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Gender-affirming mastectomy ('top surgery') is one of the most commonly requested and performed procedures in the transgender and non-binary population. The goal of female-to-male (FtM) surgery is to treat gender dysphoria by creating an aesthetically pleasing male chest, achieved by removing excess breast tissue and skin, and repositioning and resizing the nipple-areola complex. We present a modification of the double-incision, mastectomy with free nipple graft (DIFNG) technique that we have called the ‘Pisces’ mastectomy as it is common for fish to exhibit gender fluidity. With some imagination, the skin excision could also be considered fish-shaped. This technique achieves the goals of surgery, provides good access for haemostasis and decreases the need for revision surgery by adequate removal of ‘dog ears’ medially and laterally.

The objective of this analysis is to evaluate the necessity of large clinical trials using FLOW trial data. The FLOW pilot study and definitive trial were factorial trials evaluating the effect of different irrigation solutions and pressures on re-operation. To explore treatment effects over time, we analyzed data from the pilot and definitive trial in increments of 250 patients until the final sample size of 2447 patients was reached. At each increment we calculated the relative risk (RR) and associated 95% confidence interval (CI) for the treatment effect, and compared the results that would have been reported at the smaller enrolments with those seen in the final, adequately powered study. The pilot study analysis of 89 patients and initial incremental enrolments in the FLOW definitive trial favored low pressure compared to high pressure (RR: 1.50, 95% CI: 0.75–3.04; RR: 1.39, 95% CI: 0.60–3.23, respectively), which is in contradiction to the final enrolment, which found no difference between high and low pressure (RR: 1.04, 95% CI: 0.81–1.33). In the soap versus saline comparison, the FLOW pilot study suggested that re-operation rate was similar in both the soap and saline groups (RR: 0.98, 95% CI: 0.50–1.92), whereas the FLOW definitive trial found that the re-operation rate was higher in the soap treatment arm (RR: 1.28, 95% CI: 1.04–1.57). Our findings suggest that studies with smaller sample sizes would have led to erroneous conclusions in the management of open fracture wounds. NCT01069315 (FLOW Pilot Study) Date of Registration: February 17, 2010, NCT00788398 (FLOW Definitive Trial) Date of Registration: November 10, 2008.

A small body of recent research on vocabulary explanations (VEs) in second language (L2) classrooms (e.g. Mortensen, 2011; Waring et al., 2013) has attempted to provide the sequential descriptions of the key elements of VEs and investigate how teachers draw on their linguistic and semiotic resources to construct the VE sequences (e.g. Smotrova and Lantolf, 2013). Nevertheless, more work is needed in order to allow educators to better understand how VEs are provided in L2 classrooms. In particular, there is a shortage of studies (e.g. Tai and Brandt, 2018) illustrating the nature of VEs in beginning-level English for Speakers of Other Languages (ESOL) classrooms, where learners all share different first languages (L1s) and have limited English proficiency. Moreover, the shared linguistic resources between the teacher and learners are typically limited in beginning-level ESOL classrooms. To date, there is no longitudinal study which will allow for tracking the impact of VEs on contributing to learners' conceptual understandings of the meanings of target vocabulary items. The vast majority of the studies, which identified learners' display of understanding of L2 word meanings in classroom interactions, were based on one-off analyses of the classroom discourse (e.g. Waring et al., 2013). This prevents educators and researchers from observing the learner's change of conceptual understandings over time. This MSc dissertation contributes to the identified research gaps by employing Conversation Analysis (CA) to 1) investigate the nature of VEs in a beginning-level ESOL classroom and 2) conduct a 4-month longitudinal analysis to explore the potential for employing CA as the methodological tool for tracking learners' development of the conceptual understandings of the meanings of particular vocabulary items which are previously explained. The classroom data is taken from a corpus of video-data collected in a beginning-level adult ESOL classroom in the United States. The key findings demonstrate that other than verbal 3 resources, teacher's use of embodied resources in explaining vocabulary items in the classroom plays an important role in facilitating the learners' understandings of the meanings of different vocabulary items. The learner's use of gestures allows her to externalise her understandings of the L2 word meanings and also allows teachers to evaluate the learner's current knowledge states. These findings also suggest that CA provides some, albeit incomplete, evidence of the learner's developing conceptual understandings of L2 word meanings and it allows researchers to investigate how these developmental changes occur in each interactional context of L2 vocabulary use.

Purpose To evaluate factors associated with response to intravitreal bevacizumab (IVB) and intravitreal triamcinolone acetonide (IVTA) in diabetic macular edema (DME). Methods Ninety-one eyes of 88 patients diagnosed with DME were enrolled in this retrospective chart review. Group 1 included eyes that showed good response to IVB. Group 2 included eyes that did not respond to IVB but responded to IVTA. Group 3 included eyes that responded to neither. Clinical factors, HbA1c, and optical coherence tomography (OCT) findings including patterns of macular edema were compared among the 3 groups. Results A total of 44, 27, and 20 eyes were included in groups 1, 2, and 3, respectively. HbA1c was higher in group 3 than in the other groups. Proportion of full (combination of all patterns) type edema was higher in group 3 than in the other 2 groups. In group 1, the proportion of sponge-like diffuse retinal thickening type was higher and cystoid macular edema type was lower than in the other groups. Conclusions The degree of diabetic control and morphologic subtypes with OCT should be considered to better predict the prognosis after treatment in DME.

Ion channels are integral membrane proteins that enable selected ions to flow passively across membranes. Channel proteins have been the focus of computational approaches to relate their three-dimensional (3D) structure to their physiological function. We describe a number of computational tools to model ion channels. Homology modeling may be used to construct structural models of channels based on available X-ray structures. Electrostatics calculations enable an approximate evaluation of the energy profile of an ion passing through a channel. Molecular dynamics simulations and free-energy calculations provide information on the thermodynamics and kinetics of channel function.

The advances in polymer 3D printing enables multi-material printing of different types of polymer into a single part which is known as digital material. Polyjet 3D printing and Multijet printing (MJP) are methods used to print digital materials. Control of the polymeric compositions is however not made available. A range of digital materials made up of the sane two or three types of polymers with different composition are pre-set in the software with the composition unknown to the users. Layering is a way for users to control the composition. In this project. the method of layering involves manually slicing the computer-aided design (CAD) part into multiple thin layers in the loading direction and assigning eh layer with a specific polymer type to make up the desired composition. The effect of layering was studied by conducting tensile tests on the layered and non-layered samples. It is shown that layering reduces specimen’s tensile strength however this effect diminishes over time. Published version