171 research outputs found
Tapping Economies of Scale and Scope in Consumer Cooperation - A Case Analysis of Possible Cooperation among selected Cooperatives
No full textBecause of its narrow and negative perspective of safeguarding the interests of only poor consumers against unethical practices of the private traders, consumer cooperation in India seems to have failed, except probably in some isolated pockets. A number of social welfare functions like poverty alleviation and public distribution of essential items of consumption have been imposed on them at the cost of their basic economics. With the basic micro and macro-economic rationale for consumer cooperatives as a positive form of economic organization being lost sight of, they seem to be facing enormous problems both historically as well as currently in a era of economic liberalization. Their worries seem to have been compounded with the threat of impending competition from large private enterpriss - both domestic and foreign, which highlights the need for evolving strategies to rectivy their systemic weaknesses and tackling the competition head on. This case has attempted to document just such an initiative through a round table conference with several doyens of the consumer cooperative movement in India such as Warana Bazar and Amalsad Mandali as well as some fledging consumer cooperatives from West Bengal which are already in existence for some time or contemplating entry into this field. The roundtable conference organized in the spirit of Cooperation among Cooperatives attempted to evolve strategies to capture economies of scale and scope in order to take on the competition, as well as to facilitate dissemination of ideas and information across the country.
Double-Pedicle Deep Inferior Epigastric Artery (DIEP) Flap for Unilateral Breast Reconstruction: Indications, Success, and Large Experience at UT Southwestern
No full textThe 54th Annual Medical Student Research Forum at UT Southwestern Medical Center (Monday, January 19, 2016, 2-5 p.m., D1.700)BACKGROUND: Unilateral breast reconstruction is challenging in patients with radiation defects, large post-mastectomy soft tissue deficits, and obese patients. Using a hemi-abdominal flap for unilateral breast reconstruction in patients may not be ideal due to paucity of abdominal tissue, presence of a lower abdominal midline scar, or a larger and/or ptotic contralateral native breast. The lower abdomen (hemi-abdominal flaps) can be used to create one breast, in a stacked manner or bipedicled non-split composite fashion.
METHODS: 51consecutive bipedicled abdominal composite free flaps for unilateral breast reconstruction were performed. Patient demographics, type/weights of flaps, number of anastomoses, length/type of pedicles, and flap related complications were recorded. Using a simplified unique algorithm that we created, the bi-pedicled flaps were anastomosed to split internal mammary artery/vein(IMA/V) or an intraflap anastomosis was performed and anastomosed to the IMA/V.
RESULTS: 51patients underwent composite DIEP and/or superficial inferior epigastric artery(SIEA) flaps (102 total flaps). Average flap weight was 1,074 +/- 466 grams (average age 57 yrs and average Body Mass Index(BMI) 26.6 +/- 3.9). 25 patients (49%) had flaps >1,000 grams (average 1,430 grams, range 1052-2400 gms), and 36 (71%) patients had flaps >750 grams. 39 patients had delayed reconstruction and 12 were immediate. 23 patients had intra-flap anastomosis over the abdomen and carried as single composite flap to cranial IMA/V; 28 patients had independent bi-pedicle flaps anastomosed to cranial and caudal split IMA/V. There were 39 DIEP-DIEP flaps,10 DIEP-SIEA flaps, and 2 SIEA-SIEA flaps. Flaps were not split in midline, but carried as a composite hemiabdominal flap with anastomosis to the IMA/V. There were no flap losses. Donor site morbidity was equivalent to bilateral breast reconstruction with DIEP flaps.
CONCLUSION: Composite bi-pedicle hemi-abdominal flaps for unilateral breast reconstruction are feasible with low complication rates but are technically challenging, chiefly in flaps >1,000 grams. To maximize aesthetic outcomes, use of highly complex double pedicle abdominal flaps is crucial in some patients, primarily those with delayed reconstruction and large contralateral breast, radiationdeficits, and large post-mastectomy defects. Technical considerations such as flap inset and handling, use of simplified algorithm, and selection of anastomosis and pedicles will be presented to make these flaps successful. This series represents an ongoing largest experience of composite bi-pedicle DIEP and/or SIEA combination for unilateral breast reconstruction.Southwestern Medical Foundatio
Challenges Associated with Internal Mammary Vessels in Multiple Free Flap Breast Reconstruction
No full textThe 55th Annual Medical Student Research Forum at UT Southwestern Medical Center (Monday, January 17, 2017, 2-5 p.m., D1.600)INTRODUCTION: As breast reconstructive microsurgeons increase their armamentarium of flaps with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. Bi-pedicled and stacked flaps have been performed by microsurgeons using the cranial and caudal internal mammary system. We present our experience utilizing this system for flap reliability.
METHOD: 736 flaps for breast reconstruction were performed from 2010-2016 (DIEP/SIEA and PAP flaps) by 2 senior surgeons at a university hospital. 220 (30%) of those flaps were either: Stacked PAP flaps, 4-flap (Bilateral PAP+DIEP flap), or Double-pedicle DIEP/SIEA flaps. Specific data regarding number, type, and locality of anastomosis was analyzed.
RESULTS: 454 anastomosis were performed in 87 patients who underwent 220 flaps. Out of 454 anastomosis, 167 were to Caudal IMA/V (37%), 171 were to Cranial IMA/V (38%), and 116 were intra-flap (25%). There were 0 flap losses in Double-pedicle DIEP group (58-patients, 116-flaps), 3 flap losses in 4-Flap group (23-patients, 92-flaps), and 0 in Stacked-PAP group (6-patients, 12-flaps). In the 3 flap losses of 4-Flap group, 2 flaps were to Caudal IMA/V (1 arterial thrombosis, 1 venous thrombosis), and 1 cranial IMA/V (venous thrombosis). Also, in the 4-Flap group, 3 flaps were salvaged by converting to intra-flap anastomosis due to intraoperative caudal arterial thrombosis. In the Stacked-PAP group, there were 2 flaps salvaged, 1 by converting to intra-flap artery from caudal IMA, and other was venous congestion from caudal IMV pedicle kink seen POD#1. In the Double-pedicle DIEP group, 1 flap was salvaged by converting 1 arterial anastomosis from caudal IMA to intra-flap. Total flap loss rate in entire group was 1.4%. Flap loss avoidance by either conversion to intra-flap anastomosis or early suspicion of caudal system compromise was 2.7%.
CONCLUSION: Caudal IMA/V system remains a viable and safe option for anastomosis in multiple flap procedures. However, based on our large experience with stacked and multiple flaps, we add caution utilizing the caudal system, particularly in patients with radiation, anastomosis mismatch and intraoperative spasm. The enthusiasm towards usage of caudal IMA/V system should be appropriately attenuated in certain circumstances with preference towards intra-flap anastomosis.Southwestern Medical Foundatio
Erotismo e intimismo nell'opera Rāʼiḥat al-qirfa di Samar Yazbik
No full textThis article deals with the last novel Ra'ihat al-qirfa (Smell of cinnamon, 2008) by Samar Yazbik, a prolific author of the new generation of Syrian writers. In this novel, Samar Yazbik relates the story of two women of different ages and belonging to different social classes in contemporary Damascus, who fall in love with each other. The article focuses on words and figures relating to the senses of smell and of touch, used by the author to represent an erotic and intimist dimension in the text. This particular choice of words and images enables the direct expression of the inner emotions and feelings of the main characters who, through their lesbian relationship, try to oppose the oppressive society in which they live
Erotismo e intimismo nell'opera Rāʼiḥat al-qirfa di Samar Yazbik
No full textThis article deals with the last novel Ra'ihat al-qirfa (Smell of cinnamon, 2008) by Samar Yazbik, a prolific author of the new generation of Syrian writers. In this novel, Samar Yazbik relates the story of two women of different ages and belonging to different social classes in contemporary Damascus, who fall in love with each other. The article focuses on words and figures relating to the senses of smell and of touch, used by the author to represent an erotic and intimist dimension in the text. This particular choice of words and images enables the direct expression of the inner emotions and feelings of the main characters who, through their lesbian relationship, try to oppose the oppressive society in which they live
Immediate vs Delayed Breast Reconstruction: A Single Institution Experience
No full textThe 55th Annual Medical Student Research Forum at UT Southwestern Medical Center (Monday, January 17, 2017, 2-5 p.m., D1.600)BACKGROUND: Deep inferior epigastric perforator (DIEP), superficial inferior epigastric artery (SIEA), and profunda artery perforator (PAP) flaps are acceptable options for autologous breast reconstruction. This study comprehensively evaluates the differences in outcomes between patients receiving immediate, delayed/immediate (staged with the use of tissue expanders), and delayed breast reconstructions (without the use of tissue expanders).
METHODS: 547 free flaps (DIEP, SIEA, or PAP) on 331 patients were performed. Patients were grouped based on reconstruction timing: immediate (n=175 flaps), delayed-immediate (n=247 flaps), and delayed (n= 125 flaps). Comorbidities, preoperative radiation, neoadjuvant/postoperative chemotherapy, length of hospital stay, number of subsequent revision surgeries, and breast and donor site complications were analyzed among the groups.
RESULTS: Immediate reconstructions, when compared to delayed-immediate reconstructions, encountered more infections (p<0.01), more wound occurrences (p = <0.01), longer lengths of stay (5.2 versus 4.1 days), longer procedure times (p = <0.01), and larger number of revision surgeries (2.4 vs 1.4 revisions) in patients receiving a single unilateral flap. Between outcomes of single flap immediate and delayed reconstructions, immediate reconstruction resulted in longer lengths of stay (5.2 vs 4.0 days), longer procedure time (p = <0.01), larger number of revision surgeries (2.4 vs 1.7 revisions), and higher chance of wound necrosis (p = <0.01).
In patients receiving 2 free flaps (bilateral or double-pedicle unilateral reconstruction), immediate reconstructions encountered larger numbers of subsequent revision surgeries (1.7 versus 1.1 revisions) and no other significant differences compared to delayed-immediate reconstructions.
There were no significant differences between delayed and delayed-immediate reconstructions.
CONCLUSION: Immediate, delayed-immediate, and delayed reconstructions are all reasonably safe options for breast reconstruction. However, higher rates of complications among immediate reconstructions imply delayed-immediate and delayed reconstructions may be superior options to immediate reconstructions, not only in bilateral reconstructions, but especially in single free flap reconstructions. These results should be considered between the surgeon and patient when deciding an appropriate reconstruction plan based on the risks, benefits, and potential costs associated with different breast reconstruction timings.Southwestern Medical Foundatio
Abdominal Based Free Flap Breast Reconstruction: Stratifying Complications with Perforator Numbers
No full textThe 55th Annual Medical Student Research Forum at UT Southwestern Medical Center (Monday, January 17, 2017, 2-5 p.m., D1.600)BACKGROUND: Single perforator flaps in breast reconstruction have been reported to have increased fat necrosis. We were motivated to evaluate our experience and the effect of number of perforators on DIEP flap complications and donor site morbidity.
METHODS: 199 patients underwent 328 DIEP flaps by two surgeons from 2010 to 2016 at a university hospital. Perforator selection was guided by CT imaging and clinical observation. First, perforator average size was compared among flaps with 1 perforator (n= 110 flaps), 2 perforators (n= 136 flaps), and 3 perforators (n= 82 flaps). Next, rates of fat necrosis, flap failure, and abdominal bulging were analyzed among the same three perforator groups. In addition, rates of postoperative abdominal bulge requiring surgical intervention was compared to the presence of a nerve-preserving type flap harvest.
RESULTS: Average perforator size significantly decreased as the number of perforators increased (1 perforator = 2.11mm, 2 perforators = 1.80mm, 3 perforators = 1.65mm, p-value = 0.02 and 0.01 for 1 versus 2 perforator flaps and 1 versus 3 perforator flaps, respectively). However, no significant differences were noted in fat necrosis, flap failure, and abdominal bulging rates across perforator groups. Additionally, flap weights were not significantly different across the three groups (Average: 1 perforator-774 grams, 2 perforators-797 grams, and 3 perforators- 749 grams). Neither perforator number nor nerve preserving techniques were found to result in significant decreases in abdominal bulge rates.
CONCLUSIONS: Contrary to other studies, we found that the number of perforators harvested in DIEP flap breast reconstruction was not associated with increase or decrease in flap survival or fat necrosis. This occurrence could be attributed to the surgeons' choosing to proceed with single perforator flaps only when perforator size was adequately large, maintaining consistent blood supply. There was no association among perforator number, utilization of nerve sparing procedures, and abdominal bulge that required subsequent surgical intervention. Despite this, we still cautiously advocate nerve-preserving techniques that may have a subclinical effect.Southwestern Medical Foundatio
‘Regressive re-writing’ and the self-translation process: Līnā lawḥat fatāt dimashqiyyah by Samar al-‘Aṭṭār and its English version
No full textEl propósito del presente artículo es demostrar que el proceso de autotraducción
llevado a cabo por la novelista siria Samar al-‘Aṭṭār es más un proceso de interpretación
del original árabe que un proceso de auto-traducción propiamente dicho gracias a
la técnica de la re-escritura realizado por la autora-traductora al trasvasar el original árabe
a la lengua inglesa.Tries to show that the self-translation process carried out by the Syrian novelist
Samar al-‘Aṭṭār exhibits an interpretative process from the original Arabic text, rather than
a self-translation process thanks to the re-writing technique used by the author-translator
when rendering the original Arabic text into English language
‘Reescritura regresiva’ y proceso de auto-traducción: Līnā:lawḥat fatāt dimašqiyyah de Samar al-‘Aṭṭār y su versión inglesa
No full textTries to show that the self-translation process carried out by the Syrian novelist Samar al-‘Aṭṭār exhibits an interpretative process from the original Arabic text, rather than a self-translation process thanks to the re-writing technique used by the author-translator when rendering the original Arabic text into English language.El propósito del presente artículo es demostrar que el proceso de auto-traducción llevado a cabo por la novelista siria Samar al-‘Aṭṭār es más un proceso de interpretación del original árabe que un proceso de auto-traducción propiamente dicho gracias a la técnica de la re-escritura realizado por la autora-traductora al trasvasar el original árabe a la lengua inglesa
Correlates Corelates of Performance of Athletes in Eastern Samar State University
No full textABSTRACT
Title of Research : Correlates with the Performance of Athletes in the Eastern Samar Samar State University- GuiuanResearcher : Alvin B. LacabaCo-Author : Teresita Villa G. Lacaba
Keywords; Performance, Coaching skills, Technical skills, Competency, Professional preparation. This study was conducted to Correlates with the Performance of Athletes in the Eastern Samar State University, Guiuan, Specifically, this study answered the following:1. What is the level of competency of the faculty-coaches in terms of:2.1 Professional preparation2.2 Coaching skill 2.3 Technical skill? 2. What is the level of performance of athletes in the sports competition? 3. Is there a significant relationship between : 3.1. level of competency of faculty-coaches, and level of performance of athletes? This study employed descriptive-correlation which involved 30 faculty-coaches in the Eastern Samar Samar State University- Guiuan. Data were retrieved using a survey questionnaire. These were tallied and analyzed using appropriate statistical tools such as percentage, mean, Pearson product-moment correlation.Findings of the study revealed the following information: The competency of the faculty-coaches in terms of professional preparation, coaching skill, and technical skill of the faculty-coaches were all significantly associated to the performance of athletes. Hence, it was deduced that faculty-coaches who rated themselves higher in these criteria can motivate and train better athletes. Based on the findings of this study, the following conclusions are drawn:The faculty-coaches were regarded competent since they were professionally prepared for sports, with very good coaching skill and technically capable to handle their respective event or game. From the findings of the study, the following recommendations are offered:An organized sports training program should be implemented in the school or division so that all faculty-coaches will be given the chances to be trained especially the new ones.Further studies maybe conducted to validate the findings of this study.
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