Quality of Life for Pediatric Prosthetic Users

The population of children with limb loss fall into a category of children with chronic physical disability and are vulnerable to functional challenges resulting in adverse impacts on their participation and performance of life activities, known as occupational participation. A mixed method research study was aimed at answering the following research questions: (a) is there an impact on the engagement in meaningful everyday activities for children with prosthetic limbs, considering the functional, emotional, and social challenges they might encounter? (b) does their level of engagement in meaningful everyday activities have an impact on their quality of life (QoL) and (c) how does the care they receive influence their QoL? Assessment measures were administered, and interviews were completed. The inclusion criteria consisted of pediatric prosthetic users between the ages of 8 and 18 years with at least one prosthetic limb and their primary caregiver. A total of 8 families participated in this study. This study found areas of significant challenge to this population that impact their overall QoL. These include their communication and interactive skills impacting their psychosocial well-being, physical participation impacting their occupational participation, and systemic issues of healthcare and insurance coverage impacting their obtainment of necessary prosthetic limbs. This study confirmed that the skill set of occupational therapy (OT) is not being utilized to its fullest potential and that there is a general lack of understanding among the healthcare professionals who treat pediatric prosthetic users regarding each other\u27s scope of practice and level of expertise. An increased awareness of the skill set that OT’s can provide to pediatric amputees regardless of their amputation level, is necessary so that their unmet needs can be better addressed.https://soar.usa.edu/otdcapstones-spring2022/1031/thumbnail.jp

Application of Occupation-Based Models to Edward of Edward Scissorhands: OA and EHP Models

This presentation examines the character Edward Scissorhands, a young adult with hand deformities and poor social skills, through the lens of the Ecological Human Performance (EHP) Model. We propose occupational therapy interventions based off of the EHP model. Through the use of establishing social skills training, as well as adapting and modifying Edward’s hands with tips and attachments, Edward’s life could be immensely improvedhttps://soar.usa.edu/casmfall2019/1007/thumbnail.jp

Diagnoses and clinical features associated with high risk for unplanned readmission in vascular surgery. A cohort study

Background: Readmission rate is an established health quality indicator. Preventable readmissions bear an unnecessary, high cost on the healthcare system. An analysis performed by the National Centre for Health Outcomes Development (NCHOD) has demonstrated an increasing trend in emergency readmissions in the UK. Vascular surgery has been reported to have high readmission rates second only to congestive heart failure. This study aims to identify diagnoses and other clinical risk factors for high unplanned readmission rates. This may be the first step to sparing both the health care system and patients of unnecessary readmissions. Results: The overall 30 day readmission rate for Leeds Vascular Institute was 8.8%. The two diagnoses with the highest readmission rates were lower limb ischaemia and diabetic foot sepsis. The readmission rate for medical reasons was overwhelmingly higher than for surgical reasons (6.5% and 2.3% respectively). The most common medical diagnoses were renal disease and COPD. The majority of the patients readmitted under the care of vascular surgery required further surgical treatment. Conclusion: Vascular units should focus on holistic and multidisciplinary treatment of lower limb ischaemia and diabetic foot sepsis, in order to prevent readmissions. Furthermore, the early involvement and input of physicians in the treatment of vascular patients with renal disease and COPD may be appropriate

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Sadržaj

AG is supported by a NERC Independent Research Fellowship (NE/K009524/1).Insects are often chemically-defended against predators. There is considerable evidence for a group-beneficial element to their defences, and an associated potential for individuals to curtail their own investment in costly defence whilst benefitting from the investments of others, termed “automimicry”. Although females in chemically-defended taxa often lay their eggs in clusters, leading to siblings living in close proximity, current models of automimicry have neglected kin-selection effects, which may be expected to curb the evolution of such selfishness. Here we develop a general theory of automimicry that explicitly incorporates kin selection. We investigate how female promiscuity modulates intragroup and intragenomic conflicts over investment into chemical defence, finding that individuals are favoured to invest less than is optimal for their group, and that maternal-origin genes favour greater investment than do paternal-origin genes. We translate these conflicts into readily-testable predictions concerning gene-expression patterns and the phenotypic consequences of genomic perturbations, and discuss how our results may inform gene discovery in relation to economically-important agricultural products.Publisher PDFPeer reviewe

Right hemisphere has the last laugh: neural dynamics of joke appreciation

Understanding a joke relies on semantic, mnemonic, inferential, and emotional contributions from multiple brain areas. Anatomically constrained magnetoencephalography (aMEG) combining high-density whole-head MEG with anatomical magnetic resonance imaging allowed us to estimate where the humor-specific brain activations occur and to understand their temporal sequence. Punch lines provided either funny, not funny (semantically congruent), or nonsensical (incongruent) replies to joke questions. Healthy subjects rated them as being funny or not funny. As expected, incongruous endings evoke the largest N400m in left-dominant temporo-prefrontal areas, due to integration difficulty. In contrast, funny punch lines evoke the smallest N400m during this initial lexical–semantic stage, consistent with their primed “surface congruity” with the setup question. In line with its sensitivity to ambiguity, the anteromedial prefrontal cortex may contribute to the subsequent “second take” processing, which, for jokes, presumably reflects detection of a clever “twist” contained in the funny punch lines. Joke-selective activity simultaneously emerges in the right prefrontal cortex, which may lead an extended bilateral temporo-frontal network in establishing the distant unexpected creative coherence between the punch line and the setup. This progression from an initially promising but misleading integration from left frontotemporal associations, to medial prefrontal ambiguity evaluation and right prefrontal reprocessing, may reflect the essential tension and resolution underlying humor

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Extra low interstitial titanium based fully porous morphological bone scaffolds manufactured using selective laser melting

This is an accepted manuscript of an article published by Elsevier in Journal of the Mechanical Behavior of Biomedical Materials on 29/03/2019, available online: https://doi.org/10.1016/j.jmbbm.2019.03.025 The accepted version of the publication may differ from the final published version.Lattice structure based morphologically matched scaffolds is rapidly growing facilitated by developments in Additive Manufacturing. These porous structures are particularly promising due to their potential in reducing stress shielding and maladapted stress concentration. Accordingly, this study presents Extra Low Interstitial (ELI) Titanium alloy based morphological scaffolds featuring three different porous architecture. All scaffolds were additively manufactured using Selective Laser Melting from Ti6Al4V ELI with porosities of 73.85, 60.53 and 55.26% with the global geometry dictated through X-Ray Computed Tomography. The elastic and plastic performance of both the scaffold prototypes and the bone section being replaced were evaluated through uniaxial compression testing. Comparing the data, the suitability of the Maxwell criterion in evaluating the stiffness behaviour of fully porous morphological scaffolds are carried out. The outcomes show that the best performing scaffolds presented in this study have high strength (169 MPa) and low stiffness (5.09 GPa) suitable to minimise stress shielding. The matching morphology in addition to high porosity allow adequate space for flow circulation and has the potential to reduce maladapted stress concentration. Finally, the Electron Diffraction X-ray analysis revealed a small difference in the composition of aluminium between the particle and the bonding material at the scaffold surface