Search results for: intentional bias
300 Understanding the Endogenous Impact of Tropical Cyclones Floods and Sustainable Landscape Management Innovations on Farm Productivity in Malawi
Authors: Innocent Pangapanga, Eric Mungatana
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Tropical cyclones–related floods (TCRFs) in Malawi have devastating effects on smallholder agriculture, thereby threatening the food security agenda, which is already constrained by poor agricultural innovations, low use of improved varieties, and unaffordable inorganic fertilizers, and fragmenting landholding sizes. Accordingly, households have engineered and indigenously implemented sustainable landscape management (SLM) innovations to contain the adverse effects of TCRFs on farm productivity. This study, therefore, interrogated the efficacy of SLM adoption on farm productivity under varying TCRFs, while controlling for the potential selection bias and unobservable heterogeneity through the application of the Endogenous Switching Regression Model. In this study, we further investigated factors driving SLM adoption. Substantively, we found TCRFs reducing farm productivity by 31 percent, on the one hand, and influencing the adoption of SLM innovations by 27 percent, on the other hand. The study also observed that households that interacted SLM with TCRFs were more likely to enhance farm productivity by 24 percent than their counterparts. Interestingly, the study results further demonstrated that multiple adoptions of SLM-related innovations, including intercropping, agroforestry, and organic manure, enhanced farm productivity by 126 percent, suggesting promoting SLM adoption as a package to appropriately inform existing sustainable development goals’ agricultural productivity initiatives under intensifying TCRFs in the country.Keywords: tropical cyclones–related floods, sustainable landscape management innovations, farm productivity, endogeneity, endogenous switching regression model, panel data, smallholder agriculture
Procedia PDF Downloads 116299 A Comprehensive Characterization of Cell-free RNA in Spent Blastocyst Medium and Quality Prediction for Blastocyst
Authors: Huajuan Shi
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Background: The biopsy of the preimplantation embryo may increase the potential risk and concern of embryo viability. Clinically discarded spent embryo medium (SEM) has entered the view of researchers, sparking an interest in noninvasive embryo screening. However, one of the major restrictions is the extremelty low quantity of cf-RNA, which is difficult to efficiently and unbiased amplify cf-RNA using traditional methods. Hence, there is urgently need to an efficient and low bias amplification method which can comprehensively and accurately obtain cf-RNA information to truly reveal the state of SEM cf-RNA. Result: In this present study, we established an agarose PCR amplification system, and has significantly improved the amplification sensitivity and efficiency by ~90 fold and 9.29 %, respectively. We applied agarose to sequencing library preparation (named AG-seq) to quantify and characterize cf-RNA in SEM. The number of detected cf-RNAs (3533 vs 598) and coverage of 3' end were significantly increased, and the noise of low abundance gene detection was reduced. The increasing percentage 5' end adenine and alternative splicing (AS) events of short fragments (< 400 bp) were discovered by AG-seq. Further, the profiles and characterizations of cf-RNA in spent cleavage medium (SCM) and spent blastocyst medium (SBM) indicated that 4‐mer end motifs of cf-RNA fragments could remarkably differentiate different embryo development stages. Significance: This study established an efficient and low-cost SEM amplification and library preparation method. Not only that, we successfully described the characterizations of SEM cf-RNA of preimplantation embryo by using AG-seq, including abundance features fragment lengths. AG-seq facilitates the study of cf-RNA as a noninvasive embryo screening biomarker and opens up potential clinical utilities of trace samples.Keywords: cell-free RNA, agarose, spent embryo medium, RNA sequencing, non-invasive detection
Procedia PDF Downloads 64298 The Effect of Accounting Conservatism on Cost of Capital: A Quantile Regression Approach for MENA Countries
Authors: Maha Zouaoui Khalifa, Hakim Ben Othman, Hussaney Khaled
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Prior empirical studies have investigated the economic consequences of accounting conservatism by examining its impact on the cost of equity capital (COEC). However, findings are not conclusive. We assume that inconsistent results of such association may be attributed to the regression models used in data analysis. To address this issue, we re-examine the effect of different dimension of accounting conservatism: unconditional conservatism (U_CONS) and conditional conservatism (C_CONS) on the COEC for a sample of listed firms from Middle Eastern and North Africa (MENA) countries, applying quantile regression (QR) approach developed by Koenker and Basset (1978). While classical ordinary least square (OLS) method is widely used in empirical accounting research, however it may produce inefficient and bias estimates in the case of departures from normality or long tail error distribution. QR method is more powerful than OLS to handle this kind of problem. It allows the coefficient on the independent variables to shift across the distribution of the dependent variable whereas OLS method only estimates the conditional mean effects of a response variable. We find as predicted that U_CONS has a significant positive effect on the COEC however, C_CONS has a negative impact. Findings suggest also that the effect of the two dimensions of accounting conservatism differs considerably across COEC quantiles. Comparing results from QR method with those of OLS, this study throws more lights on the association between accounting conservatism and COEC.Keywords: unconditional conservatism, conditional conservatism, cost of equity capital, OLS, quantile regression, emerging markets, MENA countries
Procedia PDF Downloads 355297 Electronic Spectral Function of Double Quantum Dots–Superconductors Nanoscopic Junction
Authors: Rajendra Kumar
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We study the Electronic spectral density of a double coupled quantum dots sandwich between superconducting leads, where one of the superconducting leads (QD1) are connected with left superconductor lead and (QD1) also connected right superconductor lead. (QD1) and (QD2) are coupling to each other. The electronic spectral density through a quantum dots between superconducting leads having s-wave symmetry of the superconducting order parameter. Such junction is called superconducting –quantum dot (S-QD-S) junction. For this purpose, we have considered a renormalized Anderson model that includes the double coupled of the superconducting leads with the quantum dots level and an attractive BCS-type effective interaction in superconducting leads. We employed the Green’s function technique to obtain superconducting order parameter with the BCS framework and Ambegaoker-Baratoff formalism to analyze the electronic spectral density through such (S-QD-S) junction. It has been pointed out that electronic spectral density through such a junction is dominated by the attractive the paring interaction in the leads, energy of the level on the dot with respect to Fermi energy and also on the coupling parameter of the two in an essential way. On the basis of numerical analysis we have compared the theoretical results of electronic spectral density with the recent transport existing theoretical analysis. QDs is the charging energy that may give rise to effects based on the interplay of Coulomb repulsion and superconducting correlations. It is, therefore, an interesting question to ask how the discrete level spectrum and the charging energy affect the DC and AC Josephson transport between two superconductors coupled via a QD. In the absence of a bias voltage, a finite DC current can be sustained in such an S-QD-S by the DC Josephson effect.Keywords: quantum dots, S-QD-S junction, BCS superconductors, Anderson model
Procedia PDF Downloads 374296 The Differences and Similarities in Neurocognitive Deficits in Mild Traumatic Brain Injury and Depression
Authors: Boris Ershov
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Depression is the most common mood disorder experienced by patients who have sustained a traumatic brain injury (TBI) and is associated with poorer cognitive functional outcomes. However, in some cases, similar cognitive impairments can also be observed in depression. There is not enough information about the features of the cognitive deficit in patients with TBI in relation to patients with depression. TBI patients without depressive symptoms (TBInD, n25), TBI patients with depressive symptoms (TBID, n31), and 28 patients with bipolar II disorder (BP) were included in the study. There were no significant differences in participants in respect to age, handedness and educational level. The patients clinical status was determined by using Montgomery–Asberg Depression Rating Scale (MADRS). All participants completed a cognitive battery (The Brief Assessment of Cognition in Affective Disorders (BAC-A)). Additionally, the Rey–Osterrieth Complex Figure (ROCF) was used to assess visuospatial construction abilities and visual memory, as well as planning and organizational skills. Compared to BP, TBInD and TBID showed a significant impairments in visuomotor abilities, verbal and visual memory. There were no significant differences between BP and TBID groups in working memory, speed of information processing, problem solving. Interference effect (cognitive inhibition) was significantly greater in TBInD and TBID compared to BP. Memory bias towards mood-related information in BP and TBID was greater in comparison with TBInD. These results suggest that depressive symptoms are associated with impairments some executive functions in combination at decrease of speed of information processing.Keywords: bipolar II disorder, depression, neurocognitive deficits, traumatic brain injury
Procedia PDF Downloads 347295 Comparison of Er:YAG Laser with Bur Prepared Cavities: A Systematic Review
Authors: Sarina Sahmeddini, Fahimeh Safarpour, Forough Pazhuheian
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With the concepts of minimally invasive treatment and preventive dentistry gaining more and more recognition by dentists, there are many published clinical trials comparing the use of the erbium laser with traditional drilling for caries removal. However, the efficacy of the erbium laser is still controversial. The aim of this review study is to compare the effects of tooth preparation by laser irradiation and conventional preparation by bur to identify the best means for cavity preparation and reduction of recurrent caries. Randomized controlled trials, controlled clinical trials, and prospective, and retrospective cohort studies were included in this review. The eligibility criteria included studies in humans’ permanent teeth in which cavities were conducted in their cervical third and proximal surfaces. PubMed, Google scholar, and Scopus about Er:YAG laser and bur prepared cavities were carried out. The studies’ details were organized in four tables according to the groups: (1) Microleakage; (2) Morphological changes; (3) Microhardness; and (4) Bond strength. The initial search resulted in 134 articles, 12 studies published from 2012 up to March 2020 were included in this review. According to the risk of bias evaluation, all studies were classified as high quality. Clinical implications: Er:YAG lasers with the energy levels between 250 to 300 mJ can be proper alternatives to conventional burs, as minimal invasive instruments with no significant differences or better results in microleakage, microhardness, and bond strength compared with conventional burs. In conclusion, Er:YAG laser irradiations accompanied by phosphoric acid etching can reduce the chance of recurrent carries.Keywords: lasers, drilling, caries, micro leakage
Procedia PDF Downloads 131294 Embracing the Uniqueness and Potential of Each Child: Moving Theory to Practice
Authors: Joy Chadwick
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This Study of Teaching and Learning (SoTL) research focused on the experiences of teacher candidates involved in an inclusive education methods course within a four-year direct entry Bachelor of Education program. The placement of this course within the final fourteen-week practicum semester is designed to facilitate deeper theory-practice connections between effective inclusive pedagogical knowledge and the real life of classroom teaching. The course focuses on supporting teacher candidates to understand that effective instruction within an inclusive classroom context must be intentional, responsive, and relational. Diversity is situated not as exceptional but rather as expected. This interpretive qualitative study involved the analysis of twenty-nine teacher candidate reflective journals and six individual teacher candidate semi-structured interviews. The journal entries were completed at the start of the semester and at the end of the semester with the intent of having teacher candidates reflect on their beliefs of what it means to be an effective inclusive educator and how the course and practicum experiences impacted their understanding and approaches to teaching in inclusive classrooms. The semi-structured interviews provided further depth and context to the journal data. The journals and interview transcripts were coded and themed using NVivo software. The findings suggest that instructional frameworks such as universal design for learning (UDL), differentiated instruction (DI), response to intervention (RTI), social emotional learning (SEL), and self-regulation supported teacher candidate’s abilities to meet the needs of their students more effectively. Course content that focused on specific exceptionalities also supported teacher candidates to be proactive rather than reactive when responding to student learning challenges. Teacher candidates also articulated the importance of reframing their perspective about students in challenging moments and that seeing the individual worth of each child was integral to their approach to teaching. A persisting question for teacher educators exists as to what pedagogical knowledge and understanding is most relevant in supporting future teachers to be effective at planning for and embracing the diversity of student needs within classrooms today. This research directs us to consider the critical importance of addressing personal attributes and mindsets of teacher candidates regarding children as well as considering instructional frameworks when designing coursework. Further, the alignment of an inclusive education course during a teaching practicum allows for an iterative approach to learning. The practical application of course concepts while teaching in a practicum allows for a deeper understanding of instructional frameworks, thus enhancing the confidence of teacher candidates. Research findings have implications for teacher education programs as connected to inclusive education methods courses, practicum experiences, and overall teacher education program design.Keywords: inclusion, inclusive education, pre-service teacher education, practicum experiences, teacher education
Procedia PDF Downloads 68293 Uncertainties and Resilience: A Study of Pandemic Impact on the Pastoral-Nomadic Communities in India
Authors: Arati S. Kade, Iftikhar Hussain, Somnath Dadas
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The paper studies resilience and uncertainties among nomadic-pastoral communities in India during large events such as pandemics and attempts to understand that with changing times and increased uncertainties, how nomadic communities historically showed their resilience. A review of the literature was performed concerning nomadism and development relations and conflicts by focusing on structural violence on nomadic communities from the caste class and patriarchy as a framework along with the role of the state. Philosophical views on the anti-nomad bias of political theories by Erik Ringmar, along with the decolonial approach by Linda Smith and debrahmanization by Braj Ranjan Mani were used to analyze criminalization of nomads. Data were collected using in-depth telephonic interviews and news reports published during the COVID-19 lockdown in India. Focusing on historical context of current crises, the paper leads to the discussion on how nomadic communities negotiate with the sedentary society during the COVID-19 pandemic. Findings of the current paper approve the hypotheses that the COVID-19 pandemic followed by lockdown deeply impacted the pastoral production system, building on the continued cycle of marginalization by the state and caste society in India, while traditional knowledge stood the test of time. Be it developmental states or pandemics, the nomadic communities have shown their resilience in a number of ways, such as keeping distance from sedentary society, usage of traditional medicine, and relying on traditional leadership.Keywords: COVID-19, criminalization, India, nomadism, pandemic, pastoralism, resilience, traditional knowledge
Procedia PDF Downloads 97292 The Impact of Unconditional and Conditional Conservatism on Cost of Equity Capital: A Quantile Regression Approach for MENA Countries
Authors: Khalifa Maha, Ben Othman Hakim, Khaled Hussainey
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Prior empirical studies have investigated the economic consequences of accounting conservatism by examining its impact on the cost of equity capital (COEC). However, findings are not conclusive. We assume that inconsistent results of such association may be attributed to the regression models used in data analysis. To address this issue, we re-examine the effect of different dimension of accounting conservatism: unconditional conservatism (U_CONS) and conditional conservatism (C_CONS) on the COEC for a sample of listed firms from Middle Eastern and North Africa (MENA) countries, applying quantile regression (QR) approach developed by Koenker and Basset (1978). While classical ordinary least square (OLS) method is widely used in empirical accounting research, however it may produce inefficient and bias estimates in the case of departures from normality or long tail error distribution. QR method is more powerful than OLS to handle this kind of problem. It allows the coefficient on the independent variables to shift across the distribution of the dependent variable whereas OLS method only estimates the conditional mean effects of a response variable. We find as predicted that U_CONS has a significant positive effect on the COEC however, C_CONS has a negative impact. Findings suggest also that the effect of the two dimensions of accounting conservatism differs considerably across COEC quantiles. Comparing results from QR method with those of OLS, this study throws more lights on the association between accounting conservatism and COEC.Keywords: unconditional conservatism, conditional conservatism, cost of equity capital, OLS, quantile regression, emerging markets, MENA countries
Procedia PDF Downloads 359291 Disrupting Microaggressions in the Academic Workplace: The Role of Bystanders
Authors: Tugba Metinyurt
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Microaggressions are small, everyday verbal and behavioral slights that communicate derogatory messages to individuals on the basis of their group membership. They are often unintentional and not intended to do harm, and yet research has shown that their cumulative effect can be quite detrimental. The current pilot study focuses on the role of bystanders disrupting gender microaggressions and potential barriers of challenging them in the academic workplace at University of Massachusetts Lowell (UML). The participants in this study included 9 male and 20 female from faculty of different disciplines at UML. A Barriers to Intervening Questionnaire asks respondents 1) to rate barriers to intervening in situations described in three short vignettes and 2) to identify more general factors that make it more or less likely that UML faculty will intervene in microaggressions as bystanders through response to an open-ended question. Responses to the questionnaire scales that ask about respondents’ own reactions to the vignettes indicated that faculty may hesitate to interrupt gender microaggressions to avoid being perceived as offensive, losing their relationship with their coworkers, and engaging possible arguments. Responses to the open-ended question, which asked more generally about perceived barriers, revealed a few additional barriers; lack of interpersonal and institutional support, repercussion to self, personal orientation/personality, and privilege. Interestingly, participants tended to describe the obstacles presented in the questionnaire as unlikely to prevent them from intervening, yet the same barriers were suggested to be issues for others on the open-ended questions. Limitations and future directions are discussed. The barriers identified in this research can inform efforts to create bystander trainings to interrupt microaggressions in the academic workplaces.Keywords: academic workplace, bystander behavior, implicit bias, microaggressions
Procedia PDF Downloads 149290 I Feel Pretty: Using Discretization to Unpack Gender Disparity in Musical Theatre - A Study of Leonard Bernstein’s West Side Story
Authors: Erin McKellar, Narelle Yeo
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Gender disparity can be found in the representation of the female characters in Leonard Bernstein’s musical West Side Story. As a postmodern composer, Bernstein was open about his social activism, yet did not consider his compositional portrayal of female characters as part of that activism. Using discretization as an analysis tool, this thesis explores the melodic contours of male and female songs in West Side Story to show differences in complexity between male and female characterisation. The analysis explores the intervallic relationship between the vocal line and melodic color in relation to the accompaniment harmony, taking into consideration the use of consonance and dissonance. West Side Story is commonly known for its distinct use of the tritone motif and its inherent dissonance. It is evident when reviewing the findings of this study that there is a distinct disparity between male-led and female-led music. The male-led numbers consistently adhere to a dissonant aesthetic with the tritone motif implemented in all of the extracted songs. By contrast, the female songs remain consonant with simple intervallic movements. By examining the results of this study through the lens of Equality Feminism, this thesis finds that Bernstein has simplified the characterisations of the female leads. The thesis further proposes that without cognisant consideration of the compositional portrayal of women, the musical theatre will continue to reinforce gender stereotypes, as evident through this study of Bernstein’s West Side Story.Keywords: music theatre, gender bias, composition, Leonard Bernstein
Procedia PDF Downloads 161289 A Machine Learning Approach for Assessment of Tremor: A Neurological Movement Disorder
Authors: Rajesh Ranjan, Marimuthu Palaniswami, A. A. Hashmi
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With the changing lifestyle and environment around us, the prevalence of the critical and incurable disease has proliferated. One such condition is the neurological disorder which is rampant among the old age population and is increasing at an unstoppable rate. Most of the neurological disorder patients suffer from some movement disorder affecting the movement of their body parts. Tremor is the most common movement disorder which is prevalent in such patients that infect the upper or lower limbs or both extremities. The tremor symptoms are commonly visible in Parkinson’s disease patient, and it can also be a pure tremor (essential tremor). The patients suffering from tremor face enormous trouble in performing the daily activity, and they always need a caretaker for assistance. In the clinics, the assessment of tremor is done through a manual clinical rating task such as Unified Parkinson’s disease rating scale which is time taking and cumbersome. Neurologists have also affirmed a challenge in differentiating a Parkinsonian tremor with the pure tremor which is essential in providing an accurate diagnosis. Therefore, there is a need to develop a monitoring and assistive tool for the tremor patient that keep on checking their health condition by coordinating them with the clinicians and caretakers for early diagnosis and assistance in performing the daily activity. In our research, we focus on developing a system for automatic classification of tremor which can accurately differentiate the pure tremor from the Parkinsonian tremor using a wearable accelerometer-based device, so that adequate diagnosis can be provided to the correct patient. In this research, a study was conducted in the neuro-clinic to assess the upper wrist movement of the patient suffering from Pure (Essential) tremor and Parkinsonian tremor using a wearable accelerometer-based device. Four tasks were designed in accordance with Unified Parkinson’s disease motor rating scale which is used to assess the rest, postural, intentional and action tremor in such patient. Various features such as time-frequency domain, wavelet-based and fast-Fourier transform based cross-correlation were extracted from the tri-axial signal which was used as input feature vector space for the different supervised and unsupervised learning tools for quantification of severity of tremor. A minimum covariance maximum correlation energy comparison index was also developed which was used as the input feature for various classification tools for distinguishing the PT and ET tremor types. An automatic system for efficient classification of tremor was developed using feature extraction methods, and superior performance was achieved using K-nearest neighbors and Support Vector Machine classifiers respectively.Keywords: machine learning approach for neurological disorder assessment, automatic classification of tremor types, feature extraction method for tremor classification, neurological movement disorder, parkinsonian tremor, essential tremor
Procedia PDF Downloads 154288 An Estimating Equation for Survival Data with a Possibly Time-Varying Covariates under a Semiparametric Transformation Models
Authors: Yemane Hailu Fissuh, Zhongzhan Zhang
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An estimating equation technique is an alternative method of the widely used maximum likelihood methods, which enables us to ease some complexity due to the complex characteristics of time-varying covariates. In the situations, when both the time-varying covariates and left-truncation are considered in the model, the maximum likelihood estimation procedures become much more burdensome and complex. To ease the complexity, in this study, the modified estimating equations those have been given high attention and considerations in many researchers under semiparametric transformation model was proposed. The purpose of this article was to develop the modified estimating equation under flexible and general class of semiparametric transformation models for left-truncated and right censored survival data with time-varying covariates. Besides the commonly applied Cox proportional hazards model, such kind of problems can be also analyzed with a general class of semiparametric transformation models to estimate the effect of treatment given possibly time-varying covariates on the survival time. The consistency and asymptotic properties of the estimators were intuitively derived via the expectation-maximization (EM) algorithm. The characteristics of the estimators in the finite sample performance for the proposed model were illustrated via simulation studies and Stanford heart transplant real data examples. To sum up the study, the bias for covariates has been adjusted by estimating density function for the truncation time variable. Then the effect of possibly time-varying covariates was evaluated in some special semiparametric transformation models.Keywords: EM algorithm, estimating equation, semiparametric transformation models, time-to-event outcomes, time varying covariate
Procedia PDF Downloads 152287 Compliance of Systematic Reviews in Plastic Surgery with the PRISMA Statement: A Systematic Review
Authors: Seon-Young Lee, Harkiran Sagoo, Katherine Whitehurst, Georgina Wellstead, Alexander Fowler, Riaz Agha, Dennis Orgill
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Introduction: Systematic reviews attempt to answer research questions by synthesising the data within primary papers. They are an increasingly important tool within evidence-based medicine, guiding clinical practice, future research and healthcare policy. We sought to determine the reporting quality of recent systematic reviews in plastic surgery. Methods: This systematic review was conducted in line with the Cochrane handbook, reported in line with the PRISMA statement and registered at the ResearchRegistry (UIN: reviewregistry18). MEDLINE and EMBASE databases were searched in 2013 and 2014 for systematic reviews by five major plastic surgery journals. Screening, identification and data extraction was performed independently by two teams. Results: From an initial set of 163 articles, 79 met the inclusion criteria. The median PRISMA score was 16 out of 27 items (59.3%; range 6-26, 95% CI 14-17). Compliance between individual PRISMA items showed high variability. It was poorest for items related to the use of review protocol (item 5; 5%) and presentation of data on risk of bias of each study (item 19; 18%), while being the highest for description of rationale (item 3; 99%) and sources of funding and other support (item 27; 95%), and for structured summary in the abstract (item 2; 95%). Conclusion: The reporting quality of systematic reviews in plastic surgery requires improvement. ‘Hard-wiring’ of compliance through journal submission systems, as well as improved education, awareness and a cohesive strategy among all stakeholders is called for.Keywords: PRISMA, reporting quality, plastic surgery, systematic review, meta-analysis
Procedia PDF Downloads 293286 Frenotomy for Tongue Tie: The Unlikely Benefit of Massage
Authors: Kailas Bhandarkar, Talib Dar, Laura Karia, Manasvi Upadhyaya
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Introduction: Frenotomy for tongue tie is commonly performed in breastfed infants who experience difficulty in latching after failed conservative management for tongue tie. However, there is no consensus for the routine use of massage following frenotomy. Our aim was to assess the efficacy of massage in preventing recurrence following frenotomy. Methods: The tongue tie service in our tertiary referral hospital consists of 5 consultants and a breastfeeding (BF) midwife. 3 consultants routinely advice massage post procedure. Babies are assessed by the midwife after the procedure and a follow-up consultation after a week. After due ethical approval, data were collected by two staff members who were independent of TT service on a standardized questionnaire to avoid bias. Fischer exact test was employed (p < 0.05 considered significant). Results: Six hundred and thirty-two babies attended the clinic from January 2018 to December 2018. Thirty-three of these were excluded as the procedure was not needed. Parents were contacted at a median of six months post-procedure (range 2-10 months). 282/599 were advised massage. 92/282 could be contacted. 40/ 92 adhered to massage regimen. None of these had a recurrence. 52/92 (54%), although advised, did not perform massage. Reasons cited for lack of adherence to massage included difficulty in performing massaging and conflicting advice given by other health care professionals involved in patient care like paediatricians and group practice and lack of information on the internet). Overall, 4/599 (0.66%) had recurrences, and this difference was not statistically significant. Conclusion: In our experience, the rate of recurrence after frenotomy is low enough for us to conclude that there is no significant benefit of massage after frenotomy for tongue tie. We could also conclude that among parents who were advised massage more than half failed to adhere to the advice.Keywords: tongue tie, frenotomy, massage, recurrence
Procedia PDF Downloads 134285 Robotic Assisted vs Traditional Laparoscopic Partial Nephrectomy Peri-Operative Outcomes: A Comparative Single Surgeon Study
Authors: Gerard Bray, Derek Mao, Arya Bahadori, Sachinka Ranasinghe
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The EAU currently recommends partial nephrectomy as the preferred management for localised cT1 renal tumours, irrespective of surgical approach. With the advent of robotic assisted partial nephrectomy, there is growing evidence that warm ischaemia time may be reduced compared to the traditional laparoscopic approach. There is still no clear differences between the two approaches with regards to other peri-operative and oncological outcomes. Current limitations in the field denote the lack of single surgeon series to compare the two approaches as other studies often include multiple operators of different experience levels. To the best of our knowledge, this study is the first single surgeon series comparing peri-operative outcomes of robotic assisted and laparoscopic PN. The current study aims to reduce intra-operator bias while maintaining an adequate sample size to assess the differences in outcomes between the two approaches. We retrospectively compared patient demographics, peri-operative outcomes, and renal function derangements of all partial nephrectomies undertaken by a single surgeon with experience in both laparoscopic and robotic surgery. Warm ischaemia time, length of stay, and acute renal function deterioration were all significantly reduced with robotic partial nephrectomy, compared to laparoscopic nephrectomy. This study highlights the benefits of robotic partial nephrectomy. Further prospective studies with larger sample sizes would be valuable additions to the current literature.Keywords: partial nephrectomy, robotic assisted partial nephrectomy, warm ischaemia time, peri-operative outcomes
Procedia PDF Downloads 141284 Nanocomposites Based Micro/Nano Electro-Mechanical Systems for Energy Harvesters and Photodetectors
Authors: Radhamanohar Aepuru, R. V. Mangalaraja
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Flexible electronic devices have drawn potential interest and provide significant new insights to develop energy conversion and storage devices such as photodetectors and nanogenerators. Recently, self-powered electronic systems have captivated huge attention for next generation MEMS/NEMS devices that can operate independently by generating built-in field without any need of external bias voltage and have wide variety of applications in telecommunication, imaging, environmental and defence sectors. The basic physical process involved in these devices are charge generation, separation, and charge flow across the electrodes. Many inorganic nanostructures have been exploring to fabricate various optoelectronic and electromechanical devices. However, the interaction of nanostructures and their excited charge carrier dynamics, photoinduced charge separation, and fast carrier mobility are yet to be studied. The proposed research is to address one such area and to realize the self-powered electronic devices. In the present work, nanocomposites of inorganic nanostructures based on ZnO, metal halide perovskites; and polyvinylidene fluoride (PVDF) based nanocomposites are realized for photodetectors and nanogenerators. The characterization of the inorganic nanostructures is carried out through steady state optical absorption and luminescence spectroscopies as well as X-ray diffraction and high-resolution transmission electron microscopy (TEM) studies. The detailed carrier dynamics is investigated using various spectroscopic techniques. The developed composite nanostructures exhibit significant optical and electrical properties, which have wide potential applications in various MEMS/NEMS devices such as photodetectors and nanogenerators.Keywords: dielectrics, nanocomposites, nanogenerators, photodetectors
Procedia PDF Downloads 129283 Improving Our Understanding of the in vivo Modelling of Psychotic Disorders
Authors: Zsanett Bahor, Cristina Nunes-Fonseca, Gillian L. Currie, Emily S. Sena, Lindsay D.G. Thomson, Malcolm R. Macleod
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Psychosis is ranked as the third most disabling medical condition in the world by the World Health Organization. Despite a substantial amount of research in recent years, available treatments are not universally effective and have a wide range of adverse side effects. Since many clinical drug candidates are identified through in vivo modelling, a deeper understanding of these models, and their strengths and limitations, might help us understand reasons for difficulties in psychosis drug development. To provide an unbiased summary of the preclinical psychosis literature we performed a systematic electronic search of PubMed for publications modelling a psychotic disorder in vivo, identifying 14,721 relevant studies. Double screening of 11,000 publications from this dataset so far established 2403 animal studies of psychosis, with the most common model being schizophrenia (95%). 61% of these models are induced using pharmacological agents. For all the models only 56% of publications test a therapeutic treatment. We propose a systematic review of these studies to assess the prevalence of reporting of measures to reduce risk of bias, and a meta-analysis to assess the internal and external validity of these animal models. Our findings are likely to be relevant to future preclinical studies of psychosis as this generation of strong empirical evidence has the potential to identify weaknesses, areas for improvement and make suggestions on refinement of experimental design. Such a detailed understanding of the data which inform what we think we know will help improve the current attrition rate between bench and bedside in psychosis research.Keywords: animal models, psychosis, systematic review, schizophrenia
Procedia PDF Downloads 290282 Mindfulness and the Purpose of Being in the Present
Authors: Indujeeva Keerthila Peiris
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The secular view of mindfulness has some connotation to the original meaning of mindfulness mentioned in the Theravada Buddhist texts (Pāli Canon), but there is a substantial difference in the meaning of the two. Secular Mindfulness Based Interventions (MBI) focus on stilling the mind, which may provide short-term benefits and help individuals to deal with physical pain, grief, and distress. However, as with many popular educational innovations, the foundational values of mindfulness strategies have been distorted and subverted in a number of instances in which ‘McMindfulness’ programmes have been implemented with a view to reducing mindfulness mediation as a self-help technique that is easily misappropriated for the exclusive pursuit of corporate objectives, employee pacification, and commercial profit. The intention of this paper is not to critique the misappropriations of mindfulness. Instead, to go back to the root source and bring insights from the Buddhist Pāli Canon and its associated teachings on mindfulness in its own terms. In the Buddha’s discourses, as preserved in the Pāli Canon, there is nothing more significant than the understanding and practice of ‘Satipatthãna’. The Satipatthāna Sutta , the ‘Discourse on the Establishment of Mindfulness,’ opens with a proclamation highlighting both the purpose of this training and its methodology. The right practice of mindfulness is the gateway to understanding the Buddha’s teaching. However, although this concept is widely discussed among the Dhamma practitioners, it is the least understood one of them all. The purpose of this paper is to understand deeper meaning of mindfulness as it was originally intended by the Teacher. The natural state of mind is that it wanders. It wanders into the past, the present, and the future. One’s ability to hold attention to a mind object (emotion, thought, feeling, sensation, sense impression) called ‘concentration’. The intentional concentration process does not lead to wisdom. However, the development of wisdom starts when the mind is calm, concentrated, and unified. The practice of insight contemplation aims at gaining a direct understanding of the real nature of phenomena. According to the Buddha’s teaching, there are three basic facts of all existence: 1) impermanence (anicca in Pāli) ; 2) fabrication (also commonly known as suffering, unsatisfactoriness, sankhara or dukka in Pāli); 3) not-self (insubstantiality or impersonality, annatta in Pāli ). The entire Buddhist doctrine is based on these three facts. The problem is our ignorance covers reality. It is not that a person sees the emptiness of them or that we try to see the emptiness of our experience by conceptually thinking that they are empty. It is an experiential outcome that happens when the cause-and- effect overrides the self-view (sakkaya dhitti), and ignorance is known as ignorance and eradicated once and for all. Therefore, the right view (samma dhitti) is the starting point of the path, not ethical conduct (sila) or samadhi (jhana). In order to develop the right view, we need to first listen to the correct Dhamma and possess Yoniso manasikara (right comprehension) to know the five aggregates as five aggregates.Keywords: mindfulness, spirituality, buddhism, pali canon
Procedia PDF Downloads 76281 Humoral and Cytokine Responses to Major Human Cytomegalovirus Antigens in Mouse Model
Authors: Sahar Essa, Hussain A. Safar, Raj Raghupathy
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Human cytomegalovirus (CMV) continues to be a source of severe complications in immunologically immature and immunocompromised hosts. Effective CMV vaccines that help diminish CMV disease in transplant patients and avoid congenital infection are of great importance. Though the exact roles of defense mechanisms are unidentified, viral-specific antibodies and cytokine responses are known to be involved in controlling CMV infections. CMV envelope glycoprotein B (UL55/gB), matrix proteins (UL83/pp65, UL99/pp28, UL32/pp150), and assembly protein UL80a/pp38 are known to be targets of antiviral immune responses. We immunized mice intraperitoneally with these five CMV-related proteins (commercial) for their ability to induce specific antibody responses (in-house immunoassay) and cytokine production (commercial assay) in a mouse model. We observed a significant CMV-antigen-specific antibody response to pp38 and pp65 (E/C ˃2.0, p˂0.001). Mice immunized with pp38 had significantly higher concentrations of GM-CSF, IFN-α, IL-2 IL-4, IL-5, and IL-17A (p˂0.05). Mice immunized with pp65 showed significantly higher concentrations of GM-CSF, IFN-γ, IL-2 IL-4, IL-10, IL-12, IL-17A, and TNF-α. Th1 to Th2 cytokines ratios revealed a Th1 cytokine bias in mice immunized with pp38, pp65, pp150, and gB. We suggest that stimulation with multiple CMV-related proteins, which include pp38, pp65, and gB antigens, will allow both humoral and cellular immune responses to be efficiently activated, thus serving as appropriate CMV antigens for future vaccines.Keywords: cytomegalovirus, UL99/pp28, UL80a/pp38, UL83/pp65, UL32/pp150, UL55/gB, CMV-antigen-specific antibody, CMV antigen-specific cytokine responses
Procedia PDF Downloads 81280 Gender Differences In Pain Assessment: A Daily Activities Perspective
Authors: Hui-mei Huang, Huei-Jiun Cheng
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Introduction Many patients are aware of the health benefits associated with an active lifestyle, but they are often hindered from engaging in physical activity due to the presence of pain. The majority of patients experience pain, which can fluctuate over time and is influenced by various factors, including gender. Gender differences in clinical pain and pain-related conditions are widely recognized. Existing literature strongly supports the notion that men and women exhibit distinct responses to pain. Previous studies conducted in Taiwan have highlighted gender differences in pain assessment, but only a limited number of studies have investigated the gender-related factors that influence pain during daily activities. The objective of this study was to examine gender differences in pain assessment among inpatients in Taiwan and investigate whether gender and surgical procedures are factors that impact the daily activities of pain. Method In this study, a prospective and structured questionnaire survey method was utilized, employing intentional sampling to gather data from inpatients admitted to a medical center in central Taiwan. The research period covered in this study is from October 1, 2019, to June 30, 2020. In this study, participants who were hospitalized within 48 hours were requested to self-assess their pain using the Numeric Rating Scale (NRS) and indicate the impact of pain on their activities. The data were analyzed to explore the potential influence of gender and surgical procedures on daily activities affected by pain. Result A total of 722 cases were included in the study, with the mean age of the subjects is 54.38 years old (SD=16.3), and the range varied from 18 to 93 years old. Among the subjects, 48.23% (n=348) were male, and 62.3% (n=450) of them had received more than 12 years of education., and 56.9% (n=411) underwent surgery. The results indicated that regardless of whether the participants underwent surgery or not, females experienced higher perceived severe pain intensity than males (t=2.248, P < .05). However, in surgical patients, there was no significant difference in gender (t=1.75, P > .05). Regarding the impact of pain on daily activities when pain intensity reached 7 , male subjects experienced a 5-point effect on their daily activities (AUC=0.84, 95% CI 0.79-0.89, P <0.01), while female subjects experienced a 7-point effect (AUC=0.88, 95% CI 0.80-0.87, P <0.01). Discussion Some studies suggest that women experience painful stimuli as more intense than men, this difference has been observed in various types of experimental pain, including mechanical and thermal stimuli. Our study reached the same conclusion, female patients exhibited greater intensity of pain. According to the research findings, The research findings highlight the significant impact of gender on individuals' response to intense pain (NRS>7) during their daily activities, with men showing a higher pain tolerance. The higher pain tolerance often observed in men may be attributed to societal conditioning, which encourages them to conceal outward expressions of pain. Further research in this area could help provide a more comprehensive understanding of the topic in Taiwan.Keywords: pain assessment, gender, surgery, activities of daily living
Procedia PDF Downloads 75279 House Facades and Emotions: Exploring the Psychological Impact of Architectural Features
Authors: Nour Tawil, Sandra Weber, Kirsten K. Roessler, Martin Mau, Simone Kuhn
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The link between “quality” residential environments and human health and well-being has long been proposed. While the physical properties of a sound environment have been fairly defined, little focus has been given to the psychological impact of architectural elements. Recently, studies have investigated the response to architectural parameters, using measures of physiology, brain activity, and emotion. Results showed different aspects of interest: detailed and open versus blank and closed facades, patterns in perceiving different elements, and a visual bias for capturing faces in buildings. However, in the absence of a consensus on methodologies, the available studies remain unsystematic and face many limitations regarding the underpinning psychological mechanisms. To bridge some of these gaps, an online study was launched to investigate design features that influence the aesthetic judgement and emotional evaluation of house facades, using a well-controlled stimulus set of Canadian houses. A methodical modelling of design features will be performed to extract both high and low level image properties, in addition to segmentation of layout-related features. 300 participants from Canada, Denmark, and Germany will rate the images on twelve psychological dimensions representing appealing aspects of a house. Subjective ratings are expected to correlate with specific architectural elements while controlling for typicality and familiarity, and other individual differences. With the lack of relevant studies, this research aims to identify architectural elements of beneficial qualities that can inform design strategies for optimized residential spaces.Keywords: architectural elements, emotions, psychological response, residential facades.
Procedia PDF Downloads 230278 Exploiting Identity Grievances: Al-Shabaab Propaganda Targeting Individuals Abroad
Authors: Mustafa Mabruk
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Groups such as Al-Shabaab have managed to radicalize many individuals abroad, including the first American citizen to ever be radicalized. Yet the pathways of radicalization for these foreign individuals are understudied. Moreover, current measures to prevent foreign radicalization are ineffective, with privacy, screening and profiling implications that render current counter-radicalization efforts counterproductive. Such measures exhibit strictness, political bias, and harshness. As confirmed by recent studies, such counter-radicalization issues exacerbate existing grievances and channel fresh recruits to Al-Shabaab. Addressing these challenges is paramount, requiring alternative strategies to effectively reduce radicalization without triggering further harm. The development of counter-narratives emerges as a potential measure with minimal risk of exacerbating grievances, yet the development of such counter-narratives necessitates a thorough understanding of the radicalization pathways of foreign individuals that are understudied. This study investigates the success of Al-Shabaab in recruiting individuals abroad by analyzing their propaganda in conjunction with analyzing identity-focused theories of radicalization, including Framing Theory and Social Identity Theory. Qualitative content analysis is used to analyze various propaganda material, including tweets, speeches, and webpages. The analysis reveals that issues of identity are of major significance in the radicalization patterns identified and that grievances of Muslims worldwide are used to exploit identity-related grievances. Based on these findings, the paper argues that such evidence enhances our understanding of potential deradicalization pathways and present counter-narratives based on Islamic scripture.Keywords: counter-narratives, foreign radicalization, identity grievances, propaganda analysis
Procedia PDF Downloads 41277 Commercial Management vs. Quantity Surveying: Hoax or Harmonization
Authors: Zelda Jansen Van Rensburg
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Purpose: This study investigates the perceived disparities between Quantity Surveying and Commercial Management in the construction industry, questioning if these differences are substantive or merely semantic. It aims to challenge the conventional notion of Commercial Managers’ superiority by critically evaluating QS and CM roles, exploring CM integration possibilities, examining qualifications for aspiring Commercial Managers, assessing regulatory frameworks, and considering terminology redefinition for global QS professional enhancement. Design: Utilizing mixed methods like literature reviews, surveys, interviews, and document analyses, this research examines the QS-CM relationship. Insights from industry professionals, academics, and regulatory bodies inform the investigation into changing QS roles. Findings: Empirical data highlight evolving roles, showcasing areas of convergence and divergence between QSs and CM. Potential CM integration into QS practice and qualifications for aspiring Commercial Managers are identified. Limitations/Implications: Limitations include potential bias in self-reported data and findings. Nevertheless, the research informs future practices and educational approaches in QS and CM, reflecting the changing roles and responsibilities of Quantity Surveyors. Practical Implications: Findings inform industry practitioners, educators, and regulators, stressing the need to adapt to changing QS roles and integrate CM principles where applicable. Value to the Conference Theme: Aligned with ‘Evolving roles and responsibilities of Quantity Surveyors,’ this research offers insights crucial for understanding the changing dynamics within the QS profession and informs strategies to navigate these shifts effectively.Keywords: quantity surveying, commercial management, cost engineering, quantity survey
Procedia PDF Downloads 40276 Efficacy and Safety of Probiotic Treatment in Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis
Authors: Samir Malhotra, Rajan K. Khandotra, Rakesh K. Dhiman, Neelam Chadha
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There is paucity of data about safety and efficacy of probiotic treatment on patient outcomes in cirrhosis. Specifically, it is important to know whether probiotics can improve mortality, hepatic encephalopathy (HE), number of hospitalizations, ammonia levels, quality of life, and adverse events. Probiotics may improve outcomes in patients with acute or chronic HE. However, it is also important to know whether probiotics can prevent development of HE, even in situations where patients do not have acute HE at the time of administration. It is also important to know if probiotics are useful as primary prophylaxis of HE. We aimed to conduct an updated systematic review and meta-analysis to evaluate the safety and efficacy of probiotics in patients with cirrhosis. We searched PubMed, Cochrane library, Embase, Scopus, SCI, Google Scholar, conference proceedings, and references of included studies till June 2017 to identify randomised clinical trials comparing probiotics with other treatments in cirrhotics. Data was analyzed using MedCalc. Probiotics had no effect on mortality but significantly reduced HE (14 trials, 1073 patients, OR 0.371; 95% CI 0.282 to 0.489). There was not enough data to conduct a meta-analysis on outcomes like hospitalizations and quality of life. The effect on plasma ammonia levels was not significant (SMD -0.429; 95%CI -1.034 – 0.177). There was no difference in adverse events. To conclude, although the included studies had a high risk of bias, the available evidence does suggest a beneficial effect on HE. Larger studies with longer periods of follow-up are needed to determine if probiotics can reduce all-cause mortality.Keywords: cirrhosis, hepatic encephalopathy, meta-analysis, probiotic
Procedia PDF Downloads 201275 Cognitive Behaviour Hypnotherapy as an Effective Intervention for Nonsuicidal Self Injury Disorder
Authors: Halima Sadia Qureshi, Urooj Sadiq, Noshi Eram Zaman
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The goal of this study was to see how cognitive behavior hypnotherapy affected nonsuicidal self-injury. DSM 5 invites the researchers to explore the newly added condition under the chapter of conditions under further study named Nonsuicidal self-injury disorder. To date, no empirical sound intervention has been proven effective for NSSI as given in DSM 5. Nonsuicidal self-injury is defined by DSM 5 as harming one's self physically, without suicidal intention. Around 7.6% of teenagers are expected to fulfill the NSSI disorder criteria. 3 Adolescents, particularly university students, account for around 87 percent of self-harm studies. Furthermore, one of the risks associated with NSSI is an increased chance of suicide attempts, and in most cases, the cycle repeats again. 6 The emotional and psychological components of the illness might lead to suicide, either intentionally or unintentionally. 7 According to a research done at a Pakistani military hospital, over 80% of participants had no intention of committing suicide. Furthermore, it has been determined that improvements in NSSI prevention and intervention are necessary as a stand-alone strategy. The quasi-experimental study took place in Islamabad and Rawalpindi, Pakistan, from May 2019 to April 2020 and included students aged 18 to 25 years old from several institutions and colleges in the twin cities. According to the Diagnostic and Statistical Manual of Mental Disorders 5th edition, the individuals were assessed for >2 episodes without suicidal intent using the intentional self-harm questionnaire. The Clinician Administered Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess the individual for NSSI condition. Symptom checklist-90 (SCL-90) was used to screen the participants for differential diagnosis. Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to rule out the BPD cases. The selected participants, n=106 from the screening sample of 600, were selected. They were further screened to meet the inclusion and exclusion criteria, and the total of n=71 were split into two groups: intervention and control. The intervention group received cognitive behavior hypnotherapy for the next three months, whereas the control group received no treatment. After the period of three months, both the groups went through the post assessment, and after the three months’ period, follow-up assessment was conducted. The groups were evaluated, and SPSS 25 was used to analyse the data. The results showed that each of the two groups had 30 (50 percent) of the 60 participants. There were 41 males (68 percent) and 19 girls (32 percent) in all. The bulk of the participants were between the ages of 21 and 23. (48 percent). Self-harm events were reported by 48 (80 percent) of the pupils, and suicide ideation was found in 6 (ten percent). In terms of pre- and post-intervention values (d=4.90), post-intervention and follow-up assessment values (d=0.32), and pre-intervention and follow-up values (d=5.42), the study's effect size was good. The comparison of treatment and no-treatment groups revealed that treatment was more successful than no-treatment, F (1, 58) = 53.16, p.001. The results reveal that the treatment manual of CBH is effective for Nonsuicidal self-injury disorder.Keywords: NSSI, nonsuicidal self injury disorder, self-harm, self-injury, Cognitive behaviour hypnotherapy, CBH
Procedia PDF Downloads 182274 Influence of Loudness Compression on Hearing with Bone Anchored Hearing Implants
Authors: Anja Kurz, Marc Flynn, Tobias Good, Marco Caversaccio, Martin Kompis
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Bone Anchored Hearing Implants (BAHI) are routinely used in patients with conductive or mixed hearing loss, e.g. if conventional air conduction hearing aids cannot be used. New sound processors and new fitting software now allow the adjustment of parameters such as loudness compression ratios or maximum power output separately. Today it is unclear, how the choice of these parameters influences aided speech understanding in BAHI users. In this prospective experimental study, the effect of varying the compression ratio and lowering the maximum power output in a BAHI were investigated. Twelve experienced adult subjects with a mixed hearing loss participated in this study. Four different compression ratios (1.0; 1.3; 1.6; 2.0) were tested along with two different maximum power output settings, resulting in a total of eight different programs. Each participant tested each program during two weeks. A blinded Latin square design was used to minimize bias. For each of the eight programs, speech understanding in quiet and in noise was assessed. For speech in quiet, the Freiburg number test and the Freiburg monosyllabic word test at 50, 65, and 80 dB SPL were used. For speech in noise, the Oldenburg sentence test was administered. Speech understanding in quiet and in noise was improved significantly in the aided condition in any program, when compared to the unaided condition. However, no significant differences were found between any of the eight programs. In contrast, on a subjective level there was a significant preference for medium compression ratios of 1.3 to 1.6 and higher maximum power output.Keywords: Bone Anchored Hearing Implant, baha, compression, maximum power output, speech understanding
Procedia PDF Downloads 387273 Benefits of PRP in Third Molar Surgery - A Review of the Literature
Authors: Nitesh Kumar, Adel Elrasheed, Antonio Gagliardilugo
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Introduction and aims: PRP has been increasing in popularity over the past decade. It is used in many facets of medicine and dentistry such as osteoarthritis, hair loss, skin rejunavation, healing of tendons after injury. Due to the increasing popularity of PRP in third molar surgery in dentistry, this study aims to identify the role of platelet rich plasma and its function in third molar surgery. Methodology: Three databases were chosen to source the articles for review: pubmed, science direct, and Cochrane. The keywords “platelet rich plasma”, “third molar extraction” and “wisdom tooth extraction” and literature review were used to search for relevant articles. Articles that were not in English were omitted and only systematic reviews relevant to the study were collected. All systematic reviews abstracts pertinent to the study were read by two reviewers to avoid bias. Results/statistics: 20 review articles were obtained of which 13 fulfilled the criteria. The Amstar tool validified the strength of these review articles. There is strong evidence in the literature that PRP in third molar surgery decreases post op pain, swelling and recovery time. 20 review articles were obtained of which 13 fulfilled the criteria. The Amstar tool validified the strength of these review articles. There is strong evidence in the literature that PRP in third molar surgery decreases post op pain, swelling and recovery time. Conclusions/clinical relevance: Platelet rich plasma plays a crucial role in patient recovery following the extraction of third molars and should be considered and offered as a routine part of third molar therapy.Keywords: PRP, third molar, extractions, wisdom teeth
Procedia PDF Downloads 61272 Good Functional Outcome after Late Surgical Treatment for Traumatic Rotator Cuff Tear, a Retrospective Cohort Study
Authors: Soheila Zhaeentan, Anders Von Heijne, Elisabet Hagert, André Stark, Björn Salomonsson
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Recommended treatment for traumatic rotator cuff tear (TRCT) is surgery within a few weeks after injury if the diagnosis is made early, especially if a functional impairment of the shoulder exists. This may lead to the assumption that a poor outcome then can be expected in delayed surgical treatment, when the patient is diagnosed at a later stage. The aim of this study was to investigate if a surgical repair later than three months after injury may result in successful outcomes and patient satisfaction. There is evidence in literature that good results of treatment can be expected up to three months after the injury, but little is known of later treatment with cuff repair. 73 patients (75 shoulders), 58 males/17 females, mean age 59 (range 34-‐72), who had undergone surgical intervention for TRCT between January 1999 to December 2011 at our clinic, were included in this study. Patients were assessed by MRI investigation, clinical examination, Western Ontario Rotator Cuff index (WORC), Oxford Shoulder Score, Constant-‐Murley Score, EQ-‐5D and patient subjective satisfaction at follow-‐up. The patients treated surgically within three months ( < 12 weeks) after injury (39 cases) were compared with patients treated more than three months ( ≥ 12 weeks) after injury (36 cases). WORC was used as the primary outcome measure and the other variables as secondary. A senior consultant radiologist, blinded to patient category and clinical outcome, evaluated all MRI-‐images. Rotator cuff integrity, presence of arthritis, fatty degeneration and muscle atrophy was evaluated in all cases. The average follow-‐up time was 56 months (range 14-‐149) and the average time from injury to repair was 16 weeks (range 3-‐104). No statistically significant differences were found for any of the assessed parameters or scores between the two groups. The mean WORC score was 77 (early group, range 25-‐ 100 and late group, range 27-‐100) for both groups (p= 0.86), Constant-‐Murley Score (p= 0.91), Oxford Shoulder Score (p= 0.79), EQ-‐5D index (p= 0.86). Re-‐tear frequency was 24% for both groups, and the patients with re-‐tear reported less satisfaction with outcome. Discussion and conclusion: This study shows that surgical repair of TRCT performed later than three months after injury may result in good functional outcomes and patient satisfaction. However, this does not motivate an intentional delay in surgery when there is an indication for surgical repair as that delay may adversely affect the possibility to perform a repair. Our results show that surgeons may safely consider surgical repair even if a delay in diagnosis has occurred. A retrospective cohort study on 75 shoulders shows good functional result after traumatic rotator cuff tear (TRCT) treated surgically up to one year after the injury.Keywords: traumatic rotator cuff injury, time to surgery, surgical outcome, retrospective cohort study
Procedia PDF Downloads 223271 Between Efficacy and Danger: Narratives of Female University Students about Emergency Contraception Methods
Authors: Anthony Idowu Ajayi, Ezebunwa Ethelbert Nwokocha, Wilson Akpan, Oladele Vincent Adeniyi
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Studies on emergency contraception (EC) mostly utilise quantitative methods and focus on medically approved drugs for the prevention of unwanted pregnancies. This methodological bias necessarily obscures insider perspectives on sexual behaviour, particularly on why specific methods are utilized by women who seek to prevent unplanned pregnancies. In order to privilege this perspective, with a view to further enriching the discourse and policy on the prevention and management of unplanned pregnancies, this paper brings together the findings from several focus groups and in-depth interviews conducted amongst unmarried female undergraduate students in two Nigerian universities. The study found that while the research participants had good knowledge of the consequences of unprotected sexual intercourses - with abstinence and condom widely used - participants’ willingness to rely only on medically sound measures to prevent unwanted pregnancies was not always mediated by such knowledge. Some of the methods favored by participants appeared to be those commonly associated with people of low socio-economic status in the society where the study was conducted. Medically unsafe concoctions, some outright dangerous, were widely believed to be efficacious in preventing unwanted pregnancy. Furthermore, respondents’ narratives about their sexual behaviour revealed that inadequate sex education, socio-economic pressures, and misconceptions about the efficacy of “crude” emergency contraception methods were all interrelated. The paper therefore suggests that these different facets of the unplanned pregnancy problem should be the focus of intervention.Keywords: unplanned pregnancy, unsafe abortion, emergency contraception, concoctions
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