A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

Background The rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant. Methods We measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blinded Results The trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44). With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001). Conclusion On a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

Analisis Retouching Foto Close Up Karya Petra Sinuraya Menggunakan Teknik Digital

This study aims to describe the concept and process of visualization of the close-up photo retouching technique by Petra Sinuraya. This research method is descriptive analytic research on the work. The subject of this type of research is Petra Sinuraya's close up photography retouching work. Data were analyzed descriptively analytic with percentage analysis using simple statistical procedures. Data obtained by using interview and documentation methods. The instrument was designed based on interview and documentation guidelines, and was developed based on situations that occurred in the field. The research was conducted by taking and selecting documents in the form of 10 pieces of art photos. The results showed that the close-up photo retouching process used by Petra Sinuraya was a digital technique by sharpening skills through the touch of tools available in Photoshop software. The role of composition in the retouching process is very important for client needs so that the photo looks more attractive in the final result. As for what Petra Sinuraya does in Close Up photo retouching is in various ways such as the Spot Hiling Brush for Smoothing the Skin, Burn and dodge tool for eye retouching, Dodge and Burn for Lightening / Darkening Contrast, filter noise and Gaussian blur - for flawless skin. and the Patch tool to enhance photos.

A Novel Digital Technique for Measuring the Accuracy of an Indirect Bonding Technique Using Fixed Buccal Multibracket Appliances

The aim of this study was to analyze the accuracy and predictability of the indirect bonding technique of fixed buccal multibracket appliances using a customized iterative closest point algorithm. Materials and Methods: A total of 340 fixed buccal multibracket appliances were virtually planned and bonded on 34 experimental anatomically based acrylic resin models by using orthodontic templates designed and manufactured to indirectly bond the fixed buccal multibracket appliances. Afterwards, the models were submitted to a three-dimensional impression technique by an intraoral scanner, and the standard tessellation language digital files from the virtual planning and the digital impression were aligned, segmented, and realigned using morphometric software. Linear positioning deviations (mm) of the fixed buccal multibracket appliances were quantified at mesio-distal, bucco-lingual/palatal, and gingival/occlusal (vertical) planes, and angular deviations (°) were also recorded by analyzing the torque, tip, and rotation using a customized iterative closest point algorithm, the script for which allowed for an accuracy measurement procedure by comparing the tessellation network positioning of both standard tessellation language digital files. Results: The mean mesio-distal deviation was −0.065 ± 0.081 mm, the mean bucco-lingual/palatal deviation was 0.129 ± 0.06 m, the mean vertical deviation was −0.094 ± 0.147 mm, the mean torque deviation was −0.826 ± 1.721°, the mean tip deviation was −0.271 ± 0.920°, and the mean rotation deviation was −0.707 ± 0.648°. Conclusion: The indirect bonding technique provides accurate and predictable positioning of fixed buccal multibracket appliances.

709 PL11.05 NOVEL DIGITAL REFLUX SCINTIGRAPHY DETECTS PULMONARY MICROASPIRATION IN SEVERE GASTRO-OESOPHAGEAL AND LARYNGOPHARYNGEAL REFLUX DISEASE

No gold-standard diagnostic test for laryngopharyngeal reflux (LPR) exists. Symptoms alone are non-diagnostic, and pH-impedance studies have poor sensitivity. Pulmonary micro-aspiration is under-recognised in LPR and gastro-oesophageal reflux disease (GORD). The present study aimed to describe the results of a novel digital technique for scintigraphic reflux studies in two groups with severe reflux: those with typical reflux symptoms and those with laryngopharyngeal manifestations of reflux. Methods A prospective database of severely symptomatic, treatment-resistant reflux patients was grouped based upon predominant symptom profile of typical GORD or LPR. All patients underwent novel reflux scintigraphy. Results were obtained for early scintigraphic reflux contamination of the pharynx and proximal oesophagus, and delayed contamination of the pharynx and lungs after two hours. Results The LPR patients were predominantly female (70.5% vs. 56.1%; p = 0.042) and older than the GORD group (median age 60 years vs. 55.5 years; p = 0.002). Early scintigraphic reflux was seen at the pharynx in 89.2% (GORD 87.7%, LPR 90.4%; p = 0.133), and at the proximal oesophagus in 89.7% (GORD 88.9%, LPR 90.4%; p = 0.147). Delayed contamination of the pharynx was seen in 95.2% (GORD 93.9%, LPR 96.2%; p = 0.468). Delayed pulmonary aspiration was seen in 46% (GORD 36.6%, LPR 53.3%; p = 0.023). Conclusion Reflux scintigraphy demonstrated a high rate of digitally identified reflux pulmonary aspiration. Contamination of the proximal oesophagus and pharynx was observed frequently in both groups of severe disease. The likelihood of pulmonary aspiration and potential pulmonary disease needs to be entertained in severe GORD and LPR.

A Metacinematic Spectrum

Metacinematic moments in screen narrative regularly turn attention back toward film’s point of material origination—from story to the conditions of its technical mediation—without turning their back either on the plot or its cultural surround. This double slant of the screen story, both back toward medial operations and outward toward some thematic interface with its social setting, is what this chapter sets out to discriminate in its “technique\text/context” articulation. Revisiting moments of medial self-acknowledgment in films from Citizen Kane through Apocalypse Now to Blade Runner 2049 prepares terms for assessing a late installment in one of Hollywood’s ongoing CGI franchise blockbusters, Marvel’s Spiderman: Far from Home (2040). In that sci-fi plot both digital technique and context implode upon the developing narrative text in the irony of an international political deception perpetrated by Hollywood-schooled VFX (visual special effects) when deployed, not on some inset screen, but in real metropolitan space.