Big Bite Research Articles

How Excessive Pricing Jurisprudence Could Help the EU Commission Take a Big Bite Out Of Apple’s Commission Fee

How Excessive Pricing Jurisprudence Could Help the EU Commission Take a Big Bite Out Of Apple’s Commission Fee

1027 Small Bite vs Big Bite Closure Technique in Elective Oesophagectomy Patients

Abstract Aim After primary closure of a midline laparotomy wounds the estimated incisional hernia incidence can be as high as 25%. For many years large bite closure has been the standard in mainstream surgical training. Evidence has emerged to suggest small bite closure may be superior. We looked to examine the incidence of incisional hernias for elective oesophagectomies in one centre where both small bite and large bite techniques are performed. Method A retrospective analysis of 117 patients was performed. Follow up was for a maximum of five years and involved a combination of radiological and clinical reviews. Primary outcomes were defined as incisional hernia rates & wound infections. Patient risk factors were recorded including age, co-morbidities such as cardiovascular or renal disease, diabetes, smoking, weight, steroid use and post-op complications. Results 74 patients had big bite closures and 38 had small bite closures. Overall there were 6 incisional hernias, 3 in each group (7.8% vs 4%, p-value 0.2). There were higher rates of wound infection in the small bite groups but again this failed to reach significance (7.9% vs 2.7% p-value 0.11). Conclusions Overall both outcomes are lower than the national averages which may explain the difficulty reaching significance. However, the results do suggest there may be other factors involved contributing to outcomes between small bite and big bite closure including operator familiarity.

A Study on Consumer Preferences towards Android and iOS

Now mobile users prefer to use mainly mobile applications rather than browsers for accessing mobile services. Android and iOS are today’s two major OS who have been fighting out in the market for the big bite. Nokia has been traditionally dominated by the Indian mobile market. Application markets have grown swiftly as a result of investing user interest in mobile applications. Measuring and analyzing users perceptions in mobile application is the main focus of the study and it discusses how different operating systems being used affect the user preferences. The main contribution of this paper is to explore users' attitudes towards mobile app. Moreover, whether the gender factor and operating system (OS) being used on a user’s mobile device has any connection with that user’s insight of the applications is investigated as an issue not explored in previous studies Findings of this article may help different sectors people like service providers, business models developers and also the actors of m commerce market. Since the m-commerce market gains importance every day and provides more potential for new commerce trends, the findings of this study will be valuable for further research.

Assessing The Quality of Life Among Older Adults Having Oral Health Problems

Oral health refers to the health of the oral cavity of an individual. Oral health is the most important part of general healthcare. The oral cavity or mouth make a major part of human body and considered to be the beginning of gastrointestinal and respiratory systems. The concept of Oral Health-Related Quality of Life (OHQoL) is focused on the idea that oral health issues can harm a person's self-esteem and self-image, create other health problems, hinder social contact, and cause pain, stress, and sadness. Objective: To assess the Quality of Life (QoL) among older adults having oral health problems. Methods: A Cross-sectional study was carried out from ‘Heaven Old-Age home’, Ferozepur Road, Lahore. Middle age to older adults aged between 45 to 80 years suffering from oral health problems were selected through a non-probability convenient sampling technique, and the sample size of 100 was enrolled. Participants were assessed through a self-constructed questionnaire. The data was analyzed by SPSS version 21.0. Results: Out of 100 participants, 45 were males while 55 were females while 96 participants were married. Socioeconomically, 72 participants belonged to the middle class in which 67 participants were educated, while 33 were uneducated. Result showed that 39 felt almost inability of chewing, 51 felt uncomfortable eating, 61 were feeling difficulty in biting hard food, and 54 were feeling difficulty while taking a big bite. Moreover, 77 were feeling difficult or restricted smiling, 74 were feeling difficulty in relaxing while 71 were feeling tense, and 83 were feeling irritable. 75 were embarrassed because of oral issues. However, 65 had pain in the mouth while 35 did not. 68 individuals had history of toothache in the previous 12 months, while 32 had not. Conclusion: It was concluded that there is an association between quality of life and oral health. Older adults face problems in chewing and swallowing food, feel pain while chewing or biting the food, and face nutritional deficiencies affecting their quality of life.

Isolation of Uterosacral Ligament (USL): A Safe and Effective Way for Laparoscopic Usl Hysteropexy / Colpopexy

Study Objective Because of the potential complications from artificialmesh, native tissue repair has regained its popularity during pelvic floor reconstruction surgery. Uterosacral ligament (USL) is the most important structures for level I support. However, the attenuated or broken USL in pelvic organ prolapse (POP) patients makes it difficult to get enough strong tissue for durable pelvic support, which result in the high recurrence rate after USL suspension for uterus or vagina cuff. Besides, the close anatomical relationship between USL and other important retroperitoneal structures (ureter, vessels, nerves) and rectum may sometimes limit the accessibility and suture bite during USL colpopexy/hysteropexy. In this video, we will demonstrate the important anatomical structures near the USL, and the technique to isolate it, that will make USL suspension safe and effective. Design Video clips from different patients were collected and edited. Setting single hospital, single surgeon. Patients or Participants Video clips from young patient with minimal endometriosis as normal control (demonstrate transperitoneal view), video clips from patients undergoing nerve-sparing radical hysterectomy as teaching model for detailed retroperitoneal structures, and video clips from patients undergoing USL hysteropexy were collected and edited. Interventions Ureter was identified transperitoneally first. Peritoneal window was developed between ureter and USL, entering the Okabayashi pararectal space. All the retroperitoneal structures (including ureter, uterine artery and vein, hypogastric nerve and pelvic plexus) were lateralized. Perirectal space and rectovaginal space were opened, dissecting the rectum away from the USL. Measurements and Main Results After USL isolation, USL suspension can be performed with maximal durability (big bite) and safety (minimal risk of ureter kinking, nerve injury, or rectum injury). Conclusion Isolation of uterosacral ligament (USL) is a safe and effective way for laparoscopic USL hysteropexy / colpopexy. Because of the potential complications from artificialmesh, native tissue repair has regained its popularity during pelvic floor reconstruction surgery. Uterosacral ligament (USL) is the most important structures for level I support. However, the attenuated or broken USL in pelvic organ prolapse (POP) patients makes it difficult to get enough strong tissue for durable pelvic support, which result in the high recurrence rate after USL suspension for uterus or vagina cuff. Besides, the close anatomical relationship between USL and other important retroperitoneal structures (ureter, vessels, nerves) and rectum may sometimes limit the accessibility and suture bite during USL colpopexy/hysteropexy. In this video, we will demonstrate the important anatomical structures near the USL, and the technique to isolate it, that will make USL suspension safe and effective. Video clips from different patients were collected and edited. single hospital, single surgeon. Video clips from young patient with minimal endometriosis as normal control (demonstrate transperitoneal view), video clips from patients undergoing nerve-sparing radical hysterectomy as teaching model for detailed retroperitoneal structures, and video clips from patients undergoing USL hysteropexy were collected and edited. Ureter was identified transperitoneally first. Peritoneal window was developed between ureter and USL, entering the Okabayashi pararectal space. All the retroperitoneal structures (including ureter, uterine artery and vein, hypogastric nerve and pelvic plexus) were lateralized. Perirectal space and rectovaginal space were opened, dissecting the rectum away from the USL. After USL isolation, USL suspension can be performed with maximal durability (big bite) and safety (minimal risk of ureter kinking, nerve injury, or rectum injury). Isolation of uterosacral ligament (USL) is a safe and effective way for laparoscopic USL hysteropexy / colpopexy.

Hollywood’s Movie Production Companies in Game Theoretic Model

Assume that Dismal Science Cinema enters during the 4th of July and possesses private information regarding together with rational expectations, adaptive expectations, and a follow-up to the previously-released blockbuster. The films that the aforementioned studio is about to release comprises of different genres such as romantic comedy, drama, and etc. It also has to decide how to allocate the remaining 14 films throughout the year. Additionally, Dismal Cinema signals to the other film studios how serious it is in terms of spending millions of dollars on advertising for its blockbuster. Knowing that Dismal Cinema has already attained a large portion of the audience, the other studios would appreciate following “Rational Expectations”. After Dismal Cinema takes action and decides to release its blockbuster on the 4th of July, the other film studios observe and stick to their next best alternative which can enable them to possess a large portion of the small revenue pie remained post to the big bite of the first mover.

Alternative Dispute Resolution and the Role of Cost Accountants: A Big Bite of the Cake in the Waiting

The domain of Arbitration and arbitrators profession were historically not considered to be the areas of practice for the Cost and Managements Accountants. Only few qualified and experienced finance professionals were empanelled in the Arbitration Council of India in the category of: "Financial Experts". Very few of them got the opportunity to be ultimately appointed as "Arbitrators" in prestigious arbitral assignments. But now the changes in the statute relating to qualifications required for appointment as Arbitrators has opened up new scope for the CMA's. The present article highlights a brief concept of Alternative dispute redressal (ADR) mechanism with particular emphasis on Arbitration and the huge professional opportunity in the waiting for WE, THE COST and MANAGEMENT ACCOUNTANTS.

The associations between social factors and suboptimal use of paediatric dental services (Tiny Teeth): a mixed method study

BackgroundDental decay is the leading reason for hospital admission of children aged 5–9 years. Prevalence of dental decay is strongly associated with deprivation, decreased maternal education, and ethnicity. This study aimed to investigate social and parental factors that prevent timely and regular use of dental services in Haringey and Enfield (London, UK), and to address the suitability of the emergency department (ED) as a site of opportunistic oral health education, using a dental intervention (DI). MethodsThe study was undertaken at the North Middlesex University Hospital's paediatric ED in North London, UK. It was a mixed method study with cross-sectional surveys, a brief DI, and qualitative interviews. Parents of children aged 10 years and younger in the ED were invited to participate in the study. Informed written consent was obtained from 101 participants. Data collection was from Jan 31, 2019, to March 13, 2019. Questionnaires collected background social and medical data, and assessed each caregiver's oral health literacy. The Big Bites and Pearly Whites DI provided parents with up-to-date information about teeth cleaning practices, dentistry, and diet. A post-intervention questionnaire assessed changes in parental knowledge. Adjusted logistic regressions explored associations between social factors and child dental registration. Seven semistructured interviews were conducted, collecting data on barriers faced to the use of paediatric dental services. FindingsBlack British, Caribbean, and African children had an odds ratio of 0·158 (95% CI 0·037–0·679) for dental registration compared with their white counterparts, after adjusting for age of child and sibling number. The DI led to a significant difference between pre and post intervention median knowledge scores (Wilcoxon signed rank test; p=0·009) with a small effect size (r=0·2). Qualitative interviews exposed that current oral health advice, from dentists alone, is inconsistent and not universally delivered, resulting in late, suboptimal, and problem-based attendance. InterpretationTo maximise and reinforce early and universal parental receipt of oral health messages, collaboration and coordination is needed between educational, dental, and general health providers. Disparities in health-seeking behaviour due to ethnicity and knowledge should be accounted for when planning service engagement programmes. The study supports the ED as a site to opportunistically make every contact count by reinforcing preventive oral health messages. The major limitations of the study are its size and cross-sectional design. FundingNone.

Taking a big bite: Working together to better understand the evolution of feeding in primates.

The study of adaptation requires the integration of an array of different types of data. A single individual can find such integration daunting, if not impossible. In an effort to clarify the role of diet in the evolution of the primate craniofacial and dental apparatus, we assembled a team of researchers that have various types and degrees of expertise. This interaction has provided a range of insights for all contributors, and this has helped to refine questions, clarify the possibilities and limitations that laboratory and field settings offer, and further explore the ways in which laboratory and field data can be suitably integrated. A complete and accurate picture of dietary adaptation cannot be gained in isolation. Collaboration provides the bridge to a more holistic view of primate biology and evolution.

Dreaming of a Tiger's Corpse

Dreaming of a Tiger's Corpse Li Hongwei (bio) Translated by Ming Di (bio) and Kerry Shawn Keys (bio) Those who dream of tigers on a rainy daypossess an ancient forest inside their bodieswhere there are hundreds of green, lush trees and calm birds.Sun rays are packed, unable to find a way to flow out.Even if they poke through the leaves and pour to the ground,there will be only colorful tapestry stitches. The father of the public beasts rises.He walks at ease, eyes far-seeing.He doesn't carry weapons, just his flashing teeth.With his howling, he patrols the vast dreamand with a real tail, left and right,mopping the fern grass and earth, sweeping the wind.He leaps up to the crouching boulder, andwith one big bite eats up the rain and the dreamers. It's on a raining day like this,I dream of a tiger's corpse.Ragged, it's halfway immersed in a paddy field,two hind legs completely gone.Luckily, its mouth and wiring are intact.With electricity, it can smile a tiger smileand sing soaking-wet songs. [End Page 61] Li Hongwei Li Hongwei 李宏伟 was born in Jiangyou, Sichuan province, in 1978. He won the 2014 Young Writers Annual Performance Award and the Xu Zhimo Award. His books of poetry include 10 Kinds of Imagination in Contemporary Life. He has written two novels and the story collection Fake Time Party. He lives in Beijing. Ming Di Ming Di 明迪 is a Chinese poet based in the U.S. She attended Boston College and Boston University, where she taught Chinese. She has published six books of poetry in Chinese along with a collaborative translation, River Merchant's Wife (2012). She co-translated The Book of Cranes by Zang Di (2015) with Neil Aitken, and Empty Chairs: Selected Poems by Liu Xia (2015) with Jennifer Stern, which was a finalist for the 2016 Best Translation Book Award. She edited and co-translated New Cathay: Contemporary Chinese Poetry (2013) and New Poetry from China 1917–2017 (2019). In 2013 and 2014, she received Henry Luce Foundation fellowships. A co-founder of Poetry East West journal, she serves as the China editor for Poetry International Rotterdam. She has also translates from English into Chinese, most recently Observations by Marianne Moore (2018). Kerry Shawn Keys Kerry Shawn Keys has published nearly fifty books, including poetry, plays, fiction, and children's literature. He is the recipient of NEA and Poetry Society of America awards, and translation awards from the Lithuanian Writers' Union. A member of International PEN, he is the Republic of Užupis' World Poetry ambassador. Copyright © 2019 University of Hawaiʿi Press

Residents’ journal review

Residents’ journal review

A Little Bug with a Big Bite: Impact of Hemlock Woolly Adelgid Infestations on Forest Ecosystems in the Eastern USA and Potential Control Strategies.

Hemlock woolly adelgid (Adelges tsugae Annand, HWA) remains the single greatest threat to the health and sustainability of hemlock in the eastern USA. The loss of hemlock trees leads to further negative impacts on the diversity and stability of ecosystems in the eastern part of North America. It is, therefore, urgent to develop effective control measures to reduce HWA populations and promote overall hemlock health. Currently available individual and integrated approaches should continue to be evaluated in the laboratory and in the field along with the development of other new and innovative methods.

Pain and discomfort following insertion of miniscrews and premolar extractions: A randomized controlled trial.

To investigate and compare the experience of pain and discomfort between insertion of miniscrews and premolar extractions in adolescent patients. A total of 80 adolescents were recruited and randomized into groups A and B. Both groups were treated with extraction of the upper first premolars and fixed appliance. Beyond the fixed appliance, patients in group A received anchorage reinforcement with miniscrews. Miniscrews were inserted buccally between the second premolar and first molar when space closure started. Space closure was performed as en masse retraction with immediate loading by 150-g coil springs. Pain, discomfort, impact on daily activities, and functional jaw impairment were assessed with patient-reported questionnaires. Questionnaires were filled in at baseline, the evening after tooth extraction, 1 week after tooth extraction, the evening after screw placement, and 1 week after screw placement. Patients reported significantly lower levels of pain (P < .001) and discomfort (P = .012) after screw placement compared with premolar extractions. The ability to drink (P = .035) and the ability to take a big bite (P < .001) were also significantly less disturbed in the evening after screw placement. During the first week after screw placement, the impact on leisure time activities was significantly lower (P = .015) compared with premolar extractions. The use of miniscrews in adolescents can be recommended from a pain and discomfort perspective.

Temporary Steno-occlusive Change in the Donor Artery During Mouth Opening (Big Bite Ischemic Phenomenon) After Superficial Temporal Artery to Middle Cerebral Artery Bypass in Adult Patients with Moyamoya Disease and Atherosclerosis.

Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is one of the most common surgical procedures performed for direct extracranial (EC) to intracranial (IC) bypasses. We describe a temporary steno-occlusive change in the STA that was caused by mouth opening after the STA-MCA bypass (so-called big bite ischemic phenomenon) in an adult patient with moyamoya disease. The aim of this study was to assess the incidence of this phenomenon in patients with atherosclerosis. Adult patients with ischemic cerebrovascular disease who underwent STA-MCA anastomosis were included in this study. Ultrasound examinations were postoperatively performed on 62 sides to determine whether mouth opening affected the blood flow of the donor STA and resulted in any ischemic symptoms within 1 min. Computed tomography angiography was performed during both mouth opening and closing when blood flow changes were recognized in the donor STA. During wide mouth opening, steno-occlusion of the donor STA occurred in 8 of the 62 affected sides (12.9 %), which included 3 of the 47 sides (6.4 %) in patients with atherosclerosis and 5 of the 15 sides (33.3 %) in patients with moyamoya disease. Steno-occlusion of the donor STA occurred during wide mouth opening in 12.9 % of the sides of adult patients who had undergone STA-MCA anastomosis. This phenomenon was more common in patients with moyamoya disease than in patients with atherosclerosis.

Acquisition of Core Tissue with the SharkCoreTM FNB Needle: Big Bites or Just Nibbles?

Acquisition of Core Tissue with the SharkCoreTM FNB Needle: Big Bites or Just Nibbles?

The partitioning paradox: The big bite around small packages

We replicate the research of Do Vale et al. (2008) and Scott et al. (2008) showing that the diet-conscious tend to eat more when a portion is broken into multiple smaller partitions than when it is unpartitioned. The results show that the partitioning paradox is clearer when diet-consciousness is manipulated than measured. A meta-analysis reveals that the partitioning paradox among the diet-conscious is a medium size effect, but also that partitioning has an opposite and equal size effect on the non-diet conscious: they eat more from the unpartitioned than the partitioned package.

Consumers ?taking a big bite out of the earth

Consumers ?taking a big bite out of the earth

Life: Cats claim billions of bird and small mammal victims annually: New estimate suggests felines take a big bite out of wildlife

Life: Cats claim billions of bird and small mammal victims annually: New estimate suggests felines take a big bite out of wildlife

Operating Room Suite

I. A train of patientsbefore and afterbut the one here nowlies supine, quiet, eyelids taped shutII. Tubing, stopcocksdraw sheet, up drapethe Japanese moon bridgeof chlorhexidine swabbed over the belly.III. Bits of the patientsquiggle on monitorsshadow x-rays; inside is outmagnified on videoscreenstrimmed into specimen jars.IV. The circulating nursekeeps her scrub pants rolled and tuckedas if ready to ride a bicycleas she declogs the suction again.V. Too narrow, too widetoo purple, too redtoo worn out;and then there is cancercalling to the wife in the waiting roompray, pray now.VI. The medical student at 2:00 amis told to sew: evert, big bites, don't dogearit is a small prize, a gift, a bone;the anesthesiologist sighs,keeps the sevoflurane on.VII. Telephone, thermostatpillows, computer—the surgeon slides her hand behind omentum—and no matter whatafterwards it is always the mop.VIII. The anesthesiologist watchesthe patient breathe piped oxygen;hears the bellows force the chest to riselisten:each breath saysyesyes to timeyes to healthyes to life.

To improve the “target” of transanal hemorrhoidal dearterialization

Sir, We read with interest the paper by Toh et al. [1]. This study was carried out with the critical attitude of those who want to improve a surgical treatment that is very effective but can still be improved. Our comments about the study results concern the ‘‘functional anatomy’’ of the lower rectum. Actually, in addition to the exact number of terminal branches of the higher rectal arteries, a fundamental factor in this surgical approach is the correct understanding of the topography of these branches and their relationship with the rectal wall. Hemorrhoidal dearterialization with transanal hemorrhoidal dearterialization (THD) ensures an excellent control of rectal bleeding, and in most cases, the resolution of prolapse thanks to a ‘‘tailored mucopexy’’. The complex vascular network of the ‘‘corpus cavernosum recti’’ is the key to perfecting this therapeutic approach. According to our experience, there are always more than three (usually six) terminal branches of hemorrhoidal arteries to be ligated [2]. The target of therapy should be the point at which the arteries enter the submucosa of the low rectum, just before supplying blood to the ‘‘corpus cavernosum recti’’ [3]. In this way, an extraparietal arterial ligation can be avoided, and action can be taken right where the arterial hyperflow could have the greatest effect on the hemorrhoids. Use of Doppler-guided THD allows a detailed identification of the arteries and a rigorous and effective ligation of them. Moreover, the surgeon avoids taking big bites when suturing and making a ‘‘blind dearterialization’’ that would be at greater risk of bleeding and might partially alter both the anatomy and dynamics of the rectal wall, thus affecting rectal compliance and causing postoperative functional disturbances.