Journal articles on the topic 'Taking of handicap'

Because of many features of handicap, such as the number of actors and interactions, the complexity of the field, handicap must be considered from a system point of view, and dealt with as any system. That makes it possible to build a comprehensive response to the question of the inclusion and full citizenship of people with disabilities, better than some fragmentary solutions often proposed. The paper emphasizes relationships inside the disability field and external relationships with the environment, namely valid people in everyday life and workfield; the consideration of those external relationships leads to the compensation of handicap for a better accessibility to buildings, transports, care, communication, and soon; unexpected spin-offs of that compensation on the whole of population can be observed.

Since taking the decision to pursue a career in mental handicap, I have been increasingly aware of the debate surrounding the role of the consultant psychiatrist in this field. Nowhere else in medicine does there seem to be such uncertainty about the continued need for an already established specialty. I believe that one of the major reasons for the continued difficulty in attracting trainees into mental handicap is precisely this uncertainty about its future, which is in no way ameliorated by the College's view that a full time specialist appointment in the psychiatry of mental handicap is not superior to a joint appointment either with adult or child psychiatry.1

Increasing concern has been expressed in the psychiatric literature and general press about the use of neuroleptic medication for the treatment of behaviour disturbance in the mentally handicapped (Buck & Sprague, 1989). The issue was highlighted in a television documentary (Public Eye, BBC2, 1 May 1992) which reported a number of cases of tardive dyskinesia in mentally handicapped people who had been treated with neuroleptics. The programme, although taking a characteristically slanted view, will have made an impression on relatives, patients and the general public. It was also intimated that British families may be preparing to test the legal grounds for prescribing these drugs to the mentally handicapped, particularly where there is no formal psychiatric diagnosis.

Objective. To describe the results of a vestibular rehabilitation (VR) program in the timed up and go (TUG), gait speed (GS), and dizziness handicap inventory (DHI) scores for elderly vestibular patients in a developing country.Methods. Descriptive study with retrospective data collected from the clinical records of vestibular patients. The following information was recorded: sex, age, type of vestibular disorder, DHI score, and performance in TUG and GS, before and after participation in a VR program taking place from January 1 to August 30, 2017. The VR program consisted of 10 twice weekly sessions in the clinic and daily exercises at the patient’s home. We used Student’st-test for paired and Wilcoxon’s test according to the data distribution. The level of significance was 5%.Results. Data from 57 patients (49 females; 78 ± 5.8 years old) were used. There were statistically significant differences in TUG (12.52 versus 11.56), GS (0.81 versus 0.90 m/s), DHI total handicap (46 versus 24), physical (14 versus 8), emotional (14 versus 6), and functional (18 versus 12) domains.Conclusion. The functional outcome measures reported, including TUG, gait speed, and DHI, reflect statistically significant improvements in elderly patients after vestibular rehabilitation; the DHI improvements are clinically relevant.

SummaryWe investigated research activities on schizophrenia in 17 non-English speaking (13 European: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Italy, Luxembourg, Netherlands, Portugal, Spain, and Sweden and 4 Asian: China, Japan, South Korea, and Taiwan) countries via a MEDLINE database survey. Despite the handicap of language, a reassuringly large number of English-written papers in research into schizophrenia have been reported; 892 papers from these countries appeared over the period 1990–1994. Among the countries investigated, Scandinavian countries in particular were found to have produced more communicable papers after taking into account the number of psychiatrists.

An investigation in a large mental handicap hospital revealed that 24% of the in-patients were receiving antipsychotic drugs. Chlorpromazine and thioridazine prescriptions accounted for 62% of the total while 10% of patients received depot preparations. Fifty-five per cent of the patients receiving these drugs had no established psychiatric diagnosis; most of these could be categorised as having a behaviour disorder. Patients aged 30–50 received higher doses, and female patients received a significantly higher mean dosage than male ones. In the patients receiving neuroleptic drugs who had also been taking them four years previously, there was a significant reduction in the dosage of the drugs received and the extent of polypharmacy of these agents. A mandatory requirement to review all prescriptions annually, implemented in 1984, may be a reason for this.

Abstract40 children attending a nursery and school for the handicapped were seen in a total of 55 consultations. Following detailed case taking from parents and school staff, medicines were selected by computer repertorization and verified against the child's constitutional type. Outcome was assessed with reference to preselected target symptoms.18 of the 40 children responded well in all target symptoms, 11 showed improvement in some but not all target symptoms; 7 children did not respond to treatment, and in 4 outcome could not be assessed. Children with organic brain damage, autism and definite syndromes generally responded well; those whose handicap was due to social deprivation generally failed to respond. Major responses were increased drive and improvement in hyperactive and aggressive behaviour, which enabled the children to benefit more from their education. Physical symptoms and problems such as stammering and enuresis also improved.

Finite element computer programs are frequently used to analyze and design embankments and similar earth structures. In most of the available computer programs, lack of a proper constitutive relationship to deal with volume change when an increase in the degree of saturation occurs, namely collapse phenomena, is a major handicap. In this paper, volume change results obtained from isotropic compression tests conducted on unsaturated compacted soil specimens are presented. Dependence of the bulk modulus of the soil on water content is investigated. Next, a hyperbolic formulation for volume change behavior of unsaturated soils taking into account variation of soil water content is presented. This hyperbolic model relates mean applied stress, volume change, and water content and represents a three-dimensional surface, the so-called "state surface". Suitability of the proposed model to predict collapse phenomena is verified by examining the model prediction against available experimental data.Key words: hyperbolic, unsaturated soil, collapse, volume change, suction pressure, bulk modulus.

Abstract This paper explores sort humor ‘black humor’, a key concept in Danish conversational humor. Sort forms part of a larger class of Danish synesthetic humor metaphors that includes other categories such as tør ‘dry’, syg ‘sick’, and fed ‘fat’. Taking an ethnopragmatic perspective on humor discourse, it is argued that such constructs function as a local catalogue for socially recognized laughing practices. The aim of the paper is to provide a semantic explication for sort humor and explore the discursive practices associated with the concept. From a comparative perspective, it is demonstrated that the Danish conceptualization of “blackness” differs from that of l’humour noir, a category of French surrealism, and English black humor with its off-limit topics such as death and handicap. In Danish discourse, sort humor has come to stand for a practice of collaborative jocular non-sense making. It is further argued that the main function of sort humor is to establish or enhance a feeling of “groupy togetherness”.

In the present educational context, active methodologies and new technologies are aspects that should be included when teaching and learning a subject area. For the education to be successful, classroom management must be considered, since problems may arise and handicap this process. In order to promote learning and reduce negative behaviors and increase positive ones, intervention on students of 1st year of ESO (compulsory secondary education) was implemented. The intervention used gamification as the educational approach and ClassDojo as the online tool to track behavior to determine the effectiveness of both elements to achieve the goal. Taking advantage of the game design principles and mechanics in the learning environment to create motivation and interest, in addition to the information and communication technologies (ICT) represented by ClassDojo, the experimental study showed the benefit of this method and app regarding the improvement of desired behaviors as well as the decrease of the disruptive ones. The implementation engaged the students and activated their behavioral development in order to display a better performance.

In the long term, productivity and especially productivity growth are necessary conditions for the survival of farms and the food industry in Finland. The natural handicap and small farm size are challenges, but farmers are further challenged by the decoupling of supports and their transformation into direct income payments. Additionally, farmers’ actions are limited by some institutional settings that substantially reduce incentives to improve productivity. Technical progress was found to drive the increase in productivity on grain farms in Finland. The scale had only a moderate effect and for the whole study period (1976–2006) the effect was close to zero. Total factor productivity (TFP) increased, depending on the model, by 0.6–1.7% per year. The results demonstrated that the increase in productivity was hindered by the policy changes introduced in 1995. The cumulative increase in TFP over the study period was at the same level as the measured yearly changes in TFP. The results highlight the nature of grain farming in Finland as well as the challenges in simultaneously taking into account the general trend and yearly variation in TFP.;

Background: Several tinnitus sufferers suggest that manganese has been helpful with their tinnitus. Purpose: We tested this in a controlled experiment where participants were committed to taking manganese and Lipoflavonoid Plus® to treat their tinnitus. Research Design: Randomized controlled trial. Study Sample: 40 participants were randomized to receive both manganese and Lipoflavonoid Plus® for 6 months, or Lipoflavonoid Plus® only (as the control). Data Collection and Analysis: Pre- and postmeasures were obtained with the Tinnitus Handicap Questionnaire, Tinnitus Primary Functions Questionnaire, and tinnitus loudness and annoyance ratings. An audiologist performed the audiogram, the tinnitus loudness match, and minimal masking level. Results: Twelve participants were dropped out of the study because of the side effects or were lost to follow-up. In the manganese group, 1 participant (out of 12) showed a decrease in the questionnaires, and another showed a decrease in the loudness and annoyance ratings. No participants from the control group (total 16) showed a decrease in the questionnaires ratings. Two participants in the control group reported a loudness decrement and one reported an annoyance decrement. Conclusions: We were not able to conclude that either manganese or Lipoflavonoid Plus® is an effective treatment for tinnitus.

There are many nanoencapsulation systems available today. Among all these, mesoporous silica particles (MSPs) have received great attention in the last few years. Their large surface-to-volume ratio, biocompatibility, and versatility allow the encapsulation of a wide variety of drugs inside their pores. However, their chemical instability in biological fluids is a handicap to program the precise release of the therapeutic compounds. Taking advantage of the dissolving capacity of silica, in this study, we generate hollow capsules using MSPs as transitory sacrificial templates. We show how, upon MSP coating with different polyelectrolytes or proteins, fully customized hollow shells can be produced. These capsules are biocompatible, flexible, and biodegradable, and can be decorated with nanoparticles or carbon nanotubes to endow the systems with supplementary intrinsic properties. We also fill the capsules with a fluorescent dye to demonstrate intracellular compound release. Finally, we document how fluorescent polymeric capsules are engulfed by cells, releasing their encapsulated agent during the first 96 h. In summary, here, we describe how to assemble a highly versatile encapsulation structure based on silica mesoporous cores that are completely removed from the final polymeric capsule system. These drug encapsulation systems are highly customizable and have great versatility as they can be made using silica cores of different sizes and multiple coatings. This provides capsules with unique programmable attributes that are fully customizable according to the specific needs of each disease or target tissue for the development of nanocarriers in personalized medicine.

This experiment was conducted to assess the impact of esteem-related feedback and success-contingency on the self-protective/self-enhancing aspects of self-handicapping behavior. Following feedback about either contingent or noncontingent success on an intellectual task provided by a male experimenter, 67 male subjects randomly received either ego-enhancing or ego-diminishing feedback on an unrelated task (social skills) provided by a female experimenter. It was hypothesized that the effect of esteem-related feedback on an unrelated task (social skills) provided by the female experimenter would generalize to other ego functions and activate self-protective/self-enhancing processes. It was predicted that those individuals whose self-esteem had been lowered, whether in the conditions of contingent or noncontingent success would self-protect more in that they would be more inclined (1) to attribute their success externally, (2) to self-handicap by choosing the performance-inhibiting drug more often, (3) to show a lower expectancy of future success on retest, and (4) to self-protect by refusing more often to volunteer in a proposed high-risk experiment than those subjects whose self-esteem had been raised via ego-enhancing feedback on the unrelated task. Analysis showed that esteem-related affect did not generalize from the intellectual domain to the social-skills area or from the male to the female experimenter. The findings are discussed in terms of the compartmentalization of affect such that risk-taking reflected self-protection on tasks associated with the female experimenter while the remaining variables associated with the male experimenter showed no such effects.

Cerebral palsy (CP) is one of the most often non-progressive encephalopaties. among clinical symptoms the mobility and posture disturbances are predominantly observed, most typically neurologic and motor disturbances, showing up as spasticity, disturbances in muscle tension, ataxia or somatosensoric problems. CP and its coexisting symptoms, encompassing mental impairment are most severe causes of handicap in children and constitute an important factor deteriorating the fulfilment of developmental tasks. the improvement of the functional status depends on systematic training based on learning processes. Following training, as effect of learning, stable plastic alterations in brain occurs, based on the previously described feature of making new synaptic connections and synaptic stabilization due to apoptosis of some other neural connections. Neverless pharmacotherapy, though it cannot remove the source of the disturbances and acts mainly symptomatically, is a important element of the complex rehabilitation. However, taking into consideration the chronic and stable character of the pathologic process, it should be remembered that the pharmacologic substances used should be characterized by:•high safety,•low toxicity,•beneficial psychotropic properties,organoleptic properties accepted by children.The most frequently used drug groups in the cerebral palsy are:•tranquilizers,•anxiolytic drugs,•neuroleptics,•antidepressive drugs,•psychoenergetizing drugs, improving the brain circulation, limiting muscular tonus, - anti-epileptic drugs.Rational use of relatively wide spectrum of drugs, relaxant, sedative, anxiolytic, toning up, improving cerebral perfusion, anticonvulsory and reducing muscle tonus makes diagnostics, functional psychotherapy, kinesis therapy, ergotherapy, manual therapy, physical therapy, as well as social and occupational rehabilitation easier to a very high extent.

Background: Acute bacterial meningitis (ABM) continues to remain an important cause of morbidity, mortality and handicap in children despite availability of wide range of antimicrobials. The microorganisms vary according to age, socio economic condition and geographical area along with other factors.Methods: A prospective study was conducted over 2.5 years from October 2012 to April 2015 in the department of pediatrics, SVP Institute of Pediatrics, SCB Medical College, Cuttak, Odisha, India. Total 104 subjects were included after taking meticulous inclusion criteria.Results: Out of 104 cases, majority (70.2%) were infants. 60.6% were male with M:F ratio 1.5:1. Fever was the commonest symptom in 69.2% followed by convulsion 61.5%, vomiting 36.5%, altered sensorium 33.7%. On examination 69.2% children were febrile, having bulging fontanelle in 34.6%, pneumonia 31.7%, positive meningeal sign 29.8%, cranial nerve palsies 14.4%, papilledema 12.5% and hemiplegia 11.5% cases. GCS were poor (<7) in 26.9% cases. 33.6% had high CSF cell count (>100/cumm). In 82 cases (78.8%) etiological agents were identified consisting of H. influenzae in 46.4%, S. pneumoniae in 36.6%, E. coli in 8.6% and others in 8.4%. CT scan of brain revealed brain edema in 29.4% followed by subdural effusion 19.6%, hydrocephalus 17.6% and infarction in 5.9%. 63.5% children were recovered completely. Mortality was 16.3% with sequelae in 20.2% cases.Conclusions: Hib and Pneumococci were two most common organisms causing ABM in U-5 children with high mortality and sequelae which can be prevented by early diagnosis, optimum lab diagnostic facility and mass vaccination. There is urgent need to include Pneumococcal vaccine in NIP for substantial reduction of infant mortality.

<p class="abstract"><strong>Background:</strong> Theoretical consideration suggests an impact of the age at tinnitus onset influencing tinnitus distress. The use of masking for tinnitus is a primary method of treatment of tinnitus. The objective was to study effectiveness of masking by introducing audiometric reference signal in treatment of subjective tinnitus.</p><p class="abstract"><strong>Methods:</strong> The 90 patients (45 males and 45 females) were assessed by pure tone audiometer. Patients were divided into 6 age group sets for evaluation. The reference signal (90 to 100 dB SPL for 2-3 minutes in tinnitus ear of frequency 1000 Hz) was used for masking therapy. Outcome of the study was measured by using the tinnitus handicap inventory (THI) score and awareness time (tinnitus perception) before and after audiometric reference signal masking therapy. Success rate was measured to measure therapeutic efficacy. </p><p class="abstract"><strong>Results:</strong> Our results depict improvement in subjective tinnitus by 57.78% (in males), 55.56% (in females) and overall 56.67% success in patients aged between 21 to 60 years by using our audiometric reference signal masking therapy. Regarding gender, the finding of THI score, Awareness time and Success rate in our study showed females being affected more than males. Our study also evidenced a highest percentage of tinnitus after the age of 70 followed by the decades 61–70 and 51–60.</p><strong>Conclusions:</strong> Our new economically viable approach to subjective tinnitus patients by audiometric reference signal seems to be an effective in improv­ing the patient’s distress in age group 21 to 60 years. Before taking decision for selection of high cost hearing aids, we can use it for poor people.

<p><strong>Resumen:</strong></p><p>El sector del petróleo y gas es un sector económico estratégico con repercusiones a escala global. Sin embargo, una de las principales limitaciones de esta industria radica en las características de las regiones en las que opera, ya que a menudo se trata de zonas geográficas de elevada importancia bioclimática, zonas con poblaciones indígenas o sectores rurales sumidos en la pobreza. Esto ha generado que los stakeholders presten cada vez más atención a las implicaciones sociales, naturales y económicas de las actividades del sector del petróleo y gas.</p><p>Así las cosas, teniendo en cuenta que los países latinoamericanos cuentan con las mayores reservas convencionales mundiales de petróleo, el presente artículo tiene como objetivo cuantificar la información voluntaria sobre sostenibilidad que divulgan las empresas petroleras y gasíferas que operan en Latinoamérica.</p><p> </p><p><strong>Abstract:</strong></p><p> The oil and gas sector is a strategic area of the economy with global repercussions.</p><p>This industry faces a major handicap, namely the characteristics of the regions in which it operates, which are often geographic areas of great bioclimatic importance, or inhabited by indigenous populations, or comprised of very low income rural sectors.</p><p>In response, stakeholders are paying ever greater attention to the social, natural and economic consequences of oil and gas sector activities.</p><p>Taking into consideration that Latin American countries possess the largest conventional oil reserves in the world, this paper aims to quantify the sustainability information disclosed voluntarily by oil and gas companies operating in Latin America.</p>

The choice of membership functions plays an essential role in the success of fuzzy systems. This is a complex problem due to the possible lack of knowledge when assigning punctual values as membership degrees. To face this handicap, we propose a methodology called Ignorance functions based Interval-Valued Fuzzy Decision Tree with genetic tuning, IIVFDT for short, which allows to improve the performance of fuzzy decision trees by taking into account the ignorance degree. This ignorance degree is the result of a weak ignorance function applied to the punctual value set as membership degree. Our IIVFDT proposal is composed of four steps: (1) the base fuzzy decision tree is generated using the fuzzy ID3 algorithm; (2) the linguistic labels are modeled with Interval-Valued Fuzzy Sets. To do so, a new parametrized construction method of Interval-Valued Fuzzy Sets is defined, whose length represents such ignorance degree; (3) the fuzzy reasoning method is extended to work with this representation of the linguistic terms; (4) an evolutionary tuning step is applied for computing the optimal ignorance degree for each Interval-Valued Fuzzy Set. The experimental study shows that the IIVFDT method allows the results provided by the initial fuzzy ID3 with and without Interval-Valued Fuzzy Sets to be outperformed. The suitability of the proposed methodology is shown with respect to both several state-of-the-art fuzzy decision trees and C4.5. Furthermore, we analyze the quality of our approach versus two methods that learn the fuzzy decision tree using genetic algorithms. Finally, we show that a superior performance can be achieved by means of the positive synergy obtained when applying the well known genetic tuning of the lateral position after the application of the IIVFDT method.

ABSTRACTBackground: Tinnitus is believed to cause significant psychological distress leading to impairment in quality of life (QOL). Purpose: To assess the negative impact of tinnitus on patient’s QOL and discuss the management approach of tinnitus patient. Method: A cross-sectional study was conducted within one year duration on 88 patients who experienced tinnitus. Patients from Otorhinolaryngology clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were evaluated based on socio-demographic data, clinical data and QOL. QOL was assessed using Tinnitus Handicap Inventory (THI), a self-report questionnaire measuring 3 domains of QOL: functional, emotional and catastrophic scales. Result: Respondents consisted of 35 males (39.8%) and 53 females (60.2%), with mean age of 57.9±13.9 years old. Pure tone audiometry should be done at least once during the follow up period. Patients with persistent tinnitus had significantly higher mean THI total scores (p=0.042) and emotional subscale score (p=0.037) compared to patients with intermittent tinnitus. However, there were no significant associations between gender, duration of tinnitus and laterality of tinnitus with patient’s THI score. Discussion: All patients should have good history taking, proper physical examination and investigation. Those without the primary cause of tinnitus would be given tinnitus activity treatment by good counselling on tinnitus. Patient with vascular disorder would be given conservative treatment. Conclusion: Magnetic resonance imaging was indicated in asymmetrical hearing loss with tinnitus. Computed tomography scan with contrast was indicated when there is pulsatile tinnitus with/without abnormal ear finding. Patients with high grades THI questionnaire would be referred to psychiatrist for further assessment. ABSTRAKLatar belakang: Tinitus diyakini dapat menyebabkan stress psikologi yang signifikan sehingga mengakibatkan penurunan kualitas hidup seseorang (Quality of Life / QOL). Tujuan: Menilai dampak negatif tinitus pada kualitas hidup penderita dan merencanakan penatalaksanaannya. Metode: Penelitian ini merupakan studi potong lintang pada 88 penderita tinitus selama satu tahun. Penderita yang datang ke unit rawat jalan Telinga Hidung Tenggorok Bedah Kepala dan Leher (THT-KL), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) dilakukan evaluasi berdasarkan data demografi, data klinis dan QOL. Quality of life dinilai menggunakan Tinnitus Handicap Inventory (THI), kuesioner tentang penderita yang mengukur 3 domain QOL: skala fungsional, emosional dan katastropik. Hasil: Responden terdiri dari 35 laki-laki (39,8%) dan 53 perempuan (60,2%), dengan rerata usia 57.9±13.9 tahun. Audiometri nada murni perlu dilakukan minimal satu kali selama periode penelitian. Penderita dengan tinitus persisten secara signifikan memiliki nilai rata-rata THI yang lebih tinggi (p=0.042) dan nilai emotional subscale (p=0.037) dibandingkan dengan penderita tinitus intermiten. Tidak ada hubungan yang signifikan antara jenis kelamin, durasi tinitus dan lateralisasi tinitus dengan nilai THI penderita. Diskusi: Semua penderita diperlukan anamnesis yang baik dan pemeriksaan fisik yang menyeluruh. Penderita tanpa penyebab primer dari tinitusnya akan diberikan terapi konseling tinitus yang baik. Penderita dengan gangguan pembuluh darah akan diberikan pengobatan konservatif. Kesimpulan: Magnetic resonance imaging perlu dilakukan pada gangguan pendengaran satu sisi dengan tinitus. Computed tomography scan dengan kontras dilakukan pada tinitus pulsatil dengan atau tanpa kelainan pada telinga. Pada pendertita dengan nilai kuesioner THI yang tinggi akan dirujuk ke psikiater untuk penilaian lebih lanjut.

In this paper, we propose a family of indistinguishability operators, that we have called Yager Possibilitic Response Functions (YPRFs for short), as an appropriate tool for allocating tasks to a collective of agents. In order to select the best agent to carry out each task, we have used the so-called response threshold method, where each agent decides the next task to perform following a probabilistic Markov process and, in addition, involves a response function which models how appropriate the task is for the agent. In previous works, we developed a new response threshold method which incorporates the use of indistinguishability operators as response functions and possibility theory instead of probability, for task allocation from a very general perspective without taking into account the specific characteristics of the agents except their limitations to carry out a task. Such an allocation is modelled by means of possibilistic, instead of probabilisitic, Markov chains. We show that possibilistic Markov chains outperform its probabilistic counterparts for the aforementioned propose. All the indistinguishability operators considered in previous papers were not able to take into account the agents’ restrictions for moving from a task to another one, or equivalently to carry out a task instead of another one. In order to avoid this handicap, we introduce a new kind of response functions, YPRFs, which are modelled by means of indistinguishability operators obtained via Yager t-norms. This new type of response functions drops to zero when an agent, due to its limitations, is not able to execute a task and, therefore, is able to model a generic multi-agent system with restrictions. The performed simulation, under Matlab, allows us to compare the results obtained using the new YPRFs with those obtained applying celebrated response functions also generated via indistinguishability operators (that we call Original Possibilitic Response Functions, OPRFs for short). Moreover, the results confirm that the YPRFs are able to take into account agent’s restrictions while the OPRFs are not able. Finally, in the light of the experimental results, we can confirm that those systems modelled.

Introduction: Freshwater research in Latin America has been increasing in recent years, with a large participation of scientists based on local institutions. However, researchers in the region are facing diverse challenges, and we lack a regional overview of the status of freshwater research. Objective: To address this, we surveyed researchers in the region to assess the current activity and challenges faced by the scientific community. We were interested in understanding (1) the type of research currently taking place in the region, (2) the major research gaps, as viewed by local researchers, and (3) the main limitations or obstacles slowing the development of freshwater science in the region. Methods: We prepared a questionnaire with 26 questions regarding the background of participants, their ongoing research priorities, the products generated from their research, and the major limitations they are facing as researchers. Results: We obtained 105 answers from researchers in 19 Latin American countries. Some of the important trends identified included: (1) a focus on stream ecosystems under agricultural and natural forest; (2) emphasis on biodiversity assessment and species inventories; (3) limited ecological research, mostly centered on litter decomposition and food web studies; and (4) communicating research in the form of peer-reviewed papers and reports in gray literature. Major limitations to the scientific activity included: (1) language, with a majority of respondents considering their handling of English a handicap; (2) limited access to research equipment; (3) lack of tools, such as taxonomic keys; and (4) limited research funding. Research needs and priorities resulted in three major areas in need of attention: (1) developing taxonomy and systematics; (2) improving our current understanding of ecology and natural history; and (3) understanding species distributions and biodiversity patterns. Conclusions: Latin America has an active community of scientists. There is a need to diversify research topics, without abandoning traditional research areas (e.g., taxonomy, species distribution). We advocate for more collaboration among scientists with similar research goals, regardless of their affiliation. Improving communication and collaboration among universities and countries within Latin America will certainly facilitate overcoming obstacles and will help shaping a brighter future for freshwater research, and sciences in general, in the region.

Background: Birth asphyxia is an important cause of static development and neurological handicap in both term and preterm infants. Birth asphyxia is found to be responsible for 28.7% deaths in hospital settings and 20% deaths in rural/tribal areas. Approximately the same number develops serious sequelae which cripples these children both physically and mentally. Children who have suffered moderate encephalopathy had varying rates of infant death and morbidity. Precise determination of the prognosis in the term new born, who sustains a hypoxic ischemic insult is hindered by difficulty in determining the severity of insult.Methods: This was a prospective longitudinal, observational study was conducted in the Department of Paediatrics, CMC Bhilai with close association with the Department of Obstetrics and Gynecology, Department of Radio diagnosis and Department of Neurology. All deliveries taking place in the Department of Obstetrics and Gynecology of CMC Bhilai were enrolled for the study. Each enrolled infant underwent a detailed neurologic examination within the first 12 hours after birth. During the period of data collection 180 babies with birth asphyxia were admitted to NICU. Out of which 126 babies had fulfilled the inclusion criteria and completed one year follow up, hence as cases. Babies who lost follow up were not included in study. The neurological examination was performed 14 days after discharge, then at 1 month, 3-month, 6-month, 9 month and 12 months. Long term outcome in this study is defined as outcome at one year of age in terms of morbidity and mortality.Results: The female and male ratio is 0.4:1. Most of the asphyxiated newborn, 81 (64%) were in 2500-3000gm. Among the study population, maximum number of cases 76 (60%) were suffering from HIE-I. Majority of study population, 87 (69%) were born by LSCS. Normal CUS in 93 babies and abnormal in 33 babies; with normal CUS, there were no death in study population and out of 33 abnormal CUS, 12 deaths occurred. Out of the different complications enlisted in the table convulsions (66.7%) is most common followed by Apnea (65.08%). Recurrent infections (45.24%) is the most common complication followed by seizure disorders (22.63%) and failure to thrive (20.63%).Conclusions: Hypoxic ischemic encephalopathy is one of the major consequences of perinatal asphyxia. Despite of best care, some babies are likely to develop it.

AbstractVestibular rehabilitation (VR) is practiced across Europe but little in this area has been quantified. The aim of this study was to investigate current VR assessment, treatment, education, and research practices. This was an online, cross-sectional survey with 39 VR specific questions and four sections: demographics, current practice, education, and research. The survey was disseminated through the Dizzynet network to individual therapists through country-specific VR special interest groups. Results were analysed descriptively. A thematic approach was taken to analyse open questions. A total of 471 individuals (median age 41, range 23 − 68 years, 73.4% women), predominately physiotherapists (89.4%) from 20 European countries responded to the survey. They had worked for a median of 4 years (range < 1 − 35) in VR. The majority (58.7%) worked in hospital in-patient or out-patient settings and 21.4% in dedicated VR services. Most respondents specialized in neurology, care of the elderly (geriatrics), or otorhinolaryngology. VR was reported as hard/very hard to access by 48%, with the main barriers to access identified as lack of knowledge of health care professionals (particularly family physicians), lack of trained therapists, and lack of local services. Most respondents reported to know and treat benign paroxysmal positional vertigo (BPPV 87.5%), unilateral vestibular hypofunction (75.6%), and cervicogenic dizziness (63%). The use of vestibular assessment equipment varied widely. Over 70% used high-density foam and objective gait speed testing. Over 50% used dynamic visual acuity equipment. Infrared systems, Frenzel lenses, and dynamic posturography were not commonly employed (< 20%). The most frequently used physical outcome measures were the Clinical Test of the Sensory Interaction of Balance, Functional Gait Assessment/Dynamic Gait Index, and Romberg/Tandem Romberg. The Dizziness Handicap Inventory, Visual Analogue Scale, Falls Efficacy Scale, and the Vertigo Symptom Scale were the most commonly used patient reported outcome measures. Adaptation, balance, and habituation exercises were most frequently used (> 80%), with virtual reality used by 15.6%. Over 70% reported knowledge/use of Semont, Epley and Barbeque-Roll manoeuvres for the treatment of BPPV. Most education regarding VR was obtained at post-registration level (89.5%) with only 19% reporting pre-registration education. There was strong (78%) agreement that therapists should have professionally accredited postgraduate certification in VR, with blended learning the most popular mode. Three major research questions were identified for priority: management of specific conditions, effectiveness of VR, and mechanisms/factors influencing vestibular compensation and VR. In summary, the survey quantified current clinical practice in VR across Europe. Knowledge and treatment of common vestibular diseases was high, but use of published subjective and objective outcome measures as well as vestibular assessment varied widely. The results stress the need of improving both training of therapists and standards of care. A European approach, taking advantage of best practices in some countries, seems a reasonable approach.

Abstract The pivotal role of the gonadotropins (GtHs) luteinizing hormone (LH) and follicle stimulating hormone (FSH) in vertebrate reproduction is well documented. LH and FSH bind to the leucine-rich repeats of the extracellular domains of their cognate receptors (R) in the gonads to actuate steroidogenesis and gametogenesis. Though these GtHs specifically bind only to their cognate receptors in mammals, this interaction becomes inconsistent in the case of fish. Whilst in some fish species the gonadotropins show receptor specificity much like their mammalian homologs, FSH and LH have demonstrated mutual and/or singular cross-activation of the FSH and/or LH receptors in several fish species. These complications regarding receptor specificity are further magnified by cross activation by orthologous GtHs from different species. So far no consistent pattern has been established to chart or predict this cross-talk in specific species or higher taxonomic orders. In the current study, we strived to understand the promiscuous nature of FSH and LH through in silico perspectives. While our studies in Russian sturgeon (Acipenser gueldenstaedtii) have shown FSH and LH to exhibit mutual promiscuity but of varying magnitude, in common carp (Cyprinus carpio) only LH showed singular cross-activation of FSHR. In Nile tilapia (Oreochromis niloticus) these gonadotropins exhibited strict specificity towards their cognate receptors similar to humans. Taking these species as representatives of varying degrees of cognate binding shown by the gonadotropins, we have generated docked models of these hormones and the extracellular domain of these receptors using in silico tools. We have further tried to compare these models, their docked poses, and key residues involved in the binding of these hormone-receptor complexes. We have further tried to compare parameters such as phosphorylation sites, N-linked glycosylation motifs, surface charge, etc. of these models to better understand the docking of these complexes. Our results suggest that in cases of cross activation by FSH and/or LH within or across the species, though binding sites are present at the leucine rich repeats on concaved face of the receptor extracellular domain, the docked position and residues involved in binding may vary significantly. Furthermore, though the seatbelt loop and GTHβ loop-2 (gonadotropin hormone subunit- beta) of the gonadotropin hormones act as the key players in binding, the docking of the hormone may vary in conformation. Due the large size and flexibility of these hormones and the receptor binding interface, it seems apparent that there are multiple binding sites that activate the resulting signaling pathway. Our study aspires to provide better insights towards the promiscuous nature of these hormones and attempt to overcome the handicap of lack of individual physical models using in silico tools.

This paper uses data acquired from a visit to ASHA (Academy for Severe Handicaps and Autism), a charitable trust in Bengaluru. The response of the students at ASHA to three different games was obtained for statistical analysis. They were assessed on three different parameters namely time, accuracy and difficulty. A comparison was done between the response of the children at ASHA and the response of children without special needs to the same. It was quantitatively realised that children with special needs exhibited lower levels of accuracy and alertness, apart from taking a large amount of time to complete a certain task.

The article starts by reviewing how Protestantism in the People's Republic of China has come to be the way it is, taking into account the historical and political forces. In fact, the leadership of Protestant Christianity has had to learn to come to terms with political realities. In part due to forces of circumstances but at the same time by conscious choice, the church there has achieved her selfhood and is working out patterns of unity in remarkable ways. In the meantime the Spirit is at work promoting the church's growth and making for theological ferment. In spite of handicaps, including a shortage of pastors, the church in China is going someplace.

During the previous decade, the nature and dynamics of Indian companies' engagement with the overseas markets have gone through a shift. Overseas expansion and competitiveness are increasingly dependent on firm level capabilities rather than on national endowments in traditional products or commodities. Two meta-trends are driving the presence, growth, and competitiveness of Indian companies in overseas markets. One, the process of liberalization and globalization of Indian economy has led to the development of competitive capabilities by Indian companies and has brought about intensive interaction with global corporations, professionals, capital, ideas, and practices. Two, the transforming impact of information and communication technology (ICT) on the world of business has resulted in the emergence of new types of businesses and new ways of organizing. The context and timing bestow Indian companies with a set of advantages and challenges. This panel discussion has the benefit of six cogent contributions-from academics who have intimately researched the phenomenon to practitioners who have led their organizations and have created substantial presence in overseas markets. Some of the major patterns and conclusions that the colloquium converges upon are as follows: From comparative to competitive advantage: With shift towards advantages based on availability, lower cost and skills of the technical and scientific manpower, Indian companies' need to create complementary skills and the success are governed by competencies developed within a company and aspirations of its top management. Favourable ‘push’ and ‘pull’ conditions for overseas successes: For an increasing number of industries, Indian companies are reaching the point of having global advantages-favourable factor conditions, domestic demand characteristics comparable to that overseas, presence of ancillary and supportive skills, and pervasive confidence for looking beyond domestic markets. On the ‘pull’ side, from the situation of Indian origin being a handicap, the world has come to acknowledge ‘India advantage.’ Three strategy types for Indian companies in overseas markets: ‘Outsourcing,’ where the domestic market is either very small or unattractive; ‘Internationalization,’ where companies are aiming to expand market or balance business downturns and risks of domestic market; and, ‘Multinationalization,’ where companies are aiming to create sustainable competitive position in several geographies. Differing requirements of the institutional and the retail customers: Joint ventures are generally not viable for institutional customers, while being a useful option for reaching the latter-with benefits related to local knowledge, capital, brand, and distribution. Organizing for growth and capability building: Structure for the three strategy types is different and a ‘dual-core’ model could balance requirements of risk-taking in new areas with efficiency in stabilized activities. While carrying Indian imprint, the culture will be company-specific and should be allowed to evolve in a directed way. Critical role of conviction-laden leadership: This is a common element across all the Indian companies that have made overseas breakthroughs and the leadership traits of being clear, fundamentals oriented, and planned need to be supplemented with international orientation and preparedness for longer haul for success in overseas markets. While the first meta-trend has just started manifesting itself in overseas expansions of Indian companies, ICT positions and embodies them with powerful competitive advantages internationally. The events of last decade are just the beginning towards the emergence of Indian corporations that operate worldwide and, more importantly, hold significant and leading positions globally in a large number of industries.

This article is the text of a speech originally presented at the Second World Conference on Medical Ethics at Gijon, Spain, on 2 October 2002 under the title "Medical Experimentation Concerning Chemical and Biological Weapons for Mass Destruction: Clinical Design for New Smallpox Vaccines: Ethical and Legal Aspects". Experimentation on vaccines such as smallpox is subject to the usual ethical rules such as the need for informed consent. However, the participants will not often be at risk of catching the disease but expose themselves by taking part in the experimentation. Professor Deutsch explores the implications of this, including the position of vulnerable groups such as children, those with mental handicaps, and those acting under orders such as the military, the police and fire officers.

Abstract Taking into account that one of the major handicaps when undertaken in the cultural sector is the problem of cost and demand volatility, this paper aims to implement a viability plan for the entrepreneurship of a lyric theatre low-cost company, dedicated to Zarzuela performance, a type of Spanish music like Opera. Firstly, the cultural sector data are analysed in terms of supply and demand and secondly a viability plan is carried out for three years. According to the results it is concluded that this type of venture is very risky if you do not have grant or other financial resources, due to the variability of demand and the increase in unit costs as the artistic performance has a fixed production technology that cannot absorb the technical progress of the rest of the economy.

Approximately 5-20% of children worldwide suffer from atopic dermatitis (AD), a kind of dermatitis characterized as an inflammatory, relapsing, noncontagious and itchy skin disorder. Children often develop AD during their first year of life. An increased rate of sensitization to both food and aeroallergens has been shown to coexist in patients with AD. Sensitization to well-known allergens such as cow's milk protein can occur on average in 50% of children with AD. In general, quality of life (QoL) is perceived as the quality of an individual's daily life, that is, an assessment of their well-being or lack thereof. QoL is a broad concept that includes such things as standard of living, community, and family life. Patients with skin diseases experience a wide range of symptoms ranging from trivial problems to major handicaps which affect their lives. The misery of living with AD cannot be overstated for it may have a profoundly negative effect on the health-related QoL of children and their families in many cases. Physicians taking care of children with AD should consult parents on how their child's illness has impacted their lifestyle and recommend professional intervention if deemed necessary.

It is well known that when we have a schizophrenic patient who do not respond to two batches of neuroleptics at full dosage for more than six month, it may be wise to try with clozpine which is believed to be one of the best neuroleptics we have but with two main handicaps: it can produce leucopenia which can be fatal and epileptic seizures as well. We do think that in many cases, clozapine has been used too soon in the treatment of the schizophrenic patient, before we can really talk of a resistant patient. To prove that we have changed the clozapine treatment of four chronically ill schizophrenic patients admitted to a home for the chronically mentally ill. Two patients were changed from clozapine 400 mg/day to paliperidone 15 mg/day along two months time. They both improved in mental clarity and ability of thinking. Another patient were changed from 600 mg/day to 27 mg/day of paliperidone. That patient worsened a little bit mainly with hostility and social avoidance but it was mandatory to change neuroleptic because he had had two seizures and had low levels of platelets and therefore he was at risk of developing leukopenia. The fourth one was taking 300 mg of clozapine and was changed to 12 mg of paliperidone. We got no change in the clinical outcome.DiscussionWe discuss the different explanations for the results we got.Disclosure of interestThe authors have not supplied their declaration of competing interest.

El impacto sobre el patrimonio edificado y, especialmente, sobre aquellos inmuebles de uso residencial donde las personas desarrollamos nuestros proyectos vitales, es una consecuencia indisociable de la acción de transformación urbana, que implica en muchas ocasiones el desplazamiento de la población afectada, debido a la importante afección de las obras pretendidas sobre los inmuebles que se ocupan. El cambio de paradigma urbanístico, en terminología clásica ensanche vs reforma interior, no ha supuesto sino un continuo incremento de los casos en los que el interés general afecta directamente al derecho a la vivienda y a su ocupación. Sin embargo, han sido poco expuestas y analizadas las técnicas y el régimen jurídico y económio en el que surge y se garantiza el derecho al realojo. Este trabajo pretende realizar un primer acercamiento a esta cuestión, identificando los requisitos fácticos y personales, las consecuencias jurídicas, así como la praxis y procedimiento en esta materia, entendida como una faceta más del derecho a la vivienda, actualmente en discusión y construcción. Ondare eraikiaren gaineko eragina, eta, bereziki, pertsonok gure bizi-proiektuak garatzen ditugun bizitegi-higiezinen gaineko eragina, hiri-eraldaketaren ekintzak dakarren ondorio ezinbestekoa da; ondorio horren eraginpeko biztanleak lekuz aldatzea eragiten du askotan, okupatutako higiezinen gainean egin nahi diren obrek dakarten eragin handia dela-eta. Hirigintza-paradigma aldatzeak (terminologia klasikoaren arabera, hiri-zabalgunea vs barne eraberritzea) hau baino ez du ekarri: interes orokorrak etxebizitzarako eskubideari eta etxebizitza okupatzeari zuzenean eragiten dieten kasuak etengabe gehitzea. Hala ere, oso gutxi azaldu eta aztertu dira ordezko bizilekua izateko eskubidea sortzen eta bermatzen duten teknikak eta erregimen juridiko zein ekonomikoa. Lan honen bidez, gai horretara hurbildu nahi da, eta identifikatu egin nahi dira betekizun faktikoak eta pertsonalak, ondorio juridikoak, bai eta arlo honetako praxia eta prozedura ere, etxebizitzarako eskubidearen beste alderdi bat legez ulertuta, zeina eztabaidatzen eta eraikitzen ari baita egun. The impact over the built heritage and, specially, over residential real state where people develop our vital projects is a inseparable consequence of the urban transformation action that implies in many occasions the displacement of the affected population due to the important encumbrance of the attempted works in those properties that occupy. The change in the urban paradigm, in the classic expression expansion vs. internal reform has not meant but a constant increase of cases where general interest directly affects the right to housing and its occupation. Nevertheless, the techniques and the legal and economic regime where it arises and guarantees the right to relocation have scarcely been exposed and analyzed. This work aims at taking a first approach to the issue, by identifying the factual and personal conditions, the legal consequences and also the practice and the procedure regarding this subject as another facet of the right to housing, currently under discussion and construction.

LABURPENA: Giza Eskubideen Europako Auzitegiaren Negrepontis-Giannisis vs. Grezia epaiak atzerriko erabakiak libre zirkulatzeko bidea zabaldu du, prozesu zuzen bat izateko eskubidetik etorria, Giza Eskubideen Europako Hitzarmeneko 6.1 artikuluan aitortua. GEEAren jurisprudentzia-lerro horren eboluzioa abiatzen da Wagner eta J.M.W.L. vs. Luxenburgo eta McDonald vs. Frantzia erabakiekin, baina guk aipatzen duguna aurrerapausoa handia da, eskubidea ez zaiolako lotzen beste zuzenbide substantibo bati, eta berezko eskubidea dela planteatzen da. Gainera, ohar aipagarriak egiten dira atzerriko epai judizialak geldiarazteko ordena publikoko salbuespenari buruz, eta haien eragina leuntzen da. Oso interesgarria da EBko arautegien aplikazio-esparrutik ihes egiten duten erabakietan aplikatzeko, non exequaturra desagertzen den ad hoc prozedura gisa, baina eragindako alderdiak hura ez aitortzeko aukera mantentzen da. Ildo horretan, GEEAk Negrepontis-en erabilitako argudioak garrantzi berezikoak dira, kontuan hartuz GEEHk inspiratzen duela Batasuneko Zuzenbidea eta auzitegiak egiten duen artikuluen interpretazioa. RESUMEN: El Tribunal Europeo de Derechos Humanos abre en su sentencia Negrepontis-Giannisis c. Grecia una vía de ampliación de las posibilidades a la libre circulación de decisiones extranjeras como un derecho derivado del derecho a un proceso equitativo reconocido en el art. 6.1 del Convenio Europeo de Derechos Humanos. La evolución de esta línea jurisprudencial del TEDH arranca con las decisiones Wagner y J.M.W.L. c. Luxemburgo y McDonald c. Francia pero en la que nos ocupa se produce un avance considerable porque no se ata el derecho al reconocimiento a otro derecho sustantivo sino que se plantea como un derecho en sí mismo. Además se establecen notables consideraciones en cuanto a la excepción de orden público como freno a la ejecución de decisiones judiciales extranjeras y se suaviza su efecto. Es especialmente interesante para su aplicación en aquellas decisiones que escapan del ámbito de aplicación de los correspondientes reglamentos de la UE donde desaparece el exequátur como procedimiento ad hoc pero se mantiene la posibilidad de oposición al reconocimiento por la parte afectada. En este sentido, los argumentos utilizados por el TEDH en Negrepontis son de especial relevancia, teniendo en cuenta el carácter inspirador del Derecho de la Unión que tiene el CEDH y por ende de la interpretación que dicho tribunal haga de su articulado. ABSTRACT: The European Court of Human Rights in its judgment Negrepontis-Giannisis v. Greece opens the extension of the possibilities for a free movement of foreign decisions as a right derived from the right to a fair hearing of article 6.1 of the European Convention of Human Rights. The evolution of this case law trend of the ECHR begins with decisions Wagner and J.M.W.L. v. Luxembourg and McDonald v. France but in the judgment we are now analyzing a considerable development is made because the right to the recognizition is not linked to other substantive right but it is considered as a right itself. Besides remarkable considerations are established as far as the exception to the public order is concerned as a brake to the execution of foreign judicial decisions and it softens its effect. It is especially interesting for its application in those decisions that go beyond the scope of application of the corresponding regulations of the EU where the exequatur as an ad hoc procedure is missing but it maintains the possibility of opposition to the recognizition by the affected party. In this sense, the reasoning of the ECHR in Negrepontis is of special relevance, taking into account the inspiring character of the European Law forthe ECHR and hence the interpretation of that Tribunal of its articles.

The agricultural use of vinasse produced in the sugarcane industry has been through the ages through various changes and studies to analyze its reuse. From the 90s, with the increasing technological development allied to the great concern in the improvement of the agrarian processes, its optimization has advanced enormously. Also, it is important to note that its discharge into "vacant" fields with agricultural potential has been a very large handicap for several crops, taking into account the microbial, chemical and biochemical load that it has (BOD, COD, pH).

ResumeArtiklen diskuterer, hvordan det pædagogiske kan udvikles i dagtilbud, når det forstås som et muligt fællesgode. Med fokus på inklusion af børn med handicap illustreres det, hvordan de professionelle kan imødegå situeret ulighed ved at indgå i praksisudforskende processer med hinanden og børnene. Inklusion af børn med handicap synes at blive hjulpet på vej, når børn og voksne har mulighed for at deltage i vedvarende konfliktuel kooperation om dagtilbuddets pædagogiske arrangementer. Gennem sådanne processer bearbejdes betingelserne for deltagelse, solidaritet og fællesskabsdannelse, og herigennem formes og vitaliseres det pædagogiske fællesgode. AbstractThe article discusses how the pedagogical can emerge in day care when seen as a potential common good. By focusing on the inclusion of children with disabilities, it is shown how professionals can minimize situated inequality through engagements in exploratory practice. The inclusion of children with disabilities seem to be enhanced when children and professionals have opportunity for taking part in ongoing conflictual co-operation on the educational arrangements. This process allows the development of new ways of both expanding and strengthening the conditions for participation, solidarity and community building, forming the pedagogical common good along the way.

Abstract Background This was a prospective cohort that included 60 gastro-esophageal reflux disorder patients with suspected laryngopharyngeal reflux-related symptoms (e.g., sore throat, throat clearing, globus sensation, cough, dysphonia, and dysphagia). The diagnosis was confirmed using history taking, clinical laryngoscopic examination, and upper endoscopy guided by the Reflux Symptom Index (RSI). Patients were treated with proton pump inhibitors and prokinetics for 12 weeks. The aim of the current study was to explore the dietary risk factors in laryngopharyngeal reflux patients and to assess the response to therapy on swallowing-related problems by comparing the baseline pre-treatment and post-treatment values of RSI and Dysphagia Handicap index (DHI). Results Analysis of data regarding the role of diet as a risk factor for reflux revealed that 33 patients (55%) are eating meat, 56 patients (93.3%) eating fat, 45 patients (75%) eating sweet, 55 patients (91.7%) eating spicy food, 52 patients (96.7%) eating fried food, 34 patients (56.7%) drinking tea, 51 patients (85%) eating big meals, 21 patients (35%) drinking fruit juices, 54 patients (90%) eating sour foods, 51 patients (85%) eating citrus fruits, and 22 patients (36.7%) smokers. There was a statistically significant decrease in Reflux Symptom Index scores and an increase of Dysphagia Handicap Index scores after 12 weeks on proton pump inhibitors and prokinetics. Conclusion Different dietary factors were present in LPR patients. A short period of empiric anti-reflux treatment has a significant improving effect on Reflux Symptom Index and Dysphagia Handicap Index scores from baseline to 12 weeks post-treatment. Further research is needed to investigate longer times of treatment for the complete resolution of symptoms.

The diagnosing of diabetic retinopathy (DR) through shading structure photos needs significance of the many tiny that alongside advanced grading system makes this troublesome and long task. Diabetic Retinopathy is associate inconvenience of polygenic disorder that's caused attributable to the changes within the veins of the tissue layer. This is often one in every of the numerous reasons for visual deficiency. Diabetic Retinopathy is thus far treated by medical specialist that could be a time-taking procedure. Diabetic retinopathy is that the fastest developing reason for handicap. Thus, by taking some eye tissue layer photos, see able of that photos can find that whether the patient could be a diabetic or a non-diabetic. We will acknowledge the diabetic addicted to eye tissue layer photos utilizing some AI applications. Some of the creators used CNN, k-means that means. In this work, proposing that to enhance the truth utilizing morphological techniques.

OBJECTIVE To compare the effectiveness of two speech therapy interventions, vocal warm-up and breathing training, focusing on teachers’ voice quality.METHODS A single-blind, randomized, parallel clinical trial was conducted. The research included 31 20 to 60-year old teachers from a public school in Salvador, BA, Northeasatern Brazil, with minimum workloads of 20 hours a week, who have or have not reported having vocal alterations. The exclusion criteria were the following: being a smoker, excessive alcohol consumption, receiving additional speech therapy assistance while taking part in the study, being affected by upper respiratory tract infections, professional use of the voice in another activity, neurological disorders, and history of cardiopulmonary pathologies. The subjects were distributed through simple randomization in groups vocal warm-up (n = 14) and breathing training (n = 17). The teachers’ voice quality was subjectively evaluated through the Voice Handicap Index (Índice de Desvantagem Vocal, in the Brazilian version) and computerized voice analysis (average fundamental frequency, jitter, shimmer, noise, and glottal-to-noise excitation ratio) by speech therapists.RESULTS Before the interventions, the groups were similar regarding sociodemographic characteristics, teaching activities, and vocal quality. The variations before and after the intervention in self-assessment and acoustic voice indicators have not significantly differed between the groups. In the comparison between groups before and after the six-week interventions, significant reductions in the Voice Handicap Index of subjects in both groups were observed, as wells as reduced average fundamental frequencies in the vocal warm-up group and increased shimmer in the breathing training group. Subjects from the vocal warm-up group reported speaking more easily and having their voices more improved in a general way as compared to the breathing training group.CONCLUSIONS Both interventions were similar regarding their effects on the teachers’ voice quality. However, each contribution has individually contributed to improve the teachers’ voice quality, especially the vocal warm-up.TRIAL RECORD NCT02102399, “Vocal Warm-up and Respiratory Muscle Training in Teachers”.

SubjectsVestibular migraine (VM) is the most common neurological cause of vertigo in adults. Previous neuroimaging studies have reported structural alterations in areas associated with pain and vestibular processing. However, it is unclear whether altered resting-state functional connectivity (FC) exists in brain regions with structural abnormalities in patients with VM.MethodsResting-state functional magnetic resonance imaging (MRI) and three-dimensional T1-weighed MRI were performed in 30 patients with VM and 30 healthy controls (HCs). Patients underwent an evaluation of migraine and dizziness severity. FC and voxel-based morphometry (VBM) were performed using DPABI 4.3 and CAT12, respectively. The association between changes in gray matter (GM) volume or FC and clinical parameters was also analyzed.ResultsCompared with HCs, patients with VM demonstrated a reduced GM volume in the bilateral parietoinsular vestibular cortex (PIVC), right middle frontal gyrus, and precuneus. The GM volume of the left PIVC was negatively associated with Dizziness Handicap Inventory score in patients with VM. Taking this region as a seed region, we further observed increased FC between the left primary somatosensory cortex (S1)/inferior parietal lobule (IPL) and the left PIVC in patients with VM.ConclusionFC between regions with a decline in GM volume (the PIVC and S1/IPL) is altered in patients with VM, suggesting that abnormalities in vestibular cortical network could be useful for understanding the underlying mechanisms of VM.

AbstractLittle is known about the trajectory of tinnitus over time. This study addressed (1) how often tinnitus remitted in patients with chronic tinnitus; (2) how subjective reported tinnitus characteristics, such as loudness, laterality, and type and measures of burden, such as tinnitus distress, depression, and quality of life, changes over time; (3) how often tinnitus-specific treatments were undertaken and the prevalence of comorbidities, (4) if the number of treatments and comorbidities were associated to changes in tinnitus distress over time. Data from 388 patients with chronic tinnitus who visited a tertiary tinnitus clinic between 2012 and 2017 were interrogated via a mail survey in 2018. Tinnitus characteristics were measured with the Tinnitus Sample Case History Questionnaire and numeric rating scales; tinnitus distress with Tinnitus Handicap Inventory (THI) and the Tinnitus Questionnaire (TQ), depression with the Major Depression Inventory and Quality of life with the World Health Organisation Quality of Life BREF at both time points and the clinical global impression scale. Comorbidities experienced and undertaken treatments were assessed with an in-house survey. Three participants (0.8% of the sample) reported tinnitus remission between both assessments. A decrease in the THI and TQ, and numeric ratings for tinnitus severity, annoyance, unpleasantness, and discomfort was observed, but no differences in tinnitus characteristics, depression, quality of life or overall health status. 64% presented at least one comorbidity, and 88% sought at least on tinnitus-specific treatment. Common comorbidities were psychological and sleeping problems, and the most common interventions were going to the dentist, taking medications, and wearing hearing aids. Our results suggest that full remission of tinnitus is a rare condition, that tinnitus distress on average decreases over time, and that tinnitus characteristics, quality of life, and depression tend to remain unaltered. The high number of interventions and comorbidities displayed minimal association to the changes in tinnitus distress, highlighting the substantial and durable burden of tinnitus sufferers.

Abstract Background Vestibular migraine (VM) is the most frequent cause of recurrent spontaneous attacks of vertigo causally related to migraine. The objective of the Prophylactic treatment of vestibular migraine with metoprolol (PROVEMIG) trial was to demonstrate that metoprolol succinate is superior to placebo in the prevention of episodic vertigo- and migraine-related symptoms in patients with VM. Methods This phase III, two-arm, parallel-group, double-blind, randomized placebo-controlled trial was designed to be conducted at tertiary referral centres at neurology and ear, nose and throat departments of eight German university hospitals. The planned sample size was a total of 266 patients to be allocated. Adults aged 18 years or above diagnosed with probable or definitive VM according to the Neuhauser criteria 2001 were randomly assigned 1:1 to 6 months blinded metoprolol (maintenance dosage of 95 mg daily) or placebo. The primary efficacy outcome was the self-reported number of vertiginous attacks per 30 days documented by means of a paper-based daily symptom diary. The pre-specified time period of primary interest was defined as months 4 to 6. Secondary outcomes included the patient-reported number of migraine days and vertigo days, the Dizziness Handicap Inventory, and clinical assessments. Adverse events were reported throughout the whole 9-month study period. Results At the time of trial termination, no evidence for a difference in the incidence of vertiginous attacks between groups was detected. For the full analysis set, the incidence rate ratio was 0.983 (95% confidence interval (CI) 0.902–1.071) for metoprolol versus placebo. In both groups, there was a significant decline over time in the overall monthly vertigo attacks by a factor of 0.830 (95% CI 0.776–0.887). Results were consistent for all subjective and objective key measures of efficacy. The treatment was well tolerated with no unexpected safety findings. Conclusions After randomizing 130 patients PROVEMIG had to be discontinued because of poor participant accrual not related to the tolerability of the study medication or safety concerns; no treatment benefit of metoprolol over placebo could be established. Additional preparatory work is much needed in the development, psychometric evaluation and interpretation of clinically meaningful end points in trials on episodic syndromes like VM taking into consideration the complexity of this disease entity comprising two domains (vertigo- and headache-related disability). Trial registration EudraCT, 2009-013701-34. Prospectively registered on 8 April 2011.

La prueba de Análisis Musical es uno de los primeros exámenes que se realizan para acceder a los Conservatorios Superiores de Música en España. El alumnado suele tener problemas para superarlo debido a la extensión del temario exigido, que abarca desde el Gregoriano hasta el Romanticismo, teniendo que dominarse una gran amplitud de formas musicales (Suite, Fuga, Sonata, etc.). Las exigencias de la prueba se ven reflejadas en los resultados finales del alumnado, obteniéndose un elevado porcentaje de suspensos o bajas calificaciones, tal como confirman los datos obtenidos en los diferentes centros investigados. Ante esta situación, se consideró importante iniciar al alumnado en la preparación de esta prueba específica desde el inicio de las Enseñanzas Profesionales, tomando como referencia las propias obras del instrumento (en este caso, Clarinete), lo que al mismo tiempo repercutiría en una más correcta interpretación. Los datos obtenidos previamente a la investigación muestran que la saturación de horas lectivas y de estudio interpretativo suponen un hándicap para el alumnado a la hora de preparar esta prueba específica; en cuanto a los datos obtenidos del profesorado de diferentes conservatorios de Murcia y Alicante (Vega Baja), muestran la necesidad de preparar dicha prueba desde las Enseñanzas Profesionales, insistiéndose en tomar como referencia las obras de Clarinete. Atendiendo a esto, se propuso una metodología específica para trabajar el Análisis Musical en el aula de Clarinete, especialmente en el último ciclo de Enseñanzas Profesionales, aunque igualmente válida para los ciclos anteriores. Los resultados obtenidos con el alumnado participante mostraron que muchos de ellos obtuvieron mejores calificaciones en este examen que formaba parte de las pruebas de acceso de distintos Conservatorios Superiores de Música.ABSTRACTThe Musical Analysis test is one of the first exams to be taken to access the Superior Conservatories of Music in Spain. The students usually have problems to overcome it due to the extension of the required curriculum, which ranges from the Gregorian to Romanticism, having to master a wide range of musical forms (Suite, Fuga, Sonata, etc.). The demands of the test are reflected in the final results of the students, obtaining a high percentage of failures or low grades, as confirmed by the data obtained in the different centers which were analyzed. Faced with this situation, it was considered important to initiate the students in the preparation of this specific test from the beginning of the Professional Teachings, taking as reference the own works of the instrument (in this case, Clarinet), which at the same time would have repercussions in one more correct interpretation. The data obtained previously to the investigation show that the saturation of teaching hours and of interpretative study suppose a handicap for the students at the time of preparing this specific test; As for the data obtained from the teachers of different conservatories of Murcia and Alicante (Vega Baja), they show the need to prepare this test from the Professional Teachings, insisting on taking Clarinet's works as reference. Attending this, a specific methodology was proposed to work the Musical Analysis in the Clarinet classroom, especially in the last cycle of Professional Education, although equally valid for the previous cycles. The results obtained with the participating students showed that many of them obtained better grades in this exam that was part of the entrance exams of different Superior Conservatories of Music.

The topics of this article concern the importance of mediators in education and the inclusion of children in general and, in particular, of those children who have difficulties due to disability, disorders or handicaps. The educator must deal with the individual as a whole and, with the help of the mediators, he must be able to achieve the goals set out in his educational project (or in a relationship of support), taking into consideration the overall needs and strengths of the subject with whom he works, or rather, cooperates. The mediators are defined as a relational resource and as a support to therapeutic, educational and assistance initiatives. They could act as harmonizers and attenuators in particular conditions of stress, suffering and conflict and they could be a valid aid for people with various problems in relationships, communication and with disturbed social behavior. Especially they would support minors, but also those people who have difficulties due to disability, including intellectual disability, and those people who are living critical situations of personal and social vulnerability or suffer an extreme social marginalization. This article highlights the particular importance of mediations and mediators in educational-pedagogical practices in schools and extra-scholastic settings, which are necessary for the growth and learning of children with disabilities. These children must be guaranteed the right to have a complete education in an “ordinary” and not separate, that is inclusive, social path.

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its “plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth” (Semmler) and “extremely powerful description of Gallipoli” (Dutton 16). Within weeks, critic Nancy Keesing declared it an “Enduring Classic.” Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey’s “extraordinary memory” and “ability to describe scenes and characters with great precision” (“NBC” 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press’s ongoing viability, in no small measure, to Facey’s success (King 29). Along with Wendy Jenkins, Coffey edited Facey’s manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book’s production and distribution. Adaptations soon followed. In 1984, Kerry Packer’s PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey’s life writing. Recently, an option was taken out for a new television series (Fraser).A hundred reprints and two million readers on from initial publication, A Fortunate Life continues to rate among the most appreciated Australian books of all time. Commenting on a reader survey in 2012, writer and critic Marieke Hardy enthused, “I really loved it [. . .] I felt like I was seeing a part of my country and my country’s history through a very human voice . . .” (First Tuesday Book Club). Registering a transformed reading, Hardy’s reference to Australian “history” is unproblematically juxtaposed with amused delight in an autobiography that invents and embellishes: not believing “half” of what Facey wrote, she insists he was foremost a yarn spinner. While the work’s status as a witness account has become less authoritative over time, it seems appreciation of the author’s imagination and literary skill has increased (Williamson). A Fortunate Life has been read more commonly as an uncomplicated, first-hand account, such that editor Wendy Jenkins felt it necessary to refute as an “utter mirage” that memoir is “transferred to the page by an act of perfect dictation.” Sidonie Smith and Julia Watson argue of life narratives that some “autobiographical claims [. . .] can be verified or discounted by recourse to documentation outside the text. But autobiographical truth is a different matter” (16). With increased access to archives, especially digitised personnel records, historians have asserted that key elements of Facey’s autobiography are incorrect or “fabricated” (Roberts), including his enlistment in 1914 and participation in the Gallipoli Landing on 25 April 1915. We have researched various sources relevant to Facey’s early years and war service, including hard-copy medical and repatriation records released in 2012, and find A Fortunate Life in a range of ways deviates from “documentation outside of the text,” revealing intriguing, layered storytelling. We agree with Smith and Watson that “autobiographical acts” are “anything but simple or transparent” (63). As “symbolic interactions in the world,” they are “culturally and historically specific” and “engaged in an argument about identity” (63). Inevitably, they are also “fractured by the play of meaning” (63). Our approach, therefore, includes textual analysis of Facey’s drafts alongside the published narrative and his medical records. We do not privilege institutional records as impartial but rather interpret them in terms of their hierarchies and organisation of knowledge. This leads us to speculate on alternative readings of A Fortunate Life as an illness narrative that variously resists and subscribes to dominant cultural plots, tropes, and attitudes. Facey set about writing in earnest in the 1970s and generated (at least) three handwritten drafts, along with a typescript based on the third draft. FACP produced its own working copy from the typescript. Our comparison of the drafts offers insights into the production of Facey’s final text and the otherwise “hidden” roles of editors as transformers and enablers (Munro 1). The notion that a working man with basic literacy could produce a highly readable book in part explains Facey’s enduring appeal. His grandson and literary executor, John Rose, observed in early interviews that Facey was a “natural storyteller” who had related details of his life at every opportunity over a period of more than six decades (McLeod). Jenkins points out that Facey belonged to a vivid oral culture within which he “told and retold stories to himself and others,” so that they eventually “rubbed down into the lines and shapes that would so memorably underpin the extended memoir that became A Fortunate Life.” A mystique was thereby established that “time” was Albert Facey’s “first editor” (Jenkins). The publisher expressly aimed to retain Facey’s voice, content, and meaning, though editing included much correcting of grammar and punctuation, eradication of internal inconsistencies and anomalies, and structural reorganisation into six sections and 68 chapters. We find across Facey’s drafts a broadly similar chronology detailing childhood abandonment, life-threatening incidents, youthful resourcefulness, physical prowess, and participation in the Gallipoli Landing. However, there are also shifts and changed details, including varying descriptions of childhood abuse at a place called Cave Rock; the introduction of (incompatible accounts of) interstate boxing tours in drafts two and three which replace shearing activities in Draft One; divergent tales of Facey as a world-standard athlete, league footballer, expert marksman, and powerful swimmer; and changing stories of enlistment and war service (see Murphy and Nile, “Wounded”; “Naked”).Jenkins edited those sections concerned with childhood and youth, while Coffey attended to Facey’s war and post-war life. Drawing on C.E.W. Bean’s official war history, Coffey introduced specificity to the draft’s otherwise vague descriptions of battle and amended errors, such as Facey’s claim to have witnessed Lord Kitchener on the beach at Gallipoli. Importantly, Coffey suggested the now famous title, “A Fortunate Life,” and encouraged the author to alter the ending. When asked to suggest a title, Facey offered “Cave Rock” (Interview)—the site of his violent abuse and humiliation as a boy. Draft One concluded with Facey’s repatriation from the war and marriage in 1916 (106); Draft Two with a brief account of continuing post-war illness and ultimate defeat: “My war injuries caught up with me again” (107). The submitted typescript concludes: “I have often thought that going to War has caused my life to be wasted” (Typescript 206). This ending differs dramatically from the redemptive vision of the published narrative: “I have lived a very good life, it has been very rich and full. I have been very fortunate and I am thrilled by it when I look back” (412).In The Wounded Storyteller, Arthur Frank argues that literary markets exist for stories of “narrative wreckage” (196) that are redeemed by reconciliation, resistance, recovery, or rehabilitation, which is precisely the shape of Facey’s published life story and a source of its popularity. Musing on his post-war experiences in A Fortunate Life, Facey focuses on his ability to transform the material world around him: “I liked the challenge of building up a place from nothing and making a success where another fellow had failed” (409). If Facey’s challenge was building up something from nothing, something he could set to work on and improve, his life-writing might reasonably be regarded as a part of this broader project and desire for transformation, so that editorial interventions helped him realise this purpose. Facey’s narrative was produced within a specific zeitgeist, which historian Joy Damousi notes was signalled by publication in 1974 of Bill Gammage’s influential, multiply-reprinted study of front-line soldiers, The Broken Years, which drew on the letters and diaries of a thousand Great War veterans, and also the release in 1981 of Peter Weir’s film Gallipoli, for which Gammage was the historical advisor. The story of Australia’s war now conceptualised fallen soldiers as “innocent victims” (Damousi 101), while survivors were left to “compose” memories consistent with their sacrifice (Thomson 237–54). Viewing Facey’s drafts reminds us that life narratives are works of imagination, that the past is not fixed and memory is created in the present. Facey’s autobiographical efforts and those of his publisher to improve the work’s intelligibility and relevance together constitute an attempt to “objectify the self—to present it as a knowable object—through a narrative that re-structures [. . .] the self as history and conclusions” (Foster 10). Yet, such histories almost invariably leave “a crucial gap” or “censored chapter.” Dennis Foster argues that conceiving of narration as confession, rather than expression, “allows us to see the pathos of the simultaneous pursuit and evasion of meaning” (10); we believe a significant lacuna in Facey’s life writing is intimated by its various transformations.In a defining episode, A Fortunate Life proposes that Facey was taken from Gallipoli on 19 August 1915 due to wounding that day from a shell blast that caused sandbags to fall on him, crush his leg, and hurt him “badly inside,” and a bullet to the shoulder (348). The typescript, however, includes an additional but narratively irreconcilable date of 28 June for the same wounding. The later date, 19 August, was settled on for publication despite the author’s compelling claim for the earlier one: “I had been blown up by a shell and some 7 or 8 sandbags had fallen on top of me, the day was the 28th of June 1915, how I remembered this date, it was the day my brother Roy had been killed by a shell burst.” He adds: “I was very ill for about six weeks after the incident but never reported it to our Battalion doctor because I was afraid he would send me away” (Typescript 205). This account accords with Facey’s first draft and his medical records but is inconsistent with other parts of the typescript that depict an uninjured Facey taking a leading role in fierce fighting throughout July and August. It appears, furthermore, that Facey was not badly wounded at any time. His war service record indicates that he was removed from Gallipoli due to “heart troubles” (Repatriation), which he also claims in his first draft. Facey’s editors did not have ready access to military files in Canberra, while medical files were not released until 2012. There existed, therefore, virtually no opportunity to corroborate the author’s version of events, while the official war history and the records of the State Library of Western Australia, which were consulted, contain no reference to Facey or his war service (Interview). As a consequence, the editors were almost entirely dependent on narrative logic and clarifications by an author whose eyesight and memory had deteriorated to such an extent he was unable to read his amended text. A Fortunate Life depicts men with “nerve sickness” who were not permitted to “stay at the Front because they would be upsetting to the others, especially those who were inclined that way themselves” (350). By cross referencing the draft manuscripts against medical records, we can now perceive that Facey was regarded as one of those nerve cases. According to Facey’s published account, his wounds “baffled” doctors in Egypt and Fremantle (353). His medical records reveal that in September 1915, while hospitalised in Egypt, his “palpitations” were diagnosed as “Tachycardia” triggered by war-induced neuroses that began on 28 June. This suggests that Facey endured seven weeks in the field in this condition, with the implication being that his debility worsened, resulting in his hospitalisation. A diagnosis of “debility,” “nerves,” and “strain” placed Facey in a medical category of “Special Invalids” (Butler 541). Major A.W. Campbell noted in the Medical Journal of Australia in 1916 that the war was creating “many cases of little understood nervous and mental affections, not only where a definite wound has been received, but in many cases where nothing of the sort appears” (323). Enlisted doctors were either physicians or surgeons and sometimes both. None had any experience of trauma on the scale of the First World War. In 1915, Campbell was one of only two Australian doctors with any pre-war experience of “mental diseases” (Lindstrom 30). On staff at the Australian Base Hospital at Heliopolis throughout the Gallipoli campaign, he claimed that at times nerve cases “almost monopolised” the wards under his charge (319). Bearing out Facey’s description, Campbell also reported that affected men “received no sympathy” and, as “carriers of psychic contagion,” were treated as a “source of danger” to themselves and others (323). Credentialed by royal colleges in London and coming under British command, Australian medical teams followed the practice of classifying men presenting “nervous or mental symptoms” as “battle casualties” only if they had also been wounded by “enemy action” (Loughran 106). By contrast, functional disability, with no accompanying physical wounds, was treated as unmanly and a “hysterical” reaction to the pressures of war. Mental debility was something to be feared in the trenches and diagnosis almost invariably invoked charges of predisposition or malingering (Tyquin 148–49). This shifted responsibility (and blame) from the war to the individual. Even as late as the 1950s, medical notes referred to Facey’s condition as being “constitutional” (Repatriation).Facey’s narrative demonstrates awareness of how harshly sufferers were treated. We believe that he defended himself against this with stories of physical injury that his doctors never fully accepted and that he may have experienced conversion disorder, where irreconcilable experience finds somatic expression. His medical diagnosis in 1915 and later life writing establish a causal link with the explosion and his partial burial on 28 June, consistent with opinion at the time that linked concussive blasts with destabilisation of the nervous system (Eager 422). Facey was also badly shaken by exposure to the violence and abjection of war, including hand-to-hand combat and retrieving for burial shattered and often decomposed bodies, and, in particular, by the death of his brother Roy, whose body was blown to pieces on 28 June. (A second brother, Joseph, was killed by multiple bayonet wounds while Facey was convalescing in Egypt.) Such experiences cast a different light on Facey’s observation of men suffering nerves on board the hospital ship: “I have seen men doze off into a light sleep and suddenly jump up shouting, ‘Here they come! Quick! Thousands of them. We’re doomed!’” (350). Facey had escaped the danger of death by explosion or bayonet but at a cost, and the war haunted him for the rest of his days. On disembarkation at Fremantle on 20 November 1915, he was admitted to hospital where he remained on and off for several months. Forty-one other sick and wounded disembarked with him (HMAT). Around one third, experiencing nerve-related illness, had been sent home for rest; while none returned to the war, some of the physically wounded did (War Service Records). During this time, Facey continued to present with “frequent attacks of palpitation and giddiness,” was often “short winded,” and had “heart trouble” (Repatriation). He was discharged from the army in June 1916 but, his drafts suggest, his war never really ended. He began a new life as a wounded Anzac. His dependent and often fractious relationship with the Repatriation Department ended only with his death 66 years later. Historian Marina Larsson persuasively argues that repatriated sick and wounded servicemen from the First World War represented a displaced presence at home. Many led liminal lives of “disenfranchised grief” (80). Stephen Garton observes a distinctive Australian use of repatriation to describe “all policies involved in returning, discharging, pensioning, assisting and training returned men and women, and continuing to assist them throughout their lives” (74). Its primary definition invokes coming home but to repatriate also implies banishment from a place that is not home, so that Facey was in this sense expelled from Gallipoli and, by extension, excluded from the myth of Anzac. Unlike his two brothers, he would not join history as one of the glorious dead; his name would appear on no roll of honour. Return home is not equivalent to restoration of his prior state and identity, for baggage from the other place perpetually weighs. Furthermore, failure to regain health and independence strains hospitality and gratitude for the soldier’s service to King and country. This might be exacerbated where there is no evident or visible injury, creating suspicion of resistance, cowardice, or malingering. Over 26 assessments between 1916 and 1958, when Facey was granted a full war pension, the Repatriation Department observed him as a “neuropathic personality” exhibiting “paroxysmal tachycardia” and “neurocirculatory asthenia.” In 1954, doctors wrote, “We consider the condition is a real handicap and hindrance to his getting employment.” They noted that after “attacks,” Facey had a “busted depressed feeling,” but continued to find “no underlying myocardial disease” (Repatriation) and no validity in Facey’s claims that he had been seriously physically wounded in the war (though A Fortunate Life suggests a happier outcome, where an independent medical panel finally locates the cause of his ongoing illness—rupture of his spleen in the war—which results in an increased war pension). Facey’s condition was, at times, a source of frustration for the doctors and, we suspect, disappointment and shame to him, though this appeared to reduce on both sides when the Repatriation Department began easing proof of disability from the 1950s (Thomson 287), and the Department of Veteran’s Affairs was created in 1976. This had the effect of shifting public and media scrutiny back onto a system that had until then deprived some “innocent victims of the compensation that was their due” (Garton 249). Such changes anticipated the introduction of Post-Traumatic Shock Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Revisions to the DSM established a “genealogy of trauma” and “panic disorders” (100, 33), so that diagnoses such as “neuropathic personality” (Echterling, Field, and Stewart 192) and “soldier’s heart,” that is, disorders considered “neurotic,” were “retrospectively reinterpreted” as a form of PTSD. However, Alberti points out that, despite such developments, war-related trauma continues to be contested (80). We propose that Albert Facey spent his adult life troubled by a sense of regret and failure because of his removal from Gallipoli and that he attempted to compensate through storytelling, which included his being an original Anzac and seriously wounded in action. By writing, Facey could shore up his rectitude, work ethic, and sense of loyalty to other servicemen, which became necessary, we believe, because repatriation doctors (and probably others) had doubted him. In 1927 and again in 1933, an examining doctor concluded: “The existence of a disability depends entirely on his own unsupported statements” (Repatriation). We argue that Facey’s Gallipoli experiences transformed his life. By his own account, he enlisted for war as a physically robust and supremely athletic young man and returned nine months later to life-long anxiety and ill-health. Publication transformed him into a national sage, earning him, in his final months, the credibility, empathy, and affirmation he had long sought. Exploring different accounts of Facey, in the shape of his drafts and institutional records, gives rise to new interpretations. In this context, we believe it is time for a new edition of A Fortunate Life that recognises it as a complex testimonial narrative and theorises Facey’s deployment of national legends and motifs in relation to his “wounded storytelling” as well as to shifting cultural and medical conceptualisations and treatments of shame and trauma. ReferencesAlberti, Fay Bound. Matters of the Heart: History, Medicine, and Emotions. Oxford: Oxford UP, 2010. Butler, A.G. Official History of the Australian Medical Services 1814-1918: Vol I Gallipoli, Palestine and New Guinea. 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