In the last couple of years, another method was used where researchers applied Estimation of Physiologic Abi- lity and SurgicalStress (E-PASS) risk-scoring system for predicted and actual morbidity and mortality rates to as- sess the predictive ability of the E-PASS and compared it with the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) systems in patients with hip fractures. They showed that E-PASS scoring system is useful for defining postopera- tive risk, and its underlying algorithm can accurately predict morbidity and mortality rates in patients with hip fractures before surgery, which can be utilized to manage their condition and potentially improve treatment out- comes .
All clinical findings were collected retrospectively and were investigated. Nine factors determined the E-PASS scores, namely age, severity of heart disease, severity of pulmonary disease, diabetes mellitus, PS, American Society of Anesthesiologists physiological status classifi- cation, blood loss/body weight (g/kg), operation time (min), and extent of the skin incision. The equation of the E-PASS scoring system are shown in Table 1. The preoperative risk score (PRS) is used to evaluate pre- operative risk, and it is calculated on the basis of age, whether severe heart disease is present, whether severe lung disease is present, diabetes, the American Society of Anesthesiologists (ASA) classification, and performance status index defined by the Japanese Society for Cancer Therapy (see Table 1 for the actual calculation method). The surgicalstressscore (SSS) is used to evaluate sur- gical risk, and it is calculated on the basis of the BMI, operation time, and blood loss (Table 1). The evaluation is not made based on these individual scores alone, but by an overall evaluation of the risk of surgery itself per-
The above table shows that opinions or stress creator factors about the teaching and handling students 83.3% of the college teachers assume job insecurity, 73.3% of respondents assume poor student behavior and their negative towards study and 71.41% of respondents assume ineffective leadership, 55.55% of respondents assume lack of motivation 50% of respondents assume negative attitude of colleagues, 46.15% of respondent assume excessive additional duty, 40.74% respondent assume lack of research and personal growth opportunities and 50% of respondent believe that work home conflicts are the key stress creating factors.
Intra-abdominal infections have been well known throughout the history of surgery. However, only in the last century there has been a significant progress in the treatment of this disease. Timely surgical intervention has been one of the major reasons behind this success. However, the reduction in mortality from 90% to 10 – 20% within a century cannot be credited to surgery alone (2) . Improved antibiotics along with the improvement in post operative care have been armamentarium in this progress. With improved imaging techniques, better localization and subsequent drainage of intra-abdominal abscesses has been possible. Despite this fact; mortality persists with most patients succumbing from sepsis and MODS. It is now clear that the most influential factor in managing these cases is early accurate diagnosis and treatment (2) .
Mohil R S 17 used POSSUM and P-POSSUM for predicting the adverse outcome rate in patients undergoing emergency laparotomy at Safdurjung hospital, Delhi were studied prospectively to assess the applicability in their setup. All patients had physiological scoring done at the time of admission and intraoperative scoring was done to obtain the operative scoring variables, to calculate expected 30 day mortality and morbidity rates. 16 patients (13.3%) died within 30 days of surgery and 62(51.7%) developed significant complications. On analysis , they found an O:E ratio of 0.62 for POSSUM (x 2 =10.79, 9 d.f., p=0.148) and 0.66 using P-POSSUM scoring systems(x 2 =.33, 9 d.f., p=0.148).They concluded by validating POSSUM and P-POSSUM scoring systems for accurate prediction of post operative mortality rates even in the Indian scenario, where the patients usually belong to the lower socioeconomic strata of society with limited resources. POSSUM and P-POSSUM scoring systems can be used to help remove any bias in the patient selection and serve as important methods for predicting the post operative adverse outcome rate, even in their setup.
Few would argue that parents experience intense and extreme distress when their children are being treated for cancer. Parents are present during upsetting procedures or treatments and struggle with their own anxiety this cause disruption to their families. This psychological trauma that parents experience may lead to subsequent post traumatic stress. As cancer in their child they elicit feelings of hopeless with intrusive memories, physiological arousal, and isolated from the society.
In stressful condition, body reaction to stress was high and the body does not have necessary opportunity to return to normal levels, and stress converts to chronic stress (7). Top players exhibited consistently lower Cortisol than did less talented players. Highly successful competitors may have above average ability at managing stress (16). Kim and colleague (2010) illustrated that salivary Cortisol level was higher in competition than practice in male golfers, but it was similar in female golfers. In male golfers, salivary Cortisol level was higher before a round than at rest, but it was higher after rounds than at rest in female golfers. Salivary Cortisol was elevated during golf competition compared with practice in male junior golfers, but they were not in female golfers (25). Furthermore, salivary Cortisol was higher before a round than rest in men, but it was higher after a round than rest in women (25). The results of the present study contrasts with other studies may be due to differences in the level of sports competition (official or friendly), sports competitions (table tennis over wrestle, soccer, golf and rugby), fitness level subjects, hydration status of subjects and groups of study (14, 24, 25, 32, 34). Thus, high levels of salivary Cortisol suggest that the activation of the sympathetic nervous system activity carried out by subjects is in effect (24). In addition, psychological pressure caused by the activity or competition another mechanism influencing the secretion of Cortisol. So that many researchers believe, anticipate competition or activity before it starts may be an increase in resting Cortisol (24, 35). Decrease performance induce increased Cortisol can result in cognitive factors (3). Considering the importance of the cognitive aspects of the physical aspects of table tennis, the role of Cortisol than other indicators of physiologicalstress in more.
Clinical data was gathered from clinical records or from the surgeons of the team. The variables analyzed were a) baseline characteristics such as age, sex, tumor location (colon or rectum and the distance at the anal margin), neurological comorbidities (dementia, cerebrovascular disease, hemiplegia), weight loss > 10% in 6 months and, clinical or pathological staging according to Dukes and TNM . b) preoperative variables such as laboratory parameters (urea (mmol/l), haemoglobin (g/dL), leuco- cytes (× 10^12/l), sodium (mmol/l), potassium (mmol/ l)), heart rate (beats/min), systolic blood pressure [SBP] (mmHg), heart failure (none, mild, moderate, or severe), signs of respiratory failure (no dyspnoea, dyspnoea on exertion, limiting dyspnoea, dyspnoea at rest), electro- cardiogram (normal, atrial fibrillation [AF], other abnor- mal rhythm), and level of consciousness according to the Glasgow Coma Score. c) surgical process variables such as urgency of the intervention (scheduled, urgent, or, when done < 2 h after presentation at the emergency department, emergency), operative severity according to the National Institute for Health and Care Excellence [NICE] clinical guidelines (moderate, major or complex major) , tumor resection (yes or no), number of distinct surgical procedures in the same intervention (including tumor excision, ostomy, or surgery on other organs), peritoneal contamination (none, serous fluid, local pus, free pus or faeces or blood), and total blood loss (ml).
cadmium (Cd) solution in different concentrations to rice (Oryza sativa L.) seeds and they suggested that the RAPD band patterns have changed in high concentrations. When all the other conditions were kept stable, the only change that took place occurred in the samples with high metal exposure. This situation showed that the genotoxic agent cadmium (Cd) has a mutational effect. According to RAPD analysis, the reason of observing different band profiles in the control is the mutations that occur on the genome sites where the primers are bounded on DNA structure (Liu et al., 2007). Aksoy et al. (2010); also applied copper (Cu) in different concentrations to eggplant seeds. In different copper concentrations, the grown-up seeds can be observed in terms of their genomic structure stability changes by using the RAPD profiles (Aksoyet al., 2010). Cansaran et al. (2011); clearly indicated the genotoxic effect of the air pollution and heavy metal on lichen samples by using RAPD technic. They reported DNA polymorphism induced by accumulation of heavy metal in lichens. They also expressed that RAPD is more sensitive as they give more evidence about DNA damage (Cansaran et al., 2011). In another study, Batir et al. (2016); examined the genotoxic effects of lead and copper treatments with different concentrations on artichoke seedlings. They reported that the lead and copper cause genotoxic effect on the genomes of the artichoke and generate polymorphism in the RAPD band profiles (Batir et al., 2016). In this study, according to the results of RAPD analysis, highly important polymorphism is observed in sunflower samples subjected to zinc stress. 14 of 20 RAPD primers used in this study revealed polymorphic bands that are different from the control group of sunflower. OPC09 (57.2%), OPC08 (55.5%), OPC07 (50%) and OPC11 (50%) primers showed considerable polymorphic band patterns. This showed that these primers are powerful indicator for mutagenic effect of heavy metals for sunflower plants. Genomic template stability (GTS, %) was used to compare the alteration in RAPD profiles with the morphological characters which were root length, dry weight and total protein content in sunflower seedlings. The comparison of GTS (%), root length, dry weight and total soluble protein content were calculated according to their control value which was set to 100% (Tables 1). When compared the GTS rates that were obtained from RAPD profiles, the highest rate was 92.85% at 20mg L - 1 zinc concentration. The lowest rate was 83.33% at
[25,26] and proper development of chloroplasts [18,20]. It lead to decrease in shoot dry weight which was concomitant with a significant reduction in both length and diameter of the internodes as well as in leaf area and thickness but it is dependent on tissue age. The reduction of internode diameter is associated with significantly lower cortical and medullar tissue extends because of a disturbance of the cellular expansion, leading to organ contour distortions due to irregular cell division . In certain spp, Cd interfered with the formation of regular cell rows and caused, in the most external layers, an enlargement of cells, which appeared the result of anomalous division planes. Simultaneously, Cd caused a significant reduction of the number and diameter of the xylem vessels. This response, commonly reported in other plant species like bean , could involve a restriction of water flow translocation to shoots, and thus contribute to the perturbation of the plant water balance. Among the most spectacular effects generated by metal stress at the stem level, was the appearance of “peculiar” formations, characterized by the presence of particular cells, delimiting a dense space, whose induction and localization remain tributary to the organ developmental stage and stress intensity . Cadmium that reached the leaves resulted in further physiological and structural damages. Leaf growth was inhibited and blade thickness was diminished owing to the reduced enlargement of mesophyll cells, resulting in increasing tissue dry weight / fresh weight ratio, especially in young (third) leaves. Under Cd stress, stomatal conductance was found to sharply decline suggesting that stomatal functionality may be compromised . Changes in plant water relations with a decline
This study has a number of limitations. It would have been desirable to rate series of operations using both the original Oxford NOTECHS and the new scale in parallel, to evaluate how well we had achieved improved scalability whilst maintaining concurrent validity. This proved impossible as our observers considered they would be unable to switch between the scales and remain objective, whilst providing additional NOTECHS-trained observ- ers was impracticable. As noted above, our findings about average Oxford NOTECHS II scores for different types of surgery require confirmation, as does our conclusion that a single observer may be able to score NOTECHS II reliably, whilst the problem of scoring anaesthetic behaviour adequately within a whole-team scale requires further work. Neither Oxford NOTECHS II nor other attempts to scoresurgical team behaviour has yet demonstrated a clear ability to predict clinical outcomes: our findings suggest that a combination of Oxford NOTECHS II and glitch count is more likely to be able to achieve this than either scale alone, but numerous other factors, particularly around post-operative care, are likely to confound this analysis. Our aim here is the exploration and development of a usable scale, which is an important and necessary step towards this goal.
The networks affected by surgical processes include immune, inflammatory, stress signalling and vascular systems. Circulating biomarkers of these networks provide evidence of mediators and cellular responses differentially affected by minimally invasive surgery [4-7]. There have been advances in the characterisation of mediators released during surgery, including eicosanoids, anaphylactic mediators [8-14] and factors affecting pulmonary oncogenesis [15-18]. An early response to surgery is the release, within minutes to hours, of humoral mediators including acute phase proteins, cytokines, ROS [19-21], lipid mediators, adrenocorticoids and catecholamines. These mediators influence vascular permeability, tissue perfusion and metabolic breakdown processes, known as catabolism [22-24]. Although some of these responses result in homeostasis, the catabolic state may be serious or fatal, especially in the immediate post surgical period. Over a longer period, hours to days after surgery, changes in humoral immune mediators are associated with altered leukocyte distribution and activity . There is evidence of ROS involvement in immune responses, where lymphocyte ROS are associated with proliferative signalling at low concentrations and inhibition of lymphocyte activity at higher concentrations. Humoral immune mediators (including ROS) influence the immune system via host specific antibody production  and act on effector cells such as mononuclear and polymorphonuclear phagocytes and natural killer (NK) cells [4, 25]. The cellular arm of the immune system therefore responds to
Brevik et al in their study of experimental periodontitis in rats, illustrated a positive feedback loop between HPA axis and periodontal disease. They mentioned that periodontal disease activates HPA axis and a genetically determined high HPA responsivity further increases disease susceptibility (Brevik et al., 2001). In present study, serum cortisol levels showed no correlation with the GI which can be explained by the anti- inflammatory effect of cortisol. Furthermore, a positive correlation was found between serum cortisol levels and other clinical parameters in group 1 except clinical attachment level. Peruzzo et al. conducted a systematic review of the evidence on the influence of stress and psychological factors on periodontal disease. and concluded that 57% reported a positive relationship between stress and periodontal disease. Another 28.5% of the studies observed a positive relationship between some characteristics of stress and periodontal disease, demonstrating that the majority of the works published to date examining this relationship have indeed found significant associations (Peruzzo et al., 2007) Brief stressors appear to suppress cellular immunity whilst preserving measures of humoral immunity; in contrast, chronic stressors generally result in dysregulation of the immune system involving both cellular and humoral pathways (Segerstrom et al., 2004). Therefore, chronic stress and depression have been resulting in a higher rate of infection with pathogenic organisms and a greater degree of periodontal tissue destruction. In general, the evidence is consistent with the hypothesis that stress can modify the host immune defense and permit the progression of periodontal infections in patients susceptible to periodontitis (Doyle and Bartold, 2012).
These equations suggest that the difference u is an index representing the effect of stress σ on the moisture content u or on the voltage v. Conversely, the moisture difference u would be accompanied by a volume change in the wood, which would inevitably induce stress σ within it. Then it might be that the stress σ under consideration was the same as the stress σ itself, provided there were no external forces acting on the wood. The stress σ would be proportional to the volume change of the wood (i.e., the amount of the moisture change u). Thus, the strain ε corresponding to the stress σ would be proportional to the u . These observations led to the following equation utilizing Hooke’s law.
EPISODIC ACUTE STRESS/TIME STRESS: These involves those that suffer acute stress frequently, their lives are so disorganized that they are always in chaos and crisis. They are always in a rush, but always late if something can go wrong it does. They take on too much, have too many irons in the fire, and can’t organize the slew of self inflicted demands and pressures clamoring for their attention. People who are in this category describe themselves as having “a lot of nervous energy, always in a hurry, they tend to be abrupt and sometimes their irritability comes across as hostility. Their interpersonal relationships deteriorate rapidly when others re- spond with real hostility. Sufferers of episodic acute stress are called “worry warts” they see disaster around every corner and pessimistically predict catastrophe in every situation. They see the world as dangerous, unre- warding and punitive place where something awful is always about to happen. Individuals here see nothing wrong with their life style; they blame their woes on other people and external events.
Barraza, 2003; Lupien, King, Meaney, & McEwen, 2000). Further, behavioral parenting research has examined and shown promise for improved cortisol stress responses to behavioral parenting programs at the child level (Bugental, Schwartz, & Lynch, 2010; Cicchetti, Rogosch, Toth, & Sturge-Apple, 2011; Dozier et al., 2006; Dozier, Peloso, Lewis, Laurenceau, & Levine, 2008; Fisher, Stoolmiller, Gunnar, & Burraston, 2007). For example, Fisher and Stoolmiller (2008) assessed self-reported stress among caregivers in relation to cortisol activity among a group of 117 caregiver -foster children preschoolers (ages 3-6) dyads participating in a randomized controlled trial. Caregiver-child dyads were assigned to receive a therapeutic intervention for caregivers, or a regular foster care services. Findings from this study illustrated that while foster parents assigned to the intervention showed reductions in self-reported stress, reductions in self-reported parental stress mediated the intervention effects on impaired cortisol activity among children. Thus, evidence supports that impaired cortisol levels among children may be modifiable with caregiver engagement in parenting interventions.
In addition to known prognostic factors based on RTS, other potential prognostic factors of patients with lung cancer operated for MSCC were derived on the basis of our experience and literature review [3, 5, 14–16]. Char- acteristic factors were age, gender, history of smoking, and some serological indices, including serum tumor markers (which are related to lung cancer like CEA and AFP), albumin, calcium ion, lactic dehydrogenase, alka- line phosphatase, and erythrocyte sedimentation rate. Disease factors were histologic-type neoplasms (adeno- carcinoma versus others) and initial diagnosis of the presence or absence of spinal metastasis. Intervention factors included the adoption of targeted therapy (such as tyrosine kinase inhibitor erlotinib and gefitinib specif- ically block epidermal growth factor receptor), bispho- sphonates, and other adjuvant treatments, including chemotherapy or radiation therapy. Points were allo- cated for prognostic factors gotten from prognostic fac- tor analyses. A modified score for the prediction of survival was developed on the basis of prognostic factors and their points added to RTS. The accuracy of the modified score was evaluated by comparing the modifi- cation of RTS to the original version in the coincidence degree between predicted and observed survival.
As ‘career‐developing environment’ and ‘poor organizational structure’ have an impact on organizational performance and objective stress, companies need to ensure that C-PMs feel properly treated within the organizational hierarchy. Naturally, if a C-PM feels that there is no possibility of progressing, then his/her commitment, sense of belonging to the company and loyalty may fail. This finding corresponds closely with an earlier study by Weiss (1983) and El-Sabaa, S. (2001) who emphasised that career development difficulties and problems involving the organizational structure are significant sources of stress. Needless to say, the more complex the organizational structure in terms of rules and bureaucracy, the greater the intrapersonal conflict (Gmelch 1982). Leung et al (2009) added that, it would also inhibit one’s personal creativity, which is an essential element in the role of C-PMs. Career-developing environment indicates the culture of an organization, the degree of participation in the decision making process, and the instability of the job of C- PMs (Karasek et al. 1998 and El-Sabaa, S. 2001). Employees who have greater opportunities to participate in decision making can experience higher feelings of self- esteem and job satisfaction (French and Caplan 1970), and lower feelings of stress (Margolis et al. 1974). Therefore, a good career developing environment is necessary if the stress of C-PMs is to be relieved.
100 surgical cases admitted in the General surgery department at Stanley medical college hospital underwent surgical procedures which were categorized into minor and major surgeries based on classification of Arvindsonn et al. At the end of the surgical procedure, Surgical Apgar Score was calculated using the variables like heart rate, mean arterial pressure and estimated blood loss.