bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Large Scale Advance Care Planning Co-Design Education Program for Chinese-Speaking People in Australia
Authors: Wong Aaron Kee Yee , Collins Anna , Ng Andrew , Buizen Luke , Philip Jennifer , Le Brian
Published: May 2021

Background:

Advance care planning (ACP) is important, however ethnic minorities have half the completion rates in the United States compared to Caucasian counterparts, and in Australia only 3.5% of advance directives were completed by those overseas-born.Educational intervention improves ACP knowledge and subsequent uptake. We evaluated immediate and longer-term outcomes of a co-designed ACP education toolkit in Chinese-speaking people in Victoria, Australia.

Methods:

We conducted a cross-sectional survey of Chinese-speaking community members who participated in a co-designed Chinese ACP educational workshop. A self-selected subgroup were subsequently contacted 6 months later to determine longer-term outcomes.

Results:

Of 519 attendees across 17 workshops, 325 (63%) completed the evaluation. The majority (63%;n = 206) were previously unaware of ACP. Perception of receipt of useful information positively correlated with motivation to undertake ACP ( r = 0.3486, p < 0.001). Of the 70 participants who consented to follow up, 36% (n = 26) agreed to participate in structured telephone interviews. English speakers were more likely to have undertaken ACP (n = 6 vs n = 3). ACP completion was not associated with being a carer or suffering from cancer or chronic illness.

Conclusions:

This first Australian study evaluating ACP co-design education implementation outcomes in Chinese-speaking people supports that motivation to undertake ACP is related to knowledge, albeit a modest ACP uptake in a small follow up sample. Clinicians should note that this assists with ACP uptake, with likely downstream improved health outcomes. This co-designed toolkit could be helpful in increasing ACP uptake. Future engagement by Chinese language societies to overcome further barriers to ACP is needed.
Effects of School Climate and Parent Support on Academic Performance: Implications for School Reform
Authors: Hyseni Duraku Zamira , Hoxha Linda
Published: May 2021

This study investigated the associations among school climate domains and how school climate interacts with academic performance. A sample of Kosovan public school students ( N = 855) was assessed using the School Climate Survey. The results showed that students had positive perceptions in the school climate domains of teaching and learning and safety, indicating high school morale. Results further showed a positive correlation between students’ perceptions of school safety and their academic performance. Significant gender differences in perceptions of school safety were noted. Maternal education level was also shown to have an impact on student academic performance.
Oriahnn: New Drug Approved for Treating Heavy Menstrual Bleeding in Women With Uterine Fibroids
Authors: Lynch Sarah E. , Mayer Danielle C.
Published: May 2021

Objective

To review data of elagolix plus estradiol and norethindrone acetate as add-back therapy for the treatment of heavy menstrual bleeding (HMB) in premenopausal women with uterine fibroids.

Data Sources

Literature search of PubMed/MEDLINE and SCOPUS was performed using the search terms Oriahnn; elagolix, estradiol, norethindrone AND heavy menstrual bleeding; elagolix AND heavy menstrual bleeding; and gonadotropin-releasing hormone receptor antagonist AND heavy menstrual bleeding between January 1, 1996, to March 2, 2021. Additional data were obtained from prescribing information, references of identified articles, and abstracts from scientific meetings.

Study Selection/Data Extraction

Clinical trials and articles discussing elagolix plus add-back therapy for the management of HMB in women with leiomyomas were included.

Data Synthesis

Phase 3 trials met the primary end point of menstrual blood loss (MBL) less than 80 mL at month 6 and at least a 50% reduction in MBL from baseline to the final month in 68.5% of women taking elagolix plus add-back therapy enrolled in UF-1 (8.7% placebo) and 76.5% of women in UF-2 (10% placebo). The most common adverse effects include hot flushes, nausea, headache, and night sweats.

Relevance to Patient Care and Clinical Practice

Women with symptomatic uterine fibroids can experience significant HMB resulting in distress, depression, and anxiety. Surgical intervention remains the most commonly recommended and chosen treatment. Elagolix plus add-back therapy is a nonsurgical, oral option.

Conclusions

Elagolix plus add-back therapy is effective in reducing menstrual bleeding associated with uterine fibroids. However, there are several warnings and precautions that must be considered.
Fetal Origin of Placental Hepatic Nodule
Authors: Bu Fang , Pfau Ruthann , Deeg Carol , Wobser Jeff , Koo Selene C.
Published: May 2021

Intraplacental hepatic nodules are extremely rare and range from incidentally identified microscopic nodules to large mass-forming lesions. We describe the case of an incidentally identified intraparenchymal hepatic nodule in the placenta from a near-term delivery of a male infant at 36 weeks gestation. Lesional cells were positive for HepPar1, focally positive for glypican3, and negative for calretinin and alpha-fetoprotein, supportive of hepatocellular origin. Fluorescence in-situ hybridization and chromosomal microarray both showed a male sex chromosome complement (XY) within the nodule, confirming the fetal origin of this nodule. We provide the first report of the confirmed fetal origin of these rare lesions, lending support to the hypothesis that placental hepatic nodules may represent an embryonal rest or residua of abnormal cell migration.
The Battle for “NoFap”: Myths, Masculinity, and the Meaning of Masturbation Abstention
Authors: Burnett Scott
Published: May 2021

Critical masculinities scholarship has identified a number of ways in which abstention from sex, pornography, and masturbation works to repair and reproduce hybrid and hegemonic masculinities. Though the mercurial and plural nature of contemporary online masculinities is investigated on a number of fronts, analysis to date has often pinned down abstention to a particular subject position, often understood predominantly in its gendered dimensions. In this article, I argue that the anti-pornography, anti-masturbation movement NoFap should be understood as a site of political contestation for the meaning potential of abstention and that these subject positions should be read intersectionally. Through analysis of a large corpus of tweets (6,569) scraped from the micro-blogging site Twitter, I present evidence for seven distinct subject positions linked to discrete myths, which include extreme anti-feminist and anti-Semitic articulations. I argue that this bird’s-eye view of NoFap uniquely lays out competing myths in their specificity, facilitating a nuanced understanding of “morbid” identities.
Party fragmentation and campaign spending: A subnational analysis of the German party system
Authors: Jacob Marc S , Pollex Jan
Published: May 2021

Party finance allows elucidating parties’ behaviour in differing political and institutional contexts, yet only a few studies investigate expenditure patterns. Given that campaign activities are central for parties to fulfil their core functions in representative democracy, this study seeks to explain why parties invest in electoral campaigns to different degrees. We argue that high party fragmentation reinforces parties’ focus on electoral races in election years, a mechanism we refer to as the ‘campaign concentration effect’. By contrast, in less fragmented systems, parties invest more in campaigning on a continuous basis. A subnational analysis of the German party system between 2009 and 2017 provides evidence for this effect. Our results imply that growing party fragmentation nurtures parties’ efforts to succeed in elections, which is likely to intensify parties’ orientation towards short yet capital-intensive campaigns.
Algorithms and taste-making: Exposing the Netflix Recommender System's operational logics
Authors: Pajkovic Niko
Published: May 2021

As the Streaming Wars continue to heat up, recommendation systems like the Netflix Recommender System (NRS) will become key competitive features for every major over-the-top video streamer. As a result, film and television production and consumption will increasingly be in the hands of semi-autonomous algorithmic technologies. But how do recommendation systems like the NRS work? What purposes do they serve? And what sorts of impacts are they having on film and television culture? To respond to these questions, this article will (1) examine how algorithms are impacting processes of taste-making and (2) re-evaluate some of the critical theoretical perspectives that have come to dominate the discourse surrounding algorithmic cultures. To do so, I join Bucher ((2016) Neither black nor box: Ways of knowing algorithms. In: S Kubitscko and A Kaun (eds) Innovative Methods in Media and Communication Research. Cham: Springer International Publishing, pp. 81–98; (2018) If…then: Algorithmic Power and Politics. London: Oxford University Press) in adopting a relational materialist perspective of algorithms and proceed to reverse engineer the NRS; an experiment that exposes the system’s circular and economic logics while highlighting the complex and networked nature of taste-making in the film and television industry.
The importance of alcohol in elderly's hospital admissions for fall injuries: a population case-control study
Authors: Bye Elin K. , Bogstrand Stig Tore , Rossow Ingeborg
Published: May 2021

Background:

Fall injuries account for a substantial part of the health burden among elderly persons, and they often affect life quality severely and impose large societal costs. Alcohol intoxication is a well-known risk factor for accidental injuries, but less is known about this association among elderly people. In this study, our aim was to assess whether risk of fall injuries among the elderly is elevated with an intoxication-oriented drinking pattern.

Method:

We applied a population case-control design and data from persons aged 60 years and over in Norway. Cases comprised patients with fall injuries admitted to a hospital emergency department ( n = 424), and controls were participants in general population surveys ( n = 1859). Drinking pattern was assessed from self-reports of drinking frequency and intoxication frequency. Age and gender-adjusted association between fall injury and drinking pattern was estimated in logistic regression models. Fall injuries were considered alcohol-related if blood alcohol concentration exceeded 0.01% and/or the patient reported alcohol intake within six hours prior to injury.

Results:

The risk of fall injuries was highly elevated among those reporting drinking to intoxication monthly or more often ( OR = 10.2, 95% CI 5.5–19.0). Among cases, the vast majority of those with alcohol-related fall injuries (64 of 68) reported drinking to intoxication.

Conclusions:

A drinking pattern comprising alcohol intoxication elevated the risk of fall injuries among elderly people. As alcohol use is a modifiable risk factor, the findings suggest a potential to curb the number of fall injuries and their consequences by employing effective strategies to prevent intoxication drinking among the elderly.
A feasibility study of the impact of a communication-skills course, ‘Empowered Conversations’, for care partners of people living with dementia
Authors: Morris Lydia , Innes Anthea , Smith Emma , Williamson Tracey , McEvoy Phil
Published: May 2021

Objectives

To examine the feasibility, acceptability and impact of an experiential course for family care partners of people living with dementia, Empowered Conversations (EC). This study aimed to assess the impact of participation in an EC course on care partner stress levels, communication and mentalization (a form of relational-based empathy).

Method

This study uses an uncontrolled pre–post-follow-up design. Follow-up was at 4-months after the initial EC session where baseline data were collected. One hundred and fifty-nine care partners were recruited. EC is a training course that has been designed to improve care partner communication, well-being and relationships. It is based on an integrative framework that targets the specific psychological, relationship and communication needs of carers. This framework informs targeted strategies and interactive exercises that facilitate carers to consider the goals and emotions of those they are caring for, alongside their own goals and emotions, and to use this to maximize good communication.

Results

Stress was significantly reduced across the three time points. Communication significantly improved across time. There were no significant changes in reflective functioning (mentalization).

Discussion

This study provides preliminary evidence that a communication-skills training course for care partners of people living with dementia is an acceptable and feasible intervention and has an impact both post-intervention and at follow-up. These findings require validation in a rigorous, randomized study.
Bullshit Ability as an Honest Signal of Intelligence
Authors: Turpin Martin Harry , Kara-Yakoubian Mane , Walker Alexander C. , Walker Heather E. K. , Fugelsang Jonathan A. , Stolz Jennifer A.
Published: May 2021

Navigating social systems efficiently is critical to our species. Humans appear endowed with a cognitive system that has formed to meet the unique challenges that emerge for highly social species. Bullshitting, communication characterised by an intent to be convincing or impressive without concern for truth, is ubiquitous within human societies. Across two studies ( N = 1,017), we assess participants’ ability to produce satisfying and seemingly accurate bullshit as an honest signal of their intelligence. We find that bullshit ability is associated with an individual’s intelligence and individuals capable of producing more satisfying bullshit are judged by second-hand observers to be more intelligent. We interpret these results as adding evidence for intelligence being geared towards the navigation of social systems. The ability to produce satisfying bullshit may serve to assist individuals in negotiating their social world, both as an energetically efficient strategy for impressing others and as an honest signal of intelligence.
A Branch-to-Branch Through-and-Through Wire Technique to Redirect a Branch Malposition in Multibranched Endovascular Aortic Aneurysm Repair
Authors: Youssef Marwan , Gunaseelan Meera
Published: May 2021

Objective

To describe a novel technique to redirect a malrotated branch when treating a symptomatic juxtarenal aortic aneurysm using an off-the-shelf multibranched endograft.

Technique

A 75-year-old patient was admitted because of a symptomatic juxtarenal aortic aneurysm with a maximum diameter of 9.2 cm. The aneurysm showed no infrarenal neck. Because of his comorbidities, an endovascular repair using off-the-shelf multibranched endograft was considered as urgent procedure. During the deployment, the devise malrotated clockwise. The incorporation of the renal branches was performed successfully; however, the superior mesenteric artery (SMA) branch was malpositioned, so that the SMA could not be cannulated. Both celiac and SMA branches were simultaneously cannulated and snared outside of the endograft redirecting the malrotated SMA branch (a branch-to-branch through-and-through wire technique). Leaving the through-and-through wire in situ, the SMA could be intubated using parallel wire through the SMA branch. The final angiogram showed a good perfusion of the renovisceral vessels. The aneurysm was completely excluded. The patient was discharged into a rehabilitation facility 8 days later without complications. The 12-month follow-up period was uneventful.

Conclusion

A branch-to-branch through-and-through wire technique for branch repositioning is feasible and may present a bailout tool.
Bilateral Use of Iliac Branch Devices for Aortoiliac Aneurysms Is Safe and Feasible, and Procedural Volume Does Not Seem to Affect Technical or Clinical Effectiveness: Early and Midterm Results From the pELVIS International Multicentric Registry
Authors: D’Oria Mario , Pitoulias Georgios A. , Torsello Giovanni F. , Pitoulias Apostolos G. , Fazzini Stefano , Masciello Fabrizio , Verzini Fabio , Donas Konstantinos P. ,   for the pELVIS Registry Investigators, Taneva Gergana T. , Austermann Martin , Bosiers Michel , Dorigo Walter , Cao Piergiorgio , Ferrer Ciro , Ippoliti Arnaldo , Barbante Matteo , Parlani Gianbattista , Simonte Gioele , Kölbel Tilo , Tsilimparis Nikolaos , Haulon Stephan , Branzan Daniela , Schmidt Andrej , Pratesi Carlo , Fargion Aaron , Pratesi Giovanni
Published: May 2021

Objective

To evaluate early and follow-up outcomes following bilateral use of iliac branch devices (IBD) for aortoiliac endografting and assess the impact of center volume. We used data from the pELVIS international multicentric registry.

Methods

For the purpose of this study, only those patients receiving concomitant bilateral IBD implantation were analyzed. To assess the impact that procedural volume of bilateral IBD implantation could have on early and follow-up outcomes, participating institutions were classified as Site(s) A if they had performed >10 and/or >20% concomitant bilateral IBD procedure, otherwise they were classified as Site(s) B. Endpoints of the analysis included early (ie, 30-day) mortality and morbidity, as well as all-cause and aneurysm-related mortality during follow-up. Additional endpoints that were evaluated included IBD-related reinterventions, IBD occlusion or stenosis requiring reintervention (ie, loss of primary patency), and IBD-related type I endoleak.

Results

Overall, 96 patients received bilateral IBD implantation (out of 910 procedures collected in the whole pELVIS cohort), of whom 65 were treated at Site A (ie, Group A) and 31 were treated at Site(s) B (ie, Group B). In total, only 1 death occurred within 30 days from bilateral IBD implantation, and 9 patients experienced at least 1 major complication without any significant difference between subjects in Group A versus those in Group B (10.8% vs 6.5%, p=0.714). In the overall cohort, the 2-year freedom from IBD-related type I endoleaks and IBD primary patency were 96% and 92%, respectively; no significant differences were seen in those rates between Group A or Group B (95% vs 100%, p=0.335; 93% vs 88%, p=0.470). Freedom from any IBD-related reinterventions was 83% at 2 years, with similar rates between study groups (85% vs 83%, p=0.904).

Conclusions

Within the pELVIS registry, concomitant bilateral IBD implantation is a safe and feasible technique for management of aortoiliac aneurysms in patients with suitable anatomy. Despite increased technical complexity, effectiveness of the repair is satisfactory with low rates of IBD-related adverse events at mid-term follow-up. Procedural volume does not seem to affect technical or clinical outcomes after bilateral use of IBD, which remains a favorable treatment option in selected patients.
Improving the robustness of a service robot for continuous indoor monitoring: An incremental approach
Authors: Portugal David , Araújo André G , Couceiro Micael S
Published: May 2021

To move out of the lab, service robots must reveal a proven robustness so they can be deployed in operational environments. This means that they should function steadily for long periods of time in real-world areas under uncertainty, without any human intervention, and exhibiting a mature technology readiness level. In this work, we describe an incremental methodology for the implementation of an innovative service robot, entirely developed from the outset, to monitor large indoor areas shared by humans and other obstacles. Focusing especially on the reliability of the fundamental localization system of the robot in the long term, we discuss all the incremental software and hardware features, design choices, and adjustments conducted, and show their impact on the performance of the robot in the real world, in three distinct 24-h long trials, with the ultimate goal of validating the proposed mobile robot solution for indoor monitoring.
SuccERP: The design science based integration of ECS and ERP in post-implementation stage
Authors: Lin Yung-Yu , Nagai Yukari , Chiang Tzu-Hang , Chiang Hua-Ko
Published: May 2021

The existing studies of Enterprise Resource Planning (ERP) are primarily focusing on the adoption and implementation stages, the post-implementation stage has received less attention in comparison. However, most enterprises have been struggling under the post-implementation stage. This work aims to review the state-of-the-art issues of ERP in the post-implementation stage, including communication, legacy system, collaboration, and the manager is hard to monitor the performance. Based on the Design Science (DS) method, we highlight how to offset the lack of an ERP system and ECS according to the guidelines of DS, and show the exhaustive steps for implementing the artifact-SuccERP. Our research is rigorous and interpretive by considering the steps of the DS and the functions of Software Engineering. Further, we explore multiple ERP systems to summarize the difference in authentication, initial data, and specific procedures aspects, after that, we consider the two most popular procedures (order creation and bill of purchase creation) as examples to demonstrate and evaluate the proposed artifact—SuccERP in the result. We propose the complete and practical research for solving the issues from previous theoretical results of an ERP, and to show experimentally that the proposed SuccERP is easy to maintain by applying the Cyclomatic Complexity and the Maintainability Index as metrics. This study is a milestone that allows ERP research to move from the theoretical stage to integrating, creating things that serve a human purpose, and dealing with the issues presented by previous works practically.
How can we Agree on Anything in This Environment? Tunisian Media, Transition and Elite Compromises: A View From Parliament
Authors: Cavatorta Francesco , Mekki Nidhal
Published: May 2021

The literature on the role of the media during processes of transitions to democracy is divided over the positive or negative influence media outlets have. Both theoretically and empirically cases can be substantiated. In the case of the 2011 Arab revolts, however, there is a scholarly consensus that the media—traditional and social—have negatively affected the processes of transitions. While the criticism of the role of the media is empirically borne out, it does not explain how Tunisia was able to consolidate its democracy despite a polarizing media environment. Based on participant observation and interviews, the article argues that the inner workings of the Constituent Assembly and the role of individual deputies were crucial in overcoming a hostile atmosphere. This suggests that the role of political actors in negotiating the new rules of the game is more important than other factors shaping a transition.
Situating strategic or hybrid Confucianism(s): Issues and problematics
Authors: Law Andrew M
Published: May 2021

This commentary reviews the arguments made in An et al.’s ‘Towards a Confucian Geopolitics’. Particularly, I consider An et al.’s main claim that a form of strategic and/or ‘hybrid Confucianism’ has played a significant role in the construction of contemporary Chinese geopolitics. While I accept aspects of this argument, this commentary also raises further theoretical and empirical issues that are immanent within the work. I draw attention to: (1) concerns relating to the historical narrative constructed by the authors; (2) problematics relating to the recent diversity of contemporary Confucian discourse; and (3) questions relating to the geographies of Confucianism.
Small-head metal on metal total hip arthroplasty is associated with a high rate of complication and reoperation at mid-term follow-up
Authors: Sumiyoshi Nobuhiko , Oinuma Kazuhiro , Miura Yoko
Published: May 2021

Background:

Adverse reactions to metal debris are significant complications after metal-on-metal total hip arthroplasty. Recently, late appearances of adverse reactions to metal debris and subsequent need for reoperations have been reported with small-diameter head metal-on-metal devices. We retrospectively investigated mid-term clinical outcomes of small-head metal-on-metal total hip arthroplasty.

Methods:

We reviewed 159 hips in 139 patients who had a small-head metal-on-metal total hip arthroplasty (M2a Taper; Biomet, Warsaw, IN) with a minimum 5-year follow-up and documented postoperative complications.

Results:

Focal osteolysis in either the femur or acetabulum was observed in 12 hips (7.5%, 44 months after surgery on average), with pseudotumor observed in 8 hips (5%, 120 months after surgery on average). Four hips (2.5%) had dislocations (84 months after surgery on average) and six hips (3.8%, 122 months after surgery on average) underwent reoperation.

Conclusion:

Small-head metal-on-metal total hip arthroplasty is associated with a high degree of complications at mid-term follow-up period. Considering this, we discourage the use of metal-on-metal total hip arthroplasty regardless of head size.
A case report of COVID-19 infection and management during pregnancy
Authors: Ogamba Ifeoma , Chuang Linus , Panarelli Erin , Zilberman Dimitry
Published: May 2021

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which started in Wuhan, Hubei Province, China, and progressed to a pandemic affecting over 210 countries and territories including the United States. The severity of symptoms range from mild to critical disease involving multi-organ failure; however, many pregnant COVID-19 patients have mild symptoms. The understanding of COVID-19 is evolving and there is limited data about its effects in pregnancy. This case series features two pregnant patients with COVID-19 with a range of symptoms, including fever, non-productive cough, headache, and worsening dyspnea. Both patients had chest x-ray findings notable for lung opacities, and lymphopenia was a consistent abnormal laboratory finding. Both of the patients had hypoxia which was treated with hydroxychloroquine and lopinavir-ritonavir with significant improvement in clinical symptoms and prolongation of pregnancy.
Perilunate instability: A rare variant
Authors: Partap Amanda , Persad Ian James
Published: May 2021

Perilunate dislocations and perilunate fracture dislocations are rare injuries that occur as a result of high energy trauma. We describe a case of a volar fracture dislocation of the proximal pole of the scaphoid with an associated scapholunate and lunotriquetral ligament disruption as well as a lunate fossa fracture of the distal radius. These injuries are serious injuries that require a high degree of clinical acumen and radiographic scrutiny to allow for prompt treatment in order to avoid the sequelae of long-term complications that can arise. This case serves as a reminder of the complexity of these injuries and their associated mechanics.
Contemporary surgical management of benign prostatic obstruction: does there remain a place in the toolbox for TURP?
Authors: Trail Matthew , Hindley Richard G , Al Jaafari Feras
Published: May 2021

Level of evidence: 5
Community sanctions: Offenders’ perceptions about their appropriateness
Authors: Andrade Joana , Cruz Ana Rita , Cunha Olga , Gonçalves Rui Abrunhosa , Rodrigues Andreia Castro
Published: May 2021

This study analyzed offenders’ perceptions about distinct sanctions and their adequacy for different crimes, checking if these ideas apply to their crime. We covered a total of 163 adult offenders who were sanctioned with a non-custodial order. The results show that participants tended to express a punitive attitude toward crime, apart from their offenses. Participants who committed driving or drug trafficking offenses were those that revealed congruence regarding the adequacy of the sentence and the usefulness of the sanction imposed. Regarding sentences’ purposes, we noticed most participants considered punishment and general deterrence as the primary purposes. The main contribution of this study lies in its educational value about the cognitive particularities and specific needs of each type of offender. Not attending to offenders’ perceptions regarding sanctions may function as an obstacle for an efficient implementation of the Justice, in terms of their adherence to the sanctions, and consequently their rehabilitation.
Likely Exacerbation of Psychological Disorders from Covid-19 Response
Authors: Zolnikov Tara Rava , Clark Tanya , Zolnikov Tessa
Published: May 2021

Anxiety and fear felt by people around the world regarding the coronavirus pandemic is real and can be overwhelming, resulting in strong emotional reactions in adults and children. With depressive and anxiety disorders already highly prevalent in the general population (300 million worldwide), depression and/or anxiety specifically because of the pandemic response is likely. Moreover, the current state of panic in the face of uncertainty is apt to produce significant amounts of stress. While this situation has the potential to cause psychological disorders in previously unaffected populations, perhaps more impactful is the exacerbation of symptoms of many existing disorders including anxiety, depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and hoarding disorder.
What Does It Take to Become an Academic Plastic Surgeon in Canada: Hiring Trends Over the Last 50 Years
Authors: Copeland Andrea E. , Axelrod Daniel E. , Wong Chloe R. , Malone Janna L. , Gallo Lucas , Avram Ronen , Phillips Brett T. , Coroneos Christopher J.
Published: May 2021

Objective: Academic plastic surgery positions have become highly competitive secondary to delayed retirement, stagnant hospital funding, and an increasing number of plastic surgery graduates. Little information is available to help residents navigate this challenging landscape. Our objectives were to evaluate the training backgrounds of all Canadian academic plastic surgeons and to develop recommendations for residents interested in an academic career. Methods: All Canadian academic plastic surgeons were included. Training histories were obtained from institutions’ websites. Surgeons were subsequently emailed to confirm this information and complete missing details. Multivariate regressions were designed to analyze the effect of gender and FRCSC year on graduate and fellowship training and time to first academic position. Results: Training information was available for 196 surgeons (22% female), with a 56% email response rate; 91% of surgeons completed residency in Canada; 94% completed fellowship training, while 43% held graduate degrees; 74% were employed where they previously trained. Female gender significantly lengthened the time from graduation to first academic job, despite equal qualification. Younger surgeons were more likely to hold graduate degrees ( P < .01). Conclusions: We identified objective data that correlate with being hired at an academic centre, including training at the same institution, obtaining a graduate degree during residency, and pursuing fellowship training. In addition, we demonstrated that women take significantly longer to acquire academic positions ( P < .01), despite equal qualification. Trainees should consider these patterns when planning their careers. Future research should explore gender-based discrepancies in hiring practices.
Computer Assisted Guided Placement of IMF Screws in Craniomaxillofacial Trauma: An Evolving Technique
Authors: Muhammad Joseph Kamal
Published: May 2021

Intermaxillary fixation (IMF) screws have been introduced into maxillofacial trauma practice to reduce operation time and the complications associated with the placement of wire ligatures around teeth. Wires continue to be used to secure arch bars to teeth, form eyelets and long ligatures prior to putting a patient into maxillomandibular fixation (MMF). The application of wires to dental arches may result in sharp injuries to the operator, whereas injury to roots and nerves may arise from incorrect positioning of IMF screws in the jaws. The purpose of this technical note is to demonstrate how 3D patient specific (PS) surgical guides can be planned and fabricated to assist in the safe placement of IMF screws in the maxilla and mandible. It is proposed that PS IMF screw guides can be further developed to incorporate removable spoons and semi-circular access ports that not only facilitate safe screw placement but allow the guide to remain in position until all screw are secured. The potential benefits of PS IMF surgical guides include diminished risk of injury to facial structures and reduced operation time. The technique also lends itself to the placement of IMF screws via a robotic arm contributing to a safer operating environment for the maxillofacial surgery team.
Systemic Therapy for Head and Neck Skin Cancers
Authors: Knackstedt Rebecca , Taub Peter , Rogers Gary , Gastman Brian
Published: May 2021

The mainstay of curative therapy for head and neck skin cancers relies upon surgery and/or radiation therapy. However, for some aggressive, non-resectable or recurrent tumors, systemic therapy is necessary. Recent emerging classes of drugs have shown to improve survival for high-risk, recurrent, and unresectable variants of these tumors. The goal of this paper is to review options for systemic therapies for head and neck skin cancers including melanoma, non-melanoma skin cancers and other rare and non-malignant tumors.
RcTGA1 and glucosinolate biosynthesis pathway involvement in the defence of rose against the necrotrophic fungus Botrytis cinerea
Authors: Gao Penghua , Zhang Hao , Yan Huijun , Wang Qigang , Yan Bo , Jian Hongying , Tang Kaixue , Qiu Xianqin
Published: May 2021

Background

Rose is an important economic crop in horticulture. However, its field growth and postharvest quality are negatively affected by grey mould disease caused by Botrytis c. However, it is unclear how rose plants defend themselves against this fungal pathogen. Here, we used transcriptomic, metabolomic and VIGS analyses to explore the mechanism of resistance to Botrytis c.

Result

In this study, a protein activity analysis revealed a significant increase in defence enzyme activities in infected plants. RNA-Seq of plants infected for 0 h, 36 h, 60 h and 72 h produced a total of 54 GB of clean reads. Among these reads, 3990, 5995 and 8683 differentially expressed genes (DEGs) were found in CK vs. T36, CK vs. T60 and CK vs. T72, respectively. Gene annotation and cluster analysis of the DEGs revealed a variety of defence responses to Botrytis c. infection, including resistance (R) proteins, MAPK cascade reactions, plant hormone signal transduction pathways, plant-pathogen interaction pathways, Ca2+ and disease resistance-related genes. qPCR verification showed the reliability of the transcriptome data. The PTRV2-RcTGA1-infected plant material showed improved susceptibility of rose to Botrytis c. A total of 635 metabolites were detected in all samples, which could be divided into 29 groups. Metabonomic data showed that a total of 59, 78 and 74 DEMs were obtained for T36, T60 and T72 (T36: Botrytis c. inoculated rose flowers at 36 h; T60: Botrytis c. inoculated rose flowers at 60 h; T72: Botrytis c. inoculated rose flowers at 72 h) compared to CK, respectively. A variety of secondary metabolites are related to biological disease resistance, including tannins, amino acids and derivatives, and alkaloids, among others; they were significantly increased and enriched in phenylpropanoid biosynthesis, glucosinolates and other disease resistance pathways. This study provides a theoretical basis for breeding new cultivars that are resistant to Botrytis c.

Conclusion

Fifty-four GB of clean reads were generated through RNA-Seq. R proteins, ROS signalling, Ca2+ signalling, MAPK signalling, and SA signalling were activated in the Old Blush response to Botrytis c. RcTGA1 positively regulates rose resistance to Botrytis c. A total of 635 metabolites were detected in all samples. DEMs were enriched in phenylpropanoid biosynthesis, glucosinolates and other disease resistance pathways.
Half-leaf width symmetric distribution reveals buffering strategy of Cunninghamia lanceolata
Authors: Peng Xi , Zhao Meifang , Liu Shuguang , Yan Wende
Published: May 2021

Background

Leaf length and width could be a functioning relationship naturally as plant designs. Single-vein leaves have the simplest symmetrical distribution and structural design, which means that fast-growing single-vein species could interpret the scheme more efficiently. The distribution of leaf length and width can be modulated for better adaptation, providing an informative perspective on the various operational strategies in an emergency, while this mechanism is less clear. Here we selected six age groups ofCunninghamia lanceolatapure forests, including saplings, juveniles, mature, and old-growth trees. We pioneered a tapering model to describe half-leaf symmetric distribution with mathematical approximation based on every measured leaf along developmental sequence, and evaluated the ratio of leaf basal part length to total length (called tipping leaf length ratio).

Results

The tipping leaf length ratio varied among different tree ages. That means the changes of tipping leaf length ratio and leaf shape are a significant but less-noticed reflection of trees tradeoff strategies at different growth stages. For instance, there exhibited relatively low ratio during sapling and juvenile, then increased with increasing age, showing the highest value in their maturity, and finally decreased on mature to old-growth transition. The tipping leaf length ratio serves as a cost-benefit ratio, thus the subtle changes in the leaf symmetrical distribution within individuals reveal buffering strategy, indicating the selection for efficient design of growth and hydraulic in their developmental sequences.

Conclusions

Our model provides a physical explanation of varied signatures for tree operations in hydraulic buffering through growth stages, and the buffering strategy revealed from leaf distribution morphologically provides evidence on the regulation mechanism of leaf biomechanics, hydraulics and physiologies. Our insight contributes greatly to plant trait modeling, policy and management, and will be of interest to some scientists and policy makers who are involved in climate change, ecology and environment protection, as well as forest ecology and management.
Nomogram for predicting preoperative regional lymph nodes metastasis in patients with metaplastic breast cancer: a SEER population-based study
Authors: Zhang Mi , Wang Biyuan , Liu Na , Wang Hui , Zhang Juan , Wu Lei , Zhao Andi , Wang Le , Zhao Xiaoai , Yang Jin
Published: May 2021

Background

Metaplastic breast cancer (MBC) is a rare subtype of breast cancer, and generally associated with poor outcomes. Lymph nodes metastasis (LNM) is confirmed as a critical independent prognostic factor and determine the optimal treatment strategies in MBC patients. We aimed to develop and validate a nomogram to predict the possibility of preoperative regional LNM in MBC patients.

Methods

MBC patients diagnosed between 1990 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database were included and stochastically divided into a training set and validation set at a ratio of 7:3. The risk variables of regional LNM in the training set were determined by univariate and multivariate logistic regression analyses. And then we integrated those risk factors to construct the nomogram. The prediction nomogram was further verified in the verification set. The discrimination, calibration and clinical utility of the nomogram were evaluated by the area under the receiver operating characteristic (ROC) curve (AUC), calibration plots and decision curve analysis (DCA), respectively.

Results

A total of 2205 female MBC patients were included in the study. Among the 2205 patients, 24.8% (546/2205) had positive regional lymph nodes. The nomogram for predicting the risk of regional LNM contained predictors of grade, estrogen receptor (ER) status and tumor size, with AUC of 0.683 (95% confidence interval (CI): 0.653–0.713) and 0.667 (95% CI: 0.621–0.712) in the training and validation sets, respectively. Calibration plots showed perfect agreement between actual and predicted regional LNM risks. At the same time, DCA of the nomogram demonstrated good clinical utilities.

Conclusions

The nomogram established in this study showed excellent prediction ability, and could be used to preoperatively estimate the regional LNM risk in MBC.
Awareness screening and referral patterns among pediatricians in the United States related to early clinical features of spinal muscular atrophy (SMA)
Authors: Curry Mary , Cruz Rosángel , Belter Lisa , Schroth Mary , Lenz Megan , Jarecki Jill
Published: May 2021

Background

Spinal Muscular Atrophy (SMA), a leading genetic cause of death in infants, is an autosomal recessive neuromuscular disease characterized by progressive muscle weakness and atrophy. While early diagnosis of SMA is critical to modifying disease progression and improving outcomes, serious diagnostic delays persist. There is a need to improve SMA awareness, screening, and referral patterns.

Methods

Two online surveys, developed by Cure SMA for general pediatricians, were distributed by Medscape Education via email (September 2018,n = 300, December 2019,n = 600). The surveys asked about adherence to the American Academy of Pediatrics (AAP) developmental screening and surveillance guidelines, comfort with identification of early signs of neuromuscular disease (NMD), familiarity with SMA, and barriers to timely referral.

Results

In 2018, 70.3% of survey respondents indicated comfort in identifying early signs of NMD and 67.3% noted familiarity with SMA. 52.7% correctly indicated the need for genetic testing to make a definitive diagnosis of SMA, 74.0% meet or exceed developmental screening recommendations, and 52.0% said they would immediately refer to a specialist. In 2019, with a larger sample, 73.0% adhere to developmental screening guidelines, and awareness of the genetic testing requirement for SMA was significantly lower by 7.7% (p < 0.03). Specialist wait times emerged as a barrier to referral, with 64.2% of respondents citing wait times of 1–6 months.

Conclusions

Many pediatricians underutilize developmental screening tools and lack familiarity with diagnostic requirements for SMA. Continuing efforts to expand awareness and remove barriers to timely referral to SMA specialists, including reducing appointment wait times, are needed.
Associations of meeting 24-h movement guidelines with stress and self-rated health among adults: is meeting more guidelines associated with greater benefits?
Authors: Kastelic Kaja , Pedišić Željko , Lipovac Dean , Kastelic Nika , Chen Si-Tong , Šarabon Nejc
Published: May 2021

Background

Several countries have recently issued 24-h movement guidelines that include quantitative recommendations for moderate-to-vigorous physical activity (MVPA), sedentary behaviour (SB), and sleep. This study explored the associations of meeting the 24-h movement guidelines with stress and self-rated health among adults, and whether the likelihood of favourable outcomes increases with the number of guidelines met.

Methods

A total of 2476 adults aged 18 years and over completed a questionnaire on their time spent in MVPA, SB and sleep, frequency of stress (never, very rarely, occasionally, often, every day), self-rated health (very good, good, fair, bad, very bad), sociodemographic characteristics, and lifestyle variables.

Results

In an ordinal logistic regression analysis adjusted for age, sex, body mass index, education, socio-economic status, employment, place of residence, living with or without partner, and smoking, lower odds of higher frequency of stress were found for those meeting the combined 24-h movement guidelines (adjusted odds ratio [OR] = 0.45; 95% confidence interval [CI]: 0.32, 0.63; p <  0.001), any combination of two guidelines (OR range: 0.48–0.63; p <  0.05 for all), and sleep guideline only (OR = 0.51; 95% CI: 0.35, 0.75; p = 0.001). Higher odds of better self-rated health were found for those meeting the combined 24-h movement guidelines (OR = 2.94; 95% CI: 2.07, 4.19; p <  0.001), combination of MVPA and SB guidelines (OR = 2.33; 95% CI: 1.57, 3.44; p <  0.001), combination of MVPA and sleep guidelines (OR = 1.78; 95% CI: 1.23, 2.59; p = 0.002), and MVPA guideline only (OR = 2.24; 95% CI: 1.50, 3.36; p <  0.001). Meeting more guidelines was associated with greater odds of favourable outcomes (p for linear trend < 0.001).

Conclusion

Adults who meet the sleep guideline, any combination of two guidelines, or all three guidelines experience stress less frequently. Meeting the MVPA guideline alone or in combination with any other movement behaviour guideline was associated with better self-rated health. The likelihood of less frequent stress and better self-rated health increases with the number of guidelines met. Adults should be encouraged to meet as many movement behaviour guidelines as possible.
Factors influencing length of survival in ambulatory palliative care - a cross sectional study based on secondary data
Authors: Just Johannes , Schmitz Marie-Therese , Grabenhorst Ulrich , Joist Thomas , Horn Kirsten , Engel Bettina , Weckbecker Klaus
Published: May 2021

Background

Quality of life and patient self-determination are key elements in successful palliative care. To achieve these goals, a robust prediction of the remaining survival time is useful as it can provide patients and their relatives with information for individual goal setting including appropriate priorities. The Aim of our study was to assess factors that influence survival after enrollment into ambulatory palliative care.

Methods

In this cross-sectional, multicenter study (n = 14 study centers) clinical records of all palliative care patients who were treated in 2017 were extracted and underwent statistical analysis. The main outcome criterion was the association of survival time with clinical characteristics such as age, type of disease, symptoms and performance status.

Results

A total of 6282 cases were evaluated. Median time of survival was 26 days (95 % CI: 25–27 days). The strongest association for an increased hazard ratio was found for the following characteristics: moderate/severe weakness (aHR: 1.91; 95 % CI: 1.27–2.86) Karnofsky score 10–30 (aHR: 1.80; 95 % CI: 1.67–1.95), and age > 85 (aHR: 1.50; 95 % CI: 1.37–1.64). Surprisingly, type of disease (cancer vs. non-cancer) was not associated with a change in survival time (aHR: 1.03; 95 % CI: 0.96–1.10).

Conclusions

In this cross-sectional study, the most relevant predictor for a short survival time in specialized ambulatory palliative care was the performance status while type of disease was irrelevant to survival.