Search results for: POST herbicides
3696 'Violence Is Bad, but It's Just a Game': The Glorification of Violence from Roman Antiquity to Popular Culture
Authors: M. C. Steyn
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Violence and entertainment are not mutually exclusive subjects in the Ancient Roman world, in reality they are closely knit together. Their world is permeated by repeated and continuous episodes of violence in its many manifestations, both sanctioned and spontaneous, most of which is considered as some form of entertainment, from plays and writings through the spectrum to the gladiatorial arena. In the 21st century this socio-psychological dynamic is manifested through the stage provided by the screen and what we watch in terms of TV, movies and games. This glorification of violence in a modern world is not out of place as seen in contemporary post apocalyptical/ dystopian literature, film and computer games where the act of violence, frowned upon by social norms and values, becomes sanctioned by the (un)real nature of the game: ‘I am not a violent person, violence is bad, this is just a game’. This paper will examine how violence is framed in the Ancient World and subsequently how it is received by popular culture to represent a world in which the maintenance of stability can only be achieved through officially sanctioned violence, whether sanctioned by the State or the gaming community. This argument will examine both ancient and modern critics of violence such as Senecca, Coleman and Foucault and framed by Baudrillard’s commentary on the post-modern conceptualization of reality.Keywords: entertainment, violence, gladiatorial games, gaming
Procedia PDF Downloads 4903695 Case Study on the Effects of Early Mobilization in the Post-Surgical Recovery of Athletes with Open Triangular Fibrocartilage Complex Repair
Authors: Blair Arthur Agero Jr., Lucia Garcia Heras
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The triangular fibrocartilage complex (TFCC) is one of the crucial stabilizing ligaments of the wrist. The TFCC is also subject to excessive stress amongst performance athletes and enthusiasts. The excessive loading of the TFCC may lead to a partial or complete rupture that requires surgery. The recovery from an open TFCC surgical repair may take several months. Immobilization of the repaired wrist for a given period is part of all the current protocols in the post-surgical treatment. The immobilization to prevent the rotation of the forearm can last from six weeks to eight weeks with the wrist held in a neutral position. In all protocols reviewed, the pronosupination is only initiated between the 6th week and 8th week or even later after the cast is removed. The prolonged immobilization can cause stiffness of the wrist and hand. Furthermore, the entire period of post-surgical hand therapy has its economic impact, especially for performing athletes. However, delayed mobilization, specifically rotation of the wrist, is necessary to allow ligament healing. This study aims to report the effects of early mobilization of the wrist in athletes who had an open surgical repair of the TFCC. The surgery was done by the co-author, and the hand therapy was implemented by the main author. The cases documented spans from 2014 to 2019 and were all performed in Dubai, United Arab Emirates. All selected participants in this case study were provided with a follow-up questionnaire to ascertain their current condition since their surgery. The respondents reported high satisfaction in the results of their treatment and have verified zero re-rupture of their TFCC despite mobilizing and rotating the wrist at the third-week post-surgery during their hand therapy. There is also a negligible number of respondents who reported a limitation in their ranges of pronosupination. This case study suggests that early mobilization of the wrist after an open TFCC surgical repair can be more beneficial to the patient as opposed to the traditional treatment of prolonged immobilization. However, it should be considered that the patients selected in this case study are professional performance athletes and advanced fitness enthusiasts. Athletes are known to withstand vigorous physical stress in their training that may correlate to their ability to better cope with the progressive stress that was implemented during their hand therapy. Nevertheless, this approach has its merits, and application of it may be adjusted for patients with a similar injury and surgical procedure.Keywords: hand therapy, performance athlete, TFCC repair, wrist ligament
Procedia PDF Downloads 1503694 Post-Operative Pain Management in Ehlers-Danlos Hypermobile-Type Syndrome Following Wisdom Teeth Extraction: A Case Report and Literature Review
Authors: Aikaterini Amanatidou
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We describe the case of a 20-year-old female patient diagnosed with Ehlers-Danlos Syndrome (EDS) who was scheduled to undergo a wisdom teeth extraction in outpatient surgery. EDS is a hereditary connective tissue disorder characterized by joint hypermobility, skin hyper-extensibility, and vascular and soft tissue fragility. There are six subtypes of Ehlers-Danlos, and in our case, the patient had EDS hyper-mobility (HT) type disorder. One important clinical feature of this syndrome is chronic pain, which is often poorly understood and treated. Our patient had a long history of articular and lumbar pain when she was diagnosed. She was prescribed analgesic treatment for acute and neuropathic pain and had multiple sessions of psychotherapy and physiotherapy to ease the pain. Unfortunately, her extensive medical history was underrated by our anesthetic team, and no further measures were taken for the operation. Despite an uneventful intra-operative phase, the patient experienced several episodes of hyperalgesia during the immediate post-operative care. Management of pain was challenging for the anesthetic team: initial opioid treatment had only a temporary effect and a paradoxical reaction after a while. Final pain relief was eventually obtained with psycho-physiologic treatment, high doses of ketamine, and patient-controlled analgesia infusion of morphine-ketamine-dehydrobenzperidol. We suspected an episode of Opioid-Induced hyperalgesia. This case report supports the hypothesis that anti-hyperalgesics such as ketamine as well as lidocaine, and dexmedetomidine should be considered intra-operatively to avoid opioid-induced hyperalgesia and may be an alternative solution to manage complex chronic pain like others in neuropathic pain syndromes.Keywords: Ehlers-Danlos, post-operative management, hyperalgesia, opioid-induced hyperalgesia, rare disease
Procedia PDF Downloads 953693 Information Needs and Seeking Behaviour of Postgraduate Students of Kohat University of Science and Technology, Khyber Pakhtunkhwa, Pakistan
Authors: Saeed Ullah Jan, Muhammad Ali, Misbah Ullah Awan
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Purpose: This study investigated the information needs and seeking behaviour, and hurdles to information seeking of Post Graduate students of Kohat University of Science and Technology (KUST), Khyber Pakhtunkhwa. It focused on the information requirements of the post-graduate students of the university, the pattern they use for seeking information, and the difficulties they face while seeking information. Design/Methodology/approach: This study used a quantitative approach, adapting a survey questionnaire method for data collection. The population of this study was composed of M.Phil. and Ph.D. students of 2019 and 2020 in the faculties of Physical and Numerical Sciences, Chemical and Pharmaceutical Sciences, Biological Sciences, and Social Sciences of KUST. The sample size was 260. Students were selected randomly. The study response rate was 77%, and data were analyzed through SPSS (22 versions). Key findings: The study revealed that Most students' information needs were for study and research activities, new knowledge, and career development. To fulfill these needs, the scholars use various sources and resources. The sources they used for information needs were journal articles, textbooks, and research projects commonly. For the information-seeking purpose, often, students prefer books that have some importance. The other factors that played an essential role in selecting material were topical relevance, Novelty, Recommended by colleagues, and publisher's reputation. Most of the students thought that Book Exhibitions, Open Access systems in the Library, and the Display of new arrivals could enhance the students' information-seeking. The main problem seeking information was faced by them was a shortage of printed information resources. Overall they wanted more facilities, enhancement in the library collection, and better services. Delimitations of the study: This study has not included 1) BS and M.Sc. Students of KUST; 2) The colleges and institutions affiliated with KUST; 3) This study was delimited only to the Post Graduate students of KUST. Practical implication(s): The findings of the study motivate the policymakers and authorities of KUST to restructure the information literacy programs to fulfill the scholars' information needs. It may inform the policymakers to know the difficulties faced by scholars during information seeking. Contribution to the knowledge: No significant work has been done on the students' information needs and seeking behaviour at KUST. The study analyzed the information needs and seeking behaviour of post graduate students. It brought a clear picture of information needs and seeking behaviour of scholars and addressed the problems faced by them during the seeking process.Keywords: information needs of Pakistan, information-seeking behaviors, postgraduate students, university libraries, Kohat university of science and technology, Khyber Pakhtunkhwa, Pakistan
Procedia PDF Downloads 913692 Continuous Glucose Monitoring Systems and the Improvement in Hypoglycemic Awareness Post-Islet Transplantation: A Single-Centre Cohort Study
Authors: Clare Flood, Shareen Forbes
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Background: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder affecting >400,000 people in the UK alone, with the global prevalence expected to double in the next decade. Islet transplant offers a minimally-invasive procedure with very low morbidity and almost no mortality, and is now as effective as whole pancreas transplant. The procedure was introduced to the UK in 2011 for patients with the most severe type 1 diabetes mellitus (T1DM) – those with unstable blood glucose, frequently occurring episodes of severe hypoglycemia and impaired awareness of hypoglycemia (IAH). Objectives: To evaluate the effectiveness of islet transplantation in improving glycemic control, reducing the burden of hypoglycemia and improving awareness of hypoglycemia through a single-centre cohort study at the Royal Infirmary of Edinburgh. Glycemic control and degree of hypoglycemic awareness will be determined and monitored pre- and post-transplantation to determine effectiveness of the procedure. Methods: A retrospective analysis of data collected over three years from the 16 patients who have undergone islet transplantation in Scotland. Glycated haemoglobin (HbA1c) was measured and continuous glucose monitoring systems (CGMS) were utilised to assess glycemic control, while Gold and Clarke score questionnaires tested IAH. Results: All patients had improved glycemic control following transplant, with optimal control seen visually at 3 months post-transplant. Glycemic control significantly improved, as illustrated by percentage time in hypoglycemia in the months following transplant (p=0.0211) and HbA1c (p=0.0426). Improved Clarke (p=0.0034) and Gold (p=0.0001) scores indicate improved glycemic awareness following transplant. Conclusion: While the small sample of islet transplant recipients at the Royal Infirmary of Edinburgh prevents definitive conclusions being drawn, it is indicated that through our retrospective, single-centre cohort study of 16 patients, islet transplant is capable of improving glycemic control, reducing the burden of hypoglycemia and IAH post-transplant. Data can be combined with similar trials at other centres to increase statistical power but from research in Edinburgh, it can be suggested that the minimally invasive procedure of islet transplantation offers selected patients with extremely unstable T1DM the incredible opportunity to regain control of their condition and improve their quality of life.Keywords: diabetes, islet, transplant, CGMS
Procedia PDF Downloads 2713691 Costa and Mccrae's Neo-Pi Factor and Early Adolescents School Social Adjustment in Cross River State Nigeria
Authors: Peter Unoh Bassey
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The study examined the influence of Costa and McCrae’s Neo-PI Factor and early adolescent’s school social adjustment in Cross River State, Nigeria. The research adopted the causal-comparative design also known as the ex-post facto with about one thousand and eighteen (1,018) students who were randomly selected from one stream of JSS 1 classes in 19 schools out of seventy-three (73) in the study area. Data were collected using two instruments one is the NEO-PI scale, and students school social adjustment questionnaire. Three research questions and three research hypotheses were postulated and tested at 0.05 level of significance. The analysis of data was carried out using both the independent t-test statistics and the one-way analysis of variance (ANOVA). The analyzed result indicated that the five dimensions had a significant influence on students school social adjustment. A post hoc was equally carried out to show the relative significant difference among the study variables. In view of the above, it was recommended that teachers, parents and educational psychologists should be involved to enhance students the confidence to overcome their social adjustment problem.Keywords: Costa and McCrae’s NEO-PI Factor, early adolescents, school, social adjustment
Procedia PDF Downloads 1473690 Assessment of the Effect of Ethanolic Leaf Extract of Annona squamosa L. on Den Induced Hepatocellular Carcinoma in Experimental Animals
Authors: Vanitha Varadharaj, Vijalakshmi Krishnamurthy
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Annona squamosa Linn, commonly known as Sugar apple, belonging to the family Annonaceae, is said to show varied medicinal effects, including insecticide, antiovulatory and abortifacient. The alkaloid and flavonoids present in Annona squamosa leaf has proved to have antioxidant activity. The present work has been planned to investigate the effect of ethanolic leaf extract of Annona squamosa leaf on Den Induced wistar albino rats. The study was carried out to analyze the biochemical Parmeters like Total Proteins, Bilirubin, Enzymatic and Non –Enzymatic enzymes, Marker enzymes and Tumor markers in serum and also the histopathological studies in liver is carried out in control and DEN induced rats. Supplementation of ELAS (Ethanolic Leaf Extract Of Annona squamosa) reduced the liver weight and also reduced the tumour incidence. Chemoprevention group showed near normal values of bilirubin when compared with the control rats. Total protein was decreased in the cancer bearing group and on treatment with the extract the levels of protein were restored. Both in pre and post treatment group, the activities of enzymatic antioxidants such as superoxide dismutase, catalase, and Glutathione peroxidase were increased but in pre treated animals it was more effective than post treated animals. The non- enzymatic antioxidants such as vitamin C and vitamin E were brought back to normal level significantly in post and pre treated animals. Activities of marker enzymes such as SGOT, SGPT, ALP, γ GT were significantly elevated in the serum of cancer animals and the values returned to normal after treatment with the extract suggesting the hepato protective effect of the extract. Lipid peroxide was found to be elevated in the cancer induced group. This condition was brought back to the normal in the pre and post treated animals with ELAS. Histological examination also confirmed the anti- carcinogenic potential of ELAS, Cancer induced groups had a triple fold increase in their AFP values when compared to other groups. DEN treatment increased the level of AFP expression while ELAS partially counteracted the effect of it. So the scientific validation obtained from this study may pave way to many budding scientists to find new drugs from Annona squamosa for various ailments.Keywords: annona squamosa, biochemical parmeters, cancer, leaf extract
Procedia PDF Downloads 3313689 Frequency of Surgical Complications in Diabetic Patients after Kidney Transplantation
Authors: Hakan Duger, Alparslan Ersoy, Canan Ersoy
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The improvement of surgical techniques in recent years has reduced the frequency of postoperative complications in kidney transplant recipients. Novel immunosuppressive agents have reduced rates of graft loss due to acute rejection to less than 1%. However, surgical complications may still lead graft loss and morbidity in recipients. Because of potent immunosuppression, impaired wound healing and complications are frequent after transplantation. We compared the frequency of post-operative surgical complications in diabetic and non-diabetic patients after kidney transplantation. Materials and Methods: This retrospective study conducted in consecutive patients (213 females, 285 males, median age 39 years) who underwent kidney transplant surgery at our center between December 2005 and October 2015. The patients were divided into two groups: diabetics (46 ± 10 year, 26 males, 16 females) and non-diabetics (39 ± 12 year, 259 males, 197 females). Characteristics of both groups were obtained from medical records. Results: We performed 225 living and 273 deceased donor transplantations. Renal replacement type was hemodialysis in 60.8%, peritoneal dialysis in 17.3% and preemptive in 12%. The mean body mass indexes of the recipients were 24 ± 4.6 kg/m², donor age was 48.6 ± 14.3 years, cold ischemic time was 11.3 ± 6.1 hours, surgery time was 4.9 ± 1.2 hours, and recovery time was 54±31 min. The mean hospitalization duration was 19.1 ± 13.5 days. The frequency of postoperative surgical complications was 43.8%. There was no significant difference between the ratios of post-operative surgical complications in non-diabetic (43.5%) and diabetic (47.4%) groups (p=0.648). Post-operative surgical complications were lymphocele (24.6% vs. 23.7%), delayed wound healing (13.2% vs. 7.6%), hematoma (7.8% vs.15.8 %), urinary leak (4.6% vs. 5.3%), hemorrhage (5.1% vs. 0%), hydronephrosis (2.2% vs. 0%), renal artery thrombosis (1.5% vs. 0%), renal vein thrombosis (1% vs. 2.6%), urinoma (0.7% vs. 0%), urinary obstruction (0.5% vs. 0%), ureteral stenosis (0.5% vs. 0%) and ureteral reflux (0.2% vs. 0%) in non-diabetic and diabetic groups, respectively (p > 0.05). Mean serum creatinine levels in non-diabetics and diabetics were 1.43 ± 0.81 and 1.61 ± 0.96 mg/dL at 1st month (p=0.198). At the 6th month, the mean graft and patient survival times in patients with post-operative surgical complications were significantly lower than in those who did not (162.9 ± 3.4 vs. 175.6 ± 1.5 days, p=0.008, and 171 ± 2.9 vs. 176.1 ± 1.6 days, p=0.047, respectively). However, patient survival durations of non-diabetic (173 ± 27) and diabetic (177 ± 13 day) groups were comparable (p=0.396). Conclusion: As a result, we concluded that surgical complications such as lymphocele and delayed wound healing were common and that frequency of these complications in diabetic recipients did not differ from non-diabetic one. All persons involved in the postoperative care of kidney transplant recipients be aware of the potential surgical complications for rapid diagnosis and treatment.Keywords: kidney transplantation, diabetes mellitus, surgery, complication
Procedia PDF Downloads 1783688 Wearable Jacket for Game-Based Post-Stroke Arm Rehabilitation
Authors: A. Raj Kumar, A. Okunseinde, P. Raghavan, V. Kapila
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Stroke is the leading cause of adult disability worldwide. With recent advances in immediate post-stroke care, there is an increasing number of young stroke survivors, under the age of 65 years. While most stroke survivors will regain the ability to walk, they often experience long-term arm and hand motor impairments. Long term upper limb rehabilitation is needed to restore movement and function, and prevent deterioration from complications such as learned non-use and learned bad-use. We have developed a novel virtual coach, a wearable instrumented rehabilitation jacket, to motivate individuals to participate in long-term skill re-learning, that can be personalized to their impairment profile. The jacket can estimate the movements of an individual’s arms using embedded off-the-shelf sensors (e.g., 9-DOF IMU for inertial measurements, flex-sensors for measuring angular orientation of fingers) and a Bluetooth Low Energy (BLE) powered microcontroller (e.g., RFduino) to non-intrusively extract data. The 9-DOF IMU sensors contain 3-axis accelerometer, 3-axis gyroscope, and 3-axis magnetometer to compute the quaternions, which are transmitted to a computer to compute the Euler angles and estimate the angular orientation of the arms. The data are used in a gaming environment to provide visual, and/or haptic feedback for goal-based, augmented-reality training to facilitate re-learning in a cost-effective, evidence-based manner. The full paper will elaborate the technical aspects of communication, interactive gaming environment, and physical aspects of electronics necessary to achieve our stated goal. Moreover, the paper will suggest methods to utilize the proposed system as a cheaper, portable, and versatile system vis-à-vis existing instrumentation to facilitate post-stroke personalized arm rehabilitation.Keywords: feedback, gaming, Euler angles, rehabilitation, augmented reality
Procedia PDF Downloads 2773687 Compare the Effectiveness of Web Based and Blended Learning on Paediatric Basic Life Support
Authors: Maria Janet, Anita David, P. Vijayasamundeeswarimaria
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Introduction: The main purpose of this study is to compare the effectiveness of web-based and blended learning on Paediatric Basic Life Support on competency among undergraduate nursing students in selected nursing colleges in Chennai. Materials and methods: A descriptive pre-test and post-test study design were used for this study. Samples of 100 Fourth year B.Sc., nursing students at Sri Ramachandra Faculty of Nursing SRIHER, Chennai, 100 Fourth year B.Sc., nursing students at Apollo College of Nursing, Chennai, were selected by purposive sampling technique. The instrument used for data collection was Knowledge Questionnaire on Paediatric Basic Life Support (PBLS). It consists of 29 questions on the general expansion of Basic Life Support and Cardiopulmonary Resuscitation, Prerequisites of Basic Life Support, and Knowledge on Paediatric Basic Life Support in which each question has four multiple choices answers, each right answer carrying one mark and no negative scoring. This questionnaire was formed with reference to AHA 2020 (American Heart Association) revised guidelines. Results: After the post-test, in the web-based learning group, 58.8% of the students had an inadequate level of objective performance score, while 41.1% of them had an adequate level of objective performance score. In the blended learning group, 26.5% of the students had an inadequate level of an objective performance score, and 73.4% of the students had an adequate level of an objective performance score. There was an association between the post-test level of knowledge and the demographic variables of undergraduate nursing students undergoing blended learning. The age was significant at a p-value of 0.01, and the performance of BLS before was significant at a p-value of 0.05. The results show that there was a significant positive correlation between knowledge and objective performance score of undergraduate nursing students undergoing web-based learning on paediatric basic life support.Keywords: basic life support, paediatric basic life support, web-based learning, blended learning
Procedia PDF Downloads 693686 Music Educators for Peace: Synchronizing Music and Pedagogical Experiences to Re-Build Social Fabric in Colombia's Post-Conflict
Authors: Julian Dario Castro Cifuentes
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In Colombia, the armed conflict has lasted for more than sixty years bringing poverty, internal displacement of people, deaths from both government and insurgent forces and other violence-related problems that has damaged its social fabric. In 2016, the peace process between the Colombian government and the FARC rebels brought the possibility of ending this war and a new set of challenges to Colombian society in order to achieve pacific coexistence and reconciliation. In this scenario, there have been different efforts from diverse social actors in order to build peace and reconciliation mainly within the victims of the armed conflict. In the case of music, there have been multiple programs for social transformation through music and pedagogical experiences. Nevertheless, the need to strengthen this initiative by giving ‘peace building oriented’ pedagogical tools to the musicians that lead this experiences and understanding which aspects make this practices ‘musically meaningful’, has been recognized. For this reason, the purpose of this study is to discuss the convergences and divergences of music, and educational experiences applied to peacebuilding in the context of Colombia’s post-conflict. In this research, the hermeneutic phenomenology paradigm is applied in a case study of a peace building music education experience in the department of Nariño, Colombia articulated with the program ‘Manos a la Paz’. Two particular experiences, one on musical practice and another on music education are taken as a unit of analysis to understand its essence and structure in order to find ways to articulate efforts in peace building actions from music. This study shows how the existent gap between music experience and its subjacent pedagogical knowledge, can be reduced through deconstruction of the music and pedagogical experience. The ‘Manos a la Paz’ program showed how a peace building approach to music education can make major contributions to Pacific Coexistence and Reconciliation in Colombia’s Post-Conflict.Keywords: music education, music for peace, music pedagogy, peace building, social fabric
Procedia PDF Downloads 2293685 Patient Satisfaction Measurement Using Face-Q for Non-Incisional Double-Eyelid Blepharoplasty with Modified Single-Knot Continuous Buried Suture Technique
Authors: Kwei Huan Liw, Sashi B. Darshan
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Background: Double eyelid surgery has become one of the most sought-after aesthetic procedures among Asians. Many surgeons perform surgical blepharoplasty and various other methods of non-incisional blepharoplasty. Face-Q is a validated method of measuring patient satisfaction for facial aesthetic procedures. Here we have analyzed the overall eye satisfaction score, the upper eyelid appraisal score and the adverse effect on eyes score Methods: 274 patients (548 eyes), aged between 18 to 40 years old, were recruited from 2015-2018. Each patient underwent a non-incisional double-eyelid blepharoplasty using a single-knotted continuous buried suture. 3 – 5 stab incisions were made depending on the upper eyelid size. A needle loaded with 7-0 nylon is passed from the lateral most wound through the dermis and the conjunctiva in an alternate fashion into the remaining stab wounds. The suture is then tunneled back laterally in the deeper dermis and knotted securely with the suture end. The knot is then buried within the orbicularis oculi muscle. Each patient was required to fill the Face-Q questionnaire before the procedure and 2 weeks post procedure. The results are described based on the percentage of the maximum achievable score. Patients were reviewed after 12 to 18 months to assess the long-term outcome. Results: The overall eye satisfaction score demonstrated a high level of post-operative satisfaction (97.85%), compared to 27.32% pre-operatively. The appraisal of upper eyelid scores showed drastic improvement in perception post-operatively (95.31%) compared to 21.44% pre-operatively. Adverse effect on eyes score showed a very low post-operative complication rate (0.4%) The long-term follow-up showed 6 cases that had developed asymmetrical folds. Only 1 patient agreed for revision surgery. The other 5 patients were still satisfied with the outcome and were not keen for revision surgery. None of the cases had loosening of knots. Conclusion: Modified single-knot continuous buried suture technique is a simple and non-invasive method to create aesthetically pleasing non-surgical double-eyelids, which has long-term effects. Proper patient selection is crucial and good surgical technique is required to achieve a desirable outcome.Keywords: blepharoplasty, double-eyelid, face-Q, non-incisional
Procedia PDF Downloads 1203684 Understanding Post-Displacement Earnings Losses: The Role of Wealth Inequality
Authors: M. Bartal
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A large empirical evidence points to sizable lifetime earnings losses associated with the displacement of tenured workers. The causes of these losses are still not well-understood. Existing explanations are heavily based on human capital depreciation during non-employment spells. In this paper, a new avenue is explored. Evidence on the role of household liquidity constraints in accounting for the persistence of post-displacement earning losses is provided based on SIPP data. Then, a directed search and matching model with endogenous human capital and wealth accumulation is introduced. The model is computationally tractable thanks to its block-recursive structure and highlights a non-trivial, yet intuitive, interaction between wealth and human capital. Constrained workers tend to accept jobs with low firm-sponsored training because the latter are (endogenously) easier to find. This new channel provides a plausible explanation for why young (highly constrained) workers suffer persistent scars after displacement. Finally, the model is calibrated on US data to show that the interplay between wealth and human capital is crucial to replicate the observed lifecycle pattern of earning losses. JEL— E21, E24, J24, J63.Keywords: directed search, human capital accumulation, job displacement, wealth accumulation
Procedia PDF Downloads 2083683 Rectus Sheath Block to Extend the Effectiveness of Post Operative Epidural Analgesia
Authors: Sugam Kale, Arif Uzair Bin Mohammed Roslan, Cindy Lee, Syed Beevee Mohammed Ismail
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Preemptive analgesia is an established concept in the modern practice of anaesthesia. To be most effective, it is best instituted earlier than the surgical stimulus and should last beyond the offset of surgically induced pain till healing is complete. Whereas the start of afferent pain blockade with regional anaesthesia is common, its effect often falls short to cover the entire period of pain impulses making their way to CNS in the post-operative period. We tried to use a combination of two regional anaesthetic techniques used sequentially to overcome this handicap. Madam S., a 56 year old lady, was scheduled for elective surgery for pancreatic cancer. She underwent laparotomy and distal pancreatectomy, splenectomy, bilateral salpingo oophorectomy, and sigmoid colectomy. Surgery was expected to be extensive, and it was presumed that the standard pain relief with PCA with opiates and oral analgesics would not be adequate. After counselling the patient pre-operative about the technique of regional anaesthesia techniques, including epidural catheterization and rectus sheath catheter placement, their benefits, and potential complications, informed consent was obtained. Epidural catheter was placed awake, and general anaesthesia was then induced. Epidural infusion of local anaesthetics was started prior to surgical incision and was continued till 60 hours into the postoperative period. Before skin closure, the surgeons inserted commercially available rectus sheath catheters bilaterally along the midline incision used for laparotomy. After 46 hours post-op, local anaesthetic infusion via these was started as bridging while the epidural infusion rate was tapered off. The epidural catheter was removed at 75 hours. Elastomeric pumps were used to provide local anaesthetic infusion with the ability to vary infusion rates. Acute pain service followed up the patient’s vital signs and effectiveness of pain relief twice daily or more frequently as required. Rectus sheath catheters were removed 137 hours post-op. The patient had good post-op analgesia with the minimal additional analgesic requirement. For the most part, the visual analog score (VAS) for pain remained at 1-3 on a scale of 1 to 10. Haemodynamics remained stable, and surgical recovery was as expected. Minimal opiate requirement after an extensive laparotomy also translates to the early return of intestinal motility. Our experience was encouraging, and we are hoping to extend this combination of two regional anaesthetic techniques to patients undergoing similar surgeries. Epidural analgesia is denser and offers excellent pain relief for both visceral and somatic pain in the first few days after surgery. As the pain intensity grows weaker, rectus sheath block and oral analgesics provide almost the same degree of pain relief after the epidural catheter is removed. We discovered that the background infusion of local anaesthetic down the rectus sheath catherter largely reduced the requirement for other classes of analgesics. We aim to study this further with a larger patient cohort and hope that it may become an established clinical practice that benefits patients everywhere.Keywords: rectus sheath, epidural infusion, post operative analgesia, elastomeric
Procedia PDF Downloads 1343682 Peripheral Neuropathy after Locoregional Anesthesia
Authors: Dalila Chaid, Bennameur Fedilli, Mohammed Amine Bellelou
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The study focuses on the experience of lower-limb amputees, who face both physical and psychological challenges due to their disability. Chronic neuropathic pain and various types of limb pain are common in these patients. They often require orthopaedic interventions for issues such as dressings, infection, ulceration, and bone-related problems. Research Aim: The aim of this study is to determine the most suitable anaesthetic technique for lower-limb amputees, which can provide them with the greatest comfort and prolonged analgesia. The study also aims to demonstrate the effectiveness and cost-effectiveness of ultrasound-guided local regional anaesthesia (LRA) in this patient population. Methodology: The study is an observational analytical study conducted over a period of eight years, from 2010 to 2018. It includes a total of 955 cases of revisions performed on lower limb stumps. The parameters analyzed in this study include the effectiveness of the block and the use of sedation, the duration of the block, the post-operative visual analog scale (VAS) scores, and patient comfort. Findings: The study findings highlight the benefits of ultrasound-guided LRA in providing comfort by optimizing post-operative analgesia, which can contribute to psychological and bodily repair in lower-limb amputees. Additionally, the study emphasizes the use of alpha2 agonist adjuvants with sedative and analgesic properties, long-acting local anaesthetics, and larger volumes for better outcomes. Theoretical Importance: This study contributes to the existing knowledge by emphasizing the importance of choosing an appropriate anaesthetic technique for lower-limb amputees. It highlights the potential of ultrasound-guided LRA and the use of specific adjuvants and local anaesthetics in improving post-operative analgesia and overall patient outcomes. Data Collection and Analysis Procedures: Data for this study were collected through the analysis of medical records and relevant documentation related to the 955 cases included in the study. The effectiveness of the anaesthetic technique, duration of the block, post-operative pain scores, and patient comfort were analyzed using statistical methods. Question Addressed: The study addresses the question of which anaesthetic technique would be most suitable for lower-limb amputees to provide them with optimal comfort and prolonged analgesia. Conclusion: The study concludes that ultrasound-guided LRA, along with the use of alpha2 agonist adjuvants, long-acting local anaesthetics, and larger volumes, can be an effective approach in providing comfort and improving post-operative analgesia for lower-limb amputees. This technique can potentially contribute to the psychological and bodily repair of these patients. The findings of this study have implications for clinical practice in the management of lower-limb amputees, highlighting the importance of personalized anaesthetic approaches for better outcomes.Keywords: neuropathic pain, ultrasound-guided peripheral nerve block, DN4 quiz, EMG
Procedia PDF Downloads 783681 A Seven Year Single-Centre Study of Dental Implant Survival in Head and Neck Oncology Patients
Authors: Sidra Suleman, Maliha Suleman, Stephen Brindley
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Oral rehabilitation of head and neck cancer patients plays a crucial role in the quality of life for such individuals post-treatment. Placement of dental implants or implant-retained prostheses can help restore oral function and aesthetics, which is often compromised following surgery. Conventional prosthodontic techniques can be insufficient in rehabilitating such patients due to their altered anatomy and reduced oral competence. Hence, there is a strong clinical need for the placement of dental implants. With an increasing incidence of head and neck cancer patients, the demand for such treatment is rising. Aim: The aim of the study was to determine the survival rate of dental implants in head and neck cancer patients placed at the Restorative and Maxillofacial Department, Royal Stoke University Hospital (RSUH), United Kingdom. Methodology: All patients who received dental implants between January 1, 2013 to December 31, 2020 were identified. Patients were excluded based on three criteria: 1) non-head and neck cancer patients, 2) no outpatient follow-up post-implant placement 3) provision of non-dental implants. Scanned paper notes and electronic records were extracted and analyzed. Implant survival was defined as fixtures that had remained in-situ / not required removal. Sample: Overall, 61 individuals were recruited from the 143 patients identified. The mean age was 64.9 years, with a range of 35 – 89 years. The sample included 37 (60.7%) males and 24 (39.3%) females. In total, 211 implants were placed, of which 40 (19.0%) were in the maxilla, 152 (72.0%) in the mandible and 19 (9.0%) in autogenous bone graft sites. Histologically 57 (93.4%) patients had squamous cell carcinoma, with 43 (70.5%) patients having either stage IVA or IVB disease. As part of treatment, 42 (68.9%) patients received radiotherapy, which was carried out post-operatively for 29 (69.0%) cases. Whereas 21 (34.4%) patients underwent chemotherapy, 13 (61.9%) of which were post-operative. The Median follow-up period was 21.9 months with a range from 0.9 – 91.4 months. During the study, 23 (37.7%) patients died and their data was censored beyond the date of death. Results: In total, four patients who had received radiotherapy had one implant failure each. Two mandibular implants failed secondary to osteoradionecrosis, and two maxillary implants did not survive as a result of failure to osseointegrate. The overall implant survival rates were 99.1% at three years and 98.1% at both 5 and 7 years. Conclusions: Although this data shows that implant failure rates are low, it highlights the difficulty in predicting which patients will be affected. Future studies involving larger cohorts are warranted to further analyze factors affecting outcomes.Keywords: oncology, dental implants, survival, restorative
Procedia PDF Downloads 2333680 Ultra-deformable Drug-free Sequessome™ Vesicles (TDT 064) for the Treatment of Joint Pain Following Exercise: A Case Report and Clinical Data
Authors: Joe Collins, Matthias Rother
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Background: Oral non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the relief of joint pain during and post-exercise. However, oral NSAIDs increase the risk of systemic side effects, even in healthy individuals, and retard recovery from muscle soreness. TDT 064 (Flexiseq®), a topical formulation containing ultra-deformable drug-free Sequessome™ vesicles, has demonstrated equivalent efficacy to oral celecoxib in reducing osteoarthritis-associated joint pain and stiffness. TDT 064 does not cause NSAID-related adverse effects. We describe clinical study data and a case report on the effectiveness of TDT 064 in reducing joint pain after exercise. Methods: Participants with a pain score ≥3 (10-point scale) 12–16 hours post-exercise were randomized to receive TDT 064 plus oral placebo, TDT 064 plus oral ketoprofen, or ketoprofen in ultra-deformable phospholipid vesicles plus oral placebo. Results: In the 168 study participants, pain scores were significantly higher with oral ketoprofen plus TDT 064 than with TDT 064 plus placebo in the 7 days post-exercise (P = 0.0240) and recovery from muscle soreness was significantly longer (P = 0.0262). There was a low incidence of adverse events. These data are supported by clinical experience. A 24-year-old male professional rugby player suffered a traumatic lisfranc fracture in March 2014 and underwent operative reconstruction. He had no relevant medical history and was not receiving concomitant medications. He had undergone anterior cruciate ligament reconstruction in 2008. The patient reported restricted training due to pain (score 7/10), stiffness (score 9/10) and poor function, as well as pain when changing direction and running on consecutive days. In July 2014 he started using TDT 064 twice daily at the recommended dose. In November 2014 he noted reduced pain on running (score 2-3/10), decreased morning stiffness (score 4/10) and improved joint mobility and was able to return to competitive rugby without restrictions. No side effects of TDT 064 were reported. Conclusions: TDT 064 shows efficacy against exercise- and injury-induced joint pain, as well as that associated with osteoarthritis. It does not retard muscle soreness recovery after exercise compared with an oral NSAID, making it an alternative approach for the treatment of joint pain during and post-exercise.Keywords: exercise, joint pain, TDT 064, phospholipid vesicles
Procedia PDF Downloads 4803679 Enhanced Physiological Response of Blood Pressure and Improved Performance in Successive Divided Attention Test Seen with Classical Instrumental Background Music Compared to Controls
Authors: Shantala Herlekar
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Introduction: Entrainment effect of music on cardiovascular parameters is well established. Music is being used in the background by medical students while studying. However, does it really help them relax faster and concentrate better? Objectives: This study was done to compare the effects of classical instrumental background music versus no music on blood pressure response over time and on successively performed divided attention test in Indian and Malaysian 1st-year medical students. Method: 60 Indian and 60 Malaysian first year medical students, with an equal number of girls and boys were randomized into two groups i.e music group and control group thus creating four subgroups. Three different forms of Symbol Digit Modality Test (to test concentration ability) were used as a pre-test, during music/control session and post-test. It was assessed using total, correct and error score. Simultaneously, multiple Blood Pressure recordings were taken as pre-test, during 1, 5, 15, 25 minutes during music/control (+SDMT) and post-test. The music group performed the test with classical instrumental background music while the control group performed it in silence. Results were analyzed using students paired t test. p value < 0.05 was taken as statistically significant. A drop in BP recording was indicative of relaxed state and a rise in BP with task performance was indicative of increased arousal. Results: In Symbol Digit Modality Test (SDMT) test, Music group showed significant better results for correct (p = 0.02) and total (p = 0.029) scores during post-test while errors reduced (p = 0.002). Indian music group showed decline in post-test error scores (p = 0.002). Malaysian music group performed significantly better in all categories. Blood pressure response was similar in music and control group with following variations, a drop in BP at 5minutes, being significant in music group (p < 0.001), a steep rise in values till 15minutes (corresponding to SDMT test) also being significant only in music group (p < 0.001) and the Systolic BP readings in controls during post-test were at lower levels compared to music group. On comparing the subgroups, not much difference was noticed in recordings of Indian student’s subgroups while all the paired-t test values in the Malaysian music group were significant. Conclusion: These recordings indicate an increased relaxed state with classical instrumental music and an increased arousal while performing a concentration task. Music used in our study was beneficial to students irrespective of their nationality and preference of music type. It can act as an “active coping” strategy and alleviate stress within a very short period of time, in our study within a span of 5minutes. When used in the background, during task performance, can increase arousal which helps the students perform better. Implications: Music can be used between lectures for a short time to relax the students and help them concentrate better for the subsequent classes, especially for late afternoon sessions.Keywords: blood pressure, classical instrumental background music, ethnicity, symbol digit modality test
Procedia PDF Downloads 1413678 Topographic Mapping of Farmland by Integration of Multiple Sensors on Board Low-Altitude Unmanned Aerial System
Authors: Mengmeng Du, Noboru Noguchi, Hiroshi Okamoto, Noriko Kobayashi
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This paper introduced a topographic mapping system with time-saving and simplicity advantages based on integration of Light Detection and Ranging (LiDAR) data and Post Processing Kinematic Global Positioning System (PPK GPS) data. This topographic mapping system used a low-altitude Unmanned Aerial Vehicle (UAV) as a platform to conduct land survey in a low-cost, efficient, and totally autonomous manner. An experiment in a small-scale sugarcane farmland was conducted in Queensland, Australia. Subsequently, we synchronized LiDAR distance measurements that were corrected by using attitude information from gyroscope with PPK GPS coordinates for generation of precision topographic maps, which could be further utilized for such applications like precise land leveling and drainage management. The results indicated that LiDAR distance measurements and PPK GPS altitude reached good accuracy of less than 0.015 m.Keywords: land survey, light detection and ranging, post processing kinematic global positioning system, precision agriculture, topographic map, unmanned aerial vehicle
Procedia PDF Downloads 2363677 Clinically-Based Improvement Project Focused on Reducing Risks Associated with Diabetes Insipidus, Syndrome of Inappropriate ADH, and Cerebral Salt Wasting in Paediatric Post-Neurosurgical and Traumatic Brain Injury Patients
Authors: Shreya Saxena, Felix Miller-Molloy, Phillipa Bowen, Greg Fellows, Elizabeth Bowen
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Background: Complex fluid balance abnormalities are well-established post-neurosurgery and traumatic brain injury (TBI). The triple-phase response requires fluid management strategies reactive to urine output and sodium homeostasis as patients shift between Diabetes Insipidus (DI) and Syndrome of Inappropriate ADH (SIADH). It was observed, at a tertiary paediatric center, a relatively high prevalence of the above complications within a cohort of paediatric post-neurosurgical and TBI patients. An audit of the clinical practice against set institutional guidelines was undertaken and analyzed to understand why this was occurring. Based on those results, new guidelines were developed with structured educational packages for the specialist teams involved. This was then reaudited, and the findings were compared. Methods: Two independent audits were conducted across two time periods, pre and post guideline change. Primary data was collected retrospectively, including both qualitative and quantitative data sets from the CQUIN neurosurgical database and electronic medical records. All paediatric patients post posterior fossa (PFT) or supratentorial surgery or with a TBI were included. A literature review of evidence-based practice, initial audit data, and stakeholder feedback was used to develop new clinical guidelines and nursing standard operation procedures. Compliance against these newly developed guidelines was re-assessed and a thematic, trend-based analysis of the two sets of results was conducted. Results: Audit-1 January2017-June2018, n=80; Audit-2 January2020-June2021, n=30 (reduced operative capacity due to COVID-19 pandemic). Overall, improvements in the monitoring of both fluid balance and electrolyte trends were demonstrated; 51% vs. 77% and 78% vs. 94%, respectively. The number of clear fluid management plans documented postoperatively also increased (odds ratio of 4), leading to earlier recognition and management of evolving fluid-balance abnormalities. The local paediatric endocrine team was involved in the care of all complex cases and notified sooner for those considered to be developing DI or SIADH (14% to 35%). However, significant Na fluctuations (>12mmol in 24 hours) remained similar – 5 vs six patients – found to be due to complex pituitary hypothalamic pathology – and the recommended adaptive fluid management strategy was still not always used. Qualitative data regarding useability and understanding of fluid-balance abnormalities and the revised guidelines were obtained from health professionals via surveys and discussion in the specialist teams providing care. The feedback highlighted the new guidelines provided a more consistent approach to the post-operative care of these patients and was a better platform for communication amongst the different specialist teams involved. The potential limitation to our study would be the small sample size on which to conduct formal analyses; however, this reflects the population that we were investigating, which we cannot control. Conclusion: The revised clinical guidelines, based on audited data, evidence-based literature review and stakeholder consultations, have demonstrated an improvement in understanding of the neuro-endocrine complications that are possible, as well as increased compliance to post-operative monitoring of fluid balance and electrolytes in this cohort of patients. Emphasis has been placed on preventative rather than treatment of DI and SIADH. Consequently, this has positively impacted patient safety for the center and highlighted the importance of educational awareness and multi-disciplinary team working.Keywords: post-operative, fluid-balance management, neuro-endocrine complications, paediatric
Procedia PDF Downloads 923676 The Role of Glyceryl Trinitrate (GTN) in 99mTc-HIDA with Morphine Provocation Scan for the Investigation of Type III Sphincter of Oddi Dysfunction (SOD)
Authors: Ibrahim M Hassan, Lorna Que, Michael Rutland
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Type I SOD is usually diagnosed by anatomical imaging such as ultrasound, CT and MRCP. However, the types II and III SOD yield negative results despite the presence of significant symptoms. In particular, the type III is difficult to diagnose due to the absence of significant biochemical or anatomical abnormalities. Nuclear Medicine can aid in this diagnostic dilemma by demonstrating functional changes in the bile flow. Low dose Morphine (0.04mg/Kg) stimulates the tone of the sphincter of Oddi (SO) and its usefulness has been shown in diagnosing SOD by causing a delay in bile flow when compared to a non morphine provoked - baseline scan. This work expands on that process by using sublingual GTN at 60 minutes post tracer and morphine injection to relax the SO and induce an improvement in bile outflow, and in some cases show immediate relief of morphine induced abdominal pain. The criteria for positive SOD are as follows: if during the first hour of the morphine provocation showed (1) delayed intrahepatic biliary ducts tracer accumulation; plus (2) delayed appearance but persistent retention of activity in the common bile duct, and (3) delayed bile flow into the duodenum. In addition, patients who required GTN within the first hour to relieve abdominal pain were regarded as highly supportive of the diagnosis. Retrospective analysis of 85 patients (pts) (78F and 6M) referred for suspected SOD (type III) who had been intensively investigated because of recurrent right upper quadrant or abdominal pain post cholecystectomy. 99mTc-HIDA scan with morphine-provocation is performed followed by GTN at 60 minutes post tracer injection and a further thirty minutes of dynamic imaging are acquired. 30 pts were negative. 55 pts were regarded as positive for SOD and 38/55 (60%) of these patients with an abnormal result were further evaluated with a baseline 99mTc-HIDA. As expected, all 38 pts showed better bile flow characteristics than during the morphine provocation. 20/55 (36%) patients were treated by ERCP sphincterotomy and the rest were managed conservatively by medical therapy. In all cases regarded as positive for SOD, the sublingual GTN at 60 minutes showed immediate improvement in bile flow. 11/55(20%) who developed severe post-morphine abdominal pain were relieved by GTN almost instantaneously. We propose that GTN is a useful agent in the diagnosis of SOD when performing 99mTc-HIDA scan and that the satisfactory response to the sublingual GTN could offer additional information in patients who have severe pain at the time the procedure or when presenting to the emergency unit because of biliary pain. And also in determining whether a trial of medical therapy may be used before considering surgery.Keywords: GTN, HIDA, MORPHINE, SOD
Procedia PDF Downloads 3043675 Mental Health of the Elderly: Evaluating a Newly Developed Structured Life-Review Manual Using a Within-Subjects Pre-Post Design
Authors: Wladislaw Mill, Hariet Kirschner, Anna Zimmermann, Sashi Singh, Simon Forstmeier, Uwe Berger, Bernhard Strauss, Benedikt Werner
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Introduction: A promising method to improve mental health of elderly people are structured life-reviews. We report the evaluation of our newly developed manual for structured life-reviews. The manual was created with the emphasis on straightforward application so that it can be used by professionals and lay people alike. Method: A within-subjects pre-post design is used to evaluate the manual using a geriatric depression scale and a self-integrity measure. Participants are elderly people living by themselves and in nursing homes. Findings: It is shown that elderly people perceive the structured life-review as a very positive experience. More importantly, it is shown that a negative trend of self-integrity and geriatric depression is significantly reduced by the intervention. Conclusion: The data suggest that the manual contributes positively to self- perception and mental health. We conclude that this newly developed device is very valuable to augment elderly care.Keywords: structured life-review, self-integrity, geriatric depression, preventation research
Procedia PDF Downloads 2613674 Exploration of Community Space Environment Renewal Strategies Based on the Concept of Disaster Chain
Authors: Ma Chaoyang
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With the acceleration of urbanization, old communities are facing renewal problems such as an aging material environment, declining living quality, and insufficient resilience. The once glorious old communities have become the most vulnerable areas in the city. Through a re-understanding of the ‘disaster chain’ and resilient communities, it is believed that considering the construction of resilient communities during community renewal is of great significance for promoting the sustainable development of communities. This article proposes renewal strategies for old communities based on the concept of preventing the occurrence of disaster chains. After analyzing the main demand characteristics of old communities, it proposes a reflection on improving community spatial safety resilience based on the ‘broken chain’ concept. In the four stages of ‘pre-disaster, mid-disaster, and post-disaster’, it elaborates that considering the occurrence of disaster chain in community renewal is the main content of research on spatial safety resilience construction and clarifies that community resilience is the idea and principle of responding with the process of disaster chain. The study focuses on the four dimensions of ‘pre-disaster, mid-disaster, and post-disaster’. This can provide ideas and references for resilience construction in community updates.Keywords: community updates, disaster chain concept, community resilience, space environment
Procedia PDF Downloads 513673 Probabilistic Modeling of Post-Liquefaction Ground Deformation
Authors: Javad Sadoghi Yazdi, Robb Eric S. Moss
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This paper utilizes a probabilistic liquefaction triggering method for modeling post-liquefaction ground deformation. This cone penetration test CPT-based liquefaction triggering is employed to estimate the factor of safety against liquefaction (FSL) and compute the maximum cyclic shear strain (γmax). The study identifies a maximum PL value of 90% across various relative densities, which challenges the decrease from 90% to 70% as relative density decreases. It reveals that PL ranges from 5% to 50% for volumetric strain (εvol) less than 1%, while for εvol values between 1% and 3.2%, PL spans from 50% to 90%. The application of the CPT-based simplified liquefaction triggering procedures has been employed in previous researches to estimate liquefaction ground-failure indices, such as the Liquefaction Potential Index (LPI) and Liquefaction Severity Number (LSN). However, several studies have been conducted to highlight the variability in liquefaction probability calculations, suggesting a more accurate depiction of liquefaction likelihood. Consequently, the utilization of these simplified methods may not offer practical efficiency. This paper further investigates the efficacy of various established liquefaction vulnerability parameters, including LPI and LSN, in explaining the observed liquefaction-induced damage within residential zones of Christchurch, New Zealand using results from CPT database.Keywords: cone penetration test (CPT), liquefaction, postliquefaction, ground failure
Procedia PDF Downloads 713672 Preoperative Smoking Cessation Audit: A Single Centre Experience from Metropolitan Melbourne
Authors: Ya-Chu May Tsai, Ibrahim Yacoub, Eoin Casey
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The Australian and New Zealand College of Anaesthetists (ANZCA) advises that smoking should not be permitted within 12 hours of surgery. There is little information in the medical literature regarding patients awareness of perioperative smoking cessation recommendations nor their appreciation of how smoking might negatively impact their perioperative course. The aim of the study is to assess the prevalence of current smokers presenting to Werribee Mercy Hospital (WMH) and to evaluate if pre-operative provision of both written and verbal pre-operative advice was, 1: Effective in improving patient awareness of the benefits of pre-operative smoking cessation, 2: Associated with an increase in the number of elective surgical patients who stop smoking at least 12 hours pre-operatively. Methods: The initial survey included all patients who presented to WMH for elective surgical procedures from 19 – 30 September 2016 using a standardized questionnaire focused on patients’ smoking history and their awareness of smoking cessation preoperatively. The intervention consisted of a standard pre-operative phone call to all patients advising them of the increased perioperative risks associated with smoking, and advised patients to cease 12 hours prior. In addition, written information on smoking cessation strategies were sent out in mail at least 1 week prior to planned procedure date to all patients. Questionnaire-based study after the intervention was conducted on day of elective procedure from 10 – 21 October 2016 inclusive. Primary outcomes measured were patient’s awareness of smoking cessation and proportion of smokers who quit >12 hours, considered a clinically meaning duration to reduce anaesthetics complications. Comparison of pre and post intervention results were made using SPSS 21.0. Results: In the pre-intervention group (n=156), 36 (22.4%) patients were current smokers, 46 were ex-smokers (29.5%) and 74 were non-smokers (48.1%). Of the smokers, 12 (33%) reported having been informed of smoking cessation prior to operation and 8 (22%) were aware of increased intra- and perioperative adverse events associated with smoking. In the post-intervention group n= 177, 38 (21.5%) patients were current smokers, 39 were ex-smokers (22.0%) and 100 were non-smokers (56.5%). Of the smokers, 32 (88.9%) reported having been informed of smoking cessation prior to operation and 35 (97.2%) reported being aware of increased intra- and perioperative adverse events associated with smoking. The median time since last smoke in the pre-intervention group was 5.5 hours (Q1-Q3 = 2-14) compared with 13 hours (Q1-Q3 = 5-24) in post intervention group. Amongst the smokers, smoking cessation at least 12 hours prior to surgery significantly increased from 27.8% pre-intervention to 52.6% post intervention (P=0.03). Conclusion: A standard preoperative phone call and written instruction on smoking cessation guidelines at time of waitlist placement increase preoperative smoking cessation rates by almost 2-fold.Keywords: anaesthesia, audit, perioperative medicine, smoking cessation
Procedia PDF Downloads 3063671 The Positive Effects of Processing Instruction on the Acquisition of French as a Second Language: An Eye-Tracking Study
Authors: Cecile Laval, Harriet Lowe
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Processing Instruction is a psycholinguistic pedagogical approach drawing insights from the Input Processing Model which establishes the initial innate strategies used by second language learners to connect form and meaning of linguistic features. With the ever-growing use of technology in Second Language Acquisition research, the present study uses eye-tracking to measure the effectiveness of Processing Instruction in the acquisition of French and its effects on learner’s cognitive strategies. The experiment was designed using a TOBII Pro-TX300 eye-tracker to measure participants’ default strategies when processing French linguistic input and any cognitive changes after receiving Processing Instruction treatment. Participants were drawn from lower intermediate adult learners of French at the University of Greenwich and randomly assigned to two groups. The study used a pre-test/post-test methodology. The pre-tests (one per linguistic item) were administered via the eye-tracker to both groups one week prior to instructional treatment. One group received full Processing Instruction treatment (explicit information on the grammatical item and on the processing strategies, and structured input activities) on the primary target linguistic feature (French past tense imperfective aspect). The second group received Processing Instruction treatment except the explicit information on the processing strategies. Three immediate post-tests on the three grammatical structures under investigation (French past tense imperfective aspect, French Subjunctive used for the expression of doubt, and the French causative construction with Faire) were administered with the eye-tracker. The eye-tracking data showed the positive change in learners’ processing of the French target features after instruction with improvement in the interpretation of the three linguistic features under investigation. 100% of participants in both groups made a statistically significant improvement (p=0.001) in the interpretation of the primary target feature (French past tense imperfective aspect) after treatment. 62.5% of participants made an improvement in the secondary target item (French Subjunctive used for the expression of doubt) and 37.5% of participants made an improvement in the cumulative target feature (French causative construction with Faire). Statistically there was no significant difference between the pre-test and post-test scores in the cumulative target feature; however, the variance approximately tripled between the pre-test and the post-test (3.9 pre-test and 9.6 post-test). This suggests that the treatment does not affect participants homogenously and implies a role for individual differences in the transfer-of-training effect of Processing Instruction. The use of eye-tracking provides an opportunity for the study of unconscious processing decisions made during moment-by-moment comprehension. The visual data from the eye-tracking demonstrates changes in participants’ processing strategies. Gaze plots from pre- and post-tests display participants fixation points changing from focusing on content words to focusing on the verb ending. This change in processing strategies can be clearly seen in the interpretation of sentences in both primary and secondary target features. This paper will present the research methodology, design and results of the experimental study using eye-tracking to investigate the primary effects and transfer-of-training effects of Processing Instruction. It will then provide evidence of the cognitive benefits of Processing Instruction in Second Language Acquisition and offer suggestion in second language teaching of grammar.Keywords: eye-tracking, language teaching, processing instruction, second language acquisition
Procedia PDF Downloads 2803670 Management of Gastrointestinal Metastasis of Invasive Lobular Carcinoma
Authors: Sally Shepherd, Richard De Boer, Craig Murphy
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Background: Invasive lobular carcinoma (ILC) can metastasize to atypical sites within the peritoneal cavity, gastrointestinal, or genitourinary tract. Management varies depending on the symptom presentation, extent of disease burden, particularly if the primary disease is occult, and patient wishes. Case Series: 6 patients presented with general surgical presentations of ILC, including incomplete large bowel obstruction, cholecystitis, persistent lower abdominal pain, and faecal incontinence. 3 were diagnosed with their primary and metastatic disease in the same presentation, whilst 3 patients developed metastasis from 5 to 8 years post primary diagnosis of ILC. Management included resection of the metastasis (laparoscopic cholecystectomy), excision of the primary (mastectomy and axillary clearance), followed by a combination of aromatase inhibitors, biologic therapy, and chemotherapy. Survival post diagnosis of metastasis ranged from 3 weeks to 7 years. Conclusion: Metastatic ILC must be considered with any gastrointestinal or genitourinary symptoms in patients with a current or past history of ILC. Management may not be straightforward to chemotherapy if the acute pathology is resulting in a surgically resectable disease.Keywords: breast cancer, gastrointestinal metastasis, invasive lobular carcinoma, metastasis
Procedia PDF Downloads 1483669 The Language of Hip-Hop and Rap in Tunisia: Symbol of Cultural Change in Post-Arab Spring Tunisia
Authors: Zouhir Gabsi
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The Arab Spring has had noticeable effects on Tunisia in socio-economic, political, and cultural terms. Few have predicted that the music of hip-hop and rap could engage with the socio-political situation in Tunisia, especially after the downfall of Ben Ali’s regime. Having survived as underground music since the year 2000, the genre of hip-hop and rap remains an aberration from the folkloric tradition. By adhering to the socio-economic reality of the Tunisian street, rappers attempt to claim authenticity mainly in both thematic and language uses, and by usurping the power of ‘space’ from the regime’s control. With the songs’ fast-paced rhythms, catchy phrases, puns, vulgarisms, and linguistic innovations using metaphors, hip-hop, and rap have struck a chord with Tunisia’s youth. Tunisia’s new social reality has allowed Tunisian rappers to express dissent and voice people’s despair over the socio-economic and political situation. This paper argues that rap artists use language as a vehicle to claim the authenticity of their message. It also explores how the performative nature of the language of hip-hop and rap interacts with the Tunisian culture and argues the power of music in the context of political and socio-economic grievances in post-Arab Spring Tunisia.Keywords: Arab Spring, hip-hop, eevolution, Tunisia, Tunisian Arabic
Procedia PDF Downloads 1523668 Broad Protection against Avian Influenza Virus by Using a Modified Vaccinia Ankara Virus Expressing a Mosaic Hemagglutinin
Authors: Attapon Kamlangdee, Brock Kingstad-Bakke, Tavis K. Anderson, Tony L. Goldberg, Jorge E. Osorio
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A critical failure in our preparedness for an influenza pandemic is the lack of a universal vaccine. Influenza virus strains diverge by 1 to 2% per year, and commercially available vaccines often do not elicit protection from one year to the next, necessitating frequent formulation changes. This represents a major challenge to the development of a cross-protective vaccine that can protect against circulating viral antigenic diversity. We have constructed a recombinant modified vaccinia virus Ankara (MVA) that expresses an H5N1 mosaic hemagglutinin (H5M) (MVA-H5M). This mosaic was generated in silico using 2,145 field-sourced H5N1 isolates. A single dose of MVA-H5M provided 100% protection in mice against clade 0, 1, and 2 avian influenza viruses and also protected against seasonal H1N1 virus (A/Puerto Rico/8/34). It also provided short-term (10 days) and long-term (6 months) protection post vaccination. Both neutralizing antibodies and antigen-specific CD4+and CD8+ T cells were still detected at 5 months post vaccination, suggesting that MVA-H5M provides long-lasting immunity.Keywords: modified vaccinia Ankara, MVA, H5N1, hemagglutinin, influenza vaccine
Procedia PDF Downloads 2793667 Physical Activity and Sport Research with People with Impairments: Oppression–Empowerment Continuum
Authors: Gyozo Molnar, Nancy Spencer-Cavaliere
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Research in the area of physical activity and sport, while becoming multidisciplinary, is still dominated by post-positivist approaches that have the tendency to position the researcher as an expert and the participant as subordinate thereby perpetuating an unequal balance of power. Despite physical activity’s and sport’s universal appeal, their historic practices have excluded particular groups of people who assumed lesser forms of human capital. Adapted physical activity (APA) is a field that has responded to those segregations with specific application and relevance to people with impairments. Nevertheless, to date, similar to physical activity and sport, research in APA is still dominated by post-positivist epistemology. Stemming from this, there is gradually growing criticism within the field related to the abundance of research ‘on’ people with impairments and lack of research ‘with’ and ‘by’ people with impairments. Furthermore, research questions in the field are most often pursued from a single axis of analysis and constructed by non-disabled researchers. Concurrently, while calls for interdisciplinary approaches to understanding disability are growing in popularity, there is also a clear need to take an intersectionality-informed research methodology to understanding physical activity and sport and power (im)balances therein. In other words, impairment needs to be considered in conjunction with other socially and politically constructed and historically embedded differences such as gender, race, class, etc. when analyzing physical activity and sport experiences for people with impairments. Moreover, it is reasonable to argue that non-disabled researchers must recognize and theorize ableism in its complicated intersectional manifestation to show the structural constraints that disabled scholars face in the field. Consequently, this presentation will offer an alternative approach that acknowledges and prioritizes the perspectives and experiences of people with impairments to expand the field of APA. As such, the importance of broadening epistemologies in APA and prioritizing an appreciation for multiple bits of knowledge of people with impairments through intersections of social locations (e.g., gender, race, class) will be considered.Keywords: adapted physical activity, disability, intersectionality, post-positivist, power imbalances
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