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The aim of this study was to compare two techniques for temporary intraoperative maxillomandibular fixation (TIO-MMF) during orthognathic surgery: steel-wire ligatures versus power chains. Patients undergoing orthognathic surgery between October 2019 and March 2020 were included in a prospective cross-sectional study conducted in three participating hospitals. Data were collected using a standardized measurement form. A total of 44 patients were included, in whom TIO-MMF was applied 79 times. A statistically significant difference in intraoperative loss of stability of the segment relationship was found between steel-wire ligatures (11.4%) and power chains (0%). The mean application time of TIO-MMF differed significantly between steel-wire ligatures (99 seconds) and power chains (157 seconds) (P < 0.001). There was no statistical difference in occurrence of adverse events between the two techniques. This study found that the application of TIO-MMF with power chains is more stable compared to steel-wire ligatures. Steel-wire ligatures were significantly faster to apply, although the absolute difference (less than 1 minute) was small. Other possible advantages of the proposed technique are discussed. The results of this study suggest that power chains for the application of TIO-MMF in orthognathic surgery are a valuable alternative to steel-wire ligatures. [ABSTRACT FROM AUTHOR]

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121 Adversarial and preconception bias There exists a dilemma faced by courts and tribunals relating to expert evidence: On the one hand: it permits parties to present their case as they wish; and it can help courts and tribunals to ascertain the truth and to exercise discretionary powers. AIAL Forum No. 97 37 Justice Rachel Pepper and Amelia van Ewijk * Making sure that curiosity does not kill the CAT: The use of expert evidence in merits review fora where the rules of evidence do not apply Expert evidence is an increasingly ubiquitous aspect of modern litigation, including in jurisdictions conducting merits review (that is, the function of evaluating and substituting the correct and preferable decision standing in the place of the decision-maker as opposed to enforcing a law that constrains and limits executive power, or judicial review) such as civil or administrative tribunals (CATs). 122 The issue of biased expert witnesses is one that affects all courts and tribunals irrespective of whether or not the rules of evidence apply. [Extracted from the article]

• A technology-rich system model is created by integrating operations at MRFs and recycling paper mills. • Our model assesses sustainable pathways for U.S. domestic paper recycling industry. • Domestic recycling rate can increase by 15 % with better collection rate and sorting efficiency. • Use of recycled fibers can reduce energy and carbon intensities for most paper products. Dramatic changes in global recovered paper markets, triggered in large part by Chinese import restrictions, challenge the U.S. to find sustainable pathways for increasing the domestic paper recycling rate. This study presents a technology-rich process model of the U.S. domestic paper recycling industry to assess the energy consumption, carbon emissions, and system costs. A scenario analysis shows the viability of three potential pathways for achieving the national goals of a 15 % increase in both the paper recycling rate and the recycled paper utilization rate. The results suggest that the national goals can be achieved by recovering 80 % of recyclable papers from households and commercial stores, while trading all exported bales to domestic recovery with additional investments in processing capacity expansion. The deployment of advanced technology can enable material recovery facilities (MRFs) and paper mills to produce most recycled paper products that are more energy efficient with fewer CO 2 emissions. [ABSTRACT FROM AUTHOR]

• Systematic review of 19 years phase-II trials in recurrent/refractory osteosarcoma. • Increase in yearly registered trials eligible for recurrent/refractory osteosarcoma. • Increase in the use of survival endpoints in recent, mostly single-arm, trials. • Increase over time in trials investigating targeted and immune-directed therapy. • Ongoing need for improved, harmonized, randomized, phase-II trial design. To analyze changes in recurrent/refractory osteosarcoma phase II trials over time to inform future trials in this population with poor prognosis. A systematic review of trials registered on trial registries between 01/01/2017–14/02/2022. Comparison of 98 trials identified between 2003 and 2016. Publication search/analysis for both periods, last update on 01/12/2022. Between 2017 and 2022, 71 phase-II trials met our selection criteria (19 osteosarcoma-specific trials, 14 solid tumor trials with and 38 trials without an osteosarcoma-specific stratum). The trial number increased over time: 13.9 versus 7 trials/year (p = 0.06). Monotherapy remained the predominant treatment (62% vs. 62%, p = 1). Targeted therapies were increasingly evaluated (66% vs. 41%, P = 0.001). Heterogeneity persisted in the trial characteristics. The inclusion criteria were measurable disease (75%), evaluable disease (14%), and surgical remission (11%). 82% of the trials included pediatric or adolescent patients. Biomarker-driven trials accounted for 25% of the total trials. The survival endpoint use (rather than response) slightly increased (40% versus 31%), but the study H 1 /H 0 hypotheses remained heterogeneous. Single-arm designs predominated over multiarm trials (n = 7). Available efficacy data on 1361 osteosarcoma patients in 58 trials remained disappointing, even though 21% of these trials were considered positive, predominantly those evaluating multi-targeted kinase inhibitors. Despite observed changes in trial design and an increased number of trials investigating new therapies, high heterogeneity remained with respect to patient selection, study design, primary endpoints, and statistical hypotheses in recently registered phase II trials for osteosarcoma. Continued optimization of trial design informed by a deeper biological understanding should strengthen the development of new therapies. [ABSTRACT FROM AUTHOR]

Background: The psychometric properties of the Dutch version of the Stroke and Aphasia Quality Of Life-scale (SAQOL-39NL) have previously been assessed for people with aphasia after stroke, but not yet for stroke survivors without aphasia. Objective: The objective is to evaluate the psychometric properties of the SAQOL-39NL in a stroke sample with and without aphasia. Methods: The SAQOL-39NL was administered to survivors of stroke (N = 141) who received rehabilitation in specialized rehabilitation facilities, 3 and 6 months after the start of rehabilitation. Acceptability was explored by assessing floor and ceiling effects and missing items. For internal consistency, Cronbach's alpha and item-total correlations were computed. For internal validity, intercorrelations between domains, and between domains and total score, were assessed. Convergent validity was evaluated by correlation with EuroQoL-5D scores. Responsiveness to change was investigated using d′ and SRM-scores. Results: Mean age was 60.4 years (SD = 11.1), 62.4% were male. Mean total SAQOL-39NLg score was 3.94 (SD = 0.68, scale 1-5). No floor or ceiling effects and 2.4% missing data were found. Internal consistency was excellent (Cronbach's alpha = 0.96). Intercorrelations between domains and total scale were moderate to excellent (r = 0.57-0.88). Intercorrelations between domains were low to moderate (r = 0.22-0.63). The correlation with the EQ-5D was moderate (r = 0.57). Only small changes in SAQOL-39NLg scores were found between 3 and 6 months. Conclusions: These data provide further evidence for the acceptability, internal consistency, and initial promising data on validity of the SAQOL-39NLg. Further research on structural validity and responsiveness to change is needed. [ABSTRACT FROM AUTHOR]

• The results from one of the first integrative reviews on learning for transitions. • Learning is a process of acquiring new information and of meaning-making. • Social learning and transformative learning as dominant theoretical perspectives. • The relationship between learning and change is not deeply analysed. • Research prospects include regime-level learning, networks and power/trust. Learning has been put forward as a critical aspect to achieve sustainable transformation of societal systems. However, there is a lack of a systematic review of empirical evidence on how learning is related to sustainability transitions. To bridge this gap, we systematically reviewed 113 empirical papers that addressed the role of learning in transitions. Our results show that the complexity of the relationship between learning and transitions is not deeply analysed and that there is a need to distinguish more precisely between learning processes and learning outcomes. Further, there is a need to shift the focus towards analysing regime-level learning to increase our understanding of how learning contributes to system transformation. Finally, networks, trust, disagreement, and power are key aspects related to learning that will require further examination, especially in terms of how they play out dynamically in learning for sustainability transitions. [ABSTRACT FROM AUTHOR]

Waste from the global paper life cycle can be a lost economic opportunity and a risk to the natural environment and human health. This study assesses the recovery potential of major waste flows in the global paper life cycle to support improvements in material use. The “recovery potential” indicator shows the technical possibility for extracting value from waste through recycling and other forms of recovery. The potential is identified through a review of recovery technologies that are currently applied or likely to be commercially available by the year 2050. The analysis compares current material use in the global paper life cycle with an ideal scenario in which the recovery potential of all major waste flows is fulfilled. In the ideal scenario, the Recycled Input Ratio (RIR) is increased from 38% to 67%–73% and the landfill intensity is reduced from 331–473 kg/t paper to 0–2.6 kg/t paper. The reduction in required landfill space is achieved mainly through increased consumer waste recycling. Better management of industrial waste from the paper sector has a rather limited impact on the RIR and landfill intensity. The conditions for successful recovery of waste are discussed separately. The analysis shows that the recovery potential indicator can be usefully applied to estimate potential improvements in complex material systems and the findings may inform policies for resource efficiency and the circular economy. [ABSTRACT FROM AUTHOR]

Does retirement lead to a short, transitory health boost, followed by a stable longer-run effect? The short-run effect has been hypothesized to be a kind of honeymoon effect, that is followed by a longer-run effect that may be either positive or negative. We examine the time path of the health effect of retirement and study effect heterogeneities between individuals along several dimensions. Moreover, we study a broad range of health outcomes, all in order to come to an understanding of the effect patterns that lie behind the diverse findings reported in previous research. For identification we use a fixed effects instrumental variable approach in which the normal and early retirement age thresholds serve as instruments. Using data for 10 countries from the Survey of Health, Retirement and Ageing in Europe (SHARE), we find that retiring both at the normal and early retirement eligibility ages significantly improves all the health aspects we consider. Other than hypothesized, results do not show a honeymoon phase-like transitory health boost. Instead, especially blue-collar workers go through an adjustment period after retiring, in which their health worsens. Afterwards, health stabilizes and improves, so that retirement has a health preserving effect in the longer run. This beneficial health effect of retirement occurs across all occupational groups, across a range of health outcomes, and for both sexes, though there are a number of heterogeneities between groups regarding which health outcomes are particularly affected. • A transitory health boost ("honeymoon phase") after retirement has been hypothesized. • No evidence is found for the existence of such a phase. • On the contrary, some workers go through an adjustment phase in which health worsens. • After this phase, health stabilizes and retirement has beneficial health effects. • This health preserving effect is found across health dimensions, occupational groups, and sexes. [ABSTRACT FROM AUTHOR]

Purpose The tumor biology of older breast cancer patients (oBCP) is usually less aggressive, however applied adjuvant treatment is often less potent resulting in an impaired disease free survival and overall survival in this group. This study tries to answer the following questions for the biological subtypes of oBCP (70+ y): (1) Is there a significant difference in the distribution of the biological subtypes of oBCP vs younger breast cancer patients (yBCP; 50–69 y)? (2) Which biological subtype has the highest rate of non-guideline-adherent-treatment (GL−) among oBCP? (3) Is a single GL− (i.e. radiotherapy/surgery/endocrine-therapy/chemotherapy) significantly associated with the survival outcome in each biological subgroup? Methods Between 1992 and 2008 the BRENDA (‘BRENDA’ = quality of BREast caNcer care unDer evidence-bAsed guidelines) study group recorded medical data of 17 participating certified breast cancer centers in Germany. We performed a retrospective multi-center database analysis of 5632 patient records. Guideline-adherent-treatment (GL+) of oBCP(n = 1918) was compared to GL+ of yBCP(n = 3714). Results OBCP were more likely to have hormone receptor positive (HR+) and HER2 neu negative (HER2−) breast cancer (77.5% vs 74.5%). The rate of GL− was significantly different (p < 0.001) between the age groups and the biological subgroups (yBCP vs oBCP: 21.8%vs38.8% (HR+/HER2−); 30.6%vs49.7% (HR+/HER2+); 23.6%vs69.5% (HR−/HER2+); 31.4%vs67.8% (TNBC)). The survival parameters for HR+/HER2− and TNBC were significantly worse in case of GL− regarding chemotherapy, and if applicable endocrine therapy. A similar association only existed in HR−/HER2+ tumors for GL− for radiotherapy and in HR+/HER2+ tumors for chemotherapy. Conclusions Beside the significantly different distribution of biological subtypes in the age groups there is an association between biological subtype, and GL+ influencing survival parameters in oBCP. [ABSTRACT FROM AUTHOR]

Learning in higher education provides students with a high degree of autonomy and therefore requires them to self-regulate their learning. However, not every student copes effectively with this autonomy. Particularly, self-monitoring plays a pivotal role. With this study, we investigated the effect of a standardized electronic learning diary on self-regulation competence in the context of an academic teacher training program. The diary was used (a) as an online assessment tool to register self-regulation, motivational, and volitional states over time and (b) as an instrument for implicit intervention aimed at improving self-monitoring. In a pretest-posttest control group design, we compared two courses (N = 65) over one study term, one course serving as the experimental group (EG) with learning diaries. The EG showed higher gains in metacognitive attitude scores; additional process analyses revealed a positive trend for estimated learning efficacy. Results suggest that the intervention could benefit from explicit training to strengthen the effects. [ABSTRACT FROM AUTHOR]

Highlights: [•] We investigate effectiveness of instructed learning strategies through meta-analysis. [•] The most effective strategies are planning and the motivational aspect task value. [•] Instructing metacognitive knowledge enhances effectiveness of strategies. [•] Highest effects are found in writing, lowest effects in reading. [•] Effect sizes are moderated by type of instrument measuring academic performance. [ABSTRACT FROM AUTHOR]

Teachers' behavior in the classroom can be assessed from different perspectives using teacher ratings, student ratings, or classroom observations. This article presents an observation instrument to assess teachers' promotion of self-regulated learning (SRL), capturing teachers' instruction of self-regulation strategies as well as characteristics of the learning environment that should foster students' self-regulation. Thirty-four classroom videotapes were systematically coded regarding teachers' promotion of SRL. Moreover, student and teacher ratings were collected to compare different perspectives. For the prediction of students' SRL, the value of observation data and of teacher and student ratings was analyzed. The results sug-gested that teacher and observer ratings did not agree, and that teacher and student ratings agreed to some extent. Regression analysis showed that the instruction of metacognitive strategies assessed through observations as well as through student ratings significantly predicted students' SRL, whereas the ratings of the observed learning environment predicted student SRL and achievement negatively. In addition, teachers' perceptions of fostering situated learning also predicted SRL of their students. [ABSTRACT FROM AUTHOR]

This study investigates the potential of discrete return light detection and ranging (lidar) data to characterize forest succession in a mixed mature forest in central Ontario using indices applied to the lidar point cloud. Derived indices include statistical indices, predicted Lorey's height (R² = 0,86; RSME = 2.36 m) and quadratic mean diameter- at-breast-height (R² = 0.68; RMSE = 1.21 cm), canopy density indices and an information theory based complexity index. To assess how well these indices are able to capture the vertical structure of forest stands, they are compared to Oliver and Larson's (1996) four stages of forest stand development. Best subsets regressions indicated that no single index is able to separate all four stages adequately. However, the predicted Lorey's height index is optimal for separating early from mid succession stages (p <.0001) and a combination of height and complexity indices performed best to discriminate between mid- and late-succession stages (p <.0001). [ABSTRACT FROM AUTHOR]

Abstract: Previous studies on the effects on students’ test scores of their peers’ socioeconomic status (SES) reported varying results. A meta-regression analysis including 30 studies on the topic shows that the compositional effect that researchers find is strongly related to how they measure SES and to their model choice. If they measure SES dichotomously (e.g. free lunch eligibility) or include several average SES-variables in one model, they find smaller effects than when using a composite that captures several SES-dimensions. Composition measured at cohort/school level is associated with smaller effects than composition measured at class level. Researchers estimating compositional effects without controlling for prior achievement or not taking into account the potential for omitted variables bias, risk overestimating the effect. Correcting for a large set of not well-thought-over covariates may lead to an underestimation of the compositional effect, by artificially explaining away the effect. Little evidence was found that effect sizes differ with sample characteristics such as test type (language vs. math) and country. Estimates for a hypothetical study, making a number of “ideal” choices, suggest that peer SES may be an important determinant of academic achievement. [Copyright &y& Elsevier]

Objectives: To investigate the occurrence of respiratory pathogens in samples from children with and without respiratory symptoms and to identify whether age and/ or coinfections modify the impact of respiratory pathogens on symptoms. Study design: In a prospective longitudinal study, 18 children were sampled biweekly for respiratory pathogens, irrespective of respiratory symptoms. Polymerase chain reaction was performed for 13 respiratory pathogens. Episodes were defined “asymptomatic” if no symptoms of any respiratory tract illness were present between 1 week before and 1 week after sampling. Results: A total of 230 samples were collected. In 56% of the symptomatic episodes, a pathogen was detected, compared with 40% of the asymptomatic episodes (P = .03). Rhinovirus and coronaviruses were most prevalent in both symptomatic and asymptomatic episodes. In the youngest children, 9% of the pathogen-positive episodes were asymptomatic, compared with 36% in the oldest children (P = .01). Multiple pathogens were found in 17% of the symptomatic episodes and in 3% of the asymptomatic episodes (P = .02). Conclusions: Respiratory pathogens are frequently detected in samples from children with no respiratory symptoms. Symptomatic cases occurred more often in younger children and with detections of more than 1 respiratory pathogen. [Copyright &y& Elsevier]

Loss of histone 3 lysine 27 trimethylation (H3K27me3) has been described as a diagnostic marker for malignant peripheral nerve sheath tumor (MPNST), also discriminating MPNST with rhabdomyoblastic differentiation (malignant Triton tumor) from rhabdomyosarcoma (RMS). We studied the immunohistochemical expression of H3K27me3 in embryonal RMSs (ERMSs), performed methylation profiling in order to support the diagnosis and RNA-sequencing for comparison of the transcriptome of H3K27me3-positive and -negative cases. Of the 25 ERMS patients, 17 were males and 8 were females with an age range from 1 to 67 years (median, 6 years). None were known with neurofibromatosis type 1. One patient had Li-Fraumeni syndrome. Tumor localization included paratesticular (n = 9), genitourinary (n = 6), head/neck (n = 5), retroperitoneal (n = 4) and lower arm (n = 1). Five MPNSTs served as reference group. All ERMS had classical features including a variable spindle cell component. Immunohistochemical loss (partial or complete) of H3K27me3 was detected in 18/25 cases (72%). Based on methylation profiling, 22/22 cases were classified as ERMS. Using RNA sequencing, the ERMS group (n = 14) had a distinct gene expression profile in contrast to MPNSTs, confirming that the H3K27me3 negative ERMS cases do not represent malignant Triton tumors. When comparing H3K27me3-negative and -positive ERMSs, gene set enrichment analysis revealed differential expression of genes related to histone acetylation and normal muscle function with H3K27me3 negative ERMSs being associated with acetylation. Conclusion: Loss of H3K27me3 frequently occurs in ERMSs and correlates with H3K27 acetylation. H3K27me3 is not a suitable marker to differentiate ERMS (with spindle cell features) from malignant Triton tumor. • Loss of H3K27me3 has been detected in 72% of embryonal rhabdomyosarcomas (ERMSs) • RNA-sequencing analysis demonstrates a distinct gene expression profile of ERMSs compared to MPNST • Gene set enrichment analysis differentiates H3K27me3-negative from -positive ERMSs by genes involved in histone acetylation • Loss of H3K27me3 in ERMS correlates with H3K27 acetylation. • Deficient H3K27me3 cannot differentiate ERMS with spindle cell features from MPNST [ABSTRACT FROM AUTHOR]