Abdullah Mohammad Al Fareed has graduated from College of Medicine from University- Imam Abdulrahman Bin Faisal University. He is currently pursuing his Pediatrics Hemato- Oncology Fellowship in King Fahad Specialist Hospital.

Embryonal tumors constitute approximately 15% of all primary CNS tumors occurring in patient less than 18 years old. The most common embryonal tumors are: Medulloblastoma (MB) (62%), Atypical Teratoid Rhabdoid Tumors (ATRT) (15%), CNS Primitive Neuroectodermal Tumors (PNET) (14.9%), other embryonal tumors (8%). MB The most common malignant brain tumor of childhood occurs in the posterior fossa, like other embryonal tumors may metastasize either early or late in the disease course. The aim is to study the treatment outcome of medulloblastoma in children and adolescents treated at King Fahad Specialist Hospital Dammam from 2012 to 2016. The objective is to study the clinical symptoms and signs of medulloblastoma in our cohort, histopathological subtypes, evaluate approach to therapy (surgery, chemotherapy, and radiation therapy), to evaluate all the complications related to the disease and/or to the treatment, distribution and incidence of MB by sex, age and histologic types, calculate the relapse rate, correlation between the above points and the outcome, identify inherited syndromes associated with medulloblastoma in our cohort study. It’s a retrospective chart review for all children’s less than 16 years of age diagnosed with MB from January 2012 till December 2016. Survival curves were generated using Kaplan-Meier method. Overall Survival (OS) is defining as time from diagnosis until death from any cause. Event Free Survival (EFS) is defining as time from diagnosis until the occurrence of event. Events are failure to achieve remission, relapse, or death from any cause.

Hyeong Cheol Moon is currently working as a Medical Physicist at Chungbuk National University Hospital. He has published more than 10 papers in reputed journals. He is interested in ultra-high field 7T MRI, quality assurance for gammaknife radiosurgery and artificial neural network.

Predictions of patient outcomes after radiotherapy are essential to medical practice with the neurosurgeon, oncologist and medical physicist. Stereotactic Radiosurgery (SRS) is commonly used for brain metastases that are 3 cm or smaller in maximum diameter. Fractionation was introduced that the total dose of radiation is divided into small doses over a period of several days; there are fewer toxic effects on healthy cells. However, LINAC-based SRS have reported some studies, but Gammaknife Radiosurgery (GKRS) based has been rarely reported. We employed neural network approach towards predicting the outcomes after hypo fractionated GKRS to large brain metastatic brain tumors (>3 cm). Features engineering in this database included standard clinical and GKRS treatments parameters. A neural network consists of feed-forward which is the most well-known many applications in the functional approximation and back-propagation network is used for training. Our training process was performed Keras tools of categorical cross-entropy in lost function and Stochastic Gradient Descent (SGD) for optimization. A learning rate of 1.0x10 -6 . The best accuracy had around 95% and error under 0.05 in multi-layer neural networks. And single neural networks showed around 90% accuracy. This neural network approach was able to provide the best prediction of large brain tumor outcomes under hypo fractionated treatment. Furthermore, we could demonstrate a paradigm for personalized treatments for further development tools in medical care.

Frank van de Goot is a registered Anatomical Pathologist and an expert witness in the field of forensic pathology. He studied Medicine and Anatomical Pathology at the VU University Medical Center in Amsterdam, The Netherlands, and Rechtsmedizin at the Zentrum für Rechtsmedizin in Frankfurt am Main, Germany. The first seven years of his career he worked both as a Forensic Pathologist at the Dutch Forensic Institute (NFI) in The Hague, The Netherlands and as an Anatomical Pathologist at the VU University Medical Center. He now works at Symbiant Pathology Expert Centre, where he is on a mission to improve forensic and autopsy education for both medical and non-medical students.

We report the case of a 57 years old, male patient. The patient was previously diagnosed with an small cell neuro-endocrine carcinoma of the lung for which he received treatment. The patient encountered sudden collapse with a short epileptic episode. During routine scanning (CT/MRI brain) a circumscript lesion was found in the right frontal cerebral lobe. Biopsy revealed a small cell neuro-endocrine tumour. Immunohistochemistry revealed positivity for Synaptofysin, CD56 and TTF-1. Chromogranin was negative. Ki67 was highly expressed. Pankeratin was negative. The immune profiling was similar to the previously diagnosed lung process. Surprisingly GFAP was strongly positive as well. Due to the GFAP expression, molecular profiling was performed. This, leading undoubtedly to the conclusion that this was not a metastatic process from the lung but a strongly neuro-endocrine differentiated glioblastoma mimicking metastasis of a small cell lung carcinoma in a patient known with such a tumour. This case is illustrative for the use of molecular profiling in brain tumours, even when it appears to be an “obvious” diagnosis. MRI-scan revealed a small mass in the right frontal lobe, Due to its round structure a metastasis was suggested, but a primary brain tumour was not excluded due to the partly cystic appearance of the lesion. Diagnostic biopsy was advised. H&E histology revealed a small cell pattern with massive necrosis, moulding and many mitosis. The pattern was similar to the previous process in the lung. However, not similar to the lung was the appearance of mild vascular proliferation. Conclusion and literature: Although this tumour had the initial appearance of metastasis of a pulmonary small cell neuro-endocrine carcinoma, additional molecular profiling prevented this unusual pitfall. Eventually the lesion appeared to be rare differentiation of a glioblastoma multiforme

Bernadeth Lyn C Piamonte is a Neurology Resident at the University of the Philippines, Philippine General Hospital. She graduated cum laude at the University of the Philippines College of Medicine. She takes special interest in particular fields in neurology such as dementia and interventional neuroradiology.

Background: Among tumors of germ cell origin, the pure variant of testicular choriocarcinoma is extremely rare, accounting for 0.3% of testicular germ cell tumors and 0.19% of all testicular malignancies. About 10% of choriocarcinoma metastasizes to the brain, with tumor bleed being the most common cerebrovascular complication. Case Presentation: We describe an unusual case of a 54-years-old male with pure testicular choriocarcinoma presenting not only with brain tumor hemorrhages, but also cerebral infarctions of varying ages on cranial imaging. Further workup also demonstrated metastatic lesions to the lungs and liver. Despite treatment with Cisplatin based systemic chemotherapy, he succumbed to febrile neutropenia and subsequently to septic shock. Conclusion: The co-existence of brain tumor hemorrhages and infarctions in a patient with metastatic pure testicular choriocarcinoma is unusual and to the best of our knowledge, the first report of this kind in the literature. Early recognition of metastatic testicular choriocarcinoma by knowing such varied presentations allows for timely workup and subsequent pursuance of potentially life-saving treatments.

Loreto Yanez is a Congress of Neurological Surgeons Systematic Review and Evidence- Based Guidelines on the Use of Stereotactic Radiosurgery in the Treatment of Adults With Metastatic Brain Tumors. Graber, J. et al.

On March, 2016, the first Cyber knife M6 started Radiosurgery treatments at Fundación Arturo López Perez, in Santiago de Chile. This was the third facility in Chile with available radiosurgery in our country, the other centers have: Gamma knife (2) and LINAC based (1). Until April 2019, 309 patients have been treated, both intra and extra cranial. Intracranial cases comprehend the 51.6% of the cases, more than half of these were brain metastases. We present interesting neuro-cases to illustrate our experience. Conclusion: Extra cranial treatment indications in our experience so far are scarce, information should be reinforced so that referal is expanded. This technique allows effective and safe treatments, widely demonstrated.

Hsin-yu Chiang has completed her PhD at the age of 29 years from Boston University. She is an associate professor in Fu-Jen Catholic University. She has published more than 25 papers in international journals and has been serving as an editorial board member of different journal.

Social perception (SP) is an ability to identify the rules, roles, and context in situations. SP has shown to associate with functional outcomes in people with schizophrenia and become a target of intervention. However, the currently-available measures of SP has two limitations: 1) most SP measures were developed decades ago, which makes some items out-of- date; and 2) the scoring of these SP measures may have been affected by examinee’ gender, but such impacts have not been controlled. The objectives are: 1) to create an up-to-date assessment for SP (ASP), and 2) to control the impacts of gender on scoring. We developed the ASP based on its definition. We used Rasch analysis to calibrate the item difficulties and differential item functioning of sex (DIF of sex) of these SP items. The misfit items (infit or outfit mean square ≥ 1.4) and DIF items (DIF value ≥ 0.38) would be removed. A total of 236 patients were recruited in this study. After deleting the 7 DIF items (no misfit item was found), the remaining 26 items showed acceptable model fits (infit MNSQ = 0.90–1.14; outfit MNSQ = 0.79–1.22), supporting its construct validity. In addition, the removal of DIF items means the control of the impacts of gender on scoring, suggesting that the ASP can provide un-biased assessments for both genders. The distribution of item difficulties could cover the range of the patients’ SP levels (i.e., difference between the adjacent item difficulties was < 0.39), indicating that the ASP can be used in patients with various SP levels. The average Rasch reliability of these SP items were 0.68, suggesting the acceptable reliability. Our results reveal that the ASP serves as a reliable and valid assessment.

Tatyana V. Ramirez is an assistant professor at Graduate School of Professional Psychology, University of St. Thomas

The purpose of the present study was two-fold. First, we investigated the internal experiences of international students when they perceived themselves to be socially excluded by their American peers. Second, we examined coping strategies used to alleviate the pain caused by social exclusion. To this end, we conducted a qualitative study involving in-depth interviews of 11 international students in graduate psychology programs in the US. Our sample included students from Central and South America, Middle East, Africa, Asia, and Island Nations of the world. Using phenomenological interpretative analysis, we uncovered the following themes in the emotional experiences and coping strategies of the participants. Most students we interviewed reported acute disappointment when they realized that they were on the sidelines of group interactions and activities or that they were downright excluded (e.g., not invited to attend events or to take part in group projects). This disappointment was accompanied by a sense of confusion and efforts to make sense of why they were excluded. Typically, students first attributed exclusion to their own qualities, like accent or social deficiencies. They questioned their global self-worth and engaged in self-deprecation. As social exclusion events accumulated, most participants described increase in resultant feelings of intense loneliness, shame and inferiority, deep sadness, and hopelessness. Many students could not hold back tears when they talked about feeling excluded in interactions with their American peers. All students reported deep pain from feeling that their peers didn’t care about them personally and importantly, about their countries of origin. Very painful feelings arose when social exclusion was explained by racial and national prejudice. Some students, especially in counseling psychology programs, reported anger at the peers who proclaimed commitment to social justice and cultural sensitivity while being clearly insensitive to their international classmates. Cultural indifference, lack of curiosity, and ignorance in global affairs brought out strong emotional reactions in most of our participants. Coping strategies included two broad categories: internal self-work and external adaptational strategies. Internal self-work involved cognitive reframing of the events, finding empathy for self and others, being curious about the cultures and perspectives of others, and participating in personal therapy. External strategies included seeking emotional support, sharing emotions with trusted others, socializing with other minority groups and international students, engaging in extra-curricular activities and joining religious/spiritual communities.

Orawan Bootthumpan is currently working at Ramathibodi Chakrinareubodindra Hospital. She is a Senior Nurse at Cardiac Care Unit a new branch of the Faculty of Medicine, Ramathibodi Hospital, Thailand.

Pressure injury was mainly problem among patients in cardiac care unit. Th e 40 adult medicine- patients in cardiac care unit were admitted from 1st August 2014 through 31st August 2015 in the University Hospital, Th ailand. Data was designed as a retrospective matched-paired case control study by sampling subjects in control. Th e objective of this research study is to demonstrate and describe association between risk factors (such as Braden scale, length of stay, albumin) and pressure injury. 30 patients without having pressure injury were matched with 10 patients in case group who develop pressure injury by using matched multi variables that include age, sex and medical diagnosis. Th e Fisher’s exact test and Chi- square test were used for the association. Th e results indicated that the subjects were 24 male and 16 female. Th e average mean age in cases and control groups were 71 years (SD=10.94) and 70.77 years (SD=10.91), length of stay were 259.50 hrs. and 80.50 hrs. Th e association between length of stay at hospital and pressure injury were associated with the pressure injury (p=0.0004). Th is result should be used for create the guidelines for risk reduction strategies of pressure injury among cardiac care patients.

YuChun Yao has completed her EdD at the age of 35 years from Spalding University (School of Education) and MSN from Spalding University (School of Nursing) in United States. She is the assistant professor of I-Shou University in Taiwan. She has published more than 25 papers in reputed journals and conferences. In addition, she has been serving as an editorial board member of several repute journals and conferences.

Climate changes have serious harms on global environment, and further infl uence human health. For instance, infectious diseases caused by heavy rain, and respiratory diseases caused by air pollution. Nurses have responsibility to take care of patients with these diseases. Nurses also have responsibility to educate individuals to promote their health. However, attitudes toward climate change issues aff ect how nurses treat the patients. Thus, the aim of this study is to explore the attitudes toward climate change issues perceived by nursing students in Taiwan. A descriptive research design was used, and 182 nursing students were participated in this study. Climate Change Adaptation Questionnaire was utilized to evaluate nursing students’ attitude toward climate changes. Th ere were 89.9% participants had heard about climate changes, global warming, and greenhouse eff ect, but only 80.2% participants knew Kyoto Protocol. Most participants understood climate change issues from television news (72.5%) and followed by textbooks (52.2%). 73.6% participant would not collect informations about climate changes automatically. Nevertheless, there were 62.1% participants had participated in environment related activities. These results revealed that althoug nursing students did not have strong motivation to explore climate change issues, they still had the basic knowledge of climate changes. In addition, most of them were willing to participate in activities related to climate changes. Th ese fi ndings could provide recommendations for nursing educators to develop climate change issues into nursing curriculum design.

Varanporn Panasittivana has completed her Master’s degree from Public Health, Mahidol University, Thailand. She is currently working at Ramathibodi Chakrinareubodindra Hospital and also the Head of Nurse at Intensive Care Unit, Faculty of Medicine, Ramathibodi Hospital, Thailand.

Caring and preventing complications of peripheral intravenous infusion in patient is crucial in ICU. This experimental development research designs was aimed at developing a working model for nursing patients with peripheral intravenous infusion at the medical intensive care unit. Th e research study was conducted from June 16 toSeptember 15, 2017. Th e sample of work was care implementation for patients with peripheral intravenous infusion during pre- and post-experimental phases in total of 167 times. Th e sample of participants included 69 service receivers, 47 service providers/nurses and 2 managers. The nursing care was measured in 5 aspects: Quantity, quality, duration, satisfaction of individuals involved and economics. Data was analyzed using descriptive statistics, T-values, Paired T tests, Wilcoxon Signed-Rank test, Mann-Whitney U test with the alpha level at 0.05. Th e research fi ndings revealed that the workers’ workload did not increase, but the accuracy rate to follow the standard increased (p=0.003); work duration did not increase, the workers’ satisfaction did not decrease, and cost per service unit decreased (p<0.001). For recommendations, the research should be continuously conducted throughout the entire hospital and developed to be a good working model of the country with higher effi ciency. Policies on health service provisions should be more intense by focusing more on integrative work and multidisciplinary participation for patients to receive quality nursing care.

Chonticha Rodchuea has completed her Master degree from Mae Fah Luang University, Thailand and currently working as a Registered Nurse at Intensive Care Unit at Lopburi Cancer Hospital, Thailand.

This research is experimental study. Th e objectives of this study were to compare pain scores before and aft er using pain management program in critical cancer patients. Th e sample consisted of 18 critically ill cancer patients who were admitted to the intensive care unit at Lopburi Cancer Hospital and to study satisfaction of nurses who used the pain management program in critical cancer patients. Th e instruments used in this study were the pain management program in critical cancer patients. Data collection include pain assessment tool for critically ill cancer patients who can communicate and report their pain. Use Numerical Rating Scale (NRS) for critically ill cancer patients. Th e use of pain assessment tools in the care of critically ill patients (CPOT) and the group discussion questionnaire to evaluate the satisfaction of pain management service providers in critically ill patients. General information was analyzed using percentage and used standard deviation for age distribution. Friedman Test and Kendall's W Test for comparison of before and aft er using pain management program. Th e research found that pain scores before and aft er using program was signifi cantly diff erent (p<0.001) and didn’t fi nd that the patients who used the program had more pain. Most of nurses who used this program say to the program can help in evaluating patients, pain management of the patient according to patient characteristics. Th e pain management program in critically ill cancer patients should be improved by educating nursing personnel about pain management aft er the pain assessment of the patient.

Wanipa Wongnate is currently working as a Registered Nurse at Intensive Care Unit, Lopburi Cancer Hospital, Thailand

Incontinence-associated Dermatitis (IAD) describes the skin damage associated with exposure to urine or stool. Cancer patients in the intensive care unit that cannot control excretion most of the patients were irradiated in the abdomen and pelvic area. Side eff ects from treatment may occur. Complications of the gastrointestinal tract and urinary tract patients who control excretion do not have Incontinence Associated Dermatitis (IAD) aft er the skin is exposed to urine or feces. For a long time, infl ammation occurs around the genital area, causing IAD lesions aff ect the body, mind and may cause bacterial or fungal infections causing the hospital to stay longer and cost more purpose and goal of innovation. In order to develop an aggressive form of IAD preventive nursing and to provide patients with IAD with a better quality of life conceptual framework is derived from the physiological concept of the change of skin that touches the stool, urine from controlling excretion together with participatory action research concepts. Development process, starting from studying the problems of nursing implement empirical framework and evidence to develop nursing models using IAD assessment tools, including the Perineal Assessment Tool (PAT), risk assessment for IAD and IAD levels using the Incontinence Associate Dermatitis Intervention Tool (IADIT) in conjunction with the principles apply 100% pure oxygen (Apply Hyperbaric Oxygen Th erapy: AHBOT) to patients and create skin care fl ow chart and communicate to all personnel in the team and follow the developed care model. In 2017, patients were assessed for skin by using the perineal assessment tool, which accounted for 78.88 percent of all patients admitted in the intensive care unit. Th ere were 2 Severe IAD conditions and received AHBOT from the inquiry. Quality of life of patients who received skin assessment using the Visual Analog Scale (VAS) assessment found that patients had quality of life accounted for 70 percent. Later in 2018, all patients received in the intensive care unit received a skin assessment using the perineal assessment tool, 100 percent from questioning the quality of life of patients found that patients with an IAD condition improved.