Idea and freedom : the search for form in classical architecture and the Modern Movement.

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Occupational Therapy\u27s Role in Matching Handlers and Assistance Dogs with Occupational Needs

In the past two decades, there has been an increase in the use of assistance dogs to improve health, function, and companionship (Walther et al., 2017). Although assistance dogs offer a variety of benefits for individuals with different needs, matching a person with a suitable dog is not always successful the first time. Optimal matches can be achieved by adding occupational therapy to strengthen the evaluation process. The two major purposes of this project were: 1) to observe and assess the current matching process of assistance dog programs and 2) identifying occupational therapy’s role in aiding the evaluation process. This project included three assistance dog programs in California: Guide Dogs for the Blind (GDB), Canine Companions for Independence (CCI), and Canine Support Teams, Incorporated (CST). A total of 25 participants were recruited for interviews from early February to late March 2020. Interview questions were closed and open-ended, examining the participant’s life (routines and tasks associated with new occupations), their need for an assistance dog, tasks in which the dogs will aid, disability (if comfortable), need for additional support, costs of obtaining/maintaining a dog, adaptive tools needed, and home environment. Three themes were identified: routines, tasks associated with new occupations, and physical environment (successor versus the first-time handler). Several key findings from this project revealed a need for occupational therapy within the evaluation process and two-week team training. Although participants subsequently continued with successful matches, enhancing the programs could increase the quality of life and ease of information attainment for participants. Doing so will help clients overcome barriers before, during, and after the placement process (Winkle et al., 2012)

Occupational Therapy’s Role in Matching Handlers and Assistance Dogs

The purpose of this project was to assess and observe the matching process and to identify the role of an occupational therapist in aiding the evaluation process with potential handlers and assistance dogs. Three sites were explored within California: Canine Support Teams, Canine Companions for Independence, and Guide Dogs for the Blind. Interviews were conducted with twenty-five participants about roles, routines, physical environment, need for an assistance dog, and additional support. Key findings from this project revealed a need for occupational therapy within the evaluation process and two-week team training. Therapists could aid with adapting learning material, addressing performance patterns, conducting home evaluations, and educating staff about a range of clients who have different disabilities.https://soar.usa.edu/otdcapstonespring2020/1018/thumbnail.jp

Effect of Medium of Instruction on Students’ Motivation Towards Learning at Secondary Level

The present study aimed to investigate the effect of medium of instruction on students’ motivation towards learning at secondary level. It comprised of 1456 respondents as a sample of the study which were conveniently selected from public and private sector secondary schools from the district Kasur of Punjab province.Motivation scale towards learning by Sultana, (2014) having 20 Likert type items with a reliability coefficient value 0.85 was used for data collection.Findings of the study revealed that the medium of instruction had no significant effect on motivation level of students towards learning. On the basis of gender there was found no significant effect on motivation level. There was significant difference between English and Urdu mediums urban respondents’ motivation level as urban English medium students had significantly higher motivation level than urban Urdu medium students. There was significant difference between English and Urdu mediums rural respondents’ motivation level as rural Urdu medium students had significantly higher motivation level than rural English medium students. It was recommended that the findings of the study should be refined for further implications through further longitudinal studies with more data from other provinces of Pakistan

Necrotising fasciitis of the posterior neck crossing the midline: a case report

Introduction and importance: Craniofacial necrotising fasciitis is a complex condition, with high mortality given its propensity to descend via the deep neck spaces into the chest and mediastinum. Management requires optimal antimicrobial therapy with associated aggressive surgical debridement. Presentation of case: A 64-year-old man presented to ENT with a posterior neck swelling. Despite incision and drainage of the swelling following a trial of antimicrobial therapy, it increased in size, with areas of overlying necrosis demonstrated. Based on radiological and clinical findings, a diagnosis of necrotising fasciitis was made. He was taken to theatre for debridement. Intra-operatively, carotid sheath suppuration was noted, after tissue retraction resulted in copious bleeding from the anterior wound bed, requiring vigorous resuscitation and clamping of underlying structures to achieve haemostasis. Senior ENT and vascular surgery involvement was quickly sought to achieve haemostasis, however bleeding from the wound bed was difficult to control. This was due to the significant watershed area at the posterior neck which would not have been amenable to selective vessel ligation. After multiple cardiac arrests, a team decision was taken to discontinue resuscitation. Clinical discussion: Operating in this area of anatomical complexity required input from a number of different specialty teams. Although input from infectious diseases, microbiology, plastic surgery and tissue viability was commendable, there was room for optimising this further. Early patient referral to a tertiary centre where on-site input was available from maxillofacial surgery and plastic surgery would have been beneficial; a set-up commonly seen in regional trauma networks. Conclusion: This case demonstrates the intricacies surrounding a rare occurrence of necrotising fasciitis of the neck crossing the midline. Multi-disciplinary team involvement is imperative and should be encouraged at an early stage

Surgical polarimetric endoscopy for the detection of laryngeal cancer

The standard-of-care for the detection of laryngeal pathologies involves distinguishing suspicious lesions from surrounding healthy tissue via contrasts in colour and texture captured by white-light endoscopy. However, the technique is insufficiently sensitive and thus leads to unsatisfactory rates of false negatives. Here we show that laryngeal lesions can be better detected in real time by taking advantage of differences in the light-polarization properties of cancer and healthy tissues. By measuring differences in polarized-light retardance and depolarization, the technique, which we named 'surgical polarimetric endoscopy' (SPE), generates about one-order-of-magnitude greater contrast than white-light endoscopy, and hence allows for the better discrimination of cancerous lesions, as we show with patients diagnosed with squamous cell carcinoma. Polarimetric imaging of excised and stained slices of laryngeal tissue indicated that changes in the retardance of polarized light can be largely attributed to architectural features of the tissue. We also assessed SPE to aid routine transoral laser surgery for the removal of a cancerous lesion, indicating that SPE can complement white-light endoscopy for the detection of laryngeal cancer

COVID-VU - ENT-UK national survey of flexible nasendoscopy in the upper aerodigestive tract amidst the COVID-19 pandemic

BACKGROUND: Flexible nasendoscopy (FNE) is an invaluable multi-disciplinary tool for upper aerodigestive tract (UADT) examination. During the COVID-19 pandemic concerns were raised that FNE had the potential of generating aerosols resulting in human cross-contamination when performed on SARS-COV2 carriers. In the UK, and other European countries, national guidelines were issued restricting FNE to essential cases. We surveyed ENT-UK members and Royal College of Speech and Language Therapists (RCSLT) members to determine the impact of the COVID-19 pandemic (first peak) on FNE practice in the UK. METHODS: An observational internet-based survey constructed in accordance to the CHERRIES checklist and setup in SurveyMonkey of FNE practice amongst UK-based ENT surgeons and speech and language therapists in community clinics, the outpatient department, inpatient wards, ICU, emergency department and operating theatres (through the NHS and private sector) prior to, during and following the first COVID-19 wave in the UK. RESULTS: 314 responses collected (24% response rate), 82% from ENT clinicians, 17% from SLTs and 1% from other allied healthcare professionals. Overall, there has been a large reduction in the volume and indications for FNE during the first peak of the COVID-19 pandemic with limited recovery by mid-August 2020. Cancer and airway assessments were impacted less. A wide range of FNE protocols influenced by local factors are reported, varying in endoscope preference, Personal Protective Equipment (PPE) and sterilization methods. Where dedicated Aerosol Generating Procedure (AGP) rooms were unavailable, clinicians resorted to window opening and variable room "down-time" between patients. Endoscope preference reflected availability and user familiarity, ENT trainees favoring the use of single-use video endoscopes. CONCLUSION: Despite national guidance, local practice of FNE remains interrupted and highly variable in the UK. A collaborative inter-disciplinary approach is required to re-introduce FNE safely in volume across healthcare settings, re-establishing timely endoscopic diagnosis and pre-pandemic levels of patient care

Approaches to 3D printing teeth from X-ray microtomography.

Artificial teeth have several advantages in preclinical training. The aim of this study is to three-dimensionally (3D) print accurate artificial teeth using scans from X-ray microtomography (XMT). Extracted and artificial teeth were imaged at 90 kV and 40 kV, respectively, to create detailed high contrast scans. The dataset was visualised to produce internal and external meshes subsequently exported to 3D modelling software for modification before finally sending to a slicing program for printing. After appropriate parameter setting, the printer deposited material in specific locations layer by layer, to create a 3D physical model. Scans were manipulated to ensure a clean model was imported into the slicing software, where layer height replicated the high spatial resolution that was observed in the XMT scans. The model was then printed in two different materials (polylactic acid and thermoplastic elastomer). A multimaterial print was created to show the different physical characteristics between enamel and dentine

The use of self-expanding metallic stents in the management of benign colonic obstruction: a systematic review and meta-analysis

Introduction Patients presenting with large bowel obstruction (LBO) frequently undergo emergency surgery that is associated with significant morbidity. In malignant LBO, endoscopic approaches with placement is a self-expanding metal stent (SEMS), have been proposed to prevent emergency surgery and act as a bridge to an elective procedure—with the intention of avoiding a stoma and reducing morbidity. This systematic review aims to assess the quality and outcomes of data available on the use of SEMS in benign causes of colonic obstruction. Methods This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered on Prospero (ID: CRD42021239363). PUBMED, MEDLINE, HMIC, CINAHL, AMED, EMBASE, APA and Cochrane databases were searched. Studies were assessed for quality utilising the MINORS criteria. Pooled odds ratios with 95% confidence intervals (95% CI) were calculated using random effects models. Results Sixteen studies were included for analysis. 300 patients were included with an average age of 68, and a male predominance of 57%. The quality of the papers included were at risk of bias. The pooled rate of technical success of procedure was 94.4% (95% CI 90.5–96.8%) The pooled rate of clinical success was 77.6% (95% CI: 66.6–85.7%). Adverse effects were low, with perforation 8.8% (4.5–16.6%), recurrence 26.5% (17.2–38.5%) and stent migration 22.5% (14.1–33.8%). Discussion This systematic review demonstrated that SEMS for benign colonic obstruction can be a safe and successful procedure. The utilisation of SEMS in malignant disease as a bridge to surgery has been well documented. Whilst the limitations of the data interpreted are appreciated, we postulate that SEMS could be utilised to decompress patients acutely and allow pre-operative optimisation, leading to a more elective surgery with less subsequent morbidity