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This study focuses on the structure of self-learning as a multidimensional construct, through competences such as autonomy and study planning of undergraduate students, over the last three years. The objective of this study, framed by Technology Acceptance Model (TAM), aims to gain insights into the acceptance of self-learning in online educational models within a post-pandemic, university context. More specifically and innovatively, this study sets out to explore gender differences in self-learning adoption, as previous studies have observed various findings.Action variables and motivation play crucial roles in self-learning. Davis's original TAM model (1989) put forward five key variables, all of which are dealt with both theoretically and practically in this study. Additionally, this study puts forward several hypotheses based on the TAM model, addressing perceived ease of use, perceived usefulness, attitude, user satisfaction and intention to use in the context of online learning.From a practical perspective, a multi-group analysis is carried out that has been applied to a sample made up of 313 male and female Spanish university students from different areas of knowledge. Questionnaires were conducted with all participants and statistics calculated; the results make it possible to affirm that the different dimensions of the self-learning structure are interrelated, and significant differences between men and women are observed in the adoption of the model.The study concludes that online education fosters a positive attitude toward self-learning in female students, unlike what happens with male students. While the sample size might be considered a limitation of the study, the study nonetheless observes that female students appear to be more inclined to develop a sense of self-learning. In contrast, male students—though consumers of self-learning– do not generate the same attitude. Therefore, the conclusion can be drawn that online teaching is a way to promote self-learning in women, which may inform universities when designing programs promoting student autonomy with new technologies.

Abstract Trigeminal‐specific stimulants have been shown to activate different receptors preferentially and this likely accounts for variation in sensory perception. It is unclear whether trigeminal sensitivity is similar across different transient receptor potential (TRP) receptors or if dysfunction of different receptors results in differing patient symptoms. Therefore, a prospective cohort study was conducted, consisting of trigeminal lateralization testing with three different stimulants (eucalyptol, isothiocyanate, acetic acid), olfaction testing with Sniffin' Sticks, and measurement of various patient‐reported outcome measures (PROMs). A total of 50 participants were enrolled across the olfactory spectrum. Mean TDI score was 27.1 ± 8.3 (range 7.0–39.5) with 38% normosmic and 62% dysosmic. Mean trigeminal lateralization scores out of 20 in the overall cohort were 16.18 (2.78) for eucalyptol, 14.94 (3.49) for mustard oil, and 15.28 (3.68) for vinegar. Eucalyptol showed a significant correlation with threshold scores of Sniffin' Sticks. A significant correlation was found between acetic acid and various PROMs. None of the lateralization scores of the trigeminal stimulants correlated to each other significantly and there was no correlation to age. The lack of correlation suggests that the measured sensitivity of one type of TRP receptor may not translate to similar sensitivity of the other receptors. Additional investigations with TRPV1 and TRPA1 agonists are needed to corroborate our findings.

Abstract Objectives Prior research on olfactory dysfunction in chronic rhinosinusitis (CRS) has focused on patients with polyps and suggests that direct inflammation of the olfactory cleft mucosa plays a contributory role. The purpose of this study was to evaluate gene expression in superior turbinate mucosal specimens, comparing normosmic and dysosmic CRS patients without polyps (CRSsNP). Methods Tissue samples were obtained from the superior turbinates of patients with CRSsNP at the time of endoscopic sinus surgery. Samples subsequently underwent RNA sequencing and functional analysis to investigate biological pathways associated with differentially expressed genes between dysosmic (n = 7) and normosmic (n = 4) patients. Results Differential gene expression analysis comparing dysosmic and normosmic CRSsNP patients showed upregulation of 563 genes and downregulation of 327 genes. Using stringent criteria for multiple comparisons, one upregulated gene (Immediate Early Response 3 [IER3]) had an false discovery rate (FDR) correction adjusted P value considered statistically significant (P

Summary: Background: Janus kinase (JAK) inhibition is a promising approach for treating vitiligo. We aimed to assess the efficacy and safety of upadacitinib, an oral selective JAK inhibitor, in adults with non-segmental vitiligo. Methods: This was a phase 2, multicentre, randomised, double-blind, placebo-controlled, dose-ranging study completed at 33 clinical centres in the United States, Canada, France, and Japan. Eligible patients were aged 18–65 years with non-segmental vitiligo and had a Facial Vitiligo Area Scoring Index (F-VASI) ≥0.5 and a Total Vitiligo Area Scoring Index (T-VASI) ≥5. Patients were randomly assigned (2:2:2:1:1) using an interactive response technology to receive upadacitinib 6 mg (UPA6), upadacitinib 11 mg (UPA11), upadacitinib 22 mg (UPA22), or placebo (PBO; preassigned to switch to either UPA11 or UPA22 in period 2) once daily for 24 weeks (period 1). For weeks 24–52 (period 2), patients randomly assigned to upadacitinib continued their treatment, and patients receiving PBO switched to their preassigned upadacitinib dose in a blinded fashion. The primary endpoint was the percent change from baseline in F-VASI at week 24. Efficacy was analysed in the intention-to-treat population, and safety was examined in all randomly assigned patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, number NCT04927975. Findings: Between June 16, 2021, and June 27, 2022, 185 patients (including 115 [62%] who were female and 70 [38%] who were male) were randomly assigned to UPA6 (n = 49), UPA11 (n = 47), UPA22 (n = 43), or PBO (n = 46). At week 24, the LS mean difference versus PBO in the percent change from baseline in F-VASI was −7.60 (95% CI −22.18 to 6.97; p = 0.3037) for UPA6, −21.27 (95% CI −36.02 to −6.52; p = 0.0051) for UPA11, and −19.60 (95% CI −35.04 to −4.16; p = 0.0132) for UPA22. The LS mean difference versus PBO in the percent change from baseline in T-VASI was −7.45 (95% CI −16.86 to 1.96; p = 0.1198) for UPA6, −10.84 (95% CI −20.37 to −1.32; p = 0.0259) for UPA11 and −14.27 (95% CI −24.24 to −4.30; p = 0.0053) for UPA22. Ongoing treatment with upadacitinib induced continuous skin repigmentation over time without reaching a plateau through week 52. The rates for study drug discontinuation and serious treatment-emergent adverse events (TEAEs) were higher in the UPA22 group than in the UPA11 and UPA6 groups. Eight serious TEAEs, including one death of unknown cause and one case of infiltrating lobular breast carcinoma, were reported through 52 weeks; only two serious TEAEs (coronary artery arteriosclerosis [UPA6 (n = 1)] and non-fatal ischemic stroke [UPA11 (n = 1)]) were deemed by the investigator to have a reasonable possibility of being related to study drug. The one case of breast cancer in the UPA11 group was deemed unrelated to study drug, and the one death of unknown cause in the UPA22 group was reviewed and adjudicated and was deemed to be unrelated to study drug. The most common TEAEs were COVID-19, headache, acne, and fatigue. No new safety signals were observed. Interpretation: Upadacitinib monotherapy led to substantial repigmentation of both facial and total body vitiligo lesions and may offer an effective treatment option for adults with extensive non-segmental vitiligo. Based on these findings, upadacitinib 15 mg is being investigated in adults and adolescents with non-segmental vitiligo in an ongoing phase 3 randomised controlled trial. Funding: AbbVie Inc.

Background: Previous studies report environmental aerosolization with various endonasal procedures, but do not specifically measure intranasal levels of inhaled aerosolized particles in healthcare providers (HCP) performing such procedures. The purpose of this study is to measure the impact of various types of personal protective equipment (PPE) worn by HCP during a variety of office-based endonasal procedures. Methodology: Simulated sneeze and office-based procedures were performed in a test model and aerosol levels were quantified in the middle meatus of a simulated HCP model wearing various forms of PPE by using a laser diode-based particle counter. Endoscopic exam, balloon sinus dilation, suction and irrigation, simulated tissue resection with a microdebrider, and routine debridement procedures were evaluated. The aerosol levels were evaluated with and without the use of PPE to assess HCP aerosol exposure. Results: A simulated sneeze represents a worst-case aerosol generating event when compared to other common office-based procedures (approximately 1,000 times greater than baseline particle count). Common endoscopic procedures did not generate significantly greater particle counts above baseline. When compared to no mask, a surgical mask reduces particle counts experienced by HCP in the middle meatus by 69%, while an N95 mask significantly reduced particles by 93%. Conclusions: The levels of aerosols generated during common office-based procedures are consistent with the background aerosol levels measured at baseline. Masks are effective, with the N95 mask most effective at reducing HCP exposure to aerosols generated during a simulated sneeze.

Background: The microdebrider has become nearly universal in the treatment of sinonasal pathology; however, recent case reports have demonstrated the potential for major ophthalmic complications. The goal of this study was twofold: 1) determine the anatomical proximity of ophthalmic structures to the paranasal sinuses, and 2) assess the timeframe at which ophthalmic injury may occur with the use of a microdebrider during FESS utilizing a cadaveric model. Methodology: Computed tomography scans from 50 patients were accessed retrospectively. The distances between the lamina papyracea (LP) and orbital structures were determined at varying depths. Seven cadavers (14 sides) were studied using three microdebrider systems operated by otolaryngology residents. Following removal of a window of LP, the time from activation of the microdebrider on the periorbita until transection of the medial rectus (MR), optic nerve (ON), and to aspiration of the globe were measured. Results: The mean distance between the LP and MR at the level of the anterior aspect of the anterior ethmoid and basal lamella were 3.59 ± 1.2mm and 1.5 ± 0.8mm, respectively. The mean distance between the LP and ON at the level of the basal lamella was 8.1 ± 2.1mm. Mean transection times for the MR and ON were 13.4 ± 7.3 seconds and 37.3 ± 9.2 seconds, respectively, with minimum times of 4 seconds and 26 seconds. Conclusions: The proximity of orbital structures to the paranasal sinuses and the rapidity of ophthalmic damage following violation of the periorbita reaffirms the need for cautious use of the microdebrider during FESS.

Objective: To identify whether irrigation devices become contaminated when used by patients with allergic rhinitis (AR). Methods: Ten AR patients with no clinical or endoscopic evidence of active sinonasal infection were given a sinus rinse system and instructed on its proper use, cleaning, and storage. Two squeeze bottles (bottle A and bottle B) were given to each patient for twice-a-day rinsing. Bottle A was used in the morning and analyzed after four weeks. Bottle B was used in the evening and analyzed after 8 weeks of use. Microbial contaminants were cultured from the nose pieces and the inner surface of the bottles obtained from patients. Results: Seventeen sinus rinse devices (17/20) from all individuals in this study grew bacteria commonly in the nozzles. Twenty-four bacterial isolates consisting of 14 different species were cultured and identified with most common organisms being bacilli and staphylococcus. In addition, no correlation was apparent between the length of bottle use and the degree of contamination (r = 0.13, p = 0.76). During the study period, no patient developed acute sinus infections. Conclusion: Microbial contamination of the sinus rinse system occurs commonly, even in uninfected AR patients; however no evidence exists linking this to clinically relevant sinus infections. Trial Registration: clinicaltrials.gov Identifier: NCT01030146. Keywords: Allergic rhinitis, Microbial contaminants, Sinus irrigation, Sinus rinse, Squeeze bottles

Background: The SARS-CoV-2 virus continues to spread rapidly across the globe afflicting many with Coronavirus Disease 2019 (COVID-19). As the infection rates rise, a growing number of SARS-CoV-2 positive individuals have been reported to complain of olfactory disturbances at an alarming rate. Postviral olfactory dysfunction (PVOD) is a well-known phenomenon that may explain the olfactory dysfunction reported by SARS-CoV-2 infected individuals. Methods: A scoping literature review was performed to identify studies that investigated the mechanisms of postviral olfactory dysfunction. Studies demonstrating pathophysiological, histological, immunochemical, and epidemiological outcomes of PVOD were included. Results: Fourteen studies were included in addition to one international news article. Three studies reported destruction of the olfactory epithelium following intranasal inoculation of various viral strains in mice. Three studies isolated pathogenic, anosmia inciting viruses (Parainfluenza virus, Human Coronavirus, Rhinovirus) through nucleic acid amplification. Eleven studies demonstrated female predilection in patients with PVOD and COVID-19 associated olfactory dysfunction, of which the majority were over 50 years old. Conclusions: PVOD and COVID-19 associated olfactory dysfunction demonstrates considerable similarities in epidemiological trends and disease sequela of other viruses to suggest identical pathophysiological mechanisms. Further studies such as intranasal inoculation and histological biopsies are needed to support our hypothesis.

This study offers a novel description of the sinonasal microbiome, through an unsupervised machine learning approach combining dimensionality reduction and clustering. We apply our method to the International Sinonasal Microbiome Study (ISMS) dataset of 410 sinus swab samples. We propose three main sinonasal “microbiotypes” or “states”: the first is Corynebacterium-dominated, the second is Staphylococcus-dominated, and the third dominated by the other core genera of the sinonasal microbiome (Streptococcus, Haemophilus, Moraxella, and Pseudomonas). The prevalence of the three microbiotypes studied did not differ between healthy and diseased sinuses, but differences in their distribution were evident based on geography. We also describe a potential reciprocal relationship between Corynebacterium species and Staphylococcus aureus, suggesting that a certain microbial equilibrium between various players is reached in the sinuses. We validate our approach by applying it to a separate 16S rRNA gene sequence dataset of 97 sinus swabs from a different patient cohort. Sinonasal microbiotyping may prove useful in reducing the complexity of describing sinonasal microbiota. It may drive future studies aimed at modeling microbial interactions in the sinuses and in doing so may facilitate the development of a tailored patient-specific approach to the treatment of sinus disease in the future.

In this work, we construct elliptic analogues of the rook numbers and file numbers by attaching elliptic weights to the cells in a board. We show that our elliptic rook and file numbers satisfy elliptic extensions of corre- sponding factorization theorems which in the classical case were established by Goldman, Joichi and White and by Garsia and Remmel in the file number case. This factorization theorem can be used to define elliptic analogues of various kinds of Stirling numbers of the first and second kind as well as Abel numbers. We also give analogous results for matchings of graphs, elliptically extending the result of Haglund and Remmel.

Purpose: The necessity of serum potassium monitoring for healthy women who are prescribed spironolactone for acne has been debated. The aim of this study was to compare the incidence of hyperkalemia in women 18 to 45 years of age to that in women 46 to 65 years of age, when treated with oral spironolactone for acne. Methods and materials: Data for all women 18 to 65 years of age who were prescribed oral spironolactone by a dermatologist for acne between January 2006 and October 2016 were extracted for analysis. Retrospective data were included for women who exhibited baseline serum potassium within the normal limits and who had repeat serum potassium monitoring within 12 months after initiation of spironolactone. The rate of incident hyperkalemia was determined. Results: Of 618 women who received spironolactone for acne, 133 had serum potassium monitoring both before and after spironolactone initiation. Nine were excluded due to confounding comorbidities. Of the remaining 124 women, the mean age at initiation of spironolactone was 32 years (range, 18-57 years); 112 women were in the 18 to 45 years age group, and 12 were in the 46 to 65 years age group. All women had serum potassium within normal limits at baseline. Women in the 46 to 65 years age group had a significantly higher rate of incident hyperkalemia after spironolactone initiation compared with women 18 to 45 years of age (2 of 12 women [16.7%] vs. 1 of 112 women [