DIAGNOSTIC INDEXES FINDINGS IN EARLY STAGES OF APPENDICITIS (DIFESA STUDY): A REANALYSIS FROM THE POSAW STUDY DATABASE
Purpose: The resection of a normal-looking appendix during laparoscopic appendicectomy (LA) remains a dilemma. The optimal approach requires reliable macroscopic judgment by the surgeons. The aim of this study is to assess the surgeon’s ability to laparoscopically diagnose acute appendicitis (AA) in its initial uncomplicated grades. Method: Subgroup analysis from the POSAW study, 2016. Patients diagnosed with initial grades of AA (0 – 1) who underwent LA were included (n=718). The median age was 29.4 years, and 52% were female. The accuracy of the macroscopic intraoperative diagnosis was assessed with the histopathological examination of the resected specimens, and the agreement between the surgeon’s and the pathologist’s judgment was established. Results: Of the 79 appendices classified intraoperatively as normal-looking, 18 (22.8%) had some inflammation degree. Of the 639 appendices classified intraoperatively as inflamed, 101 (15.8%) were normal. The intraoperative surgeon’s judgment had an accuracy of 83.4% and a moderate to low agreement (Kappa 0.42). The sensitivity and specificity values were 96.8% and 37.7%, and the positive and negative predictive values were 84.2% and 77.2%, respectively. Conclusion: The surgeon’s intraoperative diagnosis of uncomplicated AA’s initial grades is not sufficiently accurate to establish good reliability for appendicectomy. The surgeon overestimates the presence of appendicular inflammation.
CHALLENGES TO BREASTFEEDING DURING THE FIRST FOUR WEEKS POSTPARTUM AMONG MOTHERS AGED 18 – 29 YEARS, WHO ATTEND SELECTED CLINICS IN ELEUTHERA, THE BAHAMAS
The present study seeks to investigate the breastfeeding challenges mothers on the Bahamian island of Eleuthera face, and propose strategies to improve the situation. Purposive sampling was utilized to recruit mothers from selected health centers in Eleuthera, the Bahamas (N=51). The study utilized a cross-sectional, quantitative research design wherein a forced choice, closeended survey questionnaire using Likert Type scale to elicit data from the research participants. Demographic data was analyzed using descriptive analysis, while ANOVA (Analysis of Variance) was used to determine the relationship between demographic variables (independent variable) and breastfeeding knowledge, attitudes and practices (dependent variables) using the Statistical Package for the Social Sciences (SPSS) Version 26. The findings demonstrated that the relationship between breastfeeding knowledge, attitudes and practices and demographic variables such as educational level, marital status, maternal parity and religion was not statistically significant. The implications of the finding are that health centers can enable mothers to overcome breastfeeding challenges, by improving breastfeeding knowledge through advocacy, education and awareness. Important recommendations pertaining to nursing interventions and social support programs for initiating and continuing breastfeeding among Bahamian mothers and focusing on erasing the social stigma associated with breastfeeding to improve breastfeeding rates were also made.
Exploration of explanatory factors underlying teachers’ perception of learning difficulties in mathematics in interaction with student performances
This study project contributes to documenting the subject of learning difficulties in mathematics [1-4]. In this research, we aimed to verify what are the main explanatory factors underlying teachers’ perception of learning difficulties in mathematics and in relation to student performance in a problem-solving test. To meet the objectives of the study, we implemented a correlational quantitative data analysis devise with the participation of 262 primary school students. Regression analyzes were performed. The results of the analyzes show that the performance in solving a written mathematics questionnaire is explained mainly by socio-demographic variables associated with the students and by factual variables relating to the conditions for taking the questionnaires. Moreover, the teacher’s perception of student performance in mathematics is mainly explained by variables directly related to the student or to the teacher’s vision of the student’s potential for success at school.
Typology of Customer Retention Schemes in the Private Sports Sector During COVID-19: Analyzing the Behavior of Martial Arts Instructors Using Latent Class Analysis
The COVID-19 pandemic brought new challenges in all aspects of life. It largely brought the sports sector to a halt: major events were postponed or canceled, while gyms and training centers were closed due to repeated lockdowns and social distancing rules and regulations. In the private sports sector, some instructors adopted technological means of maintaining contact with their students in an attempt to retain customers and maintain a high volume of cash flow. Our work focuses on the martial arts (MA) sector in Israel during two crucial periods in 2020: The first lockdown of March through June, when all sports activities were banned, and the period following it, when trainers were allowed to commence training under some regulations. Using data collected from 199 MA instructors, we test for their level and means of engagement with trainees during the lockdown, and the impact these had on customer retention in the period that followed. Using latent class analysis, we establish an empirically based typology of retention schemes (low contact, high contact, and maverick), and test whether these influenced the financial performance of MA studios. Our findings show that the financial damage and the return rate of trainees do not vary between the three types. We offer some insights into the uniqueness of the MA field, and how this may explain these counter-intuitive results.
This longitudinal case study conducted at a private University in the northeastern United States explored the impact of the edTPA assessment and preparation process as an embedded component of the University’s educator preparation program. The study tracked 59 graduate level candidates from entry into the program through candidate licensure. The researchers examined the impact of the edTPA preparation process on teacher candidates’ perceptions of their readiness to teach in comparison to their actual readiness to teach as indicated by their edTPA portfolio passing score. The University’s School of Education has an estimated 30% ethnic diversity population, thus a second research question compared perceptions of readiness to teach of candidates of color to those of Caucasian peers. Framed by Bandura’s (1977) self-efficacy theory, this study contributes to the research on the edTPA as an efficacious and inclusive evaluation tool, particularly within diverse schools of education.
My research is a result of accumulated provocation of obsolete and paralyzing education that has been frozen since the middle ages. We have to admit that before the pandemic, education was already in crisis. Governments have been ignoring to adopt any comprehensive plan to reform the educational systems till it has been unprecedently disrupted by COVID-19. I try through this paper to make a global call for governments to immediately start cooperating together for setting international qualifications framework that best suit future competencies. This call should be prioritized on the world agenda. It would be more plausible for governments, UNESCO and other education stakeholders to seize the opportunity of the 2020 disruption of life cycle for the maximum benefit of humanity. For this to happen we need exceptional leaders with extraordinary vision to transform education instead of ensuring children can keep learning and that every single child returns to school after the pandemic. Another challenge to be expected is the reduction in education budgets being under pressure as governments shift spending towards the health and economic response to the pandemic. The impact of schools closing on a generation of children will be immense on the long term. We must act now to save the education and life chances of generations of youth. At this time of unprecedented crisis, the world must come together to protect education and put it at the very heart of the global recovery effort. Recovery, not as before but as convenient and sustainable with the perspective requirements. It is time to expose youth to real life experiences; we need our children to learn about finance from characters like Jef Bezos or Bill Gates or Mukesh Ambani; to learn about psychology from John Anderson, Eliot Aronson and Ahmed Ukasha; to know approaches of math and physics as…
TREATMENT SEQUENCE OF COMBINED PELVIC INJURY, CONSISTED OF UPPER PUBIC RAMUS FRACTURE, SACROILIAC JOINT DISLOCATION WITH OPEN BOOK INJURY, USING STOPPA APPROACH
Among pelvic serious injuries is the so-called “open book” injury of the pelvis, with Sacroiliac Joint Disruption (SIJD) in combination with upper pubic ramus or anterior column fracture, contralateral or ipsilateral, or both. This combination of pelvic injury could be classified according Young and Burgess classification as LCIII or CM type (Combined Mechanism) and as 61-B3.1 61-B3.2 following AO/OTA classification. Specifically, the upper pubic ramus fracture can be classified according to Nakatani classification as type I medial of the foramen, type II within the foramen and type III lateral to the foramen. The difficulty to deal with these fractures is how to close and reduct the pubic symphysis in mechanically stable way since there is fracture in one or both the upper pubic ramus. The existence of these fractured elements, in this type of pelvis injury allow a lot of degrees of freedom which must be managed from the surgeon in the proper sequence. The incision and the approach are also mandatory for successfully treating these lesions. Anterior Intrapelvic Approach (AIP) or Stoppa approach in conjunction with the first window of ilioinguinal approach is the most appropriate surgical exposure for reduction and fixation.
Pilomatricoma is a rare, benign skin tumour arising from the hair matrix. The usual locations are the head and neck. Localization in the lower limbs is exceptional. The diagnosis of certainty is histological. Treatment is complete surgical removal to avoid recurrence. We report in this article the case of a rare localization of a pilomatricoma on the right leg, in a 25-year-old patient operated with complete surgical removal. The postoperative course was simple and without recurrence after 2 months of follow-up.
There are lots of construction projects been implemented in Khartoum State in the last decades. And, in order to implement construction projects successfully, there should be a perfect flow of materials, services and information related to those projects. The provision of providing projects with those essential needs lies within the concept of the logistics management; so, there will be a critical need for developing perfect planning for logistics services. The provision of supplying construction requirements should be conducted and handled in best manner with all the related aspects including quality, safety, time and cost to the proper execution of the construction projects. Many projects are failed and terminated because problems of the flow of logistics services. Those problems are occurred as result of many factors, but bad planning of logistics services is the one of the most important factors. Thus, in order to implement construction projects, there is a great need for the logistics supply service. Because, without delivering construction inputs in the required manner to the location of project, the project shall never be executed. And, in order to provide the project with the needed inputs in the best way and at a required time, there must be an effective planning for the logistics services of projects; in details, there must be a greater concern with the processes of purchasing, transporting and storing, handling as well as flow of information of all materials that used in the execution of projects. The study finds out that applying project management as well as perfect planning of logistics services play vital roles in better execution of construction project in Khartoum State and help maintaining the urban development master plan.
Aim: The aim of this article is to report on the safety and long-term efficacy of Cerament® BoneVoid Filler bone substitute for repairing craniofacial bone defects. Post-traumatic cranioplasty is a complex and challenging procedure for all maxillo-craniofacial surgeons and neurosurgeons, especially when repairing large areas. The standard criterion for repairing small cranial defects is the use autogenous bone from the iliac crest or split calvarial grafts. Autogenous grafts may result in donor-site morbidity, increased surgical time, reabsorption, blood loss, and longer recovery time . Alloplastic materials used for bone repair, such as methyl methacrylate, hydroxyapatite, titanium, or porous polyethylene, are expected to have optimal properties, including easy adaptation, biocompatibility, ingrowth of new tissue, stability of shape, and low rate of reabsorption. A cranial implant should be easily shaped and positioned, allowing easy tissue growth. In very wide cranium defects the new technology is a custom made cranial implant constructed three-dimensionally with different types of materials. However, this procedure is very expensive with various infection rates depending on the kind of material used and on the chemicophysical composition of the implant. Methods: The authors report the case of a 50-year-old man with a severe deformity of the forehead-supra orbital area as a result of a previous complex fronto-facial trauma treated in an emergency Unit. Secondary correction and reconstruction of the residual deformities were performed by using Cerament® Bone Void Filler, an alloplastic biphasic material, composed of 40% hydroxyapatite, 60% calcium sulfate and the radio-contrast agent iohexol. The unique ratio of hydroxyapatite and calcium sulfate is designed to enable Cerament to resorb at the same rate that bone forms. Calcium sulfate acts as a resorbable carrier for hydroxyapatite which is highly osteoconductive, promoting bone ingrowth.It seems to be a promising bone graft substitute in the management of bony irregularities in the fronto-orbital…