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Der Beitrag arbeitet mit Bezug auf das bekannte Adorno Zitat »Die Forderung, dass Auschwitz nicht noch einmal sei, ist die allererste an Erziehung« die Relevanz der Auseinandersetzung mit dem Konzept der Inklusiven Bildung im Verständnis einer »Bildung für alle« im Kontext gegenwärtiger globaler Krisen heraus. Dabei rückt insbesondere die politische Dimension der Kategorie Be_Hinderung in den Vordergrund, wenn im Sinne Klafkis Bildungsfragen als Gesellschaftsfragen behandelt werden. Nach einer menschenrechtlichen Herleitung des Begriffs der Inklusiven Bildung werden mit Bezug zu den Konzepten Intersektionalität und Othering die Operationalisierbarkeit von »alle« als Adressat*innen Inklusiver Bildung diskutiert und dem entgegenstehende Ausgrenzungsprozesse und ihre Wirkungsweisen im Bildungssystem in den Blick genommen. Pädagogisches Denken und Handeln findet diesem Verständnis nach dann stets in widersprüchlichen Verhältnissen statt, in denen jedoch subjektive Möglichkeitsräume (vgl. Riegel, 2016) ent-deckt und genutzt werden können.

OBJECTIVE: The feet of professional dancers are exposed to high work-related stresses. To date, data from the professional dance sector concerning this matter are lacking. The aim of this exploratory project was to analyze and evaluate skin health in the foot area with regard to the prevalence of dermatoses, their locations, as well as gender-specific and load-specific differences. METHODS: Professional classical and neo-classical ballet dancers were examined at two time points: in a phase with increased stress (T0: daily training sessions, rehearsals, and high performance frequency) (n=51, 35 females, 16 males) and after a 24-day rest phase (T1: n=35, 28 females, 7 males). In addition, gender-specific and load-specific (T0 and T1) differences were evaluated. RESULTS: All professional dancers were affected by skin lesions of the feet at T0. Hyperkeratosis (96.1%), onychomycosis (27.5%), and subungual hematoma (11.8%) were the most frequent dermatoses of the feet of professional dancers. Onychomycosis affected the nails of the big toes in particular (right 15.7%; left 13.7%), and subungual hematomas were found exclusively on the nails of the first toe (right 7.8%; left 7.8%). Women tended to be more frequently affected by hyperkeratosis, men more frequently by onychomycosis. There were no load-specific differences between the stress and rest phases. CONCLUSION: The prevalence of work-related dermatoses is equally high among female and male dancers. The results can be used for further research and serve as a basis for specific measures of behavioral and environmental prevention in dance.

Background: As outcomes improve in early-stage breast cancer, clinical trials are undergoing a paradigm shift from intensification trials (more therapy) to improve survival to optimization trials, which assess the potential for using less toxic therapy while preserving survival outcomes. However, little is known about physician perspectives in community and academic settings about possible barriers and facilitators that could impact accrual to optimization clinical trials and about the generalizability of future findings. Methods: We conducted a qualitative study with semi-structured interviews of medical oncologists from different academic and community practices to assess their perspectives on optimization trials. Interviews were audio-recorded and transcribed. Three independent coders utilized a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. Results: Forty-six physicians were approached from 3/31/21-11/5/21; 39 oncologists from different oncology practices across 17 states completed interviews, 7 either declined or did not respond to email requests. Physician characteristics were balanced: men vs. women (49% vs 51%) and community oncologist vs. academic oncologist (49% vs 51%); and time practicing as medical oncologist (31% 0-9 years; 33% 10-19 years; 36% 20+ years). All 39 physicians reported that they would enroll patients in optimization clinical trials. Oncologists reported the need for treatment optimization, with one oncologist noting “historically, we’ve given way too much treatment to patients.” Oncologists highlighted specific reasons to consider optimization trials. They included quality of life improvement by reducing toxicity; reduction in financial toxicity; fertility preservation; ability to avoid chemotherapy; minimization of overtreatment in patients with comorbid conditions; personalized treatment; opportunities to test novel therapies; and leveraging the availability of targeted therapies. At the same time, there was hesitancy amongst some oncologists with this approach, “All my life I’ve worked to try to improve things and so I am not totally philosophically comfortable with the notion that I’m going to be happy with a result that says, we haven’t improved it but we can get by with less.” In addition, oncologists also identified accrual barriers, like tumor-specific biology, individual (host) factors (e.g. disease characteristics, patient demographics, patient psychological state, patient preferences), prognostic markers of risk, access to therapies, provider experience, and system constraints. They voiced recommendations regarding preliminary data, trial design, and tools to support communication about and enrollment in optimization trials. Conclusions: While optimization clinical trials are generally accepted to be beneficial by oncologists, barriers impact their acceptance. Scientifically robust design and education to overcome barriers are needed to support future enrollment on trials tailoring therapy based on risk and potential benefit to allow true personalization of treatment. Citation Format: Gabrielle B. Rocque, Andrews Courtney, Rachel M. Frazier, Lawhon Valerie, Stacey A. Ingram, Mary Lou Smith, Lynne I. Wagner, Lisa Zubkoff, Nadine Tung, Lauren P. Wallner, Antonio C. Wolff. Oncologist-reported Barriers and Facilitators to enrolling patients in optimization trials that test less intense cancer treatment [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-09-04.

Background: Community learning is one approach to promote research competencies and to involve nurses and nursing students in research. This study examines the impact of community learning according to participants—both those inside and outside the community—in a joint nursing research project at a hospital. Method: A qualitative design was selected using a participatory approach. Data were collected through semistructured interviews, reflections, conversations, and patient input during 2 academic years. Results: Thematic analysis showed 11 themes, which were organized into three clusters: realization, transformation, and influencing factors. Participants perceived changes in practice and described how their perspectives have changed on care, education, and research. Reconsiderations led to some new or revised strategies, and influencing factors were associated with the contemporary context, degree of involvement, and design/facilitation. Conclusion: The impact of community learning emerged and extended beyond community boundaries, and the indicated influencing factors must be taken into account. [ J Contin Educ Nurs. 2023;54(3):131–144.]

PURPOSE: As outcomes improve in early-stage breast cancer, clinical trials are undergoing a paradigm shift from intensification trials (more therapy) to improve survival to optimization trials, which assess the potential for using less toxic therapy while preserving survival outcomes. However, little is known about physician perspectives in community and academic settings about possible barriers and facilitators that could affect accrual to optimization clinical trials and the generalizability of future findings. METHODS: We conducted a qualitative study with semistructured interviews of medical oncologists from different academic and community practices to assess their perspectives on optimization trials. Interviews were audio-recorded and transcribed. Three independent coders used a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. RESULTS: All 39 physicians reported that they would enroll patients in optimization clinical trials. Oncologists highlighted specific reasons to consider optimization trials. These included quality-of-life improvement by reducing toxicity, reduction in financial toxicity, fertility preservation, ability to avoid chemotherapy, minimization of overtreatment in patients with comorbid conditions, personalized treatment, opportunities to test novel therapies, and leveraging the availability of targeted therapies. Oncologists also identified accrual barriers, such as tumor-specific biology, individual (host) factors, prognostic markers of risk, access to therapies, provider experience, and system constraints. They voiced recommendations regarding preliminary data, trial design, and tools to support enrollment in optimization trials. CONCLUSION: Although oncologists are generally willing to enroll patients on optimization clinical trials, barriers affect their acceptance. A scientific focus on overcoming these barriers is needed to support future enrollment on trials tailoring therapy on the basis of risk and potential benefit to allow true personalization of treatment.

The oral cavity is densely populated with microorganisms. As a result, intraoral surgical sites are prone to contamination by pathogens, potentially triggering surgical site infections (SSIs). Prophylactic antibiotics have proven beneficial in reducing the rate of SSIs. However, no consensus has been reached regarding the most effective regimen. The purpose of this study was to investigate two different antibiotic regimens - single-dose and prolonged antibiotic prophylaxis - regarding the rate and severity of postoperative SSIs in patients undergoing orthognathic surgery. Data were analysed retrospectively. Patients who underwent bilateral sagittal split ramus osteotomy or bimaxillary surgery in the study department in 2017 were screened for eligibility. Ninety-nine patients were included in the study and were divided into two groups. The prolonged-antibiotic prophylaxis group (PAP; n = 49) received a 5-day antibiotic prophylaxis regimen, while the single-dose antibiotic prophylaxis group (SDAP; n = 50) received single-dose antibiotic prophylaxis. The groups were assessed for the rate and severity of SSIs following orthognathic surgery. Five patients (10.2%) in the PAP group and seven (14%) in the SDAP group developed infections; no statistically significant difference in the occurrence of SSIs was found (P = 0.380). Single-dose antibiotic prophylaxis is as effective as a 5-day antibiotic prophylaxis regimen in preventing SSIs in orthognathic surgery and is a suitable antibiotic prophylaxis option when considering the risk of antibiotic resistance.

The female breast is a symbol of femininity and plays a key role in the female body image. However, factors influencing the preferences for different breast shapes and sizes are still not elucidated. In particular, the role of the emerging social media in breast perception has not been analyzed yet. A representative cohort of 1,049 adults completed a web-based questionnaire containing hyperrealistic 3D models of the female breast in the United States. A machine-learning algorithm (Classification and Regression Tree [CART]) was implemented to identify the most influential factors. The study was able to identify the frequency of pornographic and social media consumption as the most influencing factor for altered breast preferences. Although digital media exposure did not alter satisfaction with the own breast among female participants, the tendency to undergo or history of conducted aesthetic surgery correlated with higher access frequency to digital media. Taken together, the overpowering impact of social media and pornographic consumption on the own body image was shown in preference alterations for different anatomical aspects of the breast in the whole population and distorted self-perception about the breast in female participants.

Impaired microcirculation, along with an increase in chronic medical conditions in the geriatric cohort, may favor the development of soft-tissue defects in the lower extremity and equally impair the options for plastic-reconstructive surgery. In particular, outcome analyses in the increasing patient cohort ≥ 80 years (octogenarians) are limited.Setting 80 years as the cutoff, we conducted an age-related outcome analysis of all patients undergoing free-flap reconstruction of the lower extremity from 2014 to 2020, comprising the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI) as the possible outcome predicting factors.During the study period, a total of 424 free flaps were performed in 385 patients (∅: 54.7 years ± 16.1; range: 9-89), including 19 octogenarians. Compared with the younger patient cohort, there was a significantly higher rate of early flap revision (p = 0.023) and flap loss (p = 0.028). Furthermore, the mean length of hospital (60.6 ± 37.6 vs. 51.1 ± 37.0) and intensive care unit/intermediate care stay (6.5 ± 15.0 vs. 3.5 ± 8.5) was extended (n.s.). The ASA score presented an independent predictor for major surgical [odds ratio (OR): 1.66; p = 0.041) and medical complications (OR: 3.97; p0.001). Neither the CCI nor the ASA served as an independent predictor for total flap loss.Free-flap reconstruction of the lower extremity in octogenarians is associated with a higher risk of flap revision and flap loss. Considering the prolonged immobilization associated with increased morbidity following limb amputation, it presents still a reasonable option to achieve limb salvage in carefully chosen patients. An adequate tool to predict the success of free-flap survival is still unavailable.

This study analyzes the comparative economic outcomes of the U.S. Department of Defense (DoD) Small Business Innovation Research and Small Business Technology Transfer (SBIR/ STTR) programs, conducting an analysis to determine if high-award states or low-award states are more effective at commercializing technology as a direct result of the DoD SBIR/STTR programs. Three common definitions of underserved states are used for this analysis — states that receive fewer awards (underserved), states that receive relatively fewer awards when adjusted for population, and states participating in the National Science Foundation's Established Program to Stimulate Competitive Research. The data used in these analyses represent the economic outcomes of the entire survey population of DoD SBIR Phase II awards on which information was obtained (a total of 96 percent of the 16,959 awards in the study). The findings indicate that commercialization success of DoD SBIR Phase II projects in underserved states was superior to those in high-award states. Sixty different measures were used to compare the relative success of these different states and awardees. Analysis showed that underserved states consistently outperformed high-award states in commercializing the outcomes of their DoD SBIR Phase II projects. For 47 of the 60 different measures — 30 of which were statistically significant for low-award states — the low-award states outperformed the high-award states. On only 10 of the 60 measures did the high-award states show superior results. These results support the argument that SBIR program efforts to assist firms in low-award states are a sound investment. However, the findings call for additional research as to why states with fewer awards, fewer awards per capita, and other disadvantages have more commercial success with their awards than select counterparts.

The nymphs of Acutalis Fairmaire, Bordoniana Sakakibara, Thrasymedes Kirkaldy, and Micrutalis Fowler are described and illustrated (Bordoniana and Thrasymedes for the first time). The nymphs of all four genera are exceedingly cryptic. The nymphs of some species lack scoli on the head and pronotum but all have paired scoli on the meso- and metathoracic nota and abdominal segments III–IX. Some species also have lateral rows of enlarged chalazae on the abdomen, and even large scoli ventrolaterally—the latter condition is unique within Smiliinae. The eggs are deposited in stems (not in exposed masses) and nymphs are solitary and not ant-attended. The fifth instar nymphs of Micrutalini range in length from 3.0–3.5 mm, much smaller than the fifth instars of most other treehoppers.

In recent years, the issue of the relationships between the state and the Catholic Church has been increasingly present in public discourse in Poland. New political parties have become embroiled in the debate, taking diverse stances. The paper discusses the attitude of new political parties in Poland towards religion and the Catholic Church, using three groupings as examples: the Palikot Movement [Ruch Palikota], Robert Biedroń’s Spring [Wiosna Roberta Biedronia] and the Together Party [Partia Razem]. The authors, using content analysis as the research method, reviewed the party policies and media statements made by politicians on the topic. The aim of the article is to investigate the positions taken by selected political parties towards religion and the Catholic Church and to verify the hypothesis that the new left-wing parties advocate a strict separation of church and state.

ZusammenfassungDer Klimawandel ist eine Gefahr für Gesundheit und soziale Sicherheit von Milliarden von Menschen. Gesundheit und Lebensqualität werden unter dem Einfluss der Klimakrise zunehmend auf vielfältige Weise beeinträchtigt. Der Anstieg der globalen Temperaturen hat häufigere, stärkere Extremwetterereignisse zur Folge, die insgesamt und speziell in der Gesundheitsversorgung zur weiteren Aggravierung von Ungleichheit, Diskriminierung und Ungerechtigkeit beitragen. Zudem begünstigen die klimatischen Bedingungen die Übertragung zahlreicher Infektionskrankheiten und ihr Vordringen in neue Regionen. Sozio-ökonomisch benachteiligte Gebiete mit schwacher Gesundheitsinfrastruktur, etwa im globalen Süden, werden am wenigsten in der Lage sein, ohne gezielte Unterstützung die Folgen der Klimakrise zu bewältigen. Oberstes Gebot ist es, die Verringerung der Treibhausgasemissionen in den Bereichen Verkehr, Energie- und Nahrungsmittelproduktion zu erreichen – auf globaler, nationaler und regionaler Ebene, um negative Gesundheitsfolgen zu mildern. Das Pariser Übereinkommen (2015) ist daher auch als entscheidendes Gesundheitsabkommen zu begreifen. Der Fokus dieses Beitrages liegt auf ethischen Aspekten des Klimawandels im Gesundheitsbereich.

In this article, we investigate geometric properties and modeling capabilities of quad meshes with planar faces whose mesh polylines enjoy the additional property of being contained in a single plane. This planarity is a major benefit in architectural design and building construction: If a structural element is contained in a plane, it can be manufactured on the ground without scaffolding and put into place as a whole. Further, the plane it is contained in serves as part of a so-called support structure. We discuss design of meshes under the requirement that one half of mesh polylines are planar (“P meshes”), and we also investigate the geometry and design of meshes where all polylines enjoy this property (“PP meshes”). We work in the space of planes and with appropriate transformations of that space. We also incorporate further properties relevant for architectural design, such as near-rectangular panels and repetitive nodes. We provide geometric insights, give explicit constructions, and show an approach to geometric modeling of both P meshes and PP meshes, in particular, the case of nearly rectangular panels.

Gallibacterium spp., particularly G. anatis, have received much attention as poultry pathogens in recent years. We report here the presence and antimicrobial resistance profile of 69 Gallibacterium isolates obtained from 2,204 diagnostic submissions of broiler and layer chickens in 2019–2021. Gallibacterium-positive chickens had lesions primarily in the respiratory tract, reproductive tract, and related serosal surfaces. Gallibacterium spp. were initially identified based on their typical cultural characteristics on blood agar. The isolates were confirmed by a genus-specific PCR spanning 16S-23S rRNA and MALDI-TOF mass spectrometry. Phylogenetic analysis based on 16S rRNA gene sequence revealed distinct clades. Of the 69 isolates, 68 clustered with the reference strains of G. anatis and 1 with Gallibacterium genomospecies 1 and 2. Antimicrobial susceptibility testing of 58 of the 69 isolates by a MIC method showed variable responses to antimicrobials. The isolates were all susceptible to enrofloxacin, ceftiofur, florfenicol, and gentamicin. There was a high level of susceptibility to trimethoprim–sulfamethoxazole (98.0%), streptomycin (98.0%), amoxicillin (84.0%), sulfadimethoxine (71.0%), and neomycin (71.0%). All of the isolates were resistant to tylosin. There was resistance to penicillin (98.0%), erythromycin (95.0%), clindamycin (94.0%), novobiocin (90.0%), tetracycline (88.0%), oxytetracycline (76.0%), and sulfathiazole (53.0%). A high rate of intermediate susceptibility was observed for spectinomycin (67.0%) and sulfathiazole (40.0%). Our findings indicate a potential role of G. anatis as an important poultry pathogen and cause of subsequent disease, alone or in combination with other pathogens. Continuous monitoring and an antimicrobial susceptibility assay are recommended for effective treatment and disease control.

The present contribution concentrates on the different effects of Si and Al on the carbide precipitation and austenite decomposition during the Q&P-process and an additional galvannealing treatment of up to 560 °C. These effects have been investigated by dilatometry (derivation of relative length change) and differential scanning calorimetry (heat flow) during tempering. It was possible to show the beneficial effect of Si on retarding the carbide precipitation in tempered martensite and thereby the ability to stabilize higher amounts of retained austenite compared to Al. Furthermore, the effect on retained austenite decomposition during Q&P and subsequent galvannealing could be demonstrated. Here, Al has the benefit to increase the thermal stability of austenite during galvannealing.

ZusammenfassungEinleitung Der freie Transfer einer Gewebelappenplastik mit mikrochirurgischem Anschluss ist häufig eine tagesauslastende Tätigkeit. Eine Standardisierung dieser Operationen gestaltet sich auf Grund der eingeschränkten Planbarkeit des OP-Verlaufs mit einhergehender zeitlicher Varianz immer wieder als schwierig. Dies erschwert die Planung und damit die optimale Kapazitätsauslastung erheblich. Methoden In den Jahren 2018–2020 wurden die Schnitt-Naht-Zeiten (SNZ) bei den in der Klinik am häufigsten durchgeführten freien ALT-Lappenplastiken zur Extremitätenrekonstruktion bezogen auf das Erfahrungsniveau des Operationsteams (Kategorie 1:200 freie Lappenplastiken) und die Nebenerkrankungen der Patienten analysiert. Die Kostenstruktur am Standort wurde mit der InEK Kostenmatrix abgeglichen.Ergebnisse In der vorliegenden Arbeit konnte gezeigt werden, dass im Rahmen der mikrochirurgischen Extremitätenrekonstruktion das Erfahrungsniveau des Operationsteams einen signifikanten Einfluss auf die SNZ hat. Bei ALT-Lappenplastiken waren unter Berücksichtigung von Komplikationen Kategorie 2 Operateure durchschnittlich 45 Minuten, Kategorie 3 Operateure 167 Minuten schneller. Umgekehrt hatten Nebenerkrankungen keinen signifikanten Einfluss auf die Operationsdauer. Bezogen auf die Kostensituation zeigte sich eine zumeist defizitäre Situation in Relation zur InEK Kostenmatrix. Eine weitere Analyse zeigte hingegen, dass die SNZ für freie Lappenplastiken im Durchschnitt, die Personalkosten/Schnitt-Naht-Minute unseres Krankenhauses knapp unter dem Bundesdurchschnitt lagen. Die Kosten für einen mikrochirurgischen Weiterbildungseingriff liegen nach dieser Berechnung in der Größenordnung von 1000 €/Fall. Diskussion & Schlussfolgerung Freie Lappenplastiken zur Extremitätenrekonstruktion sind nicht komplett adäquat im deutschen DRG-System abgebildet. Bezogen auf die Weiterbildung konnte gezeigt werden, dass diese bedingt durch längere SNZ nicht kostenneutral ist. Durch Hinterlegung der identifizierten operateurbedingten Zeiten im Krankenhausinformationssystem sollte eine bessere Vorgabezeitgüte mit aufgewerteter Termintreue und effizienterer Auslastung der wertvollen Ressource OP-Kapazität resultieren.

BackgroundThe pandemic has upended much clinical care, irrevocably changing our health systems and thrusting emergency physicians into a time of great uncertainty and change. This study is a follow-up to a survey that examined the early pandemic experience among Canadian emergency physicians and aimed to qualitatively describe the experiences of these physicians during the global pandemic. The study was conducted at a time when Canadian COVID-19 case numbers were low.MethodsThe investigators engaged in an interview-based study that used an interpretive description analytic technique, sensitised by the principles of phenomenology. One-to-one interviews were conducted, transcribed and then analysed to establish a codebook, which was subsequently grouped into key themes. Results underwent source triangulation (with survey data from a similar period) and investigator-driven audit trail analysis.ResultsA total of 16 interviews (11 female, 5 male) were conducted between May and September 2020. The isolated themes on emergency physicians’ experiences during the early pandemic included: (1) disruption and loss of emergency department shift work; (2) stress of COVID-19 uncertainty and information bombardment; (3) increased team bonding; (4) greater personal life stress; (5) concern for patients’ isolation, miscommunication and disconnection from care; (6) emotional distress.ConclusionsCanadian emergency physicians experienced emotional and psychological distress during the early COVID-19 pandemic, at a time when COVID-19 prevalence was low. This study’s findings could guide future interventions to protect emergency physicians against pandemic-related distress.

One strategy to improve the effectiveness of intravascular brachytherapy (IVBT) is to study its failures. Previous investigations described mostly discrete, focal recurrences, typically at the proximal or distal edges of the irradiated segment after plain angioplasty or bare metal stents. We reviewed failure patterns of 30 unselected drug-eluting stent (DES) patients who had follow-up angiograms for recurrence within their IVBT-treated vessel.Records of 53 unselected IVBT patients treated between 2016 and 2021 were reviewed. Thirty of the 53 patients had at least one subsequent percutaneous intervention (PCI) for in-stent restenosis (ISR) after IVBT. Angiographic findings of those 30 patients with ISR within their previously irradiated vessel are reported here.Of the 30 patients, 21 (70%) developed recurrent ISR within the irradiated segment. Six of the 21 patients who failed within the irradiated segment also experienced ISR proximal or distal to the irradiated segment. Only 15 patients (50%) failed exclusively within the irradiated segment. In nine patients (30%), restenosis occurred proximally and/or distally to the irradiated segment, but not inside of the irradiated segment itself.We have shown here that 50% of failures after coronary IVBT for DES ISR occur exclusively within the irradiated segment. An additional 20% of patients had failure within and outside of the irradiated segment. These percentages suggest that a higher radiation dose might improve the long-term patency rates, a conclusion that should be tempered by the lack of universal follow-up.

Aim of this study was to compare the use of split-thickness skin graft (STSG) with and without additional MatriDermThis retrospective study included patients treated in a European level I trauma center between June 2013 and July 2018 in terms of a severe traumatic soft tissue defect of the lower extremity using STSG alone or in combination with the acellular dermal substitute MatriDermA total of 147 cases were included in this study. The overall healing rate (number of patients with take rate ≥ 75%) was 88/147 (60%) and did not demonstrate significant differences between the treatment groups (p = 0.15). Despite the difference in wound complexity between the treatment groups, there was no difference regarding the scar tissue quality 12 months postoperatively. In about 25% of all cases, a post-operative event was mentioned that had to be revised surgically.Surgical treatment with STSG and additional MatriDerm

Men on active surveillance for favorable-risk prostate cancer do not receive all the recommended testing. Reasons for variation in receipt are unknown.We combined prospective registry data from the Michigan Urological Surgery Improvement Collaborative, a collaborative of 46 academic and community urology practices across Michigan, with insurance claims from 2014 to 2018 for men on active surveillance for favorable-risk prostate cancer. We defined receipt of recommended surveillance according to the collaborative's low-intensity criteria as: annual prostate specific antigen testing and either magnetic resonance imaging or prostate biopsy every 3 years. We assessed receipt of recommended surveillance among men with ≥36 months of followup (246). We conducted multilevel analyses to examine the influence of the urologist, urologist and primary care provider visits, and patient demographic and clinical factors on variation in receipt.During 3 years of active surveillance, just over half of men (56.5%) received all recommended surveillance testing (69.9% annual prostate specific antigen testing, 72.8% magnetic resonance imaging/biopsy). We found 19% of the variation in receipt was attributed to individual urologists. While increasing provider visits were not significantly associated with receipt, older men were less likely to receive magnetic resonance imaging/biopsy (≥75 vs55 years, adjusted odds ratio 0.07; 95% confidence interval 0.01-0.81).Nearly half of men on active surveillance for favorable-risk prostate cancer did not receive all recommended surveillance. While urologists substantially influenced receipt of recommended testing, exploring how to leverage patients and their visits with their primary care providers to positively influence receipt appears warranted.

Summary Background A discrepancy between sex-specific treatment of kidney failure by dialysis (higher in men) and the prevalence of chronic kidney disease in the general population (higher in women) has been reported internationally, but the prevalence by sex has not been described for Austria. Sex disparity among nephrology outpatients has not been studied. Methods We employed two formulae (2009 CKD-EPI suppressing the race factor, and race-free 2021 CKD-EPI) to estimate the sex distribution of CKD in Austrian primary care, based on creatinine measurements recorded in a medical sample of 39,800 patients from general practitioners’ offices (1989–2008). Further, we collected information from all clinic appointments scheduled at nephrology departments of 6 Austrian hospitals (Wien, Linz, Wels, St. Pölten, Villach, Innsbruck) during 2019 and calculated visit frequencies by sex. Results Using the 2009 CKD-EPI formula, the prevalence of CKD in stages G3–G5 (estimated glomerular filtration rate 2) was 16.4% among women and 8.5% among men aged > 18 years who had attended general practitioners’ offices in Austria between 1989 and 2008 and had at least one creatinine measurement performed. Using the 2021 CKD-EPI formula, the respective CKD prevalence was 12.3% among women and 6.1% among men. In 2019, 45% of all outpatients at 6 participating nephrology departments were women. The median of nephrology clinic visits in 2019 was two (per year) for both sexes. Conclusion CKD is more prevalent among Austrian women than men. Men are more prevalent in nephrology outpatient services. Research into causes of this sex disparity is urgently needed.

AimsSodium–glucose co-transporter 2 inhibition reduces the risk of hospitalization for heart failure and for death in patients with symptomatic heart failure. However, trials investigating the effects of this drug class in patients following acute myocardial infarction are lacking.Methods and resultsIn this academic, multicentre, double-blind trial, patients (n = 476) with acute myocardial infarction accompanied by a large creatine kinase elevation (>800 IU/L) were randomly assigned to empagliflozin 10 mg or matching placebo once daily within 72 h of percutaneous coronary intervention. The primary outcome was the N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP) change over 26 weeks. Secondary outcomes included changes in echocardiographic parameters. Baseline median (interquartile range) NT-proBNP was 1294 (757–2246) pg/mL. NT-proBNP reduction was significantly greater in the empagliflozin group, compared with placebo, being 15% lower [95% confidence interval (CI) −4.4% to −23.6%] after adjusting for baseline NT-proBNP, sex, and diabetes status (P = 0.026). Absolute left-ventricular ejection fraction improvement was significantly greater (1.5%, 95% CI 0.2–2.9%, P = 0.029), mean E/e′ reduction was 6.8% (95% CI 1.3–11.3%, P = 0.015) greater, and left-ventricular end-systolic and end-diastolic volumes were lower by 7.5 mL (95% CI 3.4–11.5 mL, P = 0.0003) and 9.7 mL (95% CI 3.7–15.7 mL, P = 0.0015), respectively, in the empagliflozin group, compared with placebo. Seven patients were hospitalized for heart failure (three in the empagliflozin group). Other predefined serious adverse events were rare and did not differ significantly between groups.ConclusionIn patients with a recent myocardial infarction, empagliflozin was associated with a significantly greater NT-proBNP reduction over 26 weeks, accompanied by a significant improvement in echocardiographic functional and structural parameters.ClinicalTrials.gov registration NCT03087773.

Background: The influence of common medical comorbidities on mortality and racial/ethnic disparities in mortality among women with metastatic breast cancer remains largely unknown. Methods: In this longitudinal study, women with newly diagnosed stage IV breast cancer were identified in a large, diverse, integrated healthcare delivery system from January 2009 to December 2017 (n = 995) and followed through December 31, 2018, for all-cause (overall) and breast cancer–specific mortality via electronic health records. We computed overall and breast cancer–specific mortality rates by race/ethnicity and Elixhauser comorbidity index (ECI). Multivariable-adjusted hazard ratios (HR) assessing the influence of race/ethnicity and comorbidity status on overall and breast cancer–specific mortality were estimated using proportional hazards regression adjusted for age, breast cancer subtype, geocoded income, and palliative cancer treatments. Results: Nearly 17% of this cohort had diabetes and 45% had hypertension. Overall, 644 deaths occurred in the cohort (median follow-up time of 1.8 years), of which 88% were breast cancer related. The risk of overall mortality was increased in Asian/Pacific Islander (PI; adjusted HR = 1.45; 95% CI, 1.10–1.92) and African American/Black women (adjusted HR = 1.34; 95% CI, 1.02–1.76) when compared with white women. Women with more comorbidities (ECI ≥ 5) had more than 3-fold higher overall mortality rate than those without any comorbidities [602/1,000 person-year (PY) vs. 175/1,000 PY]. Similar associations were found for breast cancer–specific mortality. Conclusions: Medical comorbidities are associated with an increased risk of overall mortality among women with de novo metastatic disease and may influence racial/ethnic disparities in mortality. Impact: Optimizing the management of medical comorbidities in metastatic breast cancer patients may also help reduce disparities in breast cancer–related mortality.

Prolonging the shelf-life of liquid-preserved semen without compromising its fertilizing capacity may increase the efficiency of artificial insemination in pigs. Many fertilization-relevant processes are adenosine triphosphate dependent. The impact of semen storage and rewarming to body temperature on the energy status of spermatozoa is as yet unknown.To investigate the energy status of boar spermatozoa during storage and subsequent rewarming and to reveal the potential role of mitochondrial function for reactivation and maintenance of sperm motility.Extended semen samples (n = 7 boars) were used. Spermatozoa were challenged by storage at 17°C for 7 days and incubation at 38°C for 180 min. The adenosine triphosphate concentration and energy charge in semen samples and lactate concentration in the extracellular medium were assessed. Viability and mitochondrial activity were determined by flow cytometry, and clustered single-cell analysis of motility parameters was performed.The energy status was not affected by semen storage (p 0.05). Rewarming resulted in a net reduction in adenosine triphosphate concentration, which increased with storage time (maximum Day 5: -24.2 ± 10.3%) but was not accompanied by a loss in viability, motility, or mitochondrial activity. Blocking glycolysis with 2-deoxy-d-glucose prevented the re-establishment of motility and mitochondrial activity after rewarming. Mitochondrial activity gradually subsided in virtually all spermatozoa during incubation at 38°C, while adenosine triphosphate and energy charge remained high. Concomitantly, extracellular lactate levels rose, and sperm populations with lower velocity, increased linearity, and low lateral head displacement grew larger. Size changes for major sperm subpopulations correlated with the percentage of viable spermatozoa with high mitochondrial activity (r = 0.44-0.70 for individual subpopulations, p 0.01).Storage of boar spermatozoa increases the demand of adenosine triphosphate for reactivation of spermatozoa towards fast, non-linear, and hyperactivation-like motility patterns upon rewarming. Maintenance of glycolysis seems to be decisive for sperm function after long-term storage in vitro.

Primary breast augmentation is one of the most commonly requested aesthetic procedures. Considering the large number of procedures performed in connection with a high demand, it is crucial to prevent complications. For this reason, finding and avoiding possible sources of complications is decisive.Between January 2010 and December 2021, 1625 female patients underwent an aesthetic breast augmentation performed by a single surgeon. The data collected were analyzed through a machine learning technique for binary recursive partitioning. This made it possible to detect unknown sources of a complication and determine a vertex for the various features.When analyzing the data, for most features a high importance score with low entropy was achieved, concluding a high significance. In addition, reproducibility was demonstrated through detailed testing and training accuracies in the algorithm. With this procedure, in addition to known risks such as a high BMI and round implant shape, a larger than A preoperative bra-cup size (OR: 2.7) and a taller body could also be identified as most significant influencing factors for complications.Preoperative breast size plays an exceptionally important role in the occurrence of complications and should be a factor held in a surgeon's considerations. In addition, this study shows ways to transfer artificial intelligence into plastic surgery to increase medical quality.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

OBJECTIVE: To evaluate whether completing a decision aid, Personal Patient Profile – Prostate (P3P), prior to prostatectomy, affects self-reported bother from post-prostatectomy urinary incontinence and erectile dysfunction. MATERIALS AND METHODS: This retrospective analysis included data from men with newly diagnosed clinically localized, very low to intermediate risk prostate cancer who elected for prostatectomy within the Michigan Urological Surgery Improvement Collaborative (MUSIC) between 2018–21. Multivariable logistic regression models were used to estimate the association between P3P use and bother from post prostatectomy erectile dysfunction and urinary incontinence as measured by the Expanded Prostate Cancer Index Composite (EPIC-26). RESULTS: Among the 3987 patients included, 7% used P3P (n=266). Men who used P3P reported significantly less bother from erectile dysfunction at 6 months vs non-users (aOR 0.42 [95% CI 0.27–0.66]). At 12 months, the effect of P3P on bother from erectile dysfunction was not statistically significant (aOR 0.62 [95% CI 0.37–1.03]). Men who used P3P did not have a statistically significant difference in bother from urinary incontinence (3-month: aOR 0.56 [95% CI 0.30–1.06]; 6-month; aOR 0.79 [95% CI 0.31–1.97]). CONCLUSION: Within the stated limitations of this study, we find that use of a decision aid for localized prostate cancer was associated with decreased odds of men being bothered from sexual dysfunction but not urinary incontinence at 6 months post prostatectomy.

Interindividual collisions while skiing or snowboarding occur regularly, they can be associated with severe injuries.To elucidate causes of accidents, injury patterns and potential risk factors for injury severity in interindividual collisions of skiers and snowboarders.Retrospective analysis of the Austrian Registry for Mountain Accidents within a 13-year timeframe (2005-2018) with regard to on- or off-piste collisions of skiers and snowboarders.A total of 30,503 collisions, involving 52,430 (85.9%) skiers and 8,576 (14.1%) snowboarders were analysed. Denominators are lacking, since total numbers of skiers and snowboarders were not available. Compared to skiers, snowboarders were younger (23 vs. 42 years; p0.001), predominantly male (77.4% vs. 61.0%; p0.001) and less often severely injured (46.8% vs. 26.2%; p0.001). Most accidents occurred on slopes (95%). Collisions involving two snowboarders occurred proportionally more often in terrain parks (4.1% of 1,664 injured snowboarders; p0.001) and while one victim was standing or sitting (9.7%; p0.001). Contusions/strains/sprains were most prevalent (23%), as were head injuries (12%). In skiers, chest, shoulder, hip, thigh and knee injuries occurred more often, leading to fractures, dislocations, concussions and internal injuries more frequently. In snowboarders, spine/back, elbow, forearm, wrist and lower leg injuries were more prevalent. Female gender and standing or sitting prior to the accident was a risk factor for being more severely injured in collisions involving i) two skiers (OR: 4.02 (3.79-4.26) and 3.91 (3.26-4.68)), ii) a skier and a snowboarder (OR: 4.50 (3.95-5.14) and 11.49 (8.04-16.41)) or iii) two snowboarders (OR: 2.85 (2.12-3.84) and 12.47 (6.17-25.20)). Wearing a helmet increased the risk when two skiers collided (OR: 1.10 (1.03-1.17)). In skier vs. snowboarder collisions, the skier had a higher risk of being injured more severely (OR: 7.93 (6.98-9.01)).In interindividual collisions of skiers and snowboarders, injury patterns and preceding causes differ substantially. Skiers are more likely to be severely injured. Awareness of an increased risk of injury should be raised particularly while standing or sitting on the slope.