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This study analyses the incidence of subjectively experienced dysphagia and voice change in post-thyroidectomy and parathyroidectomy patients without recurrent laryngeal nerve palsy.
Methods
A total of 400 patients were invited to participate in a telephone questionnaire based on the Dysphagia Handicap Index and Voice Handicap Index. At 6–24 months following surgery, participants were divided into: post-thyroid surgery (total, hemi-, parathyroidectomy) groups and controls (other ENT procedures). A total of 254 responses were received (127 following thyroid surgery, 127 controls).
Results
Twenty-two per cent of post-thyroidectomy patients had a Voice Handicap Index score of more than 3, compared to 15 per cent of parathyroid patients and 4 per cent of controls. The mean Dysphagia Handicap Index score for patients post thyroidectomy and hemi-thyroidectomy was 2.0. Parathyroidectomy patients had a mean Dysphagia Handicap Index score of 1.3, higher than controls at 1.0.
Conclusion
Dysphagia and voice alteration are common following thyroid surgery, even in the absence of recurrent laryngeal nerve injury. Both deficits occur more frequently following thyroid surgery than parathyroid surgery.
CHD are among the most common congenital defects. Due to the chronic nature of CHD, patients face various risk factors that threaten their mental health. However, a comprehensive understanding of the medical and social predictors of mental health issues in adults with CHD is lacking. This study aims to investigate the prevalence of anxiety and depression in adults with CHD.
Methods:
This cross-sectional descriptive study focused on adults with CHD in Kerman, Iran. The participants completed demographic information alongside two psychological assessment tools: the Beck Anxiety Inventory (BAI) and the Depression Anxiety Stress Scales (DASS)-21. The data were analyzed using SPSS 26.
Findings:
The mean age of the participants was 29.94 ± 12.36 years, and 63.8% were female. According to the DASS, 73.4% did not have depression, 61% did not have anxiety, and 76.2% did not have stress. In total, 19% had mild stress, and 4.8% had moderate stress. According to the BAI, 27.6% did not have anxiety. Individual characteristics were not significantly associated with depression. However, gender, age, and type of surgery were significantly associated with anxiety. Cyanosis was significantly associated with stress.
Conclusion:
The results show that mental disorders like depression, anxiety, and stress are highly prevalent in adults with CHD. The prevalence depends on individual factors such as age, gender, and disease severity. Therefore, it is recommended that mental disorders in this population be evaluated and treated accurately.
I continue the study of the blurry HOD hierarchy. The technically most involved result is that the theory ZFC + “$\aleph _\omega $ is a strong limit cardinal and $\aleph _{\omega +1}$ is the least leap” is equiconsistent with the theory ZFC + “there is a measurable cardinal.”
Most studies of genitive variation in English have considered only the choice of two variants ('s versus of), based on analysis of only tokens that are judged to be interchangeable. We argue in the present article that research on genitive variation can be usefully extended in both respects: including premodifying nouns as a third variant; and attempting to account for all tokens of the genitive. In addition, we extend the scope of analysis to explore the possibility of contextual constraints having different importance in different registers.
First, we carry out a text-linguistic analysis comparing the rates of genitive variants in texts from three registers (conversation, newspaper reports, academic articles), showing that genitives overall are much more frequent in written registers, with the premodifying noun variant being especially frequent. Then, a variationist analysis is undertaken to account for the choice of genitive variant in particular contexts and registers. A total of 3,425 genitive tokens were coded for ten contextual characteristics (e.g. length of the Modifying NP, semantic category of the Modifying noun and the Head noun, final sibilancy of the Modifying noun). Statistical analyses with random forests and conditional inference trees are triangulated, showing how contextual factors interact in predicting the use of each genitive variant – and how patterns of variation differ across registers.
Flow around curved tandem cylinders in the convex configuration has been studied by means of direct numerical simulations, for a Reynolds number of 500 and a nominal gap ratio of 3.0. Spanwise variation of flow regimes, as well as curvature-induced axial velocity, leads to an exceedingly complex vortex dynamics in the wake. Both parallel and oblique vortex shedding are observed. Oblique shedding is connected to repeated occurrences of dislocations. The dislocations are caused by two main mechanisms: frequency differences in the upper part of the curved geometry and shedding of gap vortices into the lower near wake. Both types of dislocations are closely associated with a mode switch in the gap. In parts of the gap, there is low-frequency quasi-periodic asymmetry of the gap vortices, where the flow is biased to one side of the gap for intervals of several wake vortex shedding periods. The switch from side to side is associated with a surge of the vertical velocity, and the frequency of the switch is similar to that of long-term variation of the recirculation length in the lower gap.
By 2050 the number of adults living with obesity in the UK will rise with approximately one in four in the adult population. This rising trend is not equitable, with higher prevalence in socially disadvantaged groups. There is an apparent paradox of not being able to provide food for the family to eat, a feature of food insecurity and living with obesity. With the current cost-of-living crisis, there is a challenge to afford both food and fuel bills. Environmentally sustainable and healthy diets are proposed to improve public health and reduce the impact of the food system on the environment, while also improving diet quality. However, healthier foods tend to be nearly three times more expensive than unhealthy foods, and this provides a challenge for citizens on low incomes. In this review, we explore some of the evidence for solutions in the retail food environment to support the UK food system to be safe, nutritious, environmentally friendly and fair for all. We highlight the value of co-production in research, to give value and power to the lived experience to address these inequalities. Our multidisciplinary research approach within the FIO Food research grant will generate new insights into modifiable and potentially impactful changes to the UK food system, specifically for the retail food sector. We believe that the co-creation, design and delivery of research with those living with obesity and food insecurity will help to transform the UK food system for health and the environment in this vulnerable group.
Service providers have a unique understanding of older homeless adults’ challenges and service needs. However, research on the experiences of health care providers (HCPs) who work with this population is limited. We aimed to gain a better understanding of the experiences (roles, challenges, and rewards) of HCPs who work with older homeless adults (age 50 and over) in outreach settings. We conducted individual semi-structured interviews with 10 HCPs who worked in these roles. Four themes emerged: (a) the client–provider relationship as an essential building block to HCPs’ work; (b) progression of care that acknowledges the “whole person”; (c) collaboration as integral to providers’ work; and (d) the importance of system navigation. Providers found their work personally and professionally fulfilling but were frustrated by system-level challenges. Findings can be used to identify strategies on how to further support providers in their roles and enhance service provision for older homeless individuals.
Focusing on the winter quartering of Kurdish nomadic tribes among peasant villages, this article discusses the patterns of Kurdish nomadism and nomad–peasant relations in the Ottoman sanjaks of Muş, Bayezid, and Van during the first half of the nineteenth century. It argues that the political structure of these regions and the requirements of animal husbandry among the nomads not only created a distinct pattern of nomadism among the Kurdish tribes, but also led to the polarization of relations between nomads and peasants. Moreover, the article observes how nomad–settled, tribe–peasant relations in these regions evolved as a result of the gradual sedentarization of the pastoral nomads and related changes in their subsistence economies starting from the mid-nineteenth century. Finally, this article provides a background for a better understanding of the intercommunal tensions and conflicts over land in the Ottoman Empire of the late nineteenth and early twentieth centuries.
Load balancing of constrained healthcare resources has become a critical aspect of assuring access to care during periods of pandemic related surge. These impacts include patient surges, staffing shortages, and limited access to specialty resources. This research focuses on the creation and work of a novel statewide coordination center, the Washington Medical Coordination Center (WMCC), whose primary goal is the load balancing of patients across the healthcare continuum of Washington State.
Methods:
This article discusses the origins, development, and operations of the WMCC including key partners, cooperative agreements, and structure necessary to create a patient load balancing system on a statewide level.
Results:
As of April 21, 2022, the WMCC received 3821 requests from Washington State hospitals. Nearly 90% were received during the pandemic surge. Nearly 75% originated from rural hospitals that are most often limited in their ability to transfer patients when referral centers are also overwhelmed.
Conclusions:
The WMCC served as an effective tool to carry out patient load balancing activities during the COVID-19 pandemic surge in Washington State. It (the WMCC) has been shown to be an equity enhancing, cost effective means of managing healthcare surge events across a broad geographic region.
This research article represents the design of a simple, smaller, and novel frequency reconfigurable patch antenna for 5G communication using PIN diodes. This antenna operates in both mid-5G and high-5G bands. The antenna is intended to operate in eight distinct modes with three PIN diodes in 5G wireless communication covering 27.46–50 GHz of high-5G band (range n257/n258/n260/n261/n262) and frequencies of the 3–6 GHz of mid-5G band (range n77/n78/n79/n46). The antenna has an overall size of 20 mm × 25 mm × 1.6 mm and is placed upon a low-cost FR4 substrate. A higher radiation efficiency from 75% to 98% is achieved in all the different modes. The resonant frequencies are around 3.46, 4.43, 5.83, 31.8, 35.5, and 46 GHz in different modes of operation. Different switching statuses have been carried out in this research work and their performances have also been illustrated in the form of surface current distribution in different resonant frequencies. The simulated and measured results are compared to highlight its proposed design operation.
This article opines that corporations should utilize leverage in procurement contracts with states to prevent human rights abuses. Capitalizing on leverage over state business partners should be understood as an under-explored but intriguing dimension to the advancement of human rights. This article uses the example of the Pfizer-Israel procurement contract to provide mRNA COVID-19 vaccinations as a case study. While the Pfizer-Israel contract required Israeli governmental compliance with various laws, and referenced other legal obligations, no reference to human rights, such as the right to informed consent, was referenced in any contractual provision. The failure of Pfizer to insert contractual provisions regarding the Israeli government’s duty to obtain informed consent provides a glaring exemplar of a missed corporate opportunity to fulfil the corporate responsibility to respect human rights.
This article offers a comprehensive analysis of rights-based climate litigation aimed at addressing climate change-induced loss and damage, underlining its potential as a transformative force amid the minimal progress towards a coordinated global response on this topic. It builds on literature highlighting the potential of rights-based climate litigation to fill the gap in accountability for climate change and its consequences, noting that research to date has not systematically analyzed the remedies that plaintiffs have sought or secured. By focusing on remedy claims, this study illuminates the capacity and the limitations of such litigation to unlock redress for loss and damage while highlighting its reciprocal relationship with international negotiations. This synergy implies a promising trajectory towards a more equitable climate governance framework, despite the complexities and challenges inherent in this rapidly evolving field.
In view of the celebration of the ‘International Year of Millets,’ millets are popularizing sustainable agricultural output amid challenging climates and nourishing adequately as food and feed. The extent of scientific intervention is the foundation for designing, promoting and popularizing neglected crops on social platforms. Planning future directions and adaptive strategies largely require regular evaluation of research efforts to identify hotspots and research gaps, as identified in the present study by creating a robust text-mining approach that integrates scientometrics using PubMed citation data. Keyword mining reveals that India and China are the leading publication centres on millets, possibly due to their large proportion of cultivation and indigenous nature. It further reveals that the pearl millet is the predominant one, followed by foxtail and finger millet, suggesting that most research is confined to them only; however, other millets, still have a research gap in comparison. The word abiotic stress is associated with high frequency in millet research due to its adaptive nature amid climate change. Thematic representation explored the novel concept of millet's utility as a probiotic and millet bran to ensure nutrient–cereal properties based on the persistency of keywords throughput research progression; however, incurious consumption is associated with harmful ochratoxin. Bio-concept mining and knowledge graph generation divided the millet research output into four large domains, which provides a largely covered bio-concepts for millet research and co-concurrence of emerging bio-concepts to intense progress and finds an adequate literature gap to improve millet research for sustained growth and equilibrate biodiversity.
This work investigates the statistical response of short and long laminar separation bubbles to external flow parameters, such as Reynolds number, free-stream turbulence intensity and streamwise pressure gradient, known to govern bubble formation and characteristics. A parametric experimental campaign has been performed using particle image velocimetry on a flat plate to provide a comprehensive database for the characterization of separation-induced transition in both short and long separation bubbles. The proper orthogonal decomposition (POD) was applied to the data set of all dividing streamlines commonly used to identify a laminar separation bubble. This provides an optimal state-space basis for the data-driven classification of the state of a laminar separation bubble, with the leading modes capturing the change in length and height of the laminar separation bubble in response to changes in the flow parameters. When projected onto the POD subspace constituted by the first three leading modes, the normalized data from the present study and the results from prior investigations not used in the modal analysis collapse on the same trajectory in the low-dimensional space. The present POD basis can be therefore adopted for the description of the general response of the time-mean shape of a laminar separation bubble to changes in the main influencing parameters. A well-defined pattern was observed in the case of short laminar separation bubbles in the reduced-order space defined by the first three POD coefficients, whereas a higher dispersion in the long-bubble regime indicates an increased sensitivity of long bubbles to the external flow characteristics.
In this paper, we compare the comprehension of the speech act meaning of non-canonical speech acts (i.e., rhetorical questions and surprise-disapproval questions) with the comprehension of indirect speech acts (i.e., indirect requests). Both speech act types are ‘mixed’ in the sense that they involve secondary and primary illocutionary forces, but our hypothesis is that they differ in their degree of how salient their primary illocutionary force is: On the one hand, the primary illocution is signaled by non-contextual cues (non-canonical speech acts); on the other hand, it is derived via pragmatic inferencing (indirect speech acts). We thus expect their comprehension processes to be different. We conducted a judgment experiment to test whether both speech act types differ regarding how accurate the primary illocutionary force is identified and regarding how fast that force can be identified. Our results suggest that non-canonical speech acts and indirect speech acts are indeed two distinct pragmatic and psychological phenomena: While non-canonical speech acts are more accurately identified with their primary illocutionary force than indirect speech acts, participants need more time to perform this identification for non-canonical speech acts than for indirect speech acts. Our findings shed new light on the mapping between linguistic form and illocutionary force and on the pragmatic typology of speech acts in general.
A low-profile wideband circularly polarized (CP) metasurface antenna is demonstrated for C-band applications. The metasurface consists of 4 × 4 square patches with Z-shaped slots. Characteristic mode analysis is used to investigate the modal behavior of the metasurface, and a pair of degenerate modes is chosen as the operating modes. The CP radiation is realized by exciting a pair of degenerate modes of the metasurface through a slot antenna, which is used as a feed structure with a 90° phase difference. The CP bandwidth is further widened by combining the resonance modes of the metasurface and slot antenna. The measured results show that the −10 dB impedance bandwidth of the antenna is 3.47–4.76 GHz, and the 3 dB axial ratio bandwidth is 3.5–4.9 GHz with a peak gain of 6.9 dBic. Moreover, the antenna exhibits well left-hand CP radiation performances with a low profile of 0.046λ0.
In Ethiopia, the low productivity of garlic is largely due to a shortage of high yielding and stable varieties. To address this issue, thirteen garlic genotypes were evaluated for yield stability and performance across six different environments in central and southeast Ethiopia. The genotypes were analysed using Additive Main effects and Multiplicative Interaction (AMMI) and genotype-by-environment interaction (G × E) methods. Results showed that the genotypes differed significantly for bulb yield performance and morphological traits, with G-020/03 and G-054/03 producing the highest bulb yield with 25.39% and 18.39% yield advantages over the check variety, Kuriftu, respectively. Furthermore, G-020/03 demonstrated better yield stability across most environments, while G-054/03 exhibited specific adaptability. GGE biplot analysis confirmed that these two genotypes were among the three winning genotypes in terms of yield performance and relative stability. Therefore, G-020/03 and G-054/03 have been selected as candidate varieties for release, potentially improving garlic productivity in Ethiopia.
Against the backdrop of failing environmental governance, rights of nature (RoN) are lauded as the paradigm shift needed to transform law's approach to nature. RoN have been increasingly proclaimed at the domestic level but remain mostly absent from international law. As examined in this article, this is notably as a result of some profound incompatibilities between international law and RoN, including the fact that most international treaties approach nature as a resource to be owned, exploited or protected for the sake of humans. However, despite this dominant approach to nature, some areas of international law, notably under the leadership of Indigenous peoples, are starting to acknowledge a more relational approach to nature, putting forward concepts of care, kinship, and representation of nature in international law. Building on these developments, this article offers a reflection on potential synergies between RoN and international law, specifically by changing the latter's approach to nature. It argues that some of the RoN concepts concerning duty of care, institutional representation of nature's voice, and ecocentrism could serve as a platform to reinterpret some of the anthropocentric principles of international law, creating some potential synergies between RoN and international law.