Physiotherapy and associated factors affecting mouth opening changes in noma patients during initial hospitalization at an MSF-supported hospital in Northwest Nigeria-A retrospective cohort study

Noma is a rapidly progressing infection of the oral cavity, which can cause the disintegration of the cheek, nose and eye, in under a week. One of the most disabling sequelae is trismus, the restriction of mouth opening, which results in difficulties in speech, mastication, social feeding habits and maintenance of oral hygiene. Restriction of mouth opening among noma patients mostly begins during the transition between World Health Organisation (WHO) stage 3 (gangrene) and stage 4 (scarring) of the disease. This study aims to describe the impact of physiotherapy in noma patients hospitalised with stages 3 and 4 of the disease and to identify factors that influence change in mouth opening of noma patients. This study is a retrospective analysis of routinely collected data from patients admitted at Noma Children Hospital, Sokoto, Northwest Nigeria between 1 May 2018 and 1 May 2020. Eligible patients included stage 3 and 4 noma patients who had not undergone any surgical reconstruction or trismus release surgery but received physiotherapy assessment and treatment during initial hospitalization. Factors associated with a change in mouth opening were identified using paired t-test analysis, bivariate and multivariate analyses. The mean difference in the mouth opening from admission to discharge was 6.9mm (95% CI: 5.4 to 8.3, p < 0.0001). Increased number of physiotherapy sessions and patient age above three years were significant predictors of improvement in mouth opening (p-value 0.011, 0.001 respectively). Physiotherapy treatment received within an adequate number of physiotherapy sessions for stage 3 and 4 noma patients during the period of the first hospitalization is important and results in a significant increase in mouth opening. Hence, noma patients at these stages should routinely undergo physiotherapy as part of a holistic approach to treatment.

Advances in Surgical Training Using Simulation

Simulation involves the re-creation of real-life situations, processes, or structures for the purpose of improving safety, effectiveness, and efficiency of health care services: simulation provides a controlled and safe environment for training and assessment. In an age in which regulatory burdens, fiscal challenges, and renewed focus on patient safety increasingly constrain surgical residency programs, innovation in teaching is vital for the future of oral and maxillofacial surgery (OMS) training. Of the simulation technologies in modern day health care education, many have found their way into OMS training. This article reviews these technologies, and some examples of their uses in OMS.

Early Tests of Piagetian Theory Through World War II

Psychologists recognized the importance of Jean Piaget's theory from its inception. Within a year of the appearance of his first book translated into English, The Language and Thought of the Child (J. Piaget, 1926) , it had been reviewed and welcomed; shortly thereafter, psychologists began testing the tenets of the theory empirically. The author traces the empirical testing of his theory in the 2 decades following publication of his initial book. A review of the published literature through the World War II era reveals that the research resulted in consistent failure to support the theoretical mechanisms that Piaget proposed. Nonetheless, the theory ultimately gained traction to become the bedrock of developmental psychology. Reasons for its persistence may include a possible lack of awareness by psychologists about the lack of empirical support, its breadth and complexity, and a lack of a viable alternate theory. As a result, the theory still exerts influence in psychology even though its dominance has diminished.

Thinking about quantity: the intertwined development of spatial and numerical cognition

There are many continuous quantitative dimensions in the physical world. Philosophical, psychological, and neural work has focused mostly on space and number. However, there are other important continuous dimensions (e.g., time and mass). Moreover, space can be broken down into more specific dimensions (e.g., length, area, and density) and number can be conceptualized discretely or continuously (i.e., natural vs real numbers). Variation on these quantitative dimensions is typically correlated, e.g., larger objects often weigh more than smaller ones. Number is a distinctive continuous dimension because the natural numbers (i.e., positive integers) are used to quantify collections of discrete objects. This aspect of number is emphasized by teaching of the count word sequence and arithmetic during the early school years. We review research on spatial and numerical estimation, and argue that a generalized magnitude system is the starting point for development in both domains. Development occurs along several lines: (1) changes in capacity, durability, and precision, (2) differentiation of the generalized magnitude system into separable dimensions, (3) formation of a discrete number system, i.e., the positive integers, (4) mapping the positive integers onto the continuous number line, and (5) acquiring abstract knowledge of the relations between pairs of systems. We discuss implications of this approach for teaching various topics in mathematics, including scaling, measurement, proportional reasoning, and fractions.