Adnexal torsion-symptoms, diagnosis and management: a review of literature

Adnexal torsion accounts for 3% of all gynaecologic emergencies. It consists of spectrum of pathologies including ovarian torsion, ovarian torsion with tubal torsion and isolated fallopian tube torsion. It usually presents with acute abdominal pain along with gastrointestinal symptoms such as nausea and vomiting. But due to presence of non-specific clinical features, diagnosis of adnexal torsion is a difficult task which requires high degree of clinical suspicion. Ultrasound with Doppler is helpful in its diagnosis. But even Doppler studies can miss the cases of adnexal torsion. So, laparoscopy is the gold standard for its diagnostic evaluation and simultaneous management. Conservative surgery should be preferred to preserve the future reproductive function. But in some cases such as infarcted ovaries, older women and suspicion of malignancy, adnexa may be required to be removed. Thus, prompt diagnosis and timely management of adnexal torsion is required to prevent the irreversible damage to adnexa. The authors here present a review of literature concerning the clinical features, diagnosis and management of adnexal torsion via a case series of six cases

An unusual complex mullerian anomaly: case report

Congenital anomalies are a result of defect in the normal process of embryonic formation of organs. When more than 1 complete or incomplete defect coexists, they lead to formation of a complex anomaly. Here we report a case of an unusual and unclassified complex uterine anomaly and its management. To the best of our knowledge such a case has not been reported till date in the literature. The authors also reinstate the need for classifying these unusual anomalies

Placental polyp: a diagnostic dilemma

Placental polyp is the retained fragment of placental tissue after parturition or abortion for indefinite period which forms a polypoidal mass in the uterus. It has an incidence of less than 0.25% of all pregnancies. It is predominantly composed of necrotic and hyalinized chorionic villi. These pedunculated masses present within days to weeks following an abortion or delivery of a term placenta. The patient presents with abnormal uterine bleeding and slightly elevated detectable titers of serum β-human chorionic gonadotropin (βHCG). Here we have reviewed the literature of placental polyp regarding its pathogenesis, diagnosis and management. The authors would like to stress the importance of hysteroscopy in diagnosis and management of placental polyp that can be missed on ultrasound and blind procedure like curettage and histopathology that gives a confirmatory diagnosis

Endometrial carcinoma in young women: management options and its review

Endometrial carcinoma is a disease of older postmenopausal women, and is relatively uncommon in patients younger than 40 years. The incidence in young women is 2%-14%. Endometrial carcinomas in this age group may be familial, associated with Lynch syndrome, or sporadic. Patients usually have increased exposure to estrogen. Its treatment includes hysterectomy, bilateral salpingoophorectomy and pelvic lymphadenectomy and in some cases, radiation therapy. Preservation of fertility is a major challenge encountered in such cases. Before deciding on the management of any patient with abnormal bleeding a hysteroscopic examination with biopsy should be performed for all the patients, as hysteroscopy make it easy to visualize the cavity and to obtain the biopsy from the specific site. We have reviewed the literature of endometrial cancer management in young women through a case in a 35-year-old woman with previous 3 cesarean treated for abnormal uterine bleeding. We performed Hysteroscopy which showed adenocarcinoma endometrium on histopathology. Most endometrial carcinomas presenting in this young age are associated with estrogen excess. Pathologically they are usually low-grade endometrioid carcinomas with lower stage and are associated with favourable clinical outcomes. With this review the authors emphasize the need of hysteroscopic endometrial reckoning in young females with abnormal bleeding before starting any medical treatment. Also highlighting the management options in such cases where fertility preservation holds a significant challenge

Spatial variation of trace metals within intertidal beds of native mussels (Mytilus edulis) and non-native Pacific oysters (Crassostrea gigas): implications for the food web?

Abstract Pollution is of increasing concern within coastal regions and the prevalence of invasive species is also rising. Yet the impact of invasive species on the distribution and potential trophic transfer of metals has rarely been examined. Within European intertidal areas, the non-native Pacific oyster (Crassostrea gigas) is becoming established, forming reefs and displacing beds of the native blue mussel (Mytilus edulis). The main hypothesis tested is that the spatial pattern of metal accumulation within intertidal habitats will change should the abundance and distribution of C. gigas continue to increase. A comparative analysis of trace metal content (cadmium, lead, copper and zinc) in both species was carried out at four shores in south-east England. Metal concentrations in bivalve and sediment samples were determined after acid digestion by inductively coupled plasma-optical emission spectrometry. Although results showed variation in the quantities of zinc, copper and lead (mg m-2) in the two bivalve species, differences in shell thickness are also likely to influence the feeding behaviour of predators and intake of metals. The availability and potential for trophic transfer of metals within the coastal food web, should Pacific oysters transform intertidal habitats, is discussed

So what difference does it make? Mapping the outcomes of citizen engagement

Over the last two decades, the idea that citizen engagement and participation can contribute to improved governance and development outcomes has been mainstreamed in development policy and discourse. Yet despite the normative beliefs that underpin this approach, the impact of participation on improved democratic and developmental outcomes has proved difficult to assess. Where previous research studies have attempted to demonstrate impact, they tend to be limited to single interventions, a small number of country contexts or by various conceptual and methodological constraints. In this paper, we report on a meta-case study analysis of a ten-year research programme on citizenship, participation and accountability which analysed a nonrandomised sample of 100 research studies of four types of citizen engagement in 20 countries. By mapping the observable effects of citizen participation through a close reading of these studies, we created a typology of four democratic and developmental outcomes, including (a) the construction of citizenship, (b) the strengthening of practices of participation, (c) the strengthening of responsive and accountable states, and (d) the development of inclusive and cohesive societies. We find that citizen participation produces positive effects across these outcome types, though in each category there are also examples of negative outcomes of citizen participation. We also find that these outcomes vary according to the type of citizen engagement and to political context. These findings have important implications for the design of and support for participatory programmes meant to improve state responsiveness and effectiveness

Strategic Use of Role Playing in a Training Workshop for Chemistry Laboratory Teaching Assistants

Many Canadian universities have created professional development programs for their teaching assistants (TA) but may be uncertain about how to bridge the gap between TAs’ knowledge of effective teaching strategies and TAs’ confident applications of these strategies. We present a technique used in a two-day training workshop to enhance graduate students skills in using effective teaching strategies: role playing. This paper outlines a framework that includes five key elements (Icebreaking, Shared Experiences, Modelling, Acting and Debriefing) to strategically design role playing activities in a training program. We describe each of the 5 elements and explain how they support training through role play exercises. Participant written feedback collected in 2010, 2011, 2012 and 2014 suggested that role playing was a useful and enjoyable technique. Pre and post workshop questionnaire data suggested that self-perceived competencies for specified tasks directly connected to a role play activity promoted greater positive differences between the pre and post groups compared to self-perceived competencies for specified tasks not directly connected to a role play activity. Based on these results, we assert that training programs which rely on strategic role playing activities will lead to a better overall TA experience of the training program and improvements in TAs’ self-perceptions of certain teaching competencies.  Bien que plusieurs universités canadiennes aient créé des programmes de perfectionnement professionnel pour leurs auxiliaires à l’enseignement, il peut être difficile pour ces auxiliaires d’appliquer avec confiance les techniques d’enseignement efficace qu’ils ont apprises. Nous avons donc intégré le jeu de rôles à un atelier de deux jours suivi par des étudiants diplômés afin d’améliorer leur stratégies d’enseignement. Le présent article illustre les cinq principes essentiels qui permettent d’inclure le jeu de rôles de façon stratégique en contexte de formation : brise-glace, partage d’expériences, modélisation, pratique par le jeu et compte rendu. Nous décrivons ces cinq éléments et expliquons comment, par des jeux de rôles, chacun est utile à la formation. Les remarques écrites soumises par les participants des ateliers de 2010, 2011, 2012 et 2014 soutiennent l’idée que le jeu de rôle est un outil d’apprentissage à la fois utile et agréable. Remplis avant et après la séance de formation, les réponses aux questionnaires d’auto-évaluation des aptitudes personnelles démontrent une meilleure évolution des habiletés présentées avec une activité de jeu de rôles, comparativement à celles exposées sans cette composante. De par ces résultats, nous établissons que l’emploi stratégique du jeu de rôles lors de séances de formation mène à une meilleure expérience pour les auxiliaires à l’enseignement, en plus d’améliorer leur auto-perception de certaines compétences en enseignement

Accounting for intangibles: financial reporting and value creation in the knowledge economy

A new report from The Work Foundation highlights the urgent need for UK organisations to adopt a more comprehensive and consistent approach to how they financially record their investments in intangible assets. As industrialised economies are increasingly becoming knowledge-based, competitive advantage and organisational performance are increasingly generated from investment in intangible knowledge-based assets such as R&D, human and organisational performance. The report outlines that, while there is widespread recognition of the value of such assets, we are still unable to account for them mainly because of a lack of appropriate accountancy measures. As a result, investors, shareholders and senior managers are likely to come up with less well-informed decisions

Efficiency Based Comparison of Project Delivery Methods: Efficiency Based Comparison of Project Delivery Methods

Public Private Partnerships (PPP) are the future of infrastructure project delivery. Majority of the PPPs have been successful except a few over the past decade. The reasons for their failure are well documented by researchers. The misconceptions about PPPs make it increasingly difficult to pursue projects using PPP delivery system. One of the root causes of the misconceptions is from the ambiguities arising from qualitative data and assessments. To overcome this issue, efficiency-based comparison of project delivery methods utilizing Data Envelopment Analysis (DEA) for decision making is presented through this paper. Proposed approach uses qualitative ratings and harnesses the integral utility of the ratings obtained while conducting objective assessment of qualitative data. California’s Presidio Parkway Project is used for case study analysis and the data is varied to create three hypothetical scenarios to determine sensitivity of the model. Results from case study are consistent with actual project implementation and the sensitivity analyses result are found to be consistent