Breast Reconstruction Post-Mastectomy : an Assessment of Rates, Limiting Factors and Attitudes at a Tertiary Care Center in Quebec

La reconstruction mammaire post-mastectomie améliore le bien-être psychosocial, et l’image corporelle des patientes. Parcontre, la reconstruction mammaire demeure faiblement utilisée et même inaccessible à des patients dû à des facteurs limitants. Les taux de reconstruction et les facteurs qui influencent l’accès à la reconstruction n’ont pas été évalués dans la province du Québec. Avec une revue de dossier rétrospective, l’objectif de notre étude est d’identifier les taux de reconstruction mammaire dans un centre tertiaire à Montréal et les facteurs qui influencent l’accès à la reconstruction, avec un revu de dossier rétrospective. Ensuite, nous avons évaluer directement dans la même cohorte de patientes, leur désire d’avoir une consultation en chirurgie plastique pour discuter d’une reconstruction. Il y avait un taux total de reconstruction mammaire post-mastectomie de 21%, dont 14% était immédiat et 8% tardif. Les patientes qui ont eu une reconstruction étaient plus jeunes, plus de tendance à avoir une plus grande proportion de mastectomie bilatérale, avaient des cancers non-invasifs et habitaient plus loin de l’hôpital (>10km). Environ la moitié des patientes avec une mastectomie sont intéresser à avoir une consultation avec un chirurgien plasticien mais seulement 38% ont eu une reconstruction. Les chances d’avoir subi une reconstruction, augmentent lorsqu’une reconstruction est offerte et expliquée. Présentement, il existe des barrières autres que les désires de la patiente qui empêchent l’accès à la reconstruction mammaire post-mastectomie.Breast reconstruction post-mastectomy has been shown to improve psychosocial wellbeing, and body image. However, accessibility and acceptance of breast reconstruction is limited, with patients being unequally privileged based a number of limiting factors. To date, no evaluation on the rates of reconstruction and the factors that influence patient access has been performed in the province of Quebec. The objective of the research was two-fold with the first component being to identify the rates of breast reconstruction at a tertiary care center in Montreal and the factors influencing the rates of reconstruction through a retrospective chart review. The second component was to directly evaluate in the same cohort of breast cancer patients; their interest in a consultation with plastic surgery through a telephone questionnaire. There was a total rate of PMBR of 21%, where 14% of patients had an immediate reconstruction and 8% of eligible patients underwent a delayed reconstruction. Patients that received a PMBR were younger, more likely to have bilateral mastectomies, had non-invasive breast cancer and resided further then 10km from the hospital. Approximately half of patients with a mastectomy were interested in consulting a plastic surgeon but only 38% of all patients underwent a reconstruction. The offer and awareness of reconstruction increased the chance of opting to have a reconstruction. There are barriers outside of the patient’s own desires that impede their access to breast reconstruction

An Empirical Analysis of International Stock Market Volatility Transmission

This paper examines the interplay between stock market returns and their volatility, focus ingon the Asian and global financial crises of 1997-98 and 2008-09 for Australia, Singapore, the UK, and the US. We use a multivariate generalised autoregressive conditional heteroskedasticity (MGARCH) model and weekly data (January 1992-June 2009). Based on the results obtained from the mean return equations, we could not find any significant impact on returns arising from the Asian crisis and more recent global financial crises across these four markets. However, both crises significantly increased the stock return volatilities across all of the four markets. Not surprisingly, it is also found that the US stock market is the most crucial market impacting on the volatilities of smaller economies such as Australia. Our results provide evidence of own and cross ARCH and GARCH effects among all four markets, suggesting the existence of significant volatility and cross volatility spillovers across all four markets. A high degree of time-varying co-volatility among these markets indicates that it is riskier for investors to diversify their financial portfolio by acquiring stocks withinthese four countries only.Financial crises, Stock market volatility transmission, Multivariate GARCH model

Effective strategic issues for the development of small and medium enterprises (SMEs) in Sri Lanka : special reference with fish processing industry in Sri Lanka

博士(経営学)大阪市立大

A STUDY ON THE SABARAGAMUWA DANCING TRADITION AND ITS SIGNIFICANCE OF TRADITIONAL DANCING CULTURE TO UPLIFT TOURISM IN SRI LANKA

This study examines the significance of Sabaragamuwa dancing tradition and how it is going to affect the tourism industry in Ratnapura area. A historical and a theoretical study was carried out to understand the connection between these components. Several factors were identified which are make this dancing tradition significant and why this dancing tradition doesn’t get recognition compared to other dancing traditions in Sri Lanka. Interviews and secondary data used to collect information Through this research it was identified not only gem industry, but also Sabaragamuwa dancing tradition creates a unique character to this area which will capture tourists’ attraction. Therefore, it was concluded that in order to re-establish this dying culture, we need to provide a place where all the requirements are fulfilled and the need of the place has occurred.Therefore in order to make a tourist hub in Ratnapura,Sabaragamuwa dancing tradition creates a huge impact and to achieve that need of a place to promote is essential. Keywords: Dancing Ratnapura. sabaragamuwa, Sri Lanka, Traditio

Synthesis and Characterization of Tannin Based Porous Cation Exchange Resins from Cassia auriculata (Ranawara)

Tannins are one of the most abundant compounds in the nature. Naturally tannins have ion exchanging capability. Conversely, tannins are highly water soluble compounds, thus natural tannins cannot be used as ion exchangers. In this study, tannins extracted from Cassia auriculata (Ranawara) were used to synthesise renewable tannin based porous cation exchange resin systems. Essentially, the applicability of these resin systems as an ion exchange resin were considered. Identification of the Tannin was carried out by using ferric chloride test, nitrous acid test and acid butanol tests. Total polyphenolic content of Cassia auriculata was 13.30% (w/w) and it was calculated by using Folin-ciocalteau method. Tannin-Formaldehyde resin was prepared, and the ion exchange capacity was measured. Then the Tannin-Formaldehyde resin was sulfonated to increase the ion exchange capacity by refluxing with concentrated H2SO4. Then, the ion exchange capacity of the resin was further increased by introducing a porous structure using virgin coconut oil as the porogenic agent. Ion exchange capacity, solubility, Fourier transform infrared spectroscopy and scanning electron microscopy analysis were used to characterise the resin systems. The modified resin with high fraction of surfactant contains mostly open porous structures and it has the highest IEC (0.9550 meq/g) among the synthesized resin systems.Keywords: Cassia auriculata (Ranawara), porous tannin-formaldehyde cation exchange resin, ion exchange capacity, FTIR, SE

Multivariate Poisson hidden Markov models for analysis of spatial counts

Multivariate count data are found in a variety of fields. For modeling such data, one may consider the multivariate Poisson distribution. Overdispersion is a problem when modeling the data with the multivariate Poisson distribution. Therefore, in this thesis we propose a new multivariate Poisson hidden Markov model based on the extension of independent multivariate Poisson finite mixture models, as a solution to this problem. This model, which can take into account the spatial nature of weed counts, is applied to weed species counts in an agricultural field. The distribution of counts depends on the underlying sequence of states, which are unobserved or hidden. These hidden states represent the regions where weed counts are relatively homogeneous. Analysis of these data involves the estimation of the number of hidden states, Poisson means and covariances. Parameter estimation is done using a modified EM algorithm for maximum likelihood estimation. We extend the univariate Markov-dependent Poisson finite mixture model to the multivariate Poisson case (bivariate and trivariate) to model counts of two or three species. Also, we contribute to the hidden Markov model research area by developing Splus/R codes for the analysis of the multivariate Poisson hidden Markov model. Splus/R codes are written for the estimation of multivariate Poisson hidden Markov model using the EM algorithm and the forward-backward procedure and the bootstrap estimation of standard errors. The estimated parameters are used to calculate the goodness of fit measures of the models.Results suggest that the multivariate Poisson hidden Markov model, with five states and an independent covariance structure, gives a reasonable fit to this dataset. Since this model deals with overdispersion and spatial information, it will help to get an insight about weed distribution for herbicide applications. This model may lead researchers to find other factors such as soil moisture, fertilizer level, etc., to determine the states, which govern the distribution of the weed counts

Relational Agency as a Dialectic of Belonging and Not Belonging within the Social Ecology of Plantation Life in Sri Lanka

We argue that lived spaces play a crucial role in influencing how people can or cannot enact their agency. Based on an interpretive ethnographic study of work in a large Sri Lankan tea plantation and drawing on the conceptual lenses of relational agency and social ecology, we explore how workers experience their ability to act agentically in relation to their social circumstances and examine the personal and social consequences. In doing so, we extend conceptualizations of relational agency as a dialectic of belonging and not belonging within a social ecology – an ongoing flow of intertwined activities and ways of being and relating to each other that create and reproduce social orders and forms of accountability

Digital Marketing Effectiveness of Wowmen Group Towards Gender Equity Awareness

This study seeks to investigate digital marketing effectiveness of social media platforms and how it links to gender equity awareness. Focusing on Wowmen Group (a women’s social media platform), the research aims to uncover Wowmen Group’s perception of gender equity and the awareness of their audience towards the issue. This study uses interpretive research and uses mixed methods both qualitative and quantitative approaches. The methodology will focus on the use of interviews and questionnaires to examine the issue area, which are developed from the interpretivism approach. This study also utilizes an inductive approach that begins with observations and ends as the research process concludes. Nowadays, society is very supportive about gender equity and gender equality. By using digital marketing, Wowmen Group can spread a bigger impact about gender equity. Wowmen Group have brought a big impact on inspiring people to take bigger steps forward. Thus, gender equity has been an issue in society that is slowly and steadily being addressed. Customers of Wowmen Group feel that the activities of Wowmen Group satisfy their needs on education of gender equity. These customers have several suggestions for Wowmen Group so that they can grow further in spreading gender equity awareness in their community