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IntroductionCollective decisions in dynamic tasks can be influenced by multiple factors, including the operational conditions, quality and quantity of communication, and individual differences. These factors may influence whether two heads perform better than one. This study examined the “two heads are better than one” effect (2HBT1) in distributed two-person driver-navigator teams with asymmetrical roles performing a challenging simulated driving task. We also examined the influence of communication quality and quantity on team performance under different operational conditions. In addition to traditional measures of communication volume (duration and speaking turns), patterns of communication quality (optimality of timing and accuracy of instructions) were captured.MethodsParticipants completed a simulated driving task under two operational conditions (normal and fog) either as individual drivers (N = 134; 87 females, mean age = 19.80, SD = 3.35) or two-person teams (driver and navigator; N = 80; 109 females, mean age = 19.70, SD = 4.69). The normal condition was characterized by high visibility for both driver and navigator. The fog condition was characterized by reduced visibility for the driver but not for the navigator. Participants were also measured on a range of cognitive and personality constructs.ResultsTeams had fewer collisions than individuals during normal conditions but not during fog conditions when teams had an informational advantage over individuals. Furthermore, teams drove slower than individuals during fog conditions but not during normal conditions. Communication that was poorly timed and/or inaccurate was a positive predictor of accuracy (i.e., collisions) during the normal condition and communication that was well timed and accurate was a negative predictor of speed during the fog condition. Our novel measure of communication quality (i.e., content of communication) was a stronger predictor of accuracy, but volume of communication was a stronger predictor of time (i.e., speed).DiscussionResults indicate when team performance thrives and succumbs compared with individual performance and informs theory about the 2HBT1 effect and team communication.

General chemistry students need to understand the concept of intermolecular forces and use them to predict the properties of materials. To do this, they must create symbolic representations of mole...

Literature suggests that the quality and rigor of health professions education (HPE) research can be elevated if the research is anchored in existing theories and frameworks. This critical skill is difficult for novice researchers to master. We created a workshop to introduce the practical application of theories and frameworks to HPE research.We conducted two 60- to 75-minute workshops, one in 2019 at an in-person national conference and another in 2021 during an online national education conference. After a brief role-play introduction, participants applied a relevant theory to a case scenario in small groups, led by facilitators with expertise in HPE research. The workshop concluded with a presentation on applying the lessons learned when preparing a scholarly manuscript. We conducted a postworkshop survey to measure self-reported achievement of objectives.Fifty-five individuals participated in the in-person workshop, and approximately 150 people completed the online workshop. Sixty participants (30%) completed the postworkshop survey across both workshops. As a result of participating in the workshop, 80% of participants (32) indicated they could distinguish between frameworks and theories, and 86% (32) could apply a conceptual or theoretical framework to a research question. Strengths of the workshop included the small-group activity, access to expert facilitators, and the materials provided.The workshop has been well received by participants and fills a gap in the existing resources available to HPE researchers and mentors. It can be replicated in multiple settings to model the application of conceptual and theoretical frameworks to HPE research.

Background: Refining the risk of malignancy in patients presenting with thyroid nodules with indeterminate cytology (IC) is a critical challenge. We investigated the performances of 18F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) to predict malignancy. Methods: Between May 2016 and March 2019, 107 patients presenting with a thyroid nodule ≥15 mm with IC and eligible for surgery were included in this prospective study. Head-and-neck PET/CT acquisitions were performed 20 and 60 minutes after injection of 1.5 MBq/kg of FCH. PET/CT acquisition was scored positive when maximal standardized uptake value in the IC nodule was higher than in the thyroid background. Pathology was the gold standard for diagnosis. Results: At pathology, 19 (18%) nodules were malignant, 87 were benign, and one was a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Sensitivity, specificity, accuracy, positive-predictive value (PPV), and negative-predictive value (NPV) of FCH PET/CT in detecting cancer or NIFTP were 90%, 50%, 55%, 29%, and 96% at 20 minutes and 85%, 49%, 67%, 28%, and 94% at 60 minutes, respectively. Higher specificity (58% vs. 33%, p = 0.01) was observed in nononcocytic (n = 72) than in oncocytic IC nodules (n = 35). The pre-PET/CT probability of cancer or NIFTP in Bethesda III–IV nodules was 11% and the post-PET/CT probability was 19% in PET-positives and 0% in PET-negatives. In retrospective analysis, 42% of surgeries would have been unnecessary after PET/CT and 81% before (p

This essay makes a case for teaching an interdisciplinary undergraduate course at the intersection of religion, ecology, and business. At a basic level, this approach gets students with diverse intellectual orientations and career interests in the same room; letting business and environmental studies majors work together on these questions fosters a variation on interfaith engagement. More deeply, it creates space for them to develop critical self-awareness about their own ethical commitments. The fact that no single instructor can be an expert in all three fields should not prevent us from stepping boldly into uncharted territory. The degradation of the earth is an interdisciplinary problem that requires interdisciplinary solutions, and each of us has something to contribute right now even if we cannot do it all. As teachers and lifelong learners, we can and must model intellectual humility even as we look for ways to take decisive individual and collective action.

Among existing research on social vulnerability, virtually no studies have considered homelessness as a variable in their vulnerability assessments. This study identified the relevance of homelessness as a key index in social vulnerability assessment to inform the public, policymakers and the broader body of literature of its impacts on shaping vulnerability patterns in cities. In this study, the 2018 Homeless data for Austin was disaggregated from the council district level to block group level using dasymetric mapping in Geographic Information System (GIS). Principal Component Analysis (PCA) was used to group highly correlated demographic and socioeconomic variables into factors, which were normalized and summed to model social vulnerability with homeless index (SOVI_H) and without homeless index (SOVI) for each Austin Blockgroup. The result revealed significant differences in geographic patterns between SOVI_H and SOVI. SOVI_H showed hotspots of vulnerabilities in Downtown and East-Austin neighborhoods, depicting a slight shift of social vulnerability westwards of the city. This finding differs from past results of social vulnerabilities in Austin where it used to be predominant in the East. This study showed that incorporating homelessness in identifying social vulnerability can help researchers and other associated organizations identify the most vulnerable groups when conducting social vulnerability assessments.

Resume Le traitement des petites lesions cancereuses laryngees (T1 et T2) repose sur la chirurgie partielle, endoscopique ou externe et la radiotherapie. Outre l’imperatif carcinologique ces techniques doivent au maximum preserver les fonctions de respiration, de deglutition et de phonation. Objectif Analyser les fonctions de respiration, de deglutition et de phonation chez des patients traites par laryngectomie supra-cricoidienne et reconstruction a l’aide des muscles sous-hyoidiens. Materiels et methodes Notre travail consistait a analyser les fonctions de respiration, de deglutition et de phonation chez 37 patients traites dans deux instituts entre 2005 et 2015. Nous avons inclus tous les patients beneficiant de ce type de reconstruction avec un recul d’au moins un an par rapport a la chirurgie. L’etude de la fonction respiratoire consistait a noter l’existence ou non d’une tracheotomie et a mesurer le debit inspiratoire de pointe. La preservation ou non des unites crico-arytenoidiennes, le delai de maintien de la sonde nasogastrique et le remplissage de l’auto-questionnaire DHI 30 etaient recueillis pour analyser la fonction de deglutition. La phonation etait appreciee a l’aide de l’auto-questionnaire VHI 30. Resultats Nos resultats montrent un taux de chirurgie initiale sans tracheotomie de 64,9 % (13 patients) avec une reprise rapide de l’alimentation orale (delai moyen d’ablation de la sonde de 13 jours). Le score moyen au VHI 30 etait de 28,3 et de 2,7 au DHI 30. La valeur moyenne du debit inspiratoire de pointe etait de 203,3 mL/mn. Conclusion La laryngectomie supra-cricoidienne avec reconstruction a l’aide des muscles sous-hyoidiens est une technique alternative pour le traitement des petites lesions cancereuses laryngees. Sa realisation permet d’offrir des suites fonctionnelles simples.

This letter establishes sufficient conditions for the sparse multiple measurement vector (MMV) or row-sparse matrix approximation problem for the Rank Aware Row Thresholding (RART) algorithm. Using the rank aware selection operator to define RART results in discrete MUltiple SIgnal Classification (MUSIC) from array signal processing. When the sensing matrix is drawn from the random Gaussian matrix ensemble, we establish that the rank of the row-sparse measurement matrix in the noiseless row-sparse recovery problem allows RART (MUSIC) to reduce the effect of the log ⁡ ( n ) penalty term that is present in traditional compressed sensing results and simultaneously provides a row-rank deficient recovery result for MUSIC. Empirical evidence shows that Thresholding closely matches RART in successful row-sparse approximation. The theoretical and empirical evidence provides further support for the conjecture that the thresholding operator in more sophisticated greedy algorithms is the source of their observed rank awareness.

Treatment of small laryngeal cancerous lesions (T1 and T2) is based on partial endoscopic or open surgery and radiotherapy. In addition to the oncological imperative, these techniques must optimally preserve the functions of breathing, swallowing and phonation. Objective To analyze the above functions in patients treated with supracricoid laryngectomy and reconstruction using infrahyoid muscle. Materials and methods Breathing, swallowing and phonation were analyzed in 37 patients treated in two institutes between 2005 and 2015. All patients undergoing the above type of reconstruction with a minimum 1 year's follow-up were included. Respiratory study noted any tracheotomy and measured peak inspiratory flow. Preservation of cricoarytenoid units and nasogastric intubation time, and DHI-30 self-administered questionnaire results were collected to analyze swallowing function. Phonation was assessed on the VHI-30 self-administered questionnaire. Results The rate of primary surgery without tracheotomy was 64.9% (13 patients), with rapid resumption of oral feeding (mean intubation time, 13 days). Mean VHI score was 28.3 and mean DHI 30 score 2.7. Mean peak inspiratory flow was 203.3 mL/min. Conclusion Supracricoid laryngectomy with reconstruction using subhyoid muscle is an alternative technique for the treatment of small laryngeal cancerous lesions, providing uncomplicated functional outcome.

Recent advances in phylogenomics allow for the use of large amounts of genetic information in phylogenetic inference. Ideally, the increased resolution and accuracy of such inferences facilitate improved understanding of macroevolutionary processes. Here, we integrate ultraconserved elements (UCEs) with fossil and biogeographic range data to explore diversification and geographic range evolution in the diverse turtle ant genus Cephalotes Latreille, 1802 (Hymenoptera: Formicidae). We focus on the potential role of the uplift of the Panamanian land bridge and the putative ephemeral GAARlandia land bridge linking South America and the Antilles in shaping evolution in this group. Our phylogenetic analyses provide new resolution to the backbone of the turtle ant phylogeny. We further found that most geographic range shifts between South America and Central America regions were temporally consistent with the development of the Panamanian land bridge, while we did not find support for the GAARlandia land bridge. Additionally, we did not infer any shifts in diversification rates associated with our focal land bridges, or any other historical events (we inferred a single diversification rate regime across the genus). Our findings highlight the impact of the Panamanian land bridge for Cephalotes geographic range evolution as well as the influence of taxonomic sampling on macroevolutionary inferences.

Modern technologies have enabled the development of dynamic game- and simulation-based assessments to measure psychological constructs. This has highlighted their potential for supplementing other assessment modalities, such as self-report. This study describes the development, design, and preliminary validation of a simulation-based assessment methodology to measure psychological resilience—an important construct for multiple life domains. The design was guided by theories of resilience, and principles of evidence-centered design and stealth assessment. The system analyzed log files from a simulated task to derive individual trajectories in response to stressors. Using slope analyses, these trajectories were indicative of four types of responses to stressors: thriving, recovery, surviving, and succumbing. Using Machine Learning, the trajectories were predictive of self-reported resilience (Connor-Davidson Resilience Scale) with high accuracy, supporting construct validity of the simulation-based assessment. These findings add to the growing evidence supporting the utility of gamified assessment of psychological constructs. Importantly, these findings address theoretical debates about the construct of resilience, adding to its theory, supporting the combination of the “trait” and “process” approaches to its operationalization.

International audience; Background: To describe the characteristics of the largest European study of MEC of salivary glands and to determine the prognostic factors for overall and disease free survival.Patients and methods: Patients with MEC were prospectively included in the Réseau d'Expertise Français sur les Cancers ORL Rares (REFCOR, French Network of Rare Head and Neck Tumors) database between 2009 and 2015.Results: A total of 292 patients were included. Tumors were classified as low grade in 175 cases (60%), intermediate in 39 (13%) and high grade in 78 (27%). Median follow-up was 26 months. The 5-year OS and DFS rates were respectively 83% and 69%. In multivariate analysis, age (p = 0.004), diabetes (p = 0.02) and advanced stage (p = 0.03) were found to have a significant negative impact on OS. Diabetes (p = 0.001), alcohol consumption (p = 0.003) and advanced stage (p = 0.001) were found to have a significant negative impact on DFS. Compare to low grade, high grade tended to have a negative impact on OS (p = 0.05) and had a significant effect on DFS (0.002) while intermediate grade had no significant influence on survival. The surgical treatment had a positive impact on both OS (p = 0.00005) and DFS (p = 0.0005). Postoperative radiotherapy had no impact in multivariate analysis.Conclusion: Advanced clinical stage, high grade tumor, high age, the impossibility of carrying out a complete surgical resection, and diabetes are the main prognostic factors in this prospective series of patients with MEC. Such findings open new research perspectives on the influence of these components on initial patient care.

Resume Contexte La spondylodiscite cervicale est une complication rare mais severe de la chirurgie pharyngee. Materiel et Methode Cette etude retrospective, multicentrique rapportait, au sein du groupe francais d’etude des tumeurs de la tete et du cou (GETTEC), les patients atteints d’une spondylodiscite cervicale apres chirurgie trans-orale robotisee (TORS), d’une tumeur maligne pharyngee entre janvier 2010 et janvier 2017. Objectifs Decrire les cas de spondylodiscite cervicale apres TORS, definir les signes d’alerte de cette complication potentiellement letale, ainsi que la prise en charge optimale. Resultats Un total de 7 patients de 6 centres differents etaient inclus dans notre etude. Les carcinomes etaient des stades T1 ou T2, localises a la paroi pharyngee posterieure. Tous les patients presentaient des facteurs de risque de spondylodiscite. Le delai diagnostique moyen etait de 12,6 jours. Le delai moyen entre la chirurgie et le diagnostic de spondylodiscite etait de 2,1 mois (de 20 jours a 4,5 mois). Le symptome principal etait la cervicalgie (87 %). Les infections etaient polymicobiennes ; les germes etaient identifies dans 5 cas, traites par antibiotherapie intraveineuse. Un geste chirurgical de decompression medullaire etait realise dans 3 cas. Le suivi a montre 4 evolutions favorables et 3 deces. Le taux de mortalite etait de 43 %. Conclusion Cette etude multicentrique francaise est en faveur d’une mortalite severe de la spondylodiscite cervicale dans les suites d’une TORS, meme en cas de resection limitee. Les chirurgiens doivent evoquer ce diagnostic devant une cervicalgie persistante, un defaut de cicatrisation de la paroi pharyngee posterieure, une asthenie, une fievre, un syndrome inflammatoire. L’IRM est l’examen radiologique le plus performant pour confirmer ce diagnostic.

Objective The aim of the current study was to assess the diagnostic accuracy of the Neuropad for detecting distal sensory peripheral neuropathy (DSPN) related to human immunodeficiency virus (HIV)-infection. Design Single-gate observational case-control study. Methods A convenience sample of 30 HIV-infected subjects with a mean age of 48.9 years (95% CI 45.6–52.3) and no other potential causes of neuropathy were recruited from the Ian Charleson Day Centre (London, UK). Sudomotor function was assessed with the Neuropad, an adhesive patch designed to measure sweat production, using a 10-min cut-off. Vibration perception threshold (VPT) testing with a neurothesiometer and the painDETECT questionnaire (PD-Q) were used as reference standard measures of DSPN. Results 16 participants with sudomotor dysfunction and 14 with healthy sudomotor function were included in analysis. Compared to VPT (>25 V) the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Neuropad yielded 66.7%, 48.1%, 12.5% and 92.9% respectively. For the PD-Q (>12) sensitivity of the Neuropad was 100% and specificity was 58.3%, with PPV and NPV of 37.5% and 100% respectively. Conclusions The Neuropad may be a suitable screening tool for HIV-related DSPN, and can reliably exclude healthy individuals in the clinical setting. Abnormal Neuropad results require referral to confirm diagnosis. Limitations exist in the sampling method and study size. The use of reference standard measures of small nerve fibre function and continuous Neuropad quantification would strengthen future research.

Resume But Les pharyngolaryngectomies totale circulaires sont realisees pour des tumeurs evoluees du pharynx ou dans un contexte de recidive post-radique. Plusieurs procedes de reconstruction du pharynx par lambeau libres ou pedicules sont utilises et sont choisis selon l’operateur. Cette etude a pour but d’evaluer les resultats fonctionnels sur la deglutition a long terme de ces patients en fonction du type de lambeau utilise pour la reconstruction. Materiel et methode Une etude retrospective multicentrique a ete menee de janvier a septembre 2016 dans le groupe Gettec. Tous les patients operes d’une pharyngolaryngectomie totale circulaire et en remission etaient inclus et devaient remplir le questionnaire du deglutition handicap index (DHI) et avoir une fibroscopie de deglutition. 46 patients (39 hommes 7 femmes) ont ete inclus pendant cette periode. Le lambeau ante-brachial tubulise (groupe LABT) etait utilise dans 19 cas, le grand pectoral en fer a cheval (groupe LGP) dans 15 cas et le jejunum libre (groupe LJL) dans 12 cas. Resultats Le DHI moyen etait de 24 : 20 groupes LABT, 23 groupes LJL, 25 groupes LGP, sans difference significative ; 27 patients avaient une deglutition normale, 9 mixee, 8 liquide, 3 etaient alimentes par gastrostomie. La nasofibroscopie de la deglutition obtenait un pourcentage de patient avec une deglutition normale de salive et de yaourt significativement plus important pour les patients reconstruits avec un lambeau libre (LJL et LABT) par rapport au groupe LGP (p = 0,04). Conclusion Cette etude a montre que le type de lambeau de reconstruction d’une pharyngolaryngectomie totale circulaire n’a pas d’impact sur la qualite de la deglutition postoperatoire evaluee par le patient par autoquestionnaire du DHI.

Corey D. Blanchard’s essay on Native Americans during the mission period (1769–1833) finds early articles focused on Euro-American pioneers to the near exclusion of the Indigenous population of Southern California. When they do appear in early articles they are treated more as obstacles than as sentient beings. Racial bias or condescension is evident in articles published as late as 1953 and research was limited to Euro-American sources. Articles reflecting the New Social History turn of the late 1950s-1960s; they analyzed quantifiable evidence to reconstruct the daily life of Mission Indians. The cultural history turn of the 1990s brought analyses of material culture into the pages of the SCQ. New levels of analysis and computerized data emerged in the current decade, uncovering individual lives and Native American agency into a complex understanding of California’s Indigenous history, while early articles continue to serve as data sources and indicators of Euro-American/Native American relationships.

INTRODUCTION Academies of health professions educators can amplify members' social capital, promoting educational innovation and organizational change. However, research in this area is limited. This article attempts to close the gap in literature with the results of a program evaluation of our interprofessional teaching academy through the lens of social capital and organizational culture. METHODS A program evaluation using a cross-sectional survey was conducted with all members of the Baystate Education Research and Scholarship of Teaching (BERST) Academy. The survey drew on a conceptual framework from previous literature on social capital, communities of practice, and faculty development evaluation. Data were analyzed with descriptive statistics and analysis of variance. RESULTS Overall survey response rate was 54%. More than 90% of respondents have applied the skills learned through BERST Academy into their practice. Social capital was defined with five items (Cronbach alpha = 0.87), and we found no significant difference between profession and social capital, suggesting that perceptions of social capital did not significantly differ by membership in a specific profession. DISCUSSION Our results showed that BERST Academy members were able to cultivate social capital through high-quality connections. An academy can serve as a unique culture within an institution to foster collaborative relationships that increase social capital, for members of different professions. In addition, an academy can also provide members with a community that benefits them in the greater organizational culture.

Fibrosis is a common pathological feature of chronic disease. Deletion of the NF-κB subunit c-Rel limits fibrosis in multiple organs, although the mechanistic nature of this protection is unresolved. Using cell-specific gene-targeting manipulations in mice undergoing liver damage, we elucidate a critical role for c-Rel in controlling metabolic changes required for inflammatory and fibrogenic activities of hepatocytes and macrophages and identify Pfkfb3 as the key downstream metabolic mediator of this response. Independent deletions of Rel in hepatocytes or macrophages suppressed liver fibrosis induced by carbon tetrachloride, while combined deletion had an additive anti-fibrogenic effect. In transforming growth factor-β1-induced hepatocytes, c-Rel regulates expression of a pro-fibrogenic secretome comprising inflammatory molecules and connective tissue growth factor, the latter promoting collagen secretion from HMs. Macrophages lacking c-Rel fail to polarize to M1 or M2 states, explaining reduced fibrosis in RelΔLysM mice. Pharmacological inhibition of c-Rel attenuated multi-organ fibrosis in both murine and human fibrosis. In conclusion, activation of c-Rel/Pfkfb3 in damaged tissue instigates a paracrine signalling network among epithelial, myeloid and mesenchymal cells to stimulate fibrogenesis. Targeting the c-Rel-Pfkfb3 axis has potential for therapeutic applications in fibrotic disease. ispartof: NATURE METABOLISM vol:2 issue:11 ispartof: location:Germany status: published

The in vivo efficacy of liposomal encapsulated ciprofloxacin in two formulations, lipoquin and apulmiq, were evaluated against the causative agent of anthrax, Bacillus anthracis. Liposomal encapsulated ciprofloxacin is attractive as a therapy since it allows for once daily dosing and achieves higher concentrations of the antibiotic at the site of initial mucosal entry but lower systemic drug concentrations. The in vivo efficacy of lipoquin and apulmiq delivered by intranasal instillation was studied at different doses and schedules in both a post exposure prophylaxis (PEP) therapy model and in a delayed treatment model of murine inhalational anthrax. In the mouse model of infection, the survival curves for all treatment cohorts differed significantly from the vehicle control. Ciprofloxacin, lipoquin and apulmiq provided a high level of protection (87-90%) after 7 days of therapy when administered within 24 hours of exposure. Reducing therapy to only three days still provided protection of 60-87%, if therapy was provided within 24 hours of exposure. If treatment was initiated 48 hours after exposure the survival rate was reduced to 46-65%. These studies suggest that lipoquin and apulmiq may be attractive therapies as PEP and as part of a treatment cocktail for B. anthracis.

This study describes the experiences and perspectives of health professions educators around institutional review board (IRB) review of multi-institutional education research. This survey study gathered quantitative and qualitative data from members of three of the four geographic regions of the AAMC Group on Educational Affairs (GEA) as well as a snowball sample from the fourth region, where access to the listserv was not possible. Quantitative data is described and qualitative comments were coded and themed. Ninety-six percent of the 151 respondents considered multi-institutional incredibly or somewhat valuable to their educational research goals. Sixty-two percent had submitted at least one project to multiple institutions for review. Of 57 respondents, 21 identified disagreements in the type of IRB review required (exempt, expedited, or full-board review). Disagreements between IRBs are also reported, including changes in wording or informed consent procedures. Of the 36 participants who noted disagreement between IRBs for any changes, only three participants believed that the process significantly improved the research subject protections. Most health professions education researchers across the USA and Canada appreciated the value and role of IRB review and expressed frustration in the face of review that seemingly did not result in meaningful improvements. Final changes to the federal Common Rule call for a single-IRB review in multi-institutional research, particularly for low-risk studies. This change on the horizon could not only mitigate current concerns but also bolster the proliferation of multi-institutional research studies in health professions education.

International audience; BACKGROUND:Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established.MATERIAL & METHODS:Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed.RESULTS:In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor.CONCLUSION:Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

Correction to: Nature Metabolism https://doi.org/10.1038/s42255-020-00306-2, published online 9 November 2020. In the version of this article initially published, in the ×40 diseased human kidney images in Supplementary Fig. 1, the FSGS image duplicated the DN image. The error has been corrected in the HTML version of the article.

How and why do people comply with protective behaviours during COVID-19? The emerging literature employs a variable-centered approach, typically using a narrow selection of constructs within a study. This study is the first to adopt a person-centred approach to identify complex patterns of compliance, and holistically examine underlying psychological differences, integrating multiple psychology paradigms and epidemiology. 1575 participants from Australia, US, UK, and Canada indicated their behaviours, attitudes, personality, cognitive/decision-making ability, resilience, adaptability, coping, political and cultural factors, and information consumption during the pandemic’s first wave. Using Latent Profile Analysis, two broad groups were identified. The compliant group (90%) reported greater worries, and perceived protective measures as effective, whilst the non-compliant group (about 10%) perceived them as problematic. The non-compliant group were lower on agreeableness and cultural tightness-looseness, but more extraverted, and reactant. They utilised more maladaptive coping strategies, checked/trusted the news less, and used official sources less. Females showed greater compliance than males. By promoting greater appreciation of the complexity of behaviour during COVID-19, this research provides a critical platform to inform future studies, public health policy, and targeted behaviour change interventions during pandemics. The results also challenge age-related stereotypes and assumptions.

Le fistole faringee corrispondono a comunicazioni tra la cavita faringea e l’esterno che si verificano nel 50% dei casi in media dopo chirurgia di exeresi faringolaringea. I fattori di rischio, come la denutrizione, l’estensione dell’exeresi o la radioterapia neoadiuvante, sono numerosi ma molto discussi. La diagnosi e clinica. Gli esami complementari sono utilizzati principalmente per rilevare sovrainfezioni, complicanze vascolari o un’evoluzione tumorale. Il transito esofago-gastro-duodenale puo essere utile per individuare una fistola incipiente prima della rialimentazione orale. Il trattamento iniziale e medico, basato sulle cure locali, e, poi, chirurgico, in caso di insuccesso. Occorre tenere conto dello stato locale e generale per fare la migliore scelta terapeutica. Misure di prevenzione devono essere utilizzate per ridurre l’incidenza delle fistole e le loro conseguenze psicologiche, estetiche ed economiche sulla prognosi e sulla qualita di vita dei pazienti.

Changes in the respiratory microbiome are associated with disease progression in idiopathic pulmonary fibrosis (IPF). The role of the host response to the respiratory microbiome remains unknown.To explore the host-microbial interactions in IPF.Sixty patients diagnosed with IPF were prospectively enrolled together with 20 matched control subjects. Subjects underwent bronchoalveolar lavage (BAL), and peripheral whole blood was collected into PAXgene tubes for all subjects at baseline. For subjects with IPF, additional samples were taken at 1, 3, and 6 months and (if alive) 1 year. Gene expression profiles were generated using Affymetrix Human Gene 1.1 ST arrays.By network analysis of gene expression data, we identified two gene modules that strongly associated with a diagnosis of IPF, BAL bacterial burden (determined by 16S quantitative polymerase chain reaction), and specific microbial operational taxonomic units, as well as with lavage and peripheral blood neutrophilia. Genes within these modules that are involved in the host defense response include NLRC4, PGLYRP1, MMP9, and DEFA4. The modules also contain two genes encoding specific antimicrobial peptides (SLPI and CAMP). Many of these particular transcripts were associated with survival and showed longitudinal overexpression in subjects experiencing disease progression, further strengthening the relationship of the transcripts with disease.Integrated analysis of the host transcriptome and microbial signatures demonstrated an apparent host response to the presence of an altered or more abundant microbiome. These responses remained elevated in longitudinal follow-up, suggesting that the bacterial communities of the lower airways may act as persistent stimuli for repetitive alveolar injury in IPF.

Las fistulas faringeas son comunicaciones entre la cavidad faringea y el exterior. Se producen en el 50% de los casos en promedio tras la cirugia de reseccion faringolaringea. Existen numerosos factores de riesgo, como la desnutricion, la extension de la reseccion o la radioterapia neoadyuvante, pero son controvertidos. El diagnostico es clinico. Las pruebas complementarias se utilizan sobre todo para detectar las sobreinfecciones, las complicaciones vasculares o una evolucion tumoral. El transito esofago-gastro-duodenal puede ser util para detectar una fistula inicial antes de reanudar la alimentacion oral. El tratamiento inicial es medico, basado en los cuidados locales, y despues quirurgico si lo anterior fracasa. Hay que tener en cuenta el estado local y general para tomar la mejor decision terapeutica. Se deben utilizar medidas preventivas para reducir la incidencia de las fistulas y sus consecuencias psicologicas, esteticas, economicas, asi como sobre el pronostico y la calidad de vida de los pacientes.

Measures of accessibility have long been an important metric in regional transportation planning and modeling. However, new methods are needed to provide computationally efficient, multiscale, free, transparent, and customizable tools that harness open and disparate sources of transportation network data at fine spatial resolution over large geographic extents. This research presents a new open source tool, UrbanAccess, which uses a generalized and scalable methodology to measure transit accessibility with a multimodal network comprising both pedestrian and operational schedule transit networks at a fine spatial scale over large metropolitan extents. A typical use for this tool is illustrated in a case study that characterizes regional transit accessibility in the San Francisco Bay Area in California.

Accessibility is an important metric in regional transportation and land use planning and as a component in equity analyses. Accessibility in the San Francisco Bay Area of California was characterized with a new multimodal network accessibility tool, UrbanAccess. Accessibility was measured with open pedestrian and operational schedule transit network data at the Census block level across a large metropolitan extent. In addition, a framework was developed to assess changes in accessibility that resulted from alternative transit network structures. Results indicated that accessibility to jobs in the Bay Area was relatively high by walking and by taking transit. However, accessibility varied significantly by annual household income and geography. Disparities in job accessibility were most pronounced between Census blocks that were in poverty and Census blocks that were not in poverty.

This paper presents a multicriteria suitability analysis framework to aid municipal governments in efforts to determine optimal siting of mobility hubs in their jurisdictions. Mobility hubs are agglomerations of transportation modes that concentrate emerging shared mobility services in well-defined locations, delivering several benefits to users. These benefits include primarily increased connectivity among modes and augmentation of public transit with improved first- and last-mile connections. The framework was applied to a case study in Oakland, California. The presented methodology has the potential for broader use by transportation planners and policy makers to advance various qualitative values in their practice, including equity and resiliency, and can quantitatively inform geographic, values-oriented outcomes.