a wide spectrum of clinical disorders, which may have a fatal outcome and affects mainly male 40-50 years old. The infective agent is an actinomycete, Tropheryma Whipplei (T.W.) that was isolated 100 years after first description by Wipple, and identified in macrophages of mucosa of the small intestine by biopsy which is characterized by periodic acid-Schiff-positive, products of the inner membrane of his polysaccharide bacterial cell wall. The multisystemic clinical manifestations evolve rapidly towards an organic decay characterized by weight loss, malabsorption, diarrhea, polyathralgia, opthalmoplegia, neuro-psychiatric disorders and sometimes associated to endocarditis. Early antibiotic treatment with trimethoprim and sulfometathaxazole reduces the fatal evolution of the disease. The authors present a rare experience about a female subject in which the clinical gastrointestinal signs were preceded by neuro-psychiatric disorders, and evolved into obstruction and intestinal perforation which required an emergency surgery with temporary ileostomy, recanalized only after adequate medical treatment with a full dose of antibiotic and resolution of clinical disease for the high risks of fistulae for the edema and lymphadenopathy of mucosa. The diagnosis was histologically examined by intestinal biopsy performed during surgery, which showed PAS-positive histiocytes, while PRC polymerase RNA was negative, which confirms the high sensibility of PAS positive and low specificity of RNA polymerase for T.W.

Teaching boys in neoliberal and postfeminist times: Feminization and the question of re-masculinization in the education system and policy field

This paper focuses on teaching boys, male teachers and the question of gendered pedagogies in neoliberal and postfeminist times of the proliferation of new forms of capitalism, multi-mediated technologies and the influence of globalization. It illustrates how a politics of re-masculinization and its reconstitution needs to be understood as set against changing economic and social conditions in which gender equity comes to be re-focused on boys as the ‚new disadvantaged‘. This re-framing of gender equity, it is argued, has been fuelled by both a media-inspired backlash discourse about ‚failing boys‘ and a neo-positivist emphasis on numbers derived primarily from standardized testing regimes at both global and national levels. A media-focused analysis of the proliferation of discourses about ‚failing boys‘ vis-a-vis the problem of encroaching feminization in the school system is provided to illuminate how certain truths about the influence of male teachers come to define how the terms of ensuring gender equity are delimited and reduced to a question of gendered pedagogies as grounded in sexed bodies. Historical accounts of the feminization of teaching in the North American context are also provided as a basis for building a more informed understanding of the present, particularly as it relates to the contextualization of policy articulation and enactment regarding the problem of teaching boys. In light of such historically informed and critical media analysis, it is argued that what is needed is a more informed, evidenced based policy articulation of the problem of teaching boys and a more gender sensitive reflection on the politics of masculinities in postfeminist times. (DIPF/Orig.)

A study of ignorance: suffering and freedom in early Buddhist teachings and parallels in modern neuroscience

What might early Buddhist teachings offer neuroscience and how might neuroscience inform contemporary Buddhism? Both early Buddhist teachings and cognitive neuroscience suggest that the conditioning of our cognitive apparatus and brain plays a role in agency that may be either efficacious or non-efficacious. Both consider internal time to play a central role in the efficacy of agency. Buddhism offers an approach that promises to increase the efficacy of agency. This approach is found in five early Buddhist teachings that are re-interpreted here with a view to explaining how they might be understood as a dynamic basis for ‘participatory will’ in the context of existing free will debates and the neuroscientific work of Patrick Haggard (et al.). These perspectives offer Buddhism and neuroscience a basis for informing each other as the shared themes of: (1) cognition is dynamic and complex/aggregate based, (2) being dynamic, cognition lacks a fixed basis of efficacy, and (3) efficacy of cognition may be achieved by an understanding of the concept of dynamic: as harmony and efficiency and by means of Buddha-warranted processes that involve internal time.

Acute Cholecystitis as a Complication After Colonoscopy: A Case Report and Literature Review

Acute cholecystitis after colonoscopy is a rare event, with less than 10 cases described in the literature. We report the case of a male patient with silent gallstones who underwent colonoscopy for follow-up of his Crohn’s disease. The colonoscopy revealed erosions in the terminal ileum, from which biopsies were taken. A sessile polyp 4 mm in diameter at the recto-sigmoid junction was also removed. Less than 24 h after the colonoscopy, the patient complained of upper right quadrant pain, nausea and vomiting. Based on the clinical findings, laboratory data and ultrasonography, we diagnosed acute cholecystitis and excluded any complication after the colonoscopy. Laparoscopic cholecystectomy was performed and the patient was discharged.

Ovarian sertoli-leydig cell tumour with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review

Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alphafetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrineinactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker.

Marketising Slovene adult education policies and practices using mechanisms of the Europeanisation of education

This article addresses the issue of marketisation in the field of adult education by reflecting on the Europeanisation of education currently taking place through the establishment of European adult education policies. The article argues that Europeanisation fosters marketisation of adult education and commodifies valuable knowledge and desirable forms of neoliberal subjectivity. An analysis of Slovene adult education policies from 2004-2015 reveals how a European economised vocabulary is being implemented in Slovene adult education policies and practices. The main argument of this article is that these practices are shaped through financial mechanisms that marketise the adult education field. This results in new relationships between governing bodies within the field, the unstable and decreasing role of public adult education institutions and the prevailing role of private providers of adult education, who offer training programmes to meet labour market needs. (DIPF/Orig.)

EDUCATION, TRAINING AND AWARENESS OF LAWS AS DETERMINANTS OF COMPLIANCE WITH PLANT PROTECTION LAW: THE CASE OF PESTICIDE USE PRACTICES IN TANZANIA

Pesticide residues in food and environment pose serious health risks to human beings. Plant protection laws, among other things, regulate misuse of agricultural pesticides. Compliance with such laws consequently reduces risks of pesticide residues in food and the environment. Studies were conducted to assess the compliance with plant protection laws among tomato farmers in Mvomero District, Morogoro Region, Tanzania. Compliance was assessed by examining pesticide use practices that are regulated by the Tanzanian Plant Protection Act (PPA) of 1997. A total of 91 tomato farmers were interviewed using a structured questionnaire. Purposive sampling was used in selecting at least 30 respondent farmers from each of the three villages of Msufini, Mlali and Doma in Mvomero District, Morogoro Region. Simple Random Sampling was used to obtain respondents from the sampling frame. Individual and social factors were examined on how they could affect pesticide use practices regulated by the law. Descriptive statistics, mainly frequency, were used to analyze the data while associations between variables were determined using Chi-Square and logistic regression model. The results showed that respondents were generally aware of the existence of laws on agriculture, environment and consumer health, although none of them could name a specific Act. The results revealed further that 94.5% of the farmers read instructions on the pesticides label. However, only 21% used the correct doses of pesticides, 40.7% stored pesticides in special stores, 68.1% used protective gear, while 94.5% always read instructions on the label before using a pesticide product. Training influenced the application rate of pesticide (p < 0.001) while awareness of agricultural laws significantly influenced farmers’ tendency to read information on the labels (p < 0.001). The results showed further that education significantly influenced the use of protective gears by farmers (p = 0.042). Education also significantly affected the manner in which farmers stored pesticide-applying equipment (p = 0.024). Furthermore, farmers’ awareness of environmental laws significantly (p = 0.03) affected farmers’ disposal of empty pesticide containers. Results of this study suggest the need for express provisions on safe use and handling of pesticides and related offences in the Act, and that compliance should be achieved through education rather than coercion. Results also suggest establishment of pesticide disposal mechanisms and structures to reduce unsafe disposal of pesticide containers. It is recommended that farmers should be educated and trained on proper use of pesticides. Farmers’ awareness on laws affecting food, environment and agriculture should be improved.

An historical catalogue of portraits, representing distinguished persons in the history and literature of the United Kingdom.

Catalog of an exhibition held at the British Institution for Promoting the Fine Arts in the United Kingdom.

Higher education development and knowledge economy optimism in Ethiopia

Higher education has been assigned new global importance. It is now the vehicle of choice for nations seeking to increase their competitiveness in an expanding knowledge economy. In developing nations, higher education has also been linked to goals to reduce poverty, under the influence of transnational aid agencies such as the World Bank and its knowledge-driven poverty reduction strategies. Drawing on Amartya Sen’s capability approach to development, this paper argues that this instrumentalization of higher education produces narrow conceptions of development, poverty and knowledge, and an unfounded optimism in ‘knowledge for skills’. The site for this analysis is the development and rapid expansion of Ethiopia’s higher education system, with its antecedents in a centuries-old religious education system but with more recent beginnings in the 1950s and, since the 1990s, under the influence of the World Bank. At stake are opportunity and process freedoms and the deprivation of capability (i.e. poverty) resulting from the constraint of these, evident in the nation’s higher education system. The paper concludes that without concerted efforts to redress injustices and to protect and expand people’s freedom, Ethiopian higher education has little to contribute to national socio-economic transformation agendas.

Online distance education models and research implications

As a form of education, distance education is influenced by educationaltheories and ideologies. Hence, over time its various theoretical modelshave reflected varying emphases on students, both individually and ingroups, on content and process, and on administration and costs, and itsguiding philosophies have ranged from knowledge replication to knowledge creation, and from teacher direction to learner engagement. Its founding purpose was the provision of education to populations who were not able to access available residential education. The reasons were not only based on the individual situation, such as, geographic location, family commitments,work commitments, or cost factors, but also included state issues such as insufficient institutions or a lack of enrolment places, full-time funding, or sufficient staff. These factors have contributed in various ways to the growth of distance education, both historically as when distance education was a major focus in many European countries after WWII, and as a current imperative in many countries where the need and desire for education outstrips the supply through residential institutions, regardless of their fiscal capacities. Education is seen by both individuals and states as essential for the development of a better socio-economic environment, hence, distance education has become the cost-affordable means of provision for millions worldwide.Distance education, then, is framed within larger socio-economic andpolitical contexts. These are not only reflective of societal characteristics like those identified by Keegan (2000): immediacy, globalization, privatization, and industrialization, to which we added professional learning, but also reflective of current social, political, and economic circumstances, such as the sequence of global economic crises this century.Within these contexts then, the provision of distance education seldomarises from the desire of an institution alone; rather there are likely to becomplex national, local, and individual aspirations where distance education is seen as the best solution. The realization of this provision depends on the issues being addressed and the various influences on the particular configuration of design and provision. It may be publicly or privately funded; it may seek to emulate or extend educational provision in residential institutions; its focus may be on increasing access or openness or convenience.Models or designs for distance education, then, have generally arisen from consideration of these instances, in part to provide a framework for researchers and in part to provide a means to reflect on issues that the models themselves have tried to resolve and sometimes inadvertently create.

The new heritage studies and education, training, and capacity-building

Over the last three decades, community and professional views of what constitutes significant cultural heritage have broadened in many countries around the world. Heritage practice has moved from a narrowly technical or fabric focus to a values-based approach engaging all stakeholders, including indigenous communities. While much Western heritage knowledge and practice remains indispensable, gaps can be filled in by drawing on other knowledge areas and ethical considerations, including links between heritage practice and human rights. These new directions require new approaches in the preparation of practitioners as well as others engaged in heritage processes. In addition to education and training, a third concept – capacity-building – is overarching and potentially powerful in reaching new heritage actors. The aim of giving heritage a valued role in the life of the community, which applies at global, national, and local levels, represents the greatest challenge for educators, trainers, and capacity-builders in the contemporary world.