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• The percentage of fracture healing in Sarmiento's cases is excellent, but it is difficult to be reproduced, and satisfactory results can also be achieved with operative treatment. • The incidence of malunions showed in conservative treatment may be completely avoided with ORIF (especially considering the varus deformity in conservative treatment). • The function is better in the immediate postoperative period, though we should remark that in the long term the function between the conservative and the surgical treatment is similar. • The incidence of postoperative radial nerve palsy is low and the recovery occurs in a reasonable time. Humeral shaft fractures represent about 3% of all fractures. While there are several treatment options for this type of fractures, there is no evidence in literature showing which is the best one. This study aims at analysing the outcomes for patients with humeral shaft fractures treated with Locking Compression Plate (LCP) fixation in our hospital and comparing them with the outcome for patients conservatively treated (according to data from Pubmed) , in order to determine the best treatment option. We treated surgically 220 humeral shaft fractures in our department from February 2005 to March 2012. Seventy-three of them met all the inclusion criteria for this study. All fractures were then classified according to the AO classification. The follow-up considered the radiographic healing of the fracture. All patients were treated with plate fixation (LCP - DePuySynthes Co). At the end of the four-year follow-up, the function was evaluated by means of the DASH score. A systematic review of the literature of the last 20 years was performed on MEDLINE (PubMed). We had 2 infections and 8 patients had postoperative nerve palsy which recovered in average time of 6.7 months. In addition, 4 fractures (5.48%) didn't heal within 6 months and they were considered as nonunions and healed after a second surgery. One of these 4 nonunions was infected. The mean DASH score was 18.24±19.18. No malunions were found. We identified 13 studies that were eligible for our systematic review. The mean non-union rate found was 17% in 2517 fractures with a follow-up that ranging from 67% to 100% of patients and a primary radial nerve palsy ranging from 0 to 115 patients. Malalignment rate ranged from 12.7 to 42%. After taking into account both the conservative and the surgical treatment, for humeral shaft fractures we suggest the operative treatment , because the patient's function of the upper limb recovers quickly in the immediate postoperative period and the incidence of malunions may be avoided. [ABSTRACT FROM AUTHOR]

On 19 October 1922, David Lloyd George's Coalition government fell from office, bringing to an end four years of post-war co-operation between the Conservative Party and his Coalition Liberals. It was a remarkable turnaround in fortunes, as the post-war Coalition had won the 1918 General Election with a notional majority of 333. Over the intervening four years, there had been attempts to make the temporary coalition arrangement a permanent feature of British politics. However, in the final years of the Coalition, the Conservatives became increasingly disenchanted with government policy and with the personality of the Prime Minister. Nevertheless, some Tories fought for the continuation of the Coalition to the bitter end, and one of those politicians was the leader of the Liverpool Conservative Party, Sir Archibald Salvidge. Although Lloyd George's Coalition government has been extensively examined by historians, the pivotal role that Salvidge played during these years has been overlooked. This article, therefore, provides the first contemporary examination of Salvidge's efforts to make the Coalition agreement permanent, often against the wishes of both his own party's rank-and-file and his supporters in Liverpool. [ABSTRACT FROM AUTHOR]

Purpose: Osteoarthritis (OA) is a complex disease of joints presenting with pain, swelling, stiffness, crepitus, deformation and limitation of function. There are both conservative and surgical modes of treatment for OA. This study is done to compare the therapeutic efficacy of intra-articular ozone, platelet-rich plasma (PRP) and 25% dextrose in the treatment of OA of the knee joint in early stages. Methods: A total of 120 patients with symptomatic Kellgren and Lawrence grade 2 and 3 of knee OA were studied. They were randomized into three groups and each group received three doses of intra-articular injections of either ozone or PRP or 25% dextrose at intervals of 2 weeks. Patients were advised physiotherapy and analgesics were avoided. Western Ontario and McMaster Universities Arthritis Index and Visual Analog Score for pain were used to evaluate the clinical outcomes for 6 months. Results: Ozone provided significant relief from pain and improved functionality but was short-lived. PRP and 25% dextrose results were slower initially but gave better results for a longer duration. Conclusion: Conservative treatment with intra-articular injections has promising results in the treatment of OA. This can be used in patients who are not willing or not fit for surgery. [ABSTRACT FROM AUTHOR]

Introduction Patients whose rupture of the anterior cruciate ligament (ACL) can be managed conservatively or undergo reconstruction surgery. Source of data Current scientific literature published in Web of Science, PubMed and Scopus. Areas of agreement Several studies published by July 2022 compare surgical and conservative management following ACL rupture. The latest evidence suggests that surgical management may expose patients to an increased risk of early-onset knee osteoarthritis (OA). Areas of controversy The state of art does not recommend a systematic ACL reconstruction to all patients who tore their ACL. After the initial trauma, surgical reconstruction may produce even greater damage to the intra-articular structures compared to conservative management. Growing points The state of art does not recommend systematic surgical reconstruction to all patients who tore their ACL. The present study compared surgical reconstruction versus conservative management for primary ACL ruptures in terms of joint laxity, patient reported outcome measures (PROMs) and rate of osteoarthritis. Areas timely for developing research ACL reconstruction provides significant improvement in joint laxity compared to conservative management, but is associated with a significantly greater rate of knee osteoarthritis, despite similar results at PROM assessment. [ABSTRACT FROM AUTHOR]

The question that this paper seeks to answer is that of whether the resistance to change that characterizes the conservative temperament has any rational basis. More precisely, my question is whether we have good grounds for accepting any version of the principle that if something exists then we need a reason to change it but don't need a reason to keep it. The paper defends a version of this principle whose scope is restricted to familiar traditions and customs on the one hand, and aging artifactual objects (houses, cars, toasters, and the like) on the other. The argument for that principle is that our current traditions and artifacts stand in various relations to the purposive activities of past agents—a different relation in each case—that give rise to presumptive but easily overridden reasons for their preservation. [ABSTRACT FROM AUTHOR]

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Summary: Traumatic damage to anterior teeth is a common form of dental injury, particularly in younger people. The abutment teeth only need to be slightly prepared for the conservative bridge preparation, as the name suggests. The final prosthesis can be fixed to the adjacent natural teeth in no time. This case reports a chair-side conservative and esthetic restoration in a 19-year-old girl who came with grade 3 mobility in her upper left central incisor by using her natural tooth as a pontic with ribbond fibre. [ABSTRACT FROM AUTHOR]

BackgroundMeta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery. However, guidance as to specific management does not exist.MethodsPUBMED and EMBASE search of trials describing methods of conservative treatment was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.ResultsThirty-four studies involving 2,944 antibiotic-treated participants were identified. The greatest experience with conservative treatment is in persons 5 to 50 years of age. In most trials, imaging was used to confirm localized appendicitis without evidence of abscess, phlegmon, or tumor. Antibiotics regimens were generally consistent with intra-abdominal infection treatment guidelines and used for a total of 7 to 10 days. Approaches ranged from 3-day hospitalization on parenteral agents to same-day hospital or ED discharge of stable patients with outpatient oral antibiotics. Minimum time allowed before response was evaluated varied from 8 to 72 hours. Although pain was a common criterion for nonresponse and appendectomy, analgesic regimens were poorly described. Trials differed in use of other response indicators, that is, white blood cell count, C-reactive protein, and reimaging. Diet ranged from restriction for 48 hours to as tolerated. Initial response rates were generally greater than 90% and most participants improved by 24 to 48 hours, with no related severe sepsis or deaths. In most studies, appendectomy was recommended for recurrence; however, in several, patients had antibiotic retreatment with success.ConclusionWhile further investigation of conservative treatment is ongoing, patients considering this approach should be advised and managed according to study methods and related guidelines to promote informed shared decision-making and optimize their chance of similar outcomes as described in published trials. Future studies that address biases associated with enrollment and response evaluation, employ best-practice pain control and antibiotic selection, better define cancer risk, and explore longer time thresholds for response, minimized diet restriction and hospital stays, and antibiotic re-treatment will further our understanding of the potential effectiveness of conservative management.Level of evidenceSystematic review, level II.

Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST) kidney and urogenital trauma management guidelines.

Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

Background: Knee osteoarthritis (OA) is a widespread and debilitating disease that continues to plague patients. Over the past decade, neuromuscular electrical stimulation (NMES) therapy has shown promise in alleviating knee OA-related symptoms. This study sought to evaluate the efficacy and safety of a home-based NMES therapy for reduction of pain, stiffness, and function associated with knee OA. Material and methods: A randomized, sham-controlled, double-blind, multicenter trial was conducted with 12-week follow-up in 156 knee OA patients receiving either home-based NMES therapy or a modified low-voltage NMES therapy. Outcome measures including knee pain, stiffness, and functionality were collected at baseline through week 12 after the therapy. The primary endpoint was the percentage change from baseline (PCFB) in the Visual Analog Scale (VAS) pain for a patient-nominated physical activity. Secondary endpoints included VAS for general knee pain, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score Joint Replacement, and isometric quadriceps strength test. Results: A clinically meaningful reduction for VAS Nominated Activity was higher in the per-protocol treatment-compliant NMES group than that in the sham low-voltage NMES group at week 12 (PCFB of 42.8% vs 38.6%, P = .562). This was similarly true for the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (PCFBs of 36.8% vs 26.6%, P = .038). Similar trends and reductions of pain were observed for VAS General, Knee Injury and Osteoarthritis Outcome Score Joint Replacement Pain subscale, and isometric quadriceps strength. Conclusion: Home-based NMES treatment resulted in a clinically meaningful reduction of knee pain, stiffness, and knee functional improvements at week 12 compared with sham NMES treatment.

The present study aimed to assess the effect of conservative (permissive hypoxaemia) versus conventional (normoxaemia) protocol for oxygen supplementation on outcome of type I respiratory failure patients admitted to the respiratory intensive care unit (ICU). This randomized controlled clinical trial was carried out at Respiratory ICU, Chest Department, Zagazig University Hospital for 18 months, starting from July 2018. On admission, fifty-six enrolled patients with acute respiratory failure were randomized in a 1:1 ratio into the conventional group (oxygen therapy was supplied to maintain SpO2 between 94-97%) and the conservative group (oxygen therapy was administered to maintain SpO2 values between 88-92%). Different outcomes were assessed including ICU mortality, Need for mechanical ventilation (MV): invasive or non-invasive and ICU length of stay. In the current study, Pao2 was significantly higher among the conventional group, at all times after the baseline reading and HCO3 was significantly higher among the conventional group at the first two readings. There was no significant difference in Serum lactate level in follow-up readings. The mean duration of MV and ICU length of stay was (6.17±2.05 and 9.25±2.22) days in the conventional group versus (6.46±2.0 and 9.53±2.16) days in the conservative group respectively without significant difference between both groups. About 21.4% of conventional group patients died, while 35.7% of conservative group patients died without a significant difference between both groups. We concluded that conservative oxygen therapy may be applied safely in patients with type 1 acute respiratory failure.

A colocutaneous fistula is a type of enterocutaneous fistula where communication exists between the colon and the skin of the abdominal wall. The present case report was of postoperative colocutaneous fistula in a 32-year-old male patient, who had undergone left open nephrectomy. This is unique, as nephrectomy is not a procedure that is usually associated with such colocutaneous fistulas, particularly as this was a case of non functioning kidney and was not associated with severe inflammation or adhesions, which are usually prerequisites for a fistula to arise. Following surgery, patient developed feculent discharge from the drain in the early postoperative period. A Contrast Enhanced Computed Tomography (CECT) scan for evaluation of the cause of leak was done, which showed a colocutaneous fistula arising from the proximal descending colon with an abscess surrounding the fistula tract. The abscess was drained and conservative management was initially attempted to allow for spontaneous resolution of the fistula as spontaneous closure is the norm, when there are no unfavourable factors hindering spontaneous closure, as was the case in this patient. However, despite all factors being favourable for spontaneous closure of the fistula, it failed to occur in the present case. Furthermore, this patient required multiple surgical procedures, which is also unusual for a fistula such as this, where all factors being favourable for its spontaneous healing. Closure of the fistula was finally being achieved by resection of the fistula tract along with the segment of the bowel containing the internal opening. The present case report highlighted the challenges posed by cases of colocutaneous fistulas and shows that thorough knowledge of all the treatment modalities available for its treatment, is required to successfully treat it.

Abstract The dentigerous cyst is the second most common odontogenic. The prevalence rates ranging from 0.8% to 3.6% in the general population. It affects people especially at the second and third decade of life with a male predilection. It presents a preference for the mandibular region particularly for the second lower premolar. Surgical marsupialization or decompression are the most conservative treatment modalities as it prevents the risks of cyst removal as nerve injuries and preserves the unerupted tooth. Two clinical cases of two young patients presenting a dentigerous cyst involving impacted teeth, which were successfully treated by decompression will be reported in order to highlight the benefits and limits of cyst decompression as well as detailing its operating protocol and its instructions.

Background: Following anterior cruciate ligament (ACL) tears, both repair and reconstruction may be performed to restore joint biomechanics and proprioception. The present study compared joint laxity, patient-reported outcome measures (PROMs), and rate of failure following primary repair versus reconstruction for ACL ruptures. Methods: This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pubmed, Google scholar, Embase, and Web of Science were accessed in September 2022. All the clinical investigations comparing repair versus reconstruction for primary ACL tears were accessed. Studies reporting data on multiple ligament injuries settings were not eligible. Results: Data from eight articles (708 procedures) were collected. The mean length of the follow-up was 67.3 ± 119.4 months. The mean age of the patients was 27.1 ± 5.7 years. Thirty-six percent (255 of 708 patients) were women. The mean body mass index (BMI) was 24.3 ± 1.1 kg/m2. The mean time span from injury to surgery was 36.2 ± 32.3 months. There was comparability at baseline with regards to instrumental laxity, Lachman test, International Knee Document Committee (IKDC), and Tegner Scale (P > 0.1). Similarity between ACL reconstruction and repair was found in IKDC (P = 0.2) and visual analog scale (VAS) satisfaction (P = 0.7). The repair group demonstrated greater mean laxity (P = 0.0005) and greater rate of failure (P = 0.004). Conclusion: ACL reconstruction may yield greater joint stability and lower rate of failure compared with surgical repair. Similarity was found in PROMs. Level of evidence: III [ABSTRACT FROM AUTHOR]

Intro. Genicular nerve radiofrequency ablation (GNRFA) is an effective treatment for chronic knee pain related to osteoarthritis. It is often utilized when conservative management has failed and patients wish to avoid arthroplasty, are poor surgical candidates due to comorbid medical conditions, or in those suffering from persistent pain after arthroplasty. The classic targets for GNRFA include the superior lateral genicular nerve, superior medial genicular nerve, and inferior medial genicular nerve but multiple anatomic studies have demonstrated additional sensory innervation to the knee. Objective. In this research article, we propose an image-guided technique that can safely target the infrapatellar branch of the saphenous nerve which also provides sensory innervation to the anterior capsule. Proposal. The proposed technique includes variations for conventional bipolar radiofrequency ablation, cooled radiofrequency ablation, dual-tined bipolar radiofrequency ablation, and monopolar radiofrequency ablation using a long axis approach. The described technique is based on updated anatomic studies and takes into account safety concerns such as thermal risk to the skin and/or pes anserine tendons and breaching of the synovial cavity. Conclusion. Future clinical research should be performed to confirm the safety and effectiveness of this specific approach. [ABSTRACT FROM AUTHOR]

Background: Lateral clavicle fractures account for 17% of all clavicle fractures and large studies comparing nonoperative and operative treatment are lacking. Therefore, patients cannot be properly informed about different treatment options and prognosis. We assessed long-term patient-reported and clinical outcomes in patients with lateral clavicle fractures. Methods: A multicenter cross-sectional study was performed in patients treated for lateral clavicle fractures between 2007 and 2016. Primary outcome included patient-reported outcome measures (PROMs) (DASH, EQ-5D, return to work, sports, cosmetics and satisfaction). Questionnaires were sent to 619 eligible patients, of which 353 (57%) responded after a mean follow-up of 7.4 ± 2.8 years. Secondary outcome included adverse events and secondary interventions. Outcomes after nonoperative vs. operative treatment (stratified by nondisplaced vs. displaced fractures) were compared using Student t tests and linear regression analysis. Results: Nondisplaced lateral clavicle fractures were treated nonoperatively and resulted in excellent PROMs. Six patients (3%) developed a nonunion. For displaced lateral clavicle fractures, no differences were found between nonoperative and operative treatment with regard to DASH score (7.8 ± 12.5 vs 5.4 ± 8.6), EQ-5D (0.91 ± 0.13 vs 0.91 ± 0.09), pain (0.9 ± 1.7 vs. 0.8 ± 1.6), patient satisfaction (90.1 ± 25.5 vs. 86.3 ± 20.4), return to work (96.4% vs. 100%) and sports (61.4% vs. 62.3%). The absolute risk of nonunion in patients with a displaced fracture was higher after nonoperative than operative treatment (20.2% vs. 2.9%; p = 0.002), with six patients needing treatment to avoid one nonunion. Conclusions: Nondisplaced lateral clavicle fractures should be treated nonoperatively and result in good functional outcomes and high union rates. For displaced fractures, neither nonoperative nor operative treatment seems superior. Patients opting for nonoperative treatment should be informed that nonunion occurs in 20% of patients, but only half of these need additional operative treatment. Patients who opt for surgery should be told that nonunion occurs in only 3%; however, most patients (56%) will require secondary intervention for elective implant removal. Regardless of the type of treatment, no differences in functional outcome and PROMs should be expected at long-term follow-up. [ABSTRACT FROM AUTHOR]

The aim of this prospective study of 55 patients was to analyse the cross-sectional and longitudinal relationship between disability and physical and psychological variables after conservative treatment of trigger finger and to determine the predictive factors for the post-treatment disability score and change in disability score. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand questionnaire. Potential predictive factors included pain, number of triggering events, depression, anxiety and kinesiophobia. Disability correlated strongly with anxiety, moderately with pain and depression and weakly with triggering and kinesiophobia. The change in depression score correlated significantly with the change in disability score. Post-treatment pain and anxiety scores accounted for 47% of the explained variance in disability score. Improvement in depression after treatment accounted for 18% of the explained variance in disability change score. Psychological variables appear to be potential predictors of disability. Level of evidence: IV [ABSTRACT FROM AUTHOR]

It is unclear which patient-reported outcome measures (PROMs) can assess non-operative care for scoliosis. Most existing tools aim to assess the effects of surgery. This scoping review aimed to inventory the PROMs used to assess non-operative scoliosis treatment by population and languages. We searched Medline (OVID) as per COSMIN guidelines. Studies were included if patients were diagnosed with idiopathic scoliosis or adult degenerative scoliosis and used PROMs. Studies without quantitative data or reporting on fewer than 10 participants were excluded. Nine reviewers extracted the PROMs used, the population(s), language(s), and study setting(s). We screened 3724 titles and abstracts. Of these, the full texts of 900 articles were assessed. Data were extracted from 488 studies, in which 145 PROMs were identified across 22 languages and 5 populations (Adolescent Idiopathic Scoliosis, Adult Degenerative Scoliosis, Adult Idiopathic Scoliosis, Adult Spine Deformity, and an Unclear category). Overall, the most used PROMs were the Oswestry Disability Index (ODI, 37.3%), Scoliosis Research Society-22 (SRS-22, 34.8%), and the Short Form-36 (SF-36, 20.1%), but the frequency varied by population. It is now necessary to determine the PROMs that demonstrate the best measurement properties in the non-operative treatment of scoliosis to include in a core set of outcomes. [ABSTRACT FROM AUTHOR]

Background: Meningiomas are common extra-axial primary brain tumors, which originate from the arachnoid cap cells. It's possible that intracranial meningiomas can be managed non-surgically. Objective: The aim of the current study was to evaluate non-surgical management of intracranial meningiomas to better guide the management decision-making. Patients and Methods: A retrospective analytical study was conducted at the Department of Neurosurgery in the Faculty of Medicine at Zagazig University. A total of 53 patients, with 57 meningiomas were enrolled in the current study. Patients were divided into 2 groups based on symptomatic and radiological progression; Group A included 42 patients who continued non-surgical management, and Group B included 11 patients who required surgical intervention. Results: During the follow-up period, 19.3% of patients needed surgical intervention. The mean age of cases was of 54.1 (SD 9.7) years. Group A patients had significantly older ages at diagnosis than Group B patients (P<0.05). The tumor size in Group A was <25mm (64.4%), ranged from 25-40mm (35.6%), and >40 mm (0%) versus 25%, 66.7%, and 8.3%, respectively in Group B (P=0.014). Increased size at diagnosis was a significant predictor for surgical intervention (P<0.05). In Group A, the rate of growth/year was 1.94 (SD 0.74) mm with the range 0.22-3.94 mm/year versus 4.92 (SD 1.3) mm with the range 3.1-6.75 mm/year in Group B (P=0.0001). Conclusion: Our results contribute to predicting the growth pattern of intracranial meningioma and thus select the optimal management. [ABSTRACT FROM AUTHOR]

Of late, public and school librarians have repeatedly encountered the unwillingness of many conservative communities and/or schools to support socially just collections and services. This article seeks to broaden the discussion of the factors involved. It does so for several reasons. The first is the reality that achieving a number of socially just library services in conservative communities will require the development of local coalitions. By their very nature coalitions often require compromise. This leads to the second reason, a recognition of the political limitations resulting from progressive demands for a total commitment to progressive ends to secure recognition as "allies." This overlooks the reality that certain conservatives can occasionally support what may be termed progressive objectives while some liberals can be consistently conservative on moral issues. The third reason, is the reality that United States history regularly demonstrates strong resistance to progressive legislation and regulation. Ironically, this reflects an 18th century privileging of individual freedoms over collective justice that long predates the more modern belief that government has an obligation to advance diversity, equity, inclusion, and justice. The point is stressed that in conservative communities what is needed is a greater understanding of when political realities require compromises and a mixed belief coalition for achieving aspects of the overall goal of progressive change. [ABSTRACT FROM AUTHOR]

In this paper, the reduced-order H ∞ filtering problem for discrete-time singular systems under fading channels is studied. Our aim is to design a reduced-order filter to ensure the filtering error system with fading measurements is stochastically admissible and meets the given performance index. And the designed method is less conservative. However, the standard linear matrix inequality (LMI) cannot be obtained due to the nonlinear terms in decoupling. For this purpose, a new LMI is obtained by using new decoupling method. Finally, numerical example and electrical circuit example are given to clearly illustrate that the proposed method is less conservative than that of the existing method. [ABSTRACT FROM AUTHOR]

Hyperparathyroidism (HPT) is one of the most common endocrine disorders, however it is a rare disease during pregnancy with notable maternal and fetal morbidity and mortality. We investigated 46 articles in PubMed database that seven articles focused on this topic. This review will examine the maternal and neonatal complications and the options for managing and treating this disease during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: A unilateral vertical sacral fracture that exits medial or through the L5-S1 facet joint is considered to affect the lumbo-sacral integrity, and it is denoted as an indication for surgical fixation. However, no studies have analysed the outcomes after non-operative treatment of such injuries. Methods: A retrospective review of all sacral fractures treated over a five-year period was performed to identify patients with Isler's fractures. Demographic and surgical data, all pre-operative and follow-up images (AP radiographs, CT images), functional outcomes based on VAS, SF-12 and return to work were documented for all patients. Results: The incidence of Isler's fractures was 18% (34/181). The mean age was 42.12 ± 16.3 years. As per Isler's subtypes, fractures passed through L5-S1 joint in 13 (Type 2a) and medial to it in 15 (Type 2b), fractures of L5 or S1 facets in 3 (Type 1), Type 3 injuries were not detected. All patients had concomitant pelvic ring injuries. Sixteen fractures (neurologically intact, < 1 cm displacement, anterior ring stable, no facetal dislocation) were treated non-operatively while 18 patients underwent surgery. At a mean of 15.2 months, the fractures had united in all patients radiographically. The mean VAS score for low back pain (1.4 ± 1.01 vs 1.5 ± 0.79), ability to squat and sit cross-legged (56.3% vs 55.6%) and return to work (68.8% vs 66.7%), and Majeed score (77.2 ± 3.9 vs 79.6 ± 4.1) were similar in non-surgical and surgical groups, respectively, at the final follow-up. Conclusion: Our study indicates that 47% of Isler's fractures were mechanically stable and could be effectively treated non-operatively with good radiological and functional outcomes. [ABSTRACT FROM AUTHOR]

Rumors can bring about a seriously negative impact on all respects of society in this information era. More targeted control strategies can be acquired through the research of rumor propagation. When receiving rumors, individuals may keep imperturbable according to their rationality or bygone experience, and then choose not to propagate rumors provisionally. Oppositely, others may ask people around them about the realness of rumors due to bewilderment, which may further lead to the propagation of rumors. Therefore, an Ignorant–Conservative–Disseminator–Restorer–Ignorant (ICDRI) rumor dissemination model is proposed, which comprehensively considers users' various probable actions under rumor and anti-rumor information. Furthermore, new links are added among nodes in accordance with the individual discrepancy theory and the influencing factors of rumor spreading including negation factor, authority factor, exhaustion factor, etc. According to the calculated basic regeneration number, simulation analysis and model comparison, the steady state and superiority of the ICDRI model is proved. Finally, strategies to control the spread of rumors are obtained through the sensitivity analysis of parameters. The simulation results demonstrate that the ICDRI model can more realistically reflect the dissemination of rumors, and the official rumor refutation or circular can efficaciously curb the spreading of rumors. [ABSTRACT FROM AUTHOR]

Seeking to understand and reduce partisan hostility, we propose that humans evolved to benefit from cultural societies. Societies perform two crucial tasks, which have grown apart and are now championed by political opponents: (1) amassing resources, and (2) distributing resources. The political right focuses on amassing resources, whereas the political left focuses on redistributing resources. Both tasks are needed for society to flourish, but they foster contrary policies. This explains how left and right disagree on moral emphases, attitudes about time, rights versus responsibilities, manipulative strategies, and societal enemies—and why sharing or alternation in power benefits society. Market economies use incentives to create wealth, but these increase inequality. We hope our theory will help foster mutual respect among those on the left and right as both sides come to appreciate what the other side does to benefit society. [ABSTRACT FROM AUTHOR]

Background and Purpose: Chronic, noninflammatory musculoskeletal pain is common in the aged population and management can be challenging for older people due to multimorbidity, social isolation, and physical frailty. The aim of this scoping review is to summarize and discuss the evidence related to home-based health care interventions for older adults, with chronic, musculoskeletal pain. Methods: A review of the literature using 8 electronic databases (Embase, MEDLINE, CINAHL, PubMed, Cochrane Library, Physiotherapy Evidence Database [PEDro], Scopus, and Web of Science) was performed, following the PRISMA-ScR guidelines. English language published studies that assessed home-based health care intervention/s, in men and women 75 years and older, with chronic, noninflammatory musculoskeletal pain where included. Two authors independently reviewed the articles and extracted data into a preformulated chart. Results and Discussion: The database search identified 4722 studies of which 7 studies met the inclusion criteria. Six of the 7 studies were randomized controlled trials and 5 studies focused on a single-site pain. The type of home-based interventions in the included studies was physical therapy (n = 2), psychotherapy (n = 3), and multimodal therapy (combination of multiple therapies) (n = 2). Participation completion rate was more than 74% in 6 out of 7 studies. Most studies used pain and/or physical function as their primary outcome (n = 6). Music therapy showed a statistically significant reduction in visual analog scale score for pain, and there was a trend toward improvement of pain and function in the physical therapy studies. No significant differences in outcomes between intervention and control groups were observed in the multimodal studies. Conclusion: This review highlights the scarcity of evidence related to home-based health interventions in older people 75 years and older, living with chronic, noninflammatory musculoskeletal pain. The findings were that physical, psychotherapeutic, and multimodal interventions are usually well tolerated and can be delivered as a safe self-management option. There remains a substantial need for more high-quality research with wider range of home-based interventions and comprehensive assessment of outcomes for this age group. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study is to evaluate the long-term outcomes in patients with early stage ovarian cancer undergoing fertility-sparing surgery. Methods: The present study performed a retrospective analysis of recurrence, pregnancy and survival of a total of 66 patients who were diagnosed with early stage ovarian cancer (stage I) in XXX Faculty of Medicine Hospital between 2004 and 2019. Of these patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical surgery. Results: Of 66 eligible patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical complete surgery. When demographic and descriptive data are taken into consideration, the mean age was 32.6 ± 6.76 years in patients undergoing fertility-sparing surgery and 54.05 ± 10.8 years in patients undergoing complete surgery, and the difference between the groups was statistically significant (p = 0.001). Of patients undergoing fertility-sparing surgery, 11 (16.7%) had stage Ia disease (most common), 5 (7.5%) had stage Ic disease, whereas no patient with stage Ib disease was detected. Of patients undergoing complete radical surgery, 32 (48.5%) had stage Ia disease (most common), 1 (1.5%) had stage Ib disease with bilateral ovarian involvement, and stage Ic was the second most common disease stage. Also, stage Ic3 was the most common disease stage (8 patients, 12.1%) among those with stage Ic disease. The rate of recurrence was 4.5% (3 patients) in patients undergoing fertility-sparing surgery, and recurrences occurred at 37 months, 69 months, and 76 months, respectively. A patient with stage Ic3 disease and endometrioid type tumor who developed recurrence at 37 months died at 130 months. Of patients undergoing complete surgery, ten patients (15.2%) developed recurrence, and there was no significant difference between the two groups in terms of recurrence (p = 1.00). At the end of 15-year follow-up period, there was no significant difference between patients undergoing fertility-preserving surgery and those undergoing complete surgery in terms of mortality (p = 0.668). Conclusion: The observation of significant findings in terms of the rate of recurrence and disease-free survival following fertility-sparing surgery in patients with low-risk early stage ovarian cancer suggests that survival is positively affected in early stage ovarian cancer. [ABSTRACT FROM AUTHOR]

Background: Emphysematous pyelonephritis (EPN) is one of the most serious urologic emergency which should be diagnosed and treated adequately to prevent impending septic shock and death. Computed tomography (CT) is the gold standard radiologic modality for diagnosis, grading and predicting the outcome. We aimed in this study to define the initial CT radiological findings correlated with EPN conservative management success. Results: This study involved 54 patients (42 women and 12 males) with a mean age of 48 ± 10 years. EPN grades I, II, III, and IV were noticed in 12, 17, 20, and 5 patients, respectively. Ten patients (18.5%) received successful conservative management. On the other hand, renal drainage was needed in 42 patients (77.8%). Delayed nephrectomy was required in two cases (3.7%). In univariate and multivariate analyses, the absence of hydronephrosis and decreased air locules volume were predictors of conservative treatment success (P = 0.003 and 0.01, respectively). Conclusions: Conservative therapy should be selected in certain patients of emphysematous pyelonephritis. Decreased air locules volume and the absence of hydronephrosis in pre-admission computed tomography were predictors for conservative therapy success. [ABSTRACT FROM AUTHOR]

The purpose of this pre‐registered study was to investigate how different ideological groups justified and mobilised collective action online. We collected 6878 posts from the social media accounts of pro‐Black Lives Matter (n = 13) and anti‐Black Lives Matter (n = 9) groups who promoted collective action in the month after George Floyd's murder and the Black Lives Matter (BLM) protests and counter‐protests. We used content analysis and natural language processing (NLP) to analyse the content and psychological function of the posts. We found that both groups perceived their action as 'system‐challenging', with pro‐BLM accounts focused more on outgroup actions to mobilise collective action, and anti‐BLM accounts focused more on ingroup identity. The reverse pattern occurred when the accounts were attempting to justify action. The implications are that groups' ideology and socio‐structural position should be accounted for when understanding differences in how and why groups mobilise through online interactions. [ABSTRACT FROM AUTHOR]

Due to the COVID-19 pandemic, many group education sessions provided by healthcare services during 2020 were transitioned to telehealth. Research evaluating the delivery of group continence education via telehealth is limited. To investigate the feasibility of telehealth continence education, we conducted a retrospective audit of telehealth classes from July to December 2020 and in-person continence education classes from July to December 2018. We compared client attendance to classes, demographic data including age and distance lived from the clinic, feedback survey responses, and time spent by staff organising and conducting the classes. Quantitative data were analysed using descriptive statistics. Qualitative survey responses were analysed to identify key feedback. The non-attendance rate for the telehealth classes was 32% (n=13) compared to 35% (n=26) for the in-person classes. Feedback for the telehealth classes was positive, with 73% of survey respondents agreeing or strongly agreeing that it was easy to join the session. All respondents agreed or strongly agreed that the telehealth classes were interesting compared to 94% of respondents for the in-person classes. Lack of access to, or familiarity with, technology were limiting factors for telehealth class attendance. Telehealth therefore appears to be a feasible modality for the delivery of continence education classes, with comparable attendance rates to in-person classes. However, access to technology may be a barrier to attendance for some clients and telehealth classes may be more time consuming for clinicians. [ABSTRACT FROM AUTHOR]

The communication presented, on the occasion of the 100th anniversary of the enthronement of Alba Iulia, wishes a tribute and pious gratitude to King Ferdinand and the politician of deep patriotic resonance, who was for almost 15 years the president of the Conservative Party – Alexandru Marghiloman. Both the king and the true conservative politician were animated in the years of the First World War, by a special perseverance to fulfill the great desideratum of the full unification of all Romanian territories and the creation of Great România. The “unifying” king, closely advised by a competent chamberlain, I would say, who had at his top the incomparable liberal leader I.I.C. Brătianu and Queen Maria. Even if he did not excel in the specific skills of a true political leader, being more inclined to scientific and cultural concerns, King Ferdinand knew how to choose his advisers and engage them in the fulfillment of national ideals. Such was the case of Alexandru Marghiloman, who, due to his special abilities, was elected by I.I.C. Brătianu and proposed to the king to form a government that would treat and conclude peace with the Central Powers, when the country was in great danger, in the spring of 1916. In our paper, we insisted on the most realistic presentation of the way in which Alexandru Marghiloman and his team acted to save the country, but especially of those measures and actions taken under the conditions of concluding the armistice and signing the separate capitulation by the defeated Central Powers. I also insisted on a more realistic presentation of the two personalities of the time, who also left their mark on the front page of what would become, through the joint efforts of the sovereign, also of the president of the Conservative Party, Greater Romania.

The three-temperature (3-T) radiation hydrodynamics (RH) equations play an important role in the high-energy-density-physics fields, such as astrophysics and inertial confinement fusion (ICF). It describes the interaction between radiation and high-energy-density plasmas including electron and ion in the assumption that radiation, electron and ion are in their own equilibrium state, which means they can be characterized by their own temperatures. The 3-T RH system consists of the density, momentum and three internal energy (electron, ion and radiation) equations. In this paper, we propose a high order conservative finite difference weighted essentially non-oscillatory (WENO) scheme solving one-dimensional (1D) and two-dimensional (2D) 3-T RH equations respectively. Following our previous paper [7] , we introduce the three new energy variables, and then design a finite difference scheme with both the conservative property and arbitrary high order accuracy. Based on the WENO interpolation and the strong stability preserving (SSP) high order time discretizations, taken as an example, we design a class of fifth order conservative finite difference schemes in space and third order in time. Compared with the Lagrangian method we proposed in [7] , which can only reach second order accuracy for 2D 3-T RH equations if straight-line edged meshes are used, the finite difference scheme can be easily designed to arbitrary high order accuracy for multi-dimensional 3-T RH equations. The finite difference formulation is also much less expensive in multi-dimensions than finite volume schemes used in [7]. Furthermore, our method can handle fluids with large deformation easily. Numerous 1D and 2D numerical examples are presented to verify the desired properties of the high order finite difference WENO schemes such as high order accuracy, non-oscillation, conservation and adaptation to severely distorted single-material radiation hydrodynamics problems. [ABSTRACT FROM AUTHOR]

Background: The fracture of the calcaneus is the most common traumatic lesion of the hindfoot and can cause severe disability with social and economic sequelae. Since 1980, an increasing number of studies and new technologies have led to an improvement in the management of calcaneal fractures, but treatment is still controversial. The purpose of this review was to investigate the secondary scientific literature to detect the optimal management of calcaneal fracture. Methods: A MEDLINE search via PubMed was conducted. A total of 4856 articles were identified, and only meta-analyses and systematic reviews were included. Results: 59 articles with more than 10,000 calcaneus fractures were examined, and the results were divided into various topics. Most articles agree on the superiority of surgical treatments compared to conservative ones. Moreover, minimally invasive access to the sinus tarsi showed better results and fewer complications than traditional extended lateral access. Also, reduction and osteosynthesis with percutaneous and/or minimally invasive techniques seem to provide better outcomes when compared to open treatments. Conclusions: The management of calcaneal fractures requires an individualized treatment plan based on the functional demands of the patient, the type of fracture, and associated injuries. New technologies and further studies can lead to an improvement in the management of calcaneal fractures.

Turning to the analysis of risk and protection factors of the learning environment, the role of the teacher remains unexplored. Among various characteristics of the teacher, it is necessary to highlight the importance of a special class of phenomena - values and value orientations. Values form a holistic motivational structure and integrate into one system with other components, such as attitudes and behavior. The purpose of this study is to understand the influence of the values of the teacher on the socio-psychological safety of the classroom. The focus of the study is on the following questions: Do the teacher's value orientations affect the class's socio-psychological safety? If so, what particular values affect the safety of the class? In addition, how do they relate to each other? In the framework of the acmeological approach, we used quantitative research methods: structural equation modeling (SEM), comparative analysis. Technique: “Adolescence socio-cultural safety index”, the Schwartz Value Survey and the Portrait Values Questionnaire. The study sample consisted of 38 teachers and their 510 students at the age of 11-16 years. It was concluded that the values of the teacher influence the socio-psychological safety of the classroom, which determines the importance of the acmeological aspect of the teacher's personality analysis. The basis of a safe educational environment depends on self-transcendent and conservative values of the teacher. The results of the study can be applied to create a safe learning environment of the school.

Donald Trump’s rhetoric in his campaign was markedly different, his speeches on Islamophobia and anti-immigrant rhetoric became a big issue. Trump used the rhetoric of fear to induce his followers against Muslims and immigrants by linking to both groups with the terrorism issue. This article has aims to analyse Trump’s speeches for protecting American people surrounded by the terror threat through an American studies framework. This research was under descriptively qualitative research supported by an interdisciplinary approach of American Studies. Theory of Conservatism and theory of Discursive Psychology were used to analyse American experiences of Islamophobia as seen from Donald Trump’s speeches of documentary videos as the primary data. The completion of this research shows that American conservatives in the era of Donald Trump were strongly enough and the discourse psychological approach was designed to persuade. The discursive approach also allows for an understanding of how American identity, history, and values are both invoked and constructed. It is like American identity of conservatives who are proud of their nationality of Americans.

Context: Distal radius fractures are often encountered in orthopedic outpatient department, mostly managed with a below-elbow cast though malunion is the commonest known complication. Many researches had already been conducted comparing cast with various surgical methods; however, conclusive results yet to be ascertained. While choosing the treatment, we retrospectively analyzed the results of different methods to reach a conclusion. Subjects and Methods: A total of 92 patients with unilateral extra-articular or partially articular distal radius fracture were analyzed retrospectively over a period of 2 years, 30 of which managed conservatively and 62 with various surgical techniques (plate 27, external fixation 24, and K-wires 11). Functional results were recorded by PRWE score and radiological union was assessed. Statistical Analysis Used: Unpaired t-test was used for numerical value and Chi-square test for categorical values, and analysis of variance was used for multiple comparisons among the groups. Results: PRWE pain score, PRWE functional score, and means of individual radiological parameters measurements did not show any significant association among the study groups, P > 0.05. However, Chi-square test of association showed a significant correlation between radiology and function, P < 0.001. Conclusions: There is no difference between surgical and nonsurgical methods as a whole so as to say which one is better, thus nonsurgical methods still hold a good option today and should be the first choice while dealing with such injuries. Anatomical reduction should always be tried irrespective of methods of treatment as excellent to good function was seen with undisplaced or minimally displaced or well-reduced fractures.

Background: Mid-shaft clavicle fracture management has been inclined more toward osteosynthesis in recent times for better functional outcomes. The aim of the study was to find out does operative management in displaced mid-shaft clavicle fractures provide better outcomes than conservative? Materials and Methods: The randomized trial was conducted between December 2017 and July 2019 at a tertiary trauma center on 50 consecutive patients with displaced mid-shaft clavicle fracture. The inclusion criteria included age between 16 and 60 with acute isolated closed displaced mid-shaft clavicle fracture. Patients with neurovascular deficit, compound fractures, pathological fractures, and nonunion/malunited fractures were excluded. Group A had 25 patients who were treated with operative line of management and Group B had 25 patients who were treated with a conservative line of management; division was done on basis of odd (Group A)–even (Group B) technique. Results: Out of 50 patients, the mean age group of patients was 35.5 ± 1 years of life with others ranging from 16 to 60 years. Out of 50 patients, 45 (90%) patients were male and 5 (10%) were female. Out of 50 patients, 42 had a history of road traffic accidents, while 8 had a history of falls. The right side clavicle was affected in 18 patients and left was affected in 32 patients. Out of 50 patients, the mean time of union in operative group was 11.36 ± 2.56 and 11.36 ± 2.75 weeks in nonoperative group. Constant shoulder score was 85.16 ± 15.30 and 84.64 ± 13.52 in the operative group and nonoperative group, respectively. Conclusion: In this prospective cohort study, we have concluded that long-term functional outcomes of conservative versus operative management of displaced mid-shaft clavicle fracture are similar, but primary open reduction with internal fixation of displaced mid-shaft clavicle fracture in young adult patients ensures anatomical reduction, early mobilization, and faster recovery for functional activity while avoiding complications such as malunion.

Two studies were performed to determine whether political orientations were related to loci-of-hope, which are where one acquires or sustains one's hope that one's goals may be achieved. Study 1 employed a nationally representative sample of Canadian English-speaking adults (N = 866), who completed the Locus-of-Hope Scale (Bernardo, 2010) that measures the extent to which trait hope comes from four different sources: from oneself as an individual; from one's family; from peers; and from one's sense of spirituality or religious faith. The results indicate that the peer locus-of-hope was associated with liberalism, while the spiritual and family loci were related to conservatism. The participants in Study 2 were Canadian university students (N = 555) who completed the Locus-of-Hope Scale as well as a related measure that treats hope as an emotional state rather than a trait. In this sample, there were again significant associations between political orientations and loci-of-hope at the peer and family loci such that greater reliance on peers predicted more liberal orientations, and greater dependence on family was associated with more conservative outlooks. The implications of these findings for three established theoretical paradigms that purport to explain the acquisition of political orientations are explored.

Introduction: The management of renal trauma includes operative and non operative approach based on clinical profile of patient. However, management of the high-grade renal trauma remains controversial. Aim: To evaluate mode of renal injury, staging and its management outcomes. Materials and Methods: This prospective, observational study included 49 patients (>15 years of age) who presented with abdominal trauma. Computed tomography was performed for grading of renal trauma. The patients were stratified based on whether they underwent open renal surgery or conservative management for their renal injury. Demographic characteristics and a detailed history of renal injuries were recorded. The patients were evaluated based on the rate of renal preservation and complications at 6-month follow-up. Results: The mean age was 32.10 years and majority of the patients were males (87.76%). Blunt trauma (95.92%) was most frequently reported. According to American Association for the Surgery of Trauma (AAST), 8 (16.33%) patients were categorized in grade I, 17 (34.69%) patients in grade II, 8 (16.33%) patients in grade III, 12 (24.49%) patients in grade IV, and 4 (8.16%) patients in grade V. Microscopic haematuria (42.86%) was the most common clinical presentation. The majority of the patients were managed conservatively (89.8%). Only two belonging to grade 4 and three from grade 5 were managed operatively due to haemodynamic instability. Rib fractures (n=10) were the most frequently associated injury, and Urinary Tract Infection (UTI) (n=8) was the most common complication, followed by persistent haematuria (n=3), and hypertension (n=3). All patients with grades I to III showed 100% renal preservation rate with conservative management. However, patients with grades IV and V showed renal preservation rate of 83.33% and 50%, respectively. Conclusion: Conservative treatment is a preferred choice of treatment in the most of the renal trauma. The present study reported high renal preservation rate in low-grade renal injuries, which were managed conservatively. However, there is still need of surgical treatment in high grade haemodynamically unstable patients.

PURPOSE OF REVIEW:To review the current practices of nonoperative management of posterior cruciate ligament (PCL) injuries, the natural history of conservative care, and the latest PCL rehabilitation strategies. RECENT FINDINGS:PCL injuries often occur as part of a multiligamentous knee injury and occasionally occur in isolation. Although patients may be able to tolerate or compensate for a PCL-deficient knee, long-term outcomes after conservative care demonstrate a high rate of arthrosis in the medial and patellofemoral compartments resulting from altered knee kinematics and loads. Good subjective outcomes and a high rate of return to sport have been reported after nonoperative treatment of isolated PCL injuries. However, PCL laxity grade on objective exam does not typically correlate with subjective outcomes, nor does it correlate with the risk of developing osteoarthritis. Although more research is needed on the optimal PCL rehabilitation strategies, general principles include avoiding posterior tibial translation in the initial period to optimize ligament healing, followed by progressive range of motion and strengthening of the quadriceps and core musculature. At 12 weeks, patients may begin an interval running program, followed by agility work and progressive sports-specific training to allow for return to sports. Nonoperative treatment of isolated PCL injuries results in good subjective outcomes and high rate of return to sport.

Critics have frequently argued about whether early modern plays like Shakespeare’s Twelfth Night are ultimately subversive or conservative in their attitudes towards gender and sexuality. Stephen Greenblatt, for example, claims that Twelfth Night’s conclusion confirms the desirability of both heterosexuality and traditional gender roles, whereas Valerie Traub suggests that the play is more disruptive and unconventional than that, since its ending is undermined by the previous deconstruction of gender and sexual binaries and exposure of them as essentially ‘arbitrary’. The question, therefore, is the extent to which a conventional, heteronormative conclusion may or may not work to ‘shut down’ the potentially subversive energies of a play which otherwise explores the non-hetero and the gender nonconformist.This paper explores these questions through a study of James Shirley’s c. 1638-9 tragicomedy The Doubtful Heir, and argues that this play’s ending is, in these terms, both conventional and subversive. Although, as in Twelfth Night, the last act of The Doubtful Heir works to reaffirm traditional gender roles, the effect of this is complicated or problematised by the way in which the play works to frame its hero, Ferdinand, as an object of desire for female spectators, and its encouragement both of the female gaze and of female fantasies of empowerment.

This study focuses on short-term investment and financing decisions influenced by a firm’s working capital policy and the effect of working capital policies on the financial performance of manufacturing firms in Malaysia. Working capital policies were measured by working capital financing and investment policies. Working capital investment policy was measured by the ratio of current assets to total assets. Working capital financing policy was categorized as conservative working capital financing policy, aggressive working capital financing policy, and matching working capital financing policy. This study considered matching working capital financing policy, which was not considered in previous empirical studies. The data included 147 firms with 1470 firm-year observations for the period from 2010 to 2019. The results revealed that the current asset to total asset ratio significantly negatively affected firms’ financial performance. Meanwhile, a conservative working capital financing policy was positively and significantly related to a firm’s financial performance. The finding implies that Malaysian manufacturing firms can increase their operating income by adopting an aggressive working capital investment policy. The finding also implies that Malaysian manufacturing firms can increase their operating income by implementing a conservative working capital financing policy rather than a matching or an aggressive working capital financing policy.