Search results for: facial surgery

Authors: Masahiro Miyaji

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When a driver happens to be involved in some traffic congestion or after traffic incidents, the driver may fall in a state of anger. State of anger may encounter decisive risk resulting in severer traffic accidents. Preventive safety function using driver’s psychosomatic state with regard to anger may be one of solutions which would avoid that kind of risks. Identifying driver’s anger state is important to create countermeasures to prevent the risk of traffic accidents. As a first step, this research figured out root cause of traffic incidents by means of using Internet survey. From statistical analysis of the survey, dominant psychosomatic states immediately before traffic incidents were haste, distraction, drowsiness and anger. Then, we replicated anger state of a driver while driving, and then, replicated it by means of using driving simulator on bench test basis. Six types of facial expressions including anger were introduced as alternative characteristics. Kohonen neural network was adopted to classify anger state. Then, we created a methodology to detect anger state of a driver in high accuracy. We presented a driving support safety function. The function adapts driver’s anger state in cooperation with an autonomous driving unit to reduce the number of traffic accidents. Consequently, e evaluated reduction rate of driver’s anger in the traffic accident. To validate the estimation results, we referred the reduction rate of Advanced Safety Vehicle (ASV) as well as Intelligent Transportation Systems (ITS).

Keywords: Kohonen neural network, driver’s anger state, reduction of traffic accidents, driver’s state adaptive driving support safety

Procedia PDF Downloads 359

Authors: Azeem Alphonce

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In Pakistan, there is a variety of skin tones and colors across all provinces. However, a fair complexion is one of the standards of beauty among females in Pakistan, which creates insecurities in dark-complexioned females. This research is a critical discourse analysis of the language used on beauty products for females in Pakistan. The purpose was to analyze the language used on female beauty products using Van Dijk's three-stage socio-cognitive model to understand what message is received from the few words written and repeated across the packaging of various facial products, why such language is used and what are its wider socio-cognitive effects? The criterion for the selection of beauty products was skin whitening terminologies and the language used on these products. The results showed that over 57 per cent of products utilized skin-whitening terms. The adjectives written on the package indicate that fairer skin is the ultimate beauty goal of females. The analysis explored how the language reinforces unfair beauty standards and perpetuates colorism. It was concluded that female beauty products utilize discriminatory discourse by marginalizing individuals of darker skin tones. Fairer skin is promoted, whereas darker skin is referred to as a problem, flaw or imperfection. Socially shared mental models seem to have caused beauty companies to exploit and promote perceptions of colorism in society. Therefore, such discourse should be prevented, and beauty companies should utilize their discourse to promote acceptance of various skin tones.

Keywords: language, skin whitening products, beauty standards, social mental models

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Authors: Alaa T. Ali, Nevine H. Kheir El Din, Ehab S. Abdelhamid, Ahmed E. Amr

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Objective: Severe alveolar bone resorption is usually associated with a deficient amount of soft tissues. soft tissue expansion is introduced to provide an adequate amount of soft tissue over the grafted area. This study aimed to assess the efficacy of sub-periosteal self-inflating osmotic tissue expanders used as preparatory surgery before horizontal alveolar ridge augmentation using autogenous onlay block bone graft. Methods: A prospective randomized controlled clinical trial was performed. Sixteen partially edentulous patients demanding horizontal bone augmentation in the anterior maxilla were randomly assigned to horizontal ridge augmentation with autogenous bone block grafts harvested from the mandibular symphysis. For the test group, soft tissue expanders were placed sub-periosteally before horizontal ridge augmentation. Impressions were taken before and after STE, and the cast models were optically scanned and superimposed to be used for volumetric analysis. Horizontal ridge augmentation was carried out after STE completion. For the control group, a periosteal releasing incision was performed during bone augmentation procedures. Implants were placed in both groups at re-entry surgery after six months period. A core biopsy was taken. Histomorphometric assessment for newly formed bone surface area, mature collagen area fraction, the osteoblasts count, and blood vessel count were performed. The change in alveolar ridge width was evaluated through bone caliper and CBCT. Results: Soft tissue expander successfully provides a Surplus amount of soft tissues in 5 out of 8 patients in the test group. Complications during the expansion period were perforation through oral mucosa occurred in two patients. Infection occurred in one patient. The mean soft tissue volume gain was 393.9 ± 322mm. After 6 months. The mean horizontal bone gains for the test and control groups were 3.14 mm and 3.69 mm, respectively. Conclusion: STE with a sub-periosteal approach is an applicable method to achieve an additional soft tissue and to reduce bone block graft exposure and wound dehiscence.

Keywords: soft tissue expander, ridge augmentation, block graft, symphysis bone block

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Authors: Mariette Swanepoel, Terry Ellapen, Henriette Hammil, Juandre Williams, Timothy Qumbu

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The biomechanical consequence of pes planus is a topic seldom reviewed in regards to energy expenditure and predisposition to injury. However its comprehension in the field of foot rehabilitation, pre-and post-surgery is fundamental to successful patient management. This short communication unites the present literature to provide the reader with better insight on the consequence of pes planus, foot mechanics and its predisposition to injury at the foot and tibiofemoral joint. Further, the consideration of synergistic dominance of the foot invertors to compensate for the ineffective torque production of the fibularis longus due pes planus is presented.

Keywords: pes planus, fibularis longus, synergistic dominance, injury

Procedia PDF Downloads 287

Authors: Madeleine Nicole G. Bernardo, Katrina T. Feliciano, Marcelo Nonato A. Nacionales III, Diane Frances M. Peralta, Denise Nicole V. Profeta

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This study aims to find out if heart rate variability and valence of emotion have an effect on perceived intensity of emotion. Psychology undergraduates (N = 60) from the University of the Philippines Diliman were shown 10 photographs from the Japanese Female Facial Expression (JAFFE) Database, along with a corresponding questionnaire with a Likert scale on perceived intensity of emotion. In this 3 x 2 mixed subjects factorial design, each group was either made to do a simple exercise prior to answering the questionnaire in order to increase the heart rate, listen to a heart rate of 120 bpm, or colour a drawing to keep the heart rate stable. After doing the activity, the participants then answered the questionnaire, providing a rating of the faces according to the participants’ perceived emotional intensity on the photographs. The photographs presented were either of positive or negative emotional valence. The results of the experiment showed that neither an induced fast heart rate or perceived fast heart rate had any significant effect on the participants’ perceived intensity of emotion. There was also no interaction effect of heart rate variability and valence of emotion. The insignificance of results was explained by the Philippines’ high context culture, accompanied by the prevalence of both intensely valenced positive and negative emotions in Philippine society. Insignificance in the effects were also attributed to the Cannon-Bard theory, Schachter-Singer theory and various methodological limitations.

Keywords: heart rate variability, perceived intensity of emotion, Philippines , valence of emotion

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Authors: Maria Medeiros, Suren Surenthiran, Abitha Muralithar, Soushma Seeburuth, Mohammed Mohammed

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Introduction: Appendicitis is the most common surgical emergency globally and can have devastating consequences. Diagnostic imaging in acute appendicitis has become increasingly common in aiding the diagnosis of acute appendicitis. Computerized tomography (CT) and ultrasound (US) are the most commonly used imaging modalities for diagnosing acute appendicitis. Pre-operative imaging has contributed to a reduction of negative appendicectomy rates from between 10-29% to 5%. Literature report CT scan has a diagnostic sensitivity of 94% in acute appendicitis. This clinical audit was conducted to establish if the CT scan's diagnostic yield for acute appendicitis matches the literature. CT scan has a high sensitivity and specificity for diagnosing acute appendicitis and its use can result in a lower negative appendicectomy rate. The aim of this study is to compare the pre-operative imaging findings from CT scans to the histopathology results post-operatively and establish the accuracy of CT scans in aiding the diagnosis of acute appendicitis. Methods: This was a retrospective study focusing on adult presentations to the general surgery department in a district general hospital in central London with an impression of acute appendicitis. We analyzed all patients from July 2022 to December 2022 who underwent a CT scan preceding appendicectomy. Pre-operative CT findings and post-operative histopathology findings were compared to establish the efficacy of CT scans in diagnosing acute appendicitis. Our results were also cross-referenced with pre-existing literature. Data was collected and anonymized using CERNER and analyzed in Microsoft Excel. Exclusion criteria: Children, age <16. Results: 65 patients had CT scans in which the report stated acute appendicitis. Of those 65 patients, 62 patients underwent diagnostic laparoscopies. 100% of patients who underwent an appendicectomy with a pre-operative CT scan showing acute appendicitis had acute appendicitis in histopathology analysis. 3 of the 65 patients who had a CT scan showing appendicitis received conservative treatment. Conclusion: CT scans positive for acute appendicitis had 100% sensitivity and a positive predictive value, which matches published research studies (sensitivity of 94%). The use of CT scans in the diagnostic work-up for acute appendicitis can be extremely helpful in a) confirming the diagnosis and b) reducing the rates of negative appendicectomies and consequently reducing unnecessary operative-associated risks for patients, reducing costs and reducing pressure on emergency theatre lists.

Keywords: acute apendicitis, CT scan, general surgery, imaging

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Authors: Raphael C. Zero, Thiago A. S. S. Rocha, Marita V. Cardozo, Caio C. C. Santos, Alisson D. S. Fechis, Antonio C. Shimano, FabríCio S. Oliveira

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Biomechanical analysis is an important factor in tissue studies. The objective of this study was to determine the feasibility of a new anatomical technique and quantify the changes in skin and the jejunum resistance of cats’ corpses throughout the process. Eight adult cat cadavers were used. For every kilogram of weight, 120ml of fixative solution (95% 96GL ethyl alcohol and 5% pure glycerin) was applied via the external common carotid artery. Next, the carcasses were placed in a container with 96 GL ethyl alcohol for 60 days. After fixing, all carcasses were preserved in a 30% sodium chloride solution for 60 days. Before fixation, control samples were collected from fresh cadavers and after fixation, three skin and jejunum fragments from each cadaver were tested monthly for strength and displacement until complete rupture in a universal testing machine. All results were analyzed by F-test (P <0.05). In the jejunum, the force required to rupture the fresh samples and the samples fixed in alcohol for 60 days was 31.27±19.14N and 29.25±11.69N, respectively. For the samples preserved in the sodium chloride solution for 30 and 60 days, the strength was 26.17±16.18N and 30.57±13.77N, respectively. In relation to the displacement required for the rupture of the samples, the values of fresh specimens and those fixed in alcohol for 60 days was 2.79±0.73mm and 2.80±1.13mm, respectively. For the samples preserved for 30 and 60 days with sodium chloride solution, the displacement was 2.53±1.03mm and 2.83±1.27mm, respectively. There was no statistical difference between the samples (P=0.68 with respect to strength, and P=0.75 with respect to displacement). In the skin, the force needed to rupture the fresh samples and the samples fixed for 60 days in alcohol was 223.86±131.5N and 211.86±137.53N respectively. For the samples preserved in sodium chloride solution for 30 and 60 days, the force was 227.73±129.06 and 224.78±143.83N, respectively. In relation to the displacement required for the rupture of the samples, the values of fresh specimens and those fixed in alcohol for 60 days were 3.67±1.03mm and 4.11±0.87mm, respectively. For the samples preserved for 30 and 60 days with sodium chloride solution, the displacement was 4.21±0.93mm and 3.93±0.71mm, respectively. There was no statistical difference between the samples (P=0.65 with respect to strength, and P=0.98 with respect to displacement). The resistance of the skin and intestines of the cat carcasses suffered little change when subjected to alcohol fixation and preservation in sodium chloride solution, each for 60 days, which is promising for use in surgery training. All experimental procedures were approved by the Municipal Legal Department (protocol 02.2014.000027-1). The project was funded by FAPESP (protocol 2015-08259-9).

Keywords: anatomy, conservation, fixation, small animal

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Authors: A. Shoiynbek, K. Kozhakhmet, P. Menezes, D. Kuanyshbay, D. Bayazitov

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Speech emotion recognition has received increasing research interest all through current years. There was used emotional speech that was collected under controlled conditions in most research work. Actors imitating and artificially producing emotions in front of a microphone noted those records. There are four issues related to that approach, namely, (1) emotions are not natural, and it means that machines are learning to recognize fake emotions. (2) Emotions are very limited by quantity and poor in their variety of speaking. (3) There is language dependency on SER. (4) Consequently, each time when researchers want to start work with SER, they need to find a good emotional database on their language. In this paper, we propose the approach to create an automatic tool for speech emotion extraction based on facial emotion recognition and describe the sequence of actions of the proposed approach. One of the first objectives of the sequence of actions is a speech detection issue. The paper gives a detailed description of the speech detection model based on a fully connected deep neural network for Kazakh and Russian languages. Despite the high results in speech detection for Kazakh and Russian, the described process is suitable for any language. To illustrate the working capacity of the developed model, we have performed an analysis of speech detection and extraction from real tasks.

Keywords: deep neural networks, speech detection, speech emotion recognition, Mel-frequency cepstrum coefficients, collecting speech emotion corpus, collecting speech emotion dataset, Kazakh speech dataset

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Authors: A. Dionísio, L. Roseiro, J. Fonseca, P. Nicolau

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Thermography is a non-radiating and contact-free technology which can be used to monitor skin temperature. The efficiency and safety of thermography technology make it a useful tool for detecting and locating thermal changes in skin surface, characterized by increases or decreases in temperature. This work intends to be a contribution for the use of thermography as a methodology for evaluation of skin temperature in the context of orofacial biomechanics. The study aims to identify the oscillations of skin temperature in the left and right hemiface regions of the masseter muscle, during and after thermal stimulus, and estimate the time required to restore the initial temperature after the application of the stimulus. Using a FLIR T430sc camera, a data acquisition protocol was followed with a group of eight volunteers, aged between 22 and 27 years. The tests were performed in a controlled environment with the volunteers in a comfortably static position. The thermal stimulus involves the use of an ice volume with controlled size and contact surface. The skin surface temperature was recorded in two distinct situations, namely without further stimulus and with the additions of a stimulus obtained by a chewing gum. The data obtained were treated using FLIR Research IR Max software. The time required to recover the initial temperature ranged from 20 to 52 minutes when no stimulus was added and varied between 8 and 26 minutes with the chewing gum stimulus. These results show that recovery is faster with the addition of the stimulus and may guide clinicians regarding the pre and post-operative times with ice therapy, in the presence or absence of mechanical stimulus that increases muscle functions (e.g. phonetics or mastication).

Keywords: thermography, orofacial biomechanics, skin temperature, ice therapy

Procedia PDF Downloads 255

Authors: S. Yeo, M. Mathur

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Introduction: Obesity, defined as a Body Mass Index (BMI) of more than or equal to 30kg/m, is associated with an increased risk of complications during pregnancy and delivery. During labour, obese mothers often require greater intervention and have higher rates of caesarean section. Despite a low overall rate of serious complications following caesarean section, a high BMI predisposes to a higher risk of postoperative complications. Our study, therefore, aimed to investigate the impact of antenatal obesity on adverse outcomes following caesarean section, particularly wound-related infections. Materials and Methods: A retrospective cohort study of all caesarean deliveries during the first quarter of a chosen year was undertaken in our hospital, which is a tertiary referral centre with > 12,000 deliveries per year. Patients’ health records and data from our hospital’s electronic labour and delivery database were reviewed. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS), and odds ratios plus adjusted odd ratios were calculated with 95% confidence intervals (CI). Results: A total of 1829 deliveries were reviewed during our study period. Of these, 180 (9.8%) patients were obese. The rate of caesarean delivery was 48.9% in obese patients versus 28.1% in non-obese patients. Post-operatively, 17% of obese patients experienced wound infection versus 0.2% of non-obese patients. Obese patients were also more likely to experience major postpartum haemorrhage (4.6% vs. 0.2%) and postpartum pyrexia (18.2% vs. 5.0%) in comparison to non-obese patients. Conclusions: Obesity is a significant risk factor in the development of postoperative complications following caesarean section. Wound infection remains a major concern for obese patients undergoing major surgery and results in extensive morbidity during the postnatal period. Postpartum infection can prolong recovery and affect maternal mental health, leading to reduced perinatal bonding with long-term implications on breastfeeding and parenting confidence. This study supports the need for the development of standardized protocols specifically for obese patients undergoing caesarean section. Multidisciplinary team care, in conjunction with anaesthesia, family physicians, and plastic surgery counterparts, early on in the antenatal journey, may be beneficial where wound complications are anticipated and to minimize the burden of postoperative infection in obese mothers.

Keywords: pregnancy, obesity, caesarean, infection

Procedia PDF Downloads 82

Authors: Saima Ali, Liaqat Ali, Nasir Orakzai

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Background: Hydronephrosis is the most common abnormal finding in the urinary tract on prenatal screening with Ultrasonography. The prenatal hydronephrosis is a diagnostic dilemma in differentiating between obstructive variant versus physiologic hydronephrosis. The assessment and prompt diagnosis of prenatal hydronephrosis is important because of the fact that untreated obstructive hydronephrosis usually leads to recurrent UTI, Urosepsis, deterioration of renal functions, non-functioning kidneys, and even end-stage renal disease. Objectives: To determine the etiology and outcome of postnatal treatment of children with prenatal hydronephrosis in two teaching hospitals of Khyber Pakhtunkhwa (KPK) Methods: It is a multicentric descriptive study that was conducted in department of Paediatrics in Kuwait teaching hospital Peshawar and Department of Urology in Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from January 2008 till December 2010. Total numbers of 64 neonates were included in the study with the mean follow-up of 14.5 months. All the diagnostic data in prenatal, postnatal data, and operative and non-operative data were collected on structured Proforma and was analyzed on SPSS version 17. Results: Out of 64 patients, 39 (60.9 %) were male while 25 were female. 52 patients had unilateral while 12 patients had bilateral hydronephrosis. Based upon prenatal USG in term of AP diameter, 37 (57 %) patients had mild hydronephrosis (5-10 mm AP diameter), 14 patients had moderate hydronephrosis (10-15 mm AP diameter) while 13 patients had gross hydronephrosis (More than 15mm). Regarding etiology, 44(76 %) patients were labeled as physiologic hydronephrosis, 11 patients (9.3%) with PUJ obstruction, 5 patients with Vesicoureteric reflux (VUR) and 4 patients with posterior urethral valves. Surgery was performed in total of 15 (23.4%) patients that included open Pyeloplasty in 11 patients, Vesicostomy followed by posterior valve fulguration in 4 patients. All the patients of VUR treated medically. The severity in the grade of prenatal hydronephrosis is significantly associated with the need for definitive urological surgery p < 0.005. Ancillary procedures like percutaneous nephrostomy (PCN) were inserted 7 patients. Conclusions: Prenatal hydronephrosis is a common ailment associated with significant morbidity. Physiological Hydronephrosis and VUR can be successfully treated with medical treatment. However obstructive PUJ obstructions and posterior urethral valves require surgical correction with a good success rate.

Keywords: prenatal hydronephrosis, Pelviureteric Junction (PUJ) Obstruction, vesicoureteric reflux, posterior urethral valve, renography

Procedia PDF Downloads 246

Authors: S. M. A. Ismail, M. I. Ibrahim, H. Masdar, F. M. Effendi, M. F. Suhaimi, A. Suun

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Introduction: It is generally known that the rehabilitation process is as important as the reconstruction surgery. Several literature has focused on how early the rehabilitation modalities can be initiated after the surgery to ensure a safe return of patients to sports or at least regaining the pre-injury level of function following an ACL reconstruction. Objectives: The main objective is to study and evaluate the outcome of early balance exercises and agility training in sports rehabilitation for patients post ACL reconstruction. To compare between early balance exercises and agility training as intervention and control. (material or non-material). All of them were recruited for material exercise (balance exercises and agility training with strengthening) and strengthening only rehabilitation protocol (non-material). Followed the prospective intervention trial. Materials and Methods: Post-operative ACL reconstruction patients performed in Selayang and Sg Buloh Hospitals from 2012 to 2014 were selected for this study. They were taken from Malaysian Knee Ligament Registry (MKLR) and all patients had single bundle reconstruction with autograft hamstring tendon (semitendinosus and gracilis). ACL injury from any type of sports were included. Subjects performed various type of physical activity for rehabilitation in every 18 week for a different type of rehab activity. All subject attended all 18 sessions of rehabilitation exercises and evaluation was done during the first, 9th and 18th session. Evaluation format were based on clinical assessment (anterior drawer, Lachmann, pivot shift, laxity with rolimeter, the end point and thigh circumference) and scoring (Lysholm Knee scoring and Tegner Activity Level scale). Rehabilitation protocol initiated from 24 week after the surgery. Evaluation format were based on clinical assessment (anterior drawer, Lachmann, pivot shift, laxity with rolimeter, the end point and thigh circumference) and scoring (Lysholm Knee scoring and Tegner Activity Level scale). Results and Discussion: 100 patients were selected of which 94 patients are male and 6 female. Age range is 18 to 54 year with the average of 28 years old for included 100 patients. All patients are evaluated after 24 week after the surgery. 50 of them were recruited for material exercise (balance exercises and agility training with strengthening) and 50 for strengthening only rehabilitation protocol (non-material). Demographically showed 85% suffering sports injury mainly from futsal and football. 39 % of them have abnormal BMI (26 – 38) and involving of the left knee. 100% of patient had the basic radiographic x-ray of knee and 98% had MRI. All patients had negative anterior drawer’s, Lachman test and Pivot shift test during the post ACL reconstruction after the complete rehabilitation. There was 95 subject sustained grade I injury, 5 of grade II and 0 of grade III with 90% of them had soft end-point. Overall they scored badly on presentation with 53% of Lysholm score (poor) and Tegner activity score level 3/10. After completing 9 weeks of exercises, of material group 90% had grade I laxity, 75% with firm end-point, Lysholm score 71% (fair) and Tegner activity level 5/10 comparing non-material group who had 62% of grade I laxity , 54% of firm end-point, Lyhslom score 62 % (poor) and Tegner activity level 4/10. After completed 18 weeks of exercises, of material group maintained 90% grade I laxity with 100 % with firm end-point, Lysholm score increase 91% (excellent) and Tegner activity level 7/10 comparing non-material group who had 69% of grade I laxity but maintained 54% of firm end-point, Lysholm score 76% (fair) and Tegner activity level 5/10. These showed the improvement were achieved fast on material group who have achieved satisfactory level after 9th cycle of exercises 75% (15/20) comparing non-material group who only achieved 54% (7/13) after completed 18th session. Most of them were grade I. These concepts are consolidated into our approach to prepare patients for return to play including field testing and maintenance training. Conclusions: The basic approach in ACL rehabilitation is to ensure return to sports at post-operative 6 month. Grade I and II laxity has favourable and early satisfactory outcome base on clinical assessment and Lysholm and Tegner scoring point. Reduction of laxity grading indicates satisfactory outcome. Firm end-point showed the adequacy of rehabilitation before starting previous sports game. Material exercise (balance exercises and agility training with strengthening) were beneficial and reliable in order to achieve favourable and early satisfactory outcome comparing strengthening only (non-material).We have identified that rehabilitation protocol varies between different patients. Therefore future post ACL reconstruction rehabilitation guidelines should look into focusing on rehabilitation techniques instead of time.

Keywords: post anterior cruciate ligament (ACL) reconstruction, single bundle, hamstring tendon, sports rehabilitation, balance exercises, agility balance

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Authors: Priyanka Yadav, Umesh Bnasal, Yashvinder Kumar

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The placenta is an important structure that provides oxygen and nutrients to the growing fetus in utero. It is usually thrown away after birth, but it has a therapeutic role in the regeneration of tissue. It is covered by the amniotic membrane, which can be easily separated into the amnion layer and the chorion layer—the amnion layer act as a biofilm for the healing of burn wound and non-healing ulcers. The freshly collected membrane has stem cells, cytokines, growth factors, and anti-inflammatory properties, which act as a biofilm for the healing of wounds. It functions as a barrier and prevents heat and water loss and also protects from bacterial contamination, thus supporting the healing process. The application of Amnion membranes has been successfully used for wound and reconstructive purposes for decades. It is a very cheap and easy process and has shown superior results to allograft and xenograft. However, there are very few case reports of amnion membrane grafting in newborns; we intend to highlight its therapeutic importance in burn injuries in newborns. We present a case of 9 days old male neonate who presented to the neonatal unit of Maulana Azad Medical College with a complaint of fluid-filled blisters and burns wound on the body for six days. He was born outside the hospital at 38 weeks of gestation to a 24-year-old primigravida mother by vaginal delivery. The presentation was cephalic and the amniotic fluid was clear. His birth weight was 2800 gm and APGAR scores were 7 and 8 at 1 and 5 minutes, respectively. His anthropometry was appropriate for gestational age. He developed respiratory distress after birth requiring oxygen support by nasal prongs for three days. On the day of life three, he developed blisters on his body, starting from than face then over the back and perineal region. At a presentation on the day of life nine, he had blisters and necrotic wound on the right side of the face, back, right shoulder and genitalia, affecting 60% of body surface area with full-thickness loss of skin. He was started on intravenous antibiotics and fluid therapy. Pus culture grew Pseudomonas aeuroginosa, for which culture-specific antibiotics were started. Plastic surgery reference was taken and regular wound dressing was done with antiseptics. He had a storming course during the hospital stay. On the day of life 35 when the baby was hemodynamically stable, amnion membrane grafting was done on the wound site; for the grafting, fresh amnion membrane was removed under sterile conditions from the placenta obtained by caesarean section. It was then transported to the plastic surgery unit in half an hour in a sterile fluid where the graft was applied over the infant’s wound. The amnion membrane grafting was done twice in two weeks for covering the whole wound area. After successful uptake of amnion membrane, skin from the thigh region was autografted over the whole wound area by Meek technique in a single setting. The uptake of autograft was excellent and most of the areas were healed. In some areas, there was patchy regeneration of skin so dressing was continued. The infant was discharged after three months of hospital stay and was later followed up in the plastic surgery unit of the hospital.

Keywords: amnion membrane grafting, autograft, meek technique, newborn, regeneration of skin

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Authors: Flora Tajiki

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Undoubtedly, the desire to experience the beauty of motherhood is a dream for every woman, and delays in achieving this can have significant psychological consequences. Endometriosis, which is the presence of endometrial tissue in organs other than the uterus, can cause infertility through adhesion and inflammation. The fallopian tubes play a crucial role in transferring the egg to the uterus; if adhesions are present, the chances of natural pregnancy decrease, while the likelihood of ectopic pregnancy and miscarriage increases. In cases of mild adhesions observed during hysterosalpingography or laparoscopy, the tubes may open, but in severe adhesions, this is usually not possible. The aim of this study is to assess the effectiveness of a healthy lifestyle combined with massage of the uterine and ovarian areas in relieving adhesions in the fallopian tubes and treating the complications of endometriosis. This case study focuses on a 33-year-old woman, who married at 20, and experienced a miscarriage five years ago that required curettage. Following this, a hysterosalpingography revealed blockages in both fallopian tubes. A laparoscopic examination also indicated endometriosis and specialists in infertility ruled out the possibility of natural pregnancy. Three years ago, she underwent an unsuccessful IVF procedure. Two years ago, she began a lifestyle modification program that included improving sleep patterns, eliminating sugar and preservatives, avoiding red meat and gluten, eating a balanced diet, walking, exercising, and incorporating beneficial foods like olive oil, almonds, and nutritious vegetables, along with abdominal massage using chamomile oil. She also took vitamin C and vitamin D supplements. After approximately twenty weeks of these methods, and given that infertility centers had indicated that surgery and repeated IVF were the only options for her to conceive, she became pregnant naturally and had a successful pregnancy and delivery. Endometriosis is one of the significant factors contributing to infertility and adhesions in the fallopian tubes and uterus, and unfortunately, it has no definitive cure and can recur even after surgery. The treatment of similar cases emphasizes lifestyle modifications, and this approach has proven to be both cost-effective and harmless. Therefore, it seems essential to focus on this treatment strategy.

Keywords: infertility, endometriosis, adhesions, fallopian tubes, healthy lifestyle, lifestyle modifications, abdominal massage, case study, natural pregnancy, ivf, psychological consequences, uterine health, complementary treatments, nutrition, women's health.

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Authors: Ferah Tesfaye Admasu

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Autism Spectrum Disorder (ASD) often presents significant communication challenges, particularly for non-verbal individuals who struggle to express their needs and emotions effectively. Assistive technologies (AT) have emerged as vital tools in enhancing communication abilities for this population. Recent advancements in artificial intelligence (AI) hold the potential to revolutionize the design and functionality of these technologies. This study explores the application of AI in developing intelligent, adaptive, and user-centered assistive technologies for non-verbal individuals with autism. Through a review of current AI-driven tools, including speech-generating devices, predictive text systems, and emotion-recognition software, this research investigates how AI can bridge communication gaps, improve engagement, and support independence. Machine learning algorithms, natural language processing (NLP), and facial recognition technologies are examined as core components in creating more personalized and responsive communication aids. The study also discusses the challenges and ethical considerations involved in deploying AI-based AT, such as data privacy and the risk of over-reliance on technology. Findings suggest that integrating AI into assistive technologies can significantly enhance the quality of life for non-verbal individuals with autism, providing them with greater opportunities for social interaction and participation in daily activities. However, continued research and development are needed to ensure these technologies are accessible, affordable, and culturally sensitive.

Keywords: artificial intelligence, autism spectrum disorder, non-verbal communication, assistive technology, machine learning

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Authors: Farzad Masoud Kabir, Jamshid Bagheri, Khosro Barkhordari

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This historical cohort study included 17,751 patients patients who underwent isolated CABG at our center between 2007 and 2016. The endpoints of this study were all-cause mortality and major adverse cardio-cerebrovascular events (MACCEs), comprising acute coronary syndromes, cerebrovascular accidents, and all-cause mortality at five years. Our findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs.

Keywords: body mass index, surgical outcomes, midterm, cardiac surgery patients

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Authors: G. Sandhya Devi, G. Suvarna Kumar, S. Chandini

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This research work aims to develop a system that will analyze and identify students who indulge in malpractices/suspicious activities during the course of an academic offline examination. Automated Video Surveillance provides an optimal solution which helps in monitoring the students and identifying the malpractice event immediately. This work is organized into three modules. The first module deals with performing an impersonation check using a PCA-based face recognition method which is done by cross checking his profile with the database. The presence or absence of the student is even determined in this module by implementing an image registration technique wherein a grid is formed by considering all the images registered using the frontal camera at the determined positions. Second, detecting such facial malpractices in which a student gets involved in conversation with another, trying to obtain unauthorized information etc., based on the threshold range evaluated by considering his/her mouth state whether open or closed. The third module deals with identification of unauthorized material or gadgets used in the examination hall by training the positive samples of the object through various stages. Here, a top view camera feed is analyzed to detect the suspicious activities. The system automatically alerts the administration when any suspicious activities are identified, thereby reducing the error rate caused due to manual monitoring. This work is an improvement over our previous work published in identifying suspicious activities done by examinees in an offline examination.

Keywords: impersonation, image registration, incrimination, object detection, threshold evaluation

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Authors: Darawan Augsornwan, Artitaya Sabangbal, Maneewan Srijan, Kanokarn Kongpitee, Lalida Petphai, Palakorn Surakunprapha

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Background: Srinagarind Hospital, Ward 3C, has patients with head and neck cancer, congenital urology anomalies such as hypospadis, cleft lip and cleft palate and congenital megacolon who need surgery. Undergoing surgery is a difficult time for patients/ family; they feel fear and anxiety. Nurses work closely with patients and family for 24 hours in the process of patients care, so should have the good nursing ability, innovation and an efficient nursing care system to promote patients self-care ability reducing suffering and preventing complications. From previous nursing outcomes we found patients did not receive appropriate information, could not take care of their wound, not early ambulation after the operation and lost follow-up. Objective: to develop the nursing system for patients who were undergoing an operation. Method: this is a participation action research. The sample population was 11 nurses and 60 patients. This study was divided into 3 phase: Phase 1. Situation review In this phase we review the clinical outcomes, the process of care from documents such as nurses note and interview nurses, patients and family about the process of care by nurses. Phase 2: focus group with 11 nurses, searching guideline for specific care, nursing care system then establish the protocol. This phase we have the protocol for giving information, teaching protocol and teaching record, leaflet for all of top five diseases, make video media to convey information, ambulation package and protocol for patients with head and neck cancer, patients zoning, primary nurse, improved job description for each staff level. Program to record number of patients, kind of medical procedures for showing nurses activity each day. Phase 3 implementation and evaluation. Result: patients/family receive appropriate information about deep breathing exercise, cough, early ambulation after the operation, information during the stay in the hospital. Patients family satisfaction is 95.04 percent, appropriate job description for a practical nurse, nurse aid, and worker. Nurses satisfaction is 95 percent. The complications can be prevented. Conclusion: the nursing system is the dynamic process using evidence to develop nursing care. The appropriate system depends on context and needs to keep an eye on every event.

Keywords: development, nursing system, patients undergoing operation, 3C Ward

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Authors: Raymond Xu, Ashley Hua, Andrew Wang, Yuru Lin

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During COVID-19, the depression rate has increased dramatically. Young adults are most vulnerable to the mental health effects of the pandemic. Lower-income families have a higher ratio to be diagnosed with depression than the general population, but less access to clinics. This research aims to achieve early depression detection at low cost, large scale, and high accuracy with an interdisciplinary approach by incorporating clinical practices defined by American Psychiatric Association (APA) as well as multimodal AI framework. The proposed approach detected the nine depression symptoms with Natural Language Processing sentiment analysis and a symptom-based Lexicon uniquely designed for young adults. The experiments were conducted on the multimedia survey results from adolescents and young adults and unbiased Twitter communications. The result was further aggregated with the facial emotional cues analyzed by the Convolutional Neural Network on the multimedia survey videos. Five experiments each conducted on 10k data entries reached consistent results with an average accuracy of 88.31%, higher than the existing natural language analysis models. This approach can reach 300+ million daily active Twitter users and is highly accessible by low-income populations to promote early depression detection to raise awareness in adolescents and young adults and reveal complementary cues to assist clinical depression diagnosis.

Keywords: artificial intelligence, COVID-19, depression detection, psychiatric disorder

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Authors: Wanessa G. Oliveira, Fernando C. Capovilla

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Capovilla and Raphael’s Libras Dictionary documents a corpus of 4,200 Brazilian Sign Language (Libras) signs. Duduchi and Capovilla’s software SignTracking permits users to retrieve signs even when ignoring the gloss corresponding to it and to discover the meaning of all 4,200 signs sign simply by clicking on graphic menus of the sign characteristics (phonemes). Duduchi and Capovilla have discovered that the ease with which any given sign can be retrieved is an inverse function of the average popularity of its component phonemes. Thus, signs composed of rare (distinct) phonemes are easier to retrieve than are those composed of common phonemes. SignTracking offers a means of computing the average popularity of the phonemes that make up each one of 4,200 signs. It provides a precise measure of the degree of ease with which signs can be retrieved, and sign meanings can be discovered. Duduchi and Capovilla’s logarithmic model proved valid: The degree with which any given sign can be retrieved is an inverse function of the arithmetic mean of the logarithm of the popularity of each component phoneme. Capovilla, Raphael and Mauricio’s New Libras Dictionary documents a corpus of 10,400 Libras signs. The present analysis revealed Libras DNA structure by mapping the incidence of 501 sign phonemes resulting from the layered distribution of five parameters: 163 handshape phonemes (CherEmes-ManusIculi); 34 finger shape phonemes (DactilEmes-DigitumIculi); 55 hand placement phonemes (ArtrotoToposEmes-ArticulatiLocusIculi); 173 movement dimension phonemes (CinesEmes-MotusIculi) pertaining to direction, frequency, and type; and 76 Facial Expression phonemes (MascarEmes-PersonalIculi).

Keywords: Brazilian sign language, lexical retrieval, libras sign, sign phonology

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Authors: Ibrahim Mohamed Ibrahim Hassanin, Hany Hassan Mostafa, Mona Mohamed Shaban, Ahlam El Said Kamel

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Background: New so-called minimally invasive devices have been developed to limit groin pain after sling placement for treatment of stress urinary incontinence (SUI) to minimize the risk of postoperative pain and organ perforation. A new generation of suburethral slings was described that avoided skin incision to pull out and tension the sling. Evaluation of this device through prospective short-term series has shown controversial results compared with other tension-free techniques. The aim of this study is to compare success rates and complications for tension-free vaginal tape secur (TVT secur) and trans-obturator sub urethral tape inside-out technique (TVT-O) for treatment of stress urinary incontinence (SUI). Materials and Methods: Fifty patients with genuine SUI were divided into two groups: group S (n=25) were operated upon using (TVT secur) and group O (n=25) were operated upon using trans-obturator suburethral tape inside-out technique (TVT-O). Success rate, quality of life and postoperative complications such as groin pain, urgency, urine retention and vaginal tape erosion were reported in both groups at one, three, and six months after surgery. Results: As regards objective cure rate at one, three, six months intervals; there was a significant difference between group S (56%, 64%, and 60%), and group O (80%, 88%, and 88%) respectively (P <0.05). As regards subjective cure rate at one, three, six months intervals; there was a significant difference between group S (44%, 44%, and 48%), and group O (76%, 80%, and 80%) respectively (P <0.05). Quality of life (QoL) parameters improved significantly in cured patients with no difference between both groups. As regards complications, group O had a higher frequency of complications than group S; groin pain (12% vs 12% p= 0.05), urgency (4% (1 case) vs 0%), urine retention (8% (2 cases) vs 0%), vaginal tape erosion (4% (1 case) vs 0%). No cases were complicated with wound infection. Conclusion: Compared to TVT secur, TVT-O showed higher subjective and objective cure rates after six months but higher rate of complications. Both techniques were comparable as regards improvement of quality of life after surgery.

Keywords: stress urinary incontinence, trans-vaginal tape-obturator, TVT Secur, TVT-O

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Authors: Madeleine Cox

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Objective: discussion of diagnosis of vernix caseosa peritonitis, recovery and subsequent caesarean seciton Case: 30 year old G4P1 presented in labour at 40 weeks, planning a vaginal birth afterprevious caesarean section. She underwent an emergency caesarean section due to concerns for fetal wellbeing on CTG. She was found to have a thin lower segment with a very small area of dehiscence centrally. The operation was uncomplicated, and she recovered and went home 2 days later. She then represented to the emergency department day 6 post partum feeling very unwell, with significant abdominal pain, tachycardia as well as urinary retention. Raised white cell count of 13.7 with neutrophils of 11.64, CRP of 153. An abdominal ultrasound was poorly tolerated by the patient and did not aide in the diagnosis. Chest and abdominal xray were normal. She underwent a CT chest and abdomen, which found a small volume of free fluid with no apparent collection. Given no obvious cause of her symptoms were found and the patient did not improve, she had a repeat CT 2 days later, which showed progression of free fluid. A diagnostic laparoscopy was performed with general surgeons, which reveled turbid fluid, an inflamed appendix which was removed. The patient improved remarkably post operatively. The histology showed periappendicitis with acute appendicitis with marked serosal inflammatory reaction to vernix caseosa. Following this, the patient went on to recover well. 4 years later, the patient was booked for an elective caesarean section, on entry into the abdomen, there were very minimal adhesions, and the surgery and her subsequent recovery was uncomplicated. Discussion: this case represents the diagnostic dilemma of a patient who presents unwell without a clear cause. In this circumstance, multiple modes of imaging did not aide in her diagnosis, and so she underwent diagnostic surgery. It is important to evaluate if a patient is or is not responding to the typical causes of post operative pain and adjust management accordingly. A multiteam approach can help to provide a diagnosis for these patients. Conclusion: Vernix caseosa peritonitis is a rare cause of acute abdomen post partum. There are few reports in the literature of the initial presentation and no reports on the possible effects on future pregnancies. This patient did not have any complications in her following pregnancy or delivery secondary to her diagnosis of vernix caseosa peritonitis. This may assist in counselling other women who have had this uncommon diagnosis.

Keywords: peritonitis, obstetrics, caesarean section, pain

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Authors: Ashwini Patil

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Caudal block is one of the most commonly used regional anesthetic techniques in children. Currently, fentanyl is used as an adjuvant to bupivacaine to prolong analgesia but fentanyl is a narcotic. Dexamethasone, a glucocorticoid with strong anti-inflammatory effects provides improvement in post-operative analgesia and post-operative side effects. However, its analgesic efficacy and safety in comparison with fentanyl has not been extensively studied. So the objective of this randomized controlled study is to compare dexamethasone with fentanyl as an adjuvant to bupivacaine for caudal block in children in relation to the duration of caudal analgesia, post-operative analgesic requirement and incidence of post-operative nausea and vomiting. This study included 100 children, aged 1–6 years, undergoing lower abdominal surgeries. Patients were randomized into two groups, 50 each to receive a combination of dexamethasone 0.2 mg/kg along with 1 ml/kg bupivacaine 0.25% (group A) or combination of fentanyl (1 ug/kg) along with 1ml/kg bupivacaine 0.25% (group B). In the post-operative period, pain was assessed using a Modified Objective Pain Scale (MOPS) until 12 hr after surgery and rescue analgesia is administered when MOPS score 4 or more is recorded. Residual motor block, number of analgesic doses required within 24 hr after surgery, sedation scores, intra-operative and post-operative hemodynamic variables, post-operative nausea and vomiting (PONV), and other adverse effects were recorded. Data is analysed using unpaired t test and Significance level of P< 0.05 is considered statistically significant. Group A showed a significantly longer time to first analgesic requirement than group B (p<0.05). The number of rescue analgesic doses required in the first 24 h was significantly less in group A (p<0.05). Group A showed significantly lower MOPS scores than group B(p<0.05). Intra-operative and post-operative hemodynamic variables, Modified Bromage Scale scores, and sedation scores were comparable in both the groups. Group A showed significantly fewer incidences of PONV compared with group B(p<0.05). This study reveals that adding dexamethasone to bupivacaine prolongs the duration of postoperative analgesia and decreases the incidence of PONV as compared to combination of fentanyl to bupivacaine after a caudal block in pediatric patients.

Keywords: bupivacaine, caudal analgesia, dexamethasone, pediatric

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Authors: Aisultan Shoiynbek, Darkhan Kuanyshbay, Paulo Menezes, Akbayan Bekarystankyzy, Assylbek Mukhametzhanov, Temirlan Shoiynbek

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Speech emotion recognition (SER) has received increasing research interest in recent years. It is a common practice to utilize emotional speech collected under controlled conditions recorded by actors imitating and artificially producing emotions in front of a microphone. There are four issues related to that approach: emotions are not natural, meaning that machines are learning to recognize fake emotions; emotions are very limited in quantity and poor in variety of speaking; there is some language dependency in SER; consequently, each time researchers want to start work with SER, they need to find a good emotional database in their language. This paper proposes an approach to create an automatic tool for speech emotion extraction based on facial emotion recognition and describes the sequence of actions involved in the proposed approach. One of the first objectives in the sequence of actions is the speech detection issue. The paper provides a detailed description of the speech detection model based on a fully connected deep neural network for Kazakh and Russian. Despite the high results in speech detection for Kazakh and Russian, the described process is suitable for any language. To investigate the working capacity of the developed model, an analysis of speech detection and extraction from real tasks has been performed.

Keywords: deep neural networks, speech detection, speech emotion recognition, Mel-frequency cepstrum coefficients, collecting speech emotion corpus, collecting speech emotion dataset, Kazakh speech dataset

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Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

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Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

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Authors: Seham El Kareh, Miramar Etman

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Recently, detecting liars and extracting features which distinguish them from truth-tellers have been the focus of a wide range of disciplines. To the author’s best knowledge, most of the work has been done on facial expressions and body gestures but only few works have been done on the language used by both liars and truth-tellers. This paper sheds light on four axes. The first axis copes with building an audio corpus for deceptive and truthful speech for Egyptian Arabic speakers. The second axis focuses on examining the human perception of lies and proving our need for computational linguistic-based methods to extract features which characterize truthful and deceptive speech. The third axis is concerned with building a linguistic analysis program that could extract from the corpus the inter- and intra-linguistic cues for deceptive and truthful speech. The program built here is based on selected categories from the Linguistic Inquiry and Word Count program. Our results demonstrated that Egyptian Arabic speakers on one hand preferred to use first-person pronouns and present tense compared to the past tense when lying and their lies lacked of second-person pronouns, and on the other hand, when telling the truth, they preferred to use the verbs related to motion and the nouns related to time. The results also showed that there is a need for bigger data to prove the significance of words related to emotions and numbers.

Keywords: Egyptian Arabic corpus, computational analysis, deceptive features, forensic linguistics, human perception, truthful features

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Authors: Ciro Cursio, Giulia Cursio, Pio Luigi Cursio, Luigi Cursio

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Communication between practitioner and patient is of the utmost importance in aesthetic medicine: as of today, images of previous treatments are the most common tool used by doctors to describe and anticipate future results for their patients. However, using photos of other people often reduces the engagement of the prospective patient and is further limited by the number and quality of pictures available to the practitioner. Pre-existing work solves this issue in two ways: 3D scanning of the area with manual editing of the 3D model by the doctor or automatic prediction of the treatment by warping the image with hand-written parameters. The first approach requires the manual intervention of the doctor, while the second approach always generates results that aren’t always realistic. Thus, in one case, there is significant manual work required by the doctor, and in the other case, the prediction looks artificial. We propose an AI-based algorithm that autonomously generates a realistic prediction of treatment results. For the purpose of this study, we focus on hyaluronic acid treatments in the facial area. Our approach takes into account the individual characteristics of each face, and furthermore, the prediction system allows the patient to decide which area of the face she wants to modify. We show that the predictions generated by our system are realistic: first, the quality of the generated images is on par with real images; second, the prediction matches the actual results obtained after the treatment is completed. In conclusion, the proposed approach provides a valid tool for doctors to show patients what they will look like before deciding on the treatment.

Keywords: prediction, hyaluronic acid, treatment, artificial intelligence

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Authors: Yelena Mazour-Matusevich, Jean-Robert Ancheta

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This study is based on more than fifteen years of experience of teaching a foreign language, in my case French, to the English-speaking students. It represents a qualitative research on foreign language learners’ reaction and their gains in terms of vocabulary and listening comprehension through repeatedly viewing foreign feature films with the original sountrack but without English subtitles. The initial idea emerged upon realization that the first challenge faced by my students when they find themselves in a francophone environment has been their lack of listening comprehension. Their inability to understand colloquial speech affects not only their academic performance, but their psychological health as well. To remedy this problem, I have designed and applied for many years my own teaching method based on one particular French film, exceptionally suited, for the reasons described in detail in the paper, for the intermediate-advanced level foreign language learners. This project, conducted together with my undergraduate assistant and mentoree J-R Ancheta, aims at showing how the paralinguistic features, such as characters’ facial expressions, settings, music, historical background, images provided before the actual viewing, etc., offer crucial support and enhance students’ listening comprehension. The study, based on students’ interviews, also offers special pedagogical techniques, such as ‘anticipatory’ vocabulary lists and exercises, drills, quizzes and composition topics that have proven to boost students’ performance. For this study, only the listening proficiency and vocabulary gains of the interviewed participants were assessed.

Keywords: comprehension, film, listening, subtitles, vocabulary

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Authors: Aena Iqbal

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The lack of access to maternal and reproductive health in Pakistan poses a great threat to global public health. Obstetric issues, including vesicovaginal fistulas (VVF), are the most common in South Asian countries, leaving women in a more vulnerable state. Koohi Goth Women’s Hospital offers free VVF operations, which draws in women from all over Pakistan. Although reproductive health is being handled, mental health is often neglected in these scenarios. Using a series of questions inspired by the Warwick Edinburgh Model, this paper builds on the results from interviewing women who have received vesicovaginal fistula repair surgery on their mental health, a taboo topic in Pakistan.

Keywords: obstetrics, VVF, Pakistan, reproductive health

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Authors: Amin Masoumiganjgah, Luke Salmon, Julianne Burnton, Fahimeh Bagheri, Gavin Lenton, S. L. Ezekial Tan

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Introduction: The incidence of proximal biceps tenodesis and acute distal biceps repair is increasing, and rehabilitation protocols following both are variable. Golf is a popular sport within Australia, and the Gold Coast has become a Mecca for golfers, with more courses per capita than anywhere else in the world. Currently, there are no clear guidelines regarding return to golf play following biceps procedures. The aim of this study was to determine biceps brachii activation during the golf swing through electromyographic analysis, and subsequently, aid in rehabilitation guidelines and return to golf following tenodesis and repair. Methods: Subjects were amateur golfers with no previous upper limb surgery. Surface electromyography (EMG) and high-speed video recording were used to analyse activation of the left and right biceps brachii and the anterior deltoid during the golf swing. Each participant’s maximum voluntary contraction (MVC) was recorded, and they were then required to hit a golf ball aiming for specific distances of 2, 50, 100 and 150 metres at a driving range. Noraxon myoResearch and Matlab were used for data analysis. Mean % MVC was calculated for leading and trailing arms during the full swing and its’ 4 phases: back-swing, acceleration, early follow-through and late follow-through. Results: 12 golfers (2 female and 10 male), participated in the study. Median age was 27 (25 – 38), with all being right handed. Over all distances, the mean activation of the short and long head of biceps brachii was < 10% through the full swing. When breaking down the 50, 100 and 150m swing into phases, mean MVC activation was lowest in backswing (5.1%), followed by acceleration (9.7%), early follow-through (9.2%), and late follow-through (21.4%). There was more variation and slightly higher activation in the right biceps (trailing arm) in backswing, acceleration, and early follow-through; with higher activation in the leading arm in late follow-through (25.4% leading, 17.3% trailing). 2m putts resulted in low MVC values (3.1% ) with little variation across swing phases. There was considerable individual variation in results – one tense subject averaged 11.0% biceps MVC through the 2m putting stroke and others recorded peak mean MVC biceps activations of 68.9% at 50m, 101.3% at 100m, and 111.3% at 150m. Discussion: Previous studies have investigated the role of rotator cuff, spine, and hip muscles during the golf swing however, to our knowledge, this is the first study that investigates the activation of biceps brachii. Many rehabilitation programs following a biceps tenodesis or repair allow active range against gravity and restrict strengthening exercises until 6 weeks, and this does not appear to be associated with any adverse outcome. Previous studies demonstrate a range of < 10% MVC is similar to the unloaded biceps brachii during walking(1), active elbow flexion with the hand positioned either in pronation or supination will produce MVC < 20% throughout range(2) and elbow flexion with a 4kg dumbbell can produce mean MVC’s of around 40%(3). Our study demonstrates that increasing activation is associated with the leading arm, increasing shot distance and the late follow-through phase. Although the cohort mean MVC of the biceps brachii is <10% through the full swing, variability is high and biceps activation reach peak mean MVC’s of over 100% in different swing phases for some individuals. Given these EMG values, caution is advised when advising patients post biceps procedures to return to long distance golf shots, particularly when the leading arm is involved. Even though it would appear that putting would be as safe as having an unloaded hand out of a sling following biceps procedures, the variability of activation patterns across different golfers would lead us to caution against accelerated golf rehabilitation in those who may be particularly tense golfers. The 50m short iron shot was too long to consider as a chip shot and more work can be done in this area to determine the safety of chipping.

Keywords: electromyographic analysis, biceps brachii rupture, golf swing, tendon surgery

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