Purported Advantages Research Articles

A Systematic Review of the Scope of Study of mHealth Interventions for Wellness and Related Challenges in Pediatric and Young Adult Populations.

BackgroundDespite the purported advantages and potential efficacy of mHealth interventions to promote wellness in children, adolescents, and young adults, it is not clear what areas have been explored and the challenges reported in the biomedical literature.MethodsWe conducted a scoping review of publications between 2015 and 2019.ResultsWe identified 54 papers that met our inclusion criteria. Studies were conducted in 21 countries and ranged in size from six to 9851 participants (median: 184). A total of 41% of studies enrolled adolescents only (n = 19). Of the seven types of mHealth interventions identified, apps were the most common intervention (59%; n = 32) evaluated and 44% of the studies evaluated two or more interventions. The most common topic of the studies reviewed was sexual and reproductive health (24%; n = 13).ConclusionMost pediatric mHealth intervention studies are conducted in adolescents in large part, and sexual and reproductive health is the most commonly studied topic. With the easy and widespread accessibility to smartphone technology, the use of mobile apps for wellness interventions will likely continue to expand to other wellness topics.

A Painful End for Perfectionism?

This paper examines perfectionist attempts to explain the prudential badness of pain (its badness for those who experience it). It starts by considering simple perfectionist explanations, finding them wanting, before considering the most sophisticated perfectionist attempt to explain prudential badness: Gwen Bradford’s tripartite perfectionism. The paper argues that Bradford’s view, though an improvement on earlier perfectionist proposals, still does not satisfactorily explain the full set of prudentially bad pains. It ends by showing how this provides grounds for a general kind of pessimism about perfectionism and the badness of pain and how this case undermines a general purported advantage of perfectionism over the objective list theory.

Integrated reporting: Much ado about nothing?

Integrated reporting, which helps companies to share their value creation pro-cesses with their stakeholders, has developed rapidly in recent years. Due to the increased attention paid to the International Integrated Reporting Framework is-sued by the International Integrated Reporting Council, the number of companies worldwide engaging in integrated reporting is continually rising, which is presuma-bly driven by the claimed benefits of this practice. Through recourse to legitimacy theory and management fashion theory, here we provide a preliminary assessment of the development of integrated reporting, alongside considering the potential in-fluence of academic research in its growth. We review the existing body of aca-demic literature on this topic, ultimately identifying 123 claims about the benefits of IR from 29 papers published in 15 journals between May 2011 and September 2016, before proceeding to analyse both the sources and the level of substantia-tion of these claims. Our findings suggest that only a few of the purported ad-vantages of integrated reporting are supported by actual empirical evidence, while most of the claims only cite a limited number of primary sources. Based on these results and our assessment of the development of the concept of IR, we propose a future research agenda.

Clinical and Radiological Outcomes of Rotator Cuff Repairs Using All-Suture Anchors as Medial Row Anchors.

The aim of our study is to report the clinical and radiological outcomes of a series of prospectively enrolled patients who have had double-row transosseous equivalent rotator cuff repairs, where all-suture anchors were used as medial-row anchors, with a minimum follow-up of 1 year. Twenty-two consecutive patients underwent arthroscopic transosseous equivalent double-row rotator cuff repair using all-suture anchors as medial-row anchors. Oxford Shoulder Score, Constant Score and Visual Analogue Scale pain score, together with shoulder range of motion, were used preoperatively and at 3 months, 6 months and final follow-up. Radiological evaluation was performed with magnetic resonance imaging at one-year post surgery to assess the structural integrity of the repair and the rate of cyst formation in greater tuberosity. The patient mean age was 61 years (range 46-75). Minimum follow-up was 1 year, and the mean final follow-up was 15 months (range 12-24). Healing failure in our patients was less than 5% (1/22 patients). There were significant improvements in shoulder function outcome scores at final follow-up. The Constant and Oxford scores were 78 and 44 at final follow-up respectively. There were similar magnitudes of improvement in range of motion (combined abduction and rotation), pain score and supraspinatus strength at final follow up. The improvements in outcome scores were already statistically significant at 3 months (P<.001). Using Kim's classification for cyst formation on T2-weighted MRI images, we observed no fluid or minimal fluid collection in 85% of the patients (17/22 patients). There were no correlations between the grade of bone changes and the clinical outcomes. It is safe to use all-suture anchors as medial-row anchors when performing double-row anchor transosseous equivalent rotator cuff repairs. The purported advantages of all-suture anchors may outweigh their perceived disadvantages in rotator cuff repair surgery.

Folk Classification and Factor Rotations: Whales, Sharks, and the Problems With the Hierarchical Taxonomy of Psychopathology (HiTOP).

The Hierarchical Taxonomy of Psychopathology (HiTOP) uses factor analysis to group people with similar self-reported symptoms (i.e., like-goes-with-like). It is hailed as a significant improvement over other diagnostic taxonomies. However, the purported advantages and fundamental assumptions of HiTOP have received little, if any scientific scrutiny. We critically evaluated five fundamental claims about HiTOP. We conclude that HiTOP does not demonstrate a high degree of verisimilitude and has the potential to hinder progress on understanding the etiology of psychopathology. It does not lend itself to theory-building or taxonomic evolution, and it cannot account for multifinality, equifinality, or developmental and etiological processes. In its current form, HiTOP is not ready to use in clinical settings and may result in algorithmic bias against underrepresented groups. We recommend a bifurcation strategy moving forward in which the DSM is used in clinical settings while researchers focus on developing a falsifiable theory-based classification system.

Resilience of Quantum Random Access Memory to Generic Noise

Quantum random access memory (QRAM)—memory which stores classical data but allows queries to be performed in superposition—is required for the implementation of numerous quantum algorithms. While naive implementations of QRAM are highly susceptible to decoherence and hence not scalable, it has been argued that the bucket-brigade QRAM architecture [Giovannetti et al., Phys. Rev. Lett. 100, 160501 (2008)] is highly resilient to noise, with the infidelity of a query scaling only logarithmically with the memory size. In prior analyses, however, this favorable scaling followed directly from the use of contrived noise models, thus leaving open the question of whether experimental implementations would actually enjoy the purported scaling advantage. In this work, we study the effects of decoherence on QRAM in full generality. Our main result is a proof that this favorable infidelity scaling holds for arbitrary error channels (including, e.g., depolarizing noise and coherent errors). Our proof identifies the origin of this noise resilience as the limited entanglement among the memory’s components, and it also reveals that significant architectural simplifications can be made while preserving the noise resilience. We verify these results numerically using a novel classical algorithm for the efficient simulation of noisy QRAM circuits. Our findings indicate that QRAM can be implemented with existing hardware in realistically noisy devices, and that high-fidelity queries are possible without quantum error correction. Furthermore, we also prove that the benefits of the bucket-brigade architecture persist when quantum error correction is used, in which case the scheme offers improved hardware efficiency and resilience to logical errors.4 MoreReceived 21 December 2020Accepted 13 April 2021DOI:https://doi.org/10.1103/PRXQuantum.2.020311Published by the American Physical Society under the terms of the Creative Commons Attribution 4.0 International license. Further distribution of this work must maintain attribution to the author(s) and the published article's title, journal citation, and DOI.Published by the American Physical SocietyPhysics Subject Headings (PhySH)Research AreasQuantum algorithmsQuantum computationQuantum information architectures & platformsQuantum information processingQuantum Information

Rotordynamic Behavior of Leaf Seals: Measurement of Frequency-Dependent Force Coefficients for Varying Inlet Parameters

Abstract While brush seals can be found in various applications for turbomachines today, leaf seals are a further development in compliant seal technology and have a lower level of maturity. Among the purported advantages are greater axial rigidity when subject to higher pressure differences and the potential for noncontacting operation due to lift-up. However, especially their rotordynamic behavior is little investigated in the literature so far. In this paper, measured rotordynamic force coefficients of a leaf seal are presented for varying inlet pressures, preswirl velocities, and excitation frequencies. The leaf pack of the tested leaf seal has zero rotor cold clearance, and its coverplates are designed for facilitating a lift-up effect when pressurizing the seal. Experiments were performed on a dynamic test rig with whirling rotor using active magnetic bearing (AMB) technology and evaluated in the frequency domain based on the impedance method. Test results for the leaf seal reveal positive direct stiffness and an advantageous rotordynamic behavior due to significant levels of direct damping and negative cross-coupled stiffness throughout the operating parameter range. Leaf seal results are compared to brush and labyrinth seal data from previous studies for varying inlet pressures and preswirl velocities. Additional computational fluid dynamics (CFD) simulations were carried out to predict the leaf deflection moment, which supports the findings regarding hydrostatic lift-up from the experimental results.

Your word against mine: the power of uptake

Uptake is typically understood as the hearer’s recognition of the speaker’s communicative intention. According to one theory of uptake, the hearer’s role is merely as a ratifier. The speaker, by expressing a particular communicative intention, predetermines what kind of illocutionary act she might perform. Her hearer can then render this act a success or a failure. Thus the hearer has no power over which act could be performed, but she does have some power over whether it is performed. Call this the ratification theory of uptake. Several philosophers have recently endorsed an alternative theory of uptake, according to which the hearer can determine the nature of the act the speaker performs. According to this theory, if the hearer regards an utterance as illocutionary act y, then it is act y, even if the speaker intended to perform act x. Call this the constitution theory of uptake. The purported advantage of this theory is that it identifies a common but underanalysed way in which speakers can be silenced. I argue that despite its initial intuitive pull, the constitution theory of uptake should be rejected. It is incompatible with ordinary intuitions about speech, it entails a conceptual impossibility (the unintentional exercise of normative powers), and it has unsavoury political implications, entailing that marginalised speakers barely qualify as agents.

Prevalence and associated factors of prelacteal feeding among neonates admitted to neonatal intensive care units, North central Ethiopia, 2019

BackgroundPrelacteal feeding compromises the benefits of exclusive breastfeeding, thereby increasing neonatal malnutrition, infection and mortality. About 26% of the Ethiopian neonates are given prelacteal feeds and nearly 48% of whom are attributed to Amhara region. Besides, prior Ethiopian studies have shown significance of the problem at different community settings in the country. However, the prevalence and associated factors of prelacteal feeding among neonatal admissions has been overlooked in the country in general and in the study area in particular. Therefore, this study was aimed to assess the prevalence and associated factors of prelacteal feeding among neonatal admissions in the study setting.MethodsA cross-sectional study was conducted among 321 mother-neonate pairs admitted to Neonatal Intensive Care Unit (NICU) of Debre Tabor General Hospital between September 2018 and February 2019. Every fourth mother neonate pair was included to the study. Multivariable logistic regressions were fitted to find out adjusted odds ratios (AORs) of factors associated with pre-lacteal feeding.ResultsThe prevalence of prelacteal feeding was 20.2% [95% CI: 15.31–26.75%]. Plain water was the most common prelacteal food (32.3%). Factors associated with prelacteal feeding include rural residence (AOR = 4.07, 95% CI: 1.30, 12.81), primiparity (AOR = 4.50, 95% CI: 1.30–12.81), less than four ANC visits (AOR = 4.71, 95% CI: 1.23–17.84), spousal accompany to ANC (AOR = 0.20, 95% CI: 0.05–0.75), home delivery (AOR = 5.94, 95% CI: 1.80–19.67), having twin newborns (AOR = 6.69, 95% CI: 1.25, 35.91) and maternal belief on the purported advantages of prelacteal feeding (AOR = 2.74, 95% CI: 2.09–25.39).Conclusion and recommendationOne out of five sick neonates was given prelacteal feeds. Twin neonates, home delivered neonates, rural neonates, neonates born to primiparous mothers, neonates delivered from mothers who had less than four ANC visits, neonates born to mothers who weren’t accompanied by their spouse during ANC and those born to mothers who believe on the purported advantages of prelacteal feeding had higher odds of receiving prelacteal feeds. Therefore, mothers of these vulnerable neonates should be provided with more emphasis about counseling of infant and young child feeding practice during their stay at NICU.

Real Differences between OT and CRDT in Correctness and Complexity for Consistency Maintenance in Co-Editors

OT (Operational Transformation) was invented for supporting real-time co-editors in the late 1980s and has evolved to become core techniques widely used in today's working co-editors and adopted in industrial products. CRDT (Commutative Replicated Data Type) for co-editors was first proposed around 2006, under the name of WOOT (WithOut Operational Transformation). Follow-up CRDT variations are commonly labeled as "post-OT" techniques capable of making concurrent operations natively commutative in co-editors. On top of that, CRDT solutions have made broad claims of superiority over OT solutions, and often portrayed OT as an incorrect and inefficient technique. Over one decade later, however, CRDT is rarely found in working co-editors; OT remains the choice for building the vast majority of today's co-editors. Contradictions between the reality and CRDT's purported advantages have been the source of much confusion and debate in co-editing researcher and developer communities. To seek truth from facts, we set out to conduct a comprehensive and critical review on representative OT and CRDT solutions and working co-editors based on them. From this work, we have made important discoveries about OT and CRDT, and revealed facts and evidences that refute CRDT claims over OT on all accounts. These discoveries help explain the underlying reasons for the choice between OT and CRDT in the real world. We report these results in a series of three articles. In this article (the second in the series), we reveal the differences between OT and CRDT in their basic approaches to realizing the same general transformation and how such differences had resulted in different technical challenges and consequential correctness and complexity issues. Moreover, we reveal hidden complexity and algorithmic flaws with representative CRDT solutions, and discuss common myths and facts related to correctness and complexity of OT and CRDT. We hope the discoveries from this work help clear up common myths and confusions surrounding OT and CRDT, and accelerate progress in co-editing technology for real world applications.

Femtolaser-assisted keratoplasty: Surgical outcomes and benefits

Femtosecond laser technology has evolved as an alternative method to make surgical incisions in keratoplasty. The use of this approach has a number of purported advantages that may lead to superior clinical outcomes. However, there remains a low uptake of the femtolaser-assisted keratoplasty within public healthcare, and incongruity remains between perceived expert opinion on the presence and significance of superior clinical outcomes based on available data. This review is registered publicly on the Open Science Framework registry and aims to evaluate the evidence base on femtolaser-assisted keratoplasty and its comparison with manual trephination in intraoperative and postoperative outcomes. Over 2000 studies were screened and critically appraised in the field of keratoplasty, using multiple databases. 17 studies were included via predetermined criteria for full analysis. The studies covered interventional research into penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), and posterior lamellar keratoplasty (PLK). The results of this review show that PK studies shared a trend of improved visual outcomes with the femtolaser, and evidence for earlier suture removal. Complication rates were similar. When used for DALK, studies showed some evidence of improved visual outcomes with the femtolaser, and evidence for earlier suture removal, reduced intraoperative complications and increased wound healing activity. The use in Descemet’s membrane endothelial keratoplasty (DMEK) showed reduced graft detachment whereas in Descemet’s stripping automated endothelial keratoplasty (DSAEK) the results were limited. Overall, this review shows a trend that the use of the femtolaser may improve clinical outcomes in PK, DALK and DMEK. However, it was also clear that in order to corroborate the superiority of femtolaser-assisted keratoplasty versus manual methods, further research is required.

Robotic spine surgery: Ushering in a new era

The endeavour to make spine surgery safe with reproducible, consistent outcomes has led to growing interest and research in the field of intraoperative imaging, navigation and robotics. The advent of surgical robot systems in spine surgery is relatively recent – with only a few systems approved for commercial use. At present, pedicle screw insertion remains the primary application of robotic systems in spine surgery. The purported advantages of robot-assisted pedicle screw insertion over other conventional techniques are its increased accuracy, reproducible consistency and reduced radiation exposure. Many of these claims have been supported or refuted by individual studies – and high quality evidence for the same is lacking. Robotic spine surgery also has its share of limitations which include increased operative time, considerable learning curve and technical pitfalls unique to the robotic systems. The applications of robotic spine surgery are evolving and expanding to spinal deformity, spine oncology and needle-based interventional treatments. This review provides an overview of the evolution and current status of robotic spine surgery along with an evidence-based discussion of its current applications in spine surgery.

(Non)Urban Humans: Questions for a Research Agenda (the Work the Urban Could Do)

AbstractThis interventions essay deploys the notion of the (non)urban human to address the conundrums associated with identifying spaces, operations and entities outside of urbanization's planetary encompassment. In the piece, the objective of which is to call for a programme of prospective research collaborations, it seeks to explore domains of intersection among that which appears ‘left out’ of urbanization's purported advantages, that whose time has yet to come, and forms of the human that exceed the possibilities of self‐reflexive consciousness and free will. The essay draws upon the temporalities, rhythms, spatial arrangements and sensoria generated through histories of blackness and ‘natural worlds’ and their interactions, to posit extensionality—a dispersal of bodies and their capacities into more reciprocal and mutual enactments with the earthly surrounds—as a generative by‐product of extended urbanization.

Real Differences between OT and CRDT under a General Transformation Framework for Consistency Maintenance in Co-Editors

OT (Operational Transformation) was invented for supporting real-time co-editors in the late 1980s and has evolved to become a collection of core techniques widely used in today's working co-editors and adopted in major industrial products. CRDT (Commutative Replicated Data Type) for co-editors was first proposed around 2006, under the name of WOOT (WithOut Operational Transformation). Follow-up CRDT variations are commonly labeled as "post-OT" techniques capable of making concurrent operations natively commutativity in co-editors. On top of that, CRDT solutions have made broad claims of superiority over OT solutions, and routinely portrayed OT as an incorrect, complex and inefficient technique. Over one decade later, however, CRDT is rarely found in working co-editors, and OT remains the choice for building the vast majority of today's co-editors. Contradictions between the reality and CRDT's purported advantages have been the source of much confusion and debate in co-editing research and developer communities. Have the vast majority of co-editors been unfortunate in choosing the faulty and inferior OT, or those CRDT claims are false? What are the real differences between OT and CRDT for co-editors? What are the key factors and underlying reasons behind the choices between OT and CRDT in the real world? A thorough examination of these questions is relevant not only to researchers who are exploring the frontiers of co-editing technologies and systems, but also to practitioners who are seeking viable techniques to build real world applications. To seek truth from facts, we set out to conduct a comprehensive and critical review on representative OT and CRDT solutions and working co-editors based on them. From this work, we have made important discoveries about OT and CRDT, and revealed facts and evidences that refute CRDT claims over OT on all accounts. We report our discoveries in a series of articles and the current article is the first one in this series. In this paper, we present a general transformation framework for consistency maintenance in co-editors, which was distilled from dissecting and examining representative OT and CRDT solutions (and other alternative solutions) during this work, and report our discoveries under the guidance of this framework. In particular, we reveal that CRDT is like OT in following a general transformation approach, but achieves the same transformation indirectly, in contrast to OT direct transformation approach; and CRDT is not natively commutative for concurrent co-editing operations, but has to achieve the same OT commutativity indirectly as well, with consequential correctness and complexity issues. Uncovering the hidden transformation nature and demystifying the commutativity property of CRDT provides much-needed clarity about what CRDT really is and is not to co-editing, and serves as the foundation to explore the real differences between OT and CRDT in correctness, complexity, implementation, and real world applications, which are reported in follow-up articles. We hope discoveries from this work help clear up common misconceptions and confusions surrounding OT and CRDT, and accelerate progress in co-editing technology for real world applications.?

Applying organized skepticism to preprints

A preprint is a scholarly work posted by the author(s) in an openly accessible platform, usually before or in parallel with submission to a peer reviewed publication. While the sharing of manuscripts via preprint platforms has been common for many years in disciplines such as physics and mathematics, uptake in other disciplines had, until very recently, been low. The use of preprints is now growing exponentially. The reasons for this appear to be based on several purported advantages of preprints that have not been thoroughly assessed: low cost (but is it sustainable?); immediate publication; establishes precedence; improves quality of papers pre-submission; eliminates journal hierarchies and inequalities; identifies hypotheses not to test further (by making negative results available); a source of submissions for journals. I will take a skeptical view of these advantages and ask: do preprints really accomplish all of this? I will also present the many disadvantages – even dangers – of preprints as these have not been adequately scrutinized: bypasses peer review allowing documents containing unvetted claims to be made freely available; results in multiple competing versions (all of which are citable) of what – without careful and informed examination – appears to be the same content to persist in perpetuity (the preprint version of which is much more likely to contain errors and unvetted claims); presently, no one is responsible for updating the preprint server version, nor to link it to the final published version.

Lasers in Spine Surgery.

Laser spine surgery has been a focus of intense interest in the lay press and among patients. On the Internet, a host of purported benefits to laser surgery exists. Lasers have long been used in pain management procedures such as percutaneous diskectomy. However, a few published articles are available on lasers in conventional spine surgery. From our review of the literature, the purported advantages of lasers, such as reduced inflammation and degeneration, are not been supported by preclinical research. The available clinical studies do not show a notable advantage for laser surgery. Moreover, the low enrollment, nonblinded, retrospective studies that are available are heavily subject to bias. The documented advantages of laser spine surgery described in the research studies are not consistent with the public's impression of its purported benefits. Furthermore, laser-specific complications are present about which patients should be informed. On the basis of the current research, we conclude that lasers add distinct potential complications without any corresponding clinical benefit. Because of the public interest, we feel that this is an important topic for the general orthopaedic community.

Contraceptive method choice and spousal communication: Examining the effect of family planning method using an instrumental variable approach

ObjectivesSpousal communication is an important factor in reproductive health outcomes, including family size, contraceptive use and conflict. A purported advantage of traditional contraception is that it increases communication about family planning, since both partners need to be involved in contraceptive practice. However, there is likely to be some degree of endogeneity due to selection: couples who communicate better are more likely to select methods requiring higher degrees of communication. MethodThis paper uses an instrumental variable approach to assess the causal effect of method choice on spousal communication in 7 countries in Sub-Saharan Africa. Religion is used as an instrument since this is correlated with method but not communication. ResultsResults indicate that both traditional and modern methods are associated with greater discussion of family planning, and this is robust to the introduction of controls. However, when using the instrumental variable to account for selection effect, many of the significant results for traditional methods disappear although they persist for modern methods. ConclusionsThese findings indicate that the effect of traditional methods in improving communication is due to selection, rather than causation. While traditional methods still have a role to play in the contraceptive method mix, enthusiasm for side benefits such as family planning communication should be tempered.

Communication through quantum-controlled noise

In a recent series of works [Ebler et al. Phys. Rev. Lett. 120, 120502 (2018); arXiv:1809.06655v2; arXiv:1810.10457v2], it has been proposed that the quantum superposition of causal order -- the quantum switch -- may offer an enhancement of classical and quantum channel capacity through noisy channels, a phenomena that was coined `causal activation'. In this paper we attempt to clarify the nature of the purported advantage, by comparing the quantum switch to a class of processes that can be interpreted as quantum superposition of processes with the same causal order. We show that some of these processes can match or even outperform the quantum switch at enhancing classical and quantum channel capacity, and argue that they require the same resources as the switch. We conclude, in agreement with Abbott et al. [arXiv:1810.09826v1], that the aforementioned advantages appear to be attributable to the ability to coherently control quantum operations, and not to indefinite causal order per se.

Using minimally invasive techniques adds to the value equation for select patients.

Conditions of the spine are one of the most prevalent causes of global disability, and result in a considerable portion of total health expenditures. Surgical treatment of the spine has been demonstrated in multiple studies to be a cost-effective treatment option for many patients, especially with continuing improvements in surgical technique and instrumentation. Minimally invasive spine surgery (MISS), in particular, has evolved as a valuable option in treating certain patients. Numerous studies have analyzed minimally invasive techniques in regards to cost-effectiveness and other purported advantages. These advantages include conduciveness to outpatient settings, better perioperative and immediate post-operative benefits, and faster time to recovery. This article will describe the current literature on the advantages of MISS, specifically in regards to value and cost savings.

Laparoscopic Adrenalectomy for Pheochromocytoma - Intraoperative Cardiac Arrest and Cardiopulmonary Resuscitation in Lateral Position: A Case Report

Anaesthetic management of patients with large adrenal gland tumor pheochromocytoma is a challenge to the anesthesiologist, due to perioperative uncontrolled blood pressure, risk of arrhythmias and sudden cardiac arrest. Therefore, preoperative assessment and appropriate anaesthetic management are important in patients with pheochromocytoma. Laparoscopic adrenalectomy for Pheochromocytoma offers some technical advantages owing to its improved ability to visualize the contiguous anatomy and its relationship to the adrenal tumor. The decreased manipulation of the tumor during dissection of the adrenal gland has been espoused as another benefit of the laparoscopic approach. The decreased release of catecholamines and the resultant attenuation in haemodynamic liability has been a purported advantage of the laparoscopic approach.1,2,3,4 This is a case report of successful anaesthetic management of a patient with pheochromocytoma undergoing laparoscopic adrenalectomy using combined general and epidural anaesthesia the patient who developed intraoperative cardiac arrest and complete recovery after given lateral position CPR.&#x0D; Birdem Med J 2019; 9(2): 165-169