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Introduction: The efficient utilization of resources is a crucial aspect of healthcare, particularly in both Level I and Level II American College of Surgeons (ACS)-verified trauma centers. The effect of resource allocation on emergency department length of stay (ED-LOS) of trauma patients has remained under-investigated. As ED crowding has become more prevalent, especially at quaternary care centers, an evaluation of the potential disparities in ED-LOS between Level I and Level II trauma centers is warranted. We hypothesized a longer ED-LOS at Level I centers compared to Level II centers.Methods: We queried the 2017–2021 Trauma Quality Improvement Process (TQIP) database for trauma patients ≥18 years of age presenting to either a Level-I or -II center. The TQIP defines ED-LOS as the time from arrival until the time an ED disposition (admission or discharge) order is written. We excluded transferred patients and those with missing data regarding ACS trauma center verification level. We performed bivariate analyses, as well as subgroup analyses based on location of disposition.Results: Of 2,225,067 trauma patients, 59.3% (1,318,497) received treatment at Level I centers. No significant differences were found in Injury Severity Scores between patients admitted to the operating room or non-intensive care unit (ICU) locations, or discharged home from Level-I and -II centers (all P < 0.05). The ED-LOS for trauma patients was longer at Level-I centers for all patient categories: overall (198 vs 145 minutes [min], P < 0.001), discharged home (286 vs 160 min, P < 0.001), non-ICU admissions (234 vs 164 min, P < 0.001), and those requiring surgery (126 vs 101 min, P < 0.001).Conclusion: Even when treating patients with similar injury severity, trauma patients at Level I trauma centers had longer ED-LOS compared to Level II centers, irrespective of the patients’ final disposition (surgery, non-ICU admission, or discharge). To optimize resource utilization and alleviate ED saturation, further research must delve into the underlying causes of these discrepancies to identify best practices and solutions.

Climate change reduces snowpack, advances snowmelt phenology, drives summer warming, alters growing season precipitation regimes, and consequently modifies vegetation phenology in mountain systems. Elevational migrants track spatial variation in seasonal plant growth by moving between ranges at different elevations during spring, so climate-driven vegetation change may disrupt historic benefits of migration. Elevational migrants can furthermore cope with short-term environmental variability by undertaking brief vertical movements to refugia when sudden adverse conditions arise. We uncover drivers of fine-scale vertical movement variation during upland migration in an endangered alpine specialist, Sierra Nevada bighorn sheep (Ovis canadensis sierrae) using a 20-year study of GPS collar data collected from 311 unique individuals. We used integrated step-selection analysis to determine factors that promote vertical movements and drive selection of destinations following vertical movements. Our results reveal that relatively high temperatures consistently drive uphill movements, while precipitation likely drives downhill movements. Furthermore, bighorn select destinations at their peak annual biomass and maximal time since snowmelt. These results indicate that although Sierra Nevada bighorn sheep seek out foraging opportunities related to landscape phenology, they compensate for short-term environmental stressors by undertaking brief up- and downslope vertical movements. Migrants may therefore be impacted by future warming and increased storm frequency or intensity, with shifts in annual migration timing, and fine-scale vertical movement responses to environmental variability.

Background: Porcine epidemic diarrhea virus (PEDV) is a recurring coronavirus that causes severe diarrhea in pigs with high mortality and morbidity rates, especially in neonatal pigs. Despite the availability of vaccines, their efficacy is limited owing to antigenic differences between the vaccine and field strains, which poses a challenge to infection control. Antiviral drugs targeting conserved PEDV proteins show promise for complementing vaccination strategies. PEDV Nsp3 (PL2Pro) and Nsp5 (3CLPro) are essential proteases vital for viral replication, making them attractive targets for drug development against PEDV. Aim: To address the lack of therapeutics against recurring PEDV outbreaks and bridge the gap in the application of bioinformatics in veterinary drug discovery, this study aimed to discover compounds that inhibit PEDV proteases from Philippine medicinal plants by applying a modified virtual screening methodology that considers the physiology of swine hosts. Methods: This study employed a library of 690 metabolites from Philippine medicinal plants to screen for potential protease inhibitors targeting PEDV PL2Pro and 3CLPro. This includes evaluating the binding affinity, pharmacokinetics, dynamic stability, and critical binding site residues. Compounds demonstrating high affinity underwent a modified ADMET analysis, considering the enteric localization of the virus and potential toxicity to swine hosts. Furthermore, molecular dynamics simulations assessed compound stability under physiological swine conditions. Results: The study identified Bisandrographolide from Andrographis paniculata, CID 162866964 from Euphorbia neriifolia, and betulinic acid from Vitex negundo and Ocimum basilicum as metabolites that bind favorably and selectively to PEDV 3CLPro and have excellent pharmacokinetic properties and dynamic stability. In contrast, no selective inhibitor for PL2pro passed the same criteria. Conclusion: Employing the modified virtual screening protocol tailored for swine host considerations, the compounds identified in this study are anticipated to exert inhibitory effects against PEDV without off-target binding to analogous swine proteases and receptors. CID 162866964, bisandrographolide, and betulinic acid show promise for developing potent antivirals against PEDV. [Open Vet J 2024; 14(9.000): 2192-2214]

When European writers of the seventeenth and eighteenth centuries wrote about utopia or their vision of the best possible way to live, they usually included reflections on religion. Religion as it was known in their day was not perfect and had been criticized for causing numerous abuses. If a perfect or near-perfect society were to be imagined, it would have to include a perfect or near-perfect understanding of religion. This could range from atheism to a minimal religion which avoided all the institutional factors, to one in which detailed regulations governed all facets of religion and life. This article reviews and interprets the treatment of religion in a wide range of seventeenth- and eighteenth-century utopias. It concludes that some utopian writers set high goals for change, some settled for lesser reforms, and some left religion as it was while changing other parts of life.

The majority of hepatocellular carcinoma cases are caused by infection with hepatitis B (HBV) or C (HCV) viruses. CTNNB1 is the most mutated oncogene in HBV- and HCV-associated tumors. CTNNB1 mutations can lead to β-catenin accumulation, resulting in tumor progression. Small interfering RNAs (siRNAs) can be used to silence CTNNB1 mRNA. After prediction and evaluation, four siRNAs were found to have the highest silencing potential. All four siRNAs had an acceptable GC content, no palindromic sequences, no off-targets, were thermostable, and had accessible target sites. Molecular docking of the siRNAs to Argonaute 2 demonstrated favorable docking scores within the binding pocket for three siRNAs. Molecular dynamics simulations and binding energy calculations demonstrated that the siRNAs steadily remained in the binding pocket. In this study, three siRNAs were successfully designed to silence oncogenic CTNNB1 mRNA as a therapeutic strategy against hepatocellular carcinoma and warrant further in vitro and in vivo validation.

Introduction: Ultrasound-guided peripheral nerve blockade is a common pain management strategy to decrease perioperative pain and opioid/general anesthetic use. In this article our goal was to systematically review publications supporting upper extremity nerve blocks distal to the brachial plexus.We assessed the efficacy and safety of median, ulnar, radial, suprascapular, and axillary nerve blocks by reviewing previous studies.Methods: We searched MEDLINE and Embase databases to capture studies investigating these nerve blocks across all specialties. We screened titles and abstracts according to agreed-upon inclusion/exclusion criteria. We then conducted a hand search of references to identify studies not found in the initial search strategy.Results: We included 20 studies with1,273 enrolled patients in qualitative analysis. Both anesthesiology (12, 60%) and emergency medicine (5, 25%) specialties have evidence of safe and effective use of radial, ulnar, median, suprascapular, and axillary blocks for numerous clinical applications. Recently, multiple randomized controlled trials show suprascapular nerve blocks may result in lower pain scores in patients with shoulder dislocations and rotator cuff injuries, as well as in patients undergoing anesthesia for shoulder surgery.Conclusion: Distal upper extremity nerve blocks under ultrasound guidance may be safe, practical strategies for both acute and chronic pain in perioperative,emergent, and outpatient settings. These blocks provide accessible, opioid-sparing pain management, and their use across multiple specialties may be expanded with increased procedural education of trainees.

This study investigates the impact of gender role stress on self-esteem and self-efficacy among parents with interchanged roles in Cavite, Philippines. The significance of this research lies in its exploration of evolving gender roles within the context of a traditionally gendered society. Using Structural Equation Modeling (SEM), the study examines hypothesized relationships between gender role stress and psychological constructs. The results reveal that gender role stress generally has a negative impact on self-esteem, particularly for working wives, while enhancing self-efficacy could help househusbands better manage stress. In contrast, the SEM model for working wives highlights the persistent impact of gender role stress as a negative predictor of self-esteem, unlike the househusbands' model. The study's conclusions emphasize the need for societal support mechanisms to mitigate the adverse effects of gender role stress and promote mental well-being in these contexts. This research contributes to the understanding of gender dynamics and their psychological implications in non-traditional family structures.

Keratophagous insects consume proteinaceous foods (animal hair, feathers, and other substances containing keratin) that are low or even lacking in water, which necessitates a source of moisture beyond the primary diet. Tinea occidentella Chambers 1880 (Lepidoptera, Tineidae), which feeds upon the keratin in fur and feathers in mammalian carnivore scat and in pellets of birds of prey (foods very low in water), affords an understanding of the ecology of keratophagous insects in nature. The common name “western clothes moth” is a misnomer as it does not eat clothes but only scat and pellets. In laboratory experiments, we found that larvae did not absorb water vapour directly from the atmosphere, and they died at 45% rh–55% relative humidity (rh). We found no evidence that larvae drank. Larvae grew normally, had high survival, pupation, and eclosion only when feeding at very high (>88%–99%) rh upon fur from pellets and scat; the fur absorbed water from the atmosphere. While scat and pellets are abundant throughout North America, T. occidentella is mostly restricted to the moist, mild climates of coastal central and southern California, where fog, dew, and morning high rh of 99% are common. Outside of this coastal envelope where growing season climate is warmer, drier, and becoming more so, the species is rare. An intriguing notion, requiring research beyond the present report, is that the warming and drying climate of southwestern North America will contract the range of this insect.

Assumptions about factors such as climate in shaping species' realized and potential distributions underlie much of conservation planning and wildlife management. Climate and climatic change lead to shifts in species distributions through both direct and indirect ecological pressures. Distributional shifts may be particularly important if range overlap is altered between interacting species, or between species and protected areas. The cattle family (Bovidae) represents a culturally, economically, and ecologically important taxon that occupies many of the world's rangelands. In contemporary North America, five wild bovid species inhabit deserts, prairies, mountains, and tundra from Mexico to Greenland. Here, we aim to understand how future climate change will modify environmental characteristics associated with North American bovid species relative to the distribution of extant protected areas. We fit species distribution models for each species to climate, topography, and land cover data using observations from a citizen science dataset. We then projected modeled distributions to the end of the 21st century for each bovid species under two scenarios of anticipated climate change. Modeling results suggest that suitable habitat will shift inconsistently across species and that such shifts will lead to species-specific variation in overlap between potential habitat and existing protected areas. Furthermore, projected overlap with protected areas was sensitive to the warming scenario under consideration, with diminished realized protected area under greater warming. Conservation priorities and designation of new protected areas should account for ecological consequences of climate change.

Rice (Oryza sativa), as a staple crop feeding a significant portion of the global population, particularly in Asian countries, faces constant threats from various diseases jeopardizing global food security. A precise understanding of disease resistance mechanisms is crucial for developing resilient rice varieties. Traditional genetic mapping methods, such as QTL mapping, provide valuable insights into the genetic basis of diseases. However, the complex nature of rice diseases demands a holistic approach to gain an accurate knowledge of it. Omics technologies, including genomics, transcriptomics, proteomics, and metabolomics, enable a comprehensive analysis of biological molecules, uncovering intricate molecular interactions within the rice plant. The integration of various mapping techniques using multi-omics data has revolutionized our understanding of rice disease resistance. By overlaying genetic maps with high-throughput omics datasets, researchers can pinpoint specific genes, proteins, or metabolites associated with disease resistance. This integration enhances the precision of disease-related biomarkers with a better understanding of their functional roles in disease resistance. The improvement of rice breeding for disease resistance through this integration represents a significant stride in agricultural science because a better understanding of the molecular intricacies and interactions underlying disease resistance architecture leads to a more precise and efficient development of resilient and productive rice varieties. In this review, we explore how the integration of mapping and omics data can result in a transformative impact on rice breeding for enhancing disease resistance.

Co-designing research-informed guidelines with youth for adapting research methods to other contexts has received little research attention. We report on guidelines co-designed with youth for adapting arts-based methods (ABM) for youth mental health (MH) research in online environments. Seven youth co-researchers participated in 3 co-design workshops and 2 graphic recording focus groups. Data analysis involved a thematic analysis approach. We identified one overarching theme (sustaining mindful presence when conducting research) and 4 subthemes (creating a safe space, youth having a say, facilitating meaningful engagement, paying receptive attention throughout the research process). Facilitating participants’ authentic expression in online environments requires: 1) Letting youth self-identify; 2) incorporating diversity and inclusion; 3) providing accommodations, recognition, and compensation; 4) language considerations; 5) offering ABM training and resources for creating art; 6) using virtual platforms youth use; 7) being mindful of ethical considerations and technology fatigue; 8) addressing barriers in accessing and using technology; 9) providing choice in type of ABM and research methods used; and 10) providing options for communicating during research activities and for engaging in research outside of allotted time (e.g., email, group chat). These research-informed guidelines can be useful for conducting youth MH research and other youth research in online environments.

Objective In 2011, School of Medicine, University of California, Irvine was among the first schools to implement a 4-year ultrasound curriculum. We aimed to find the point-of-care ultrasound (POCUS) utilization pattern among University of California, Irvine alumni. Methods We surveyed University of California, Irvine alumni from the class of 2011 and beyond. Survey questions included POCUS reliance, frequency of use, and comfort with image acquisition and interpretation compared with peers. The primary outcomes were self-reported comfort and reliance on POCUS. Results We received 93 responses from 624 surveyed alumni (response rate, 14.9%), of which 87 were analyzed. Although 46 respondents (52.9%) reported more reliance on POCUS, three (3.4%) relied on it less than their peers. At the same time, 72 (82.7%) and 67 (77.0%) felt more comfortable than their colleagues in obtaining and interpreting POCUS, respectively. No respondents felt less comfortable obtaining or interpreting POCUS than their peers. The frequency of POCUS use correlated directly with the frequency with which POCUS changed the responder’s case management (rho, 0.860; P

Även om den samtida forskningen förlägger Nya testamentets kanonisering från 300-talet och framåt fortsätter 100-talet att spela en viktig roll i diskussionerna kring kanonbildningen i den tidiga kyrkan. I denna artikel ges en kort forskningshistorisk bakgrund till diskussionen rörande Nya testamentets kanonisering för att sedan belysa vad som kan utläsas om Nya testamentets kanoniska status hos några inflytelserika kristna 100-talsprofiler.

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Följande böcker recenseras: Aasgaard, Reidar, Ona Maria Cojocaru och Cornelia B. Horn (red), Childhood in History: Perceptions of Children in the Ancient Medieval Worlds (Mikael Larsson) Ben Zvi, Ehud and Diana Vikander Edemann, Imagining the Other and Constructing Israelite Identity in the Early Second Temple Period (Karin Tillberg) Biblica, nuBibeln (Per-Olof Hermansson) Brodersen, Alma, The End of the Psalter: Psalms 146–150 in the Masoretic Text, the Dead Sea Scrolls, and the Septuagint (David Willgren) Dodson Joseph R. and David E. Briones (eds.), Paul and Seneca in Dialogue (Adam Sabir) Dodson, Joseph R. and Andrew W. Pitts (eds.), Paul and the Greco-Roman Philosophical Tradition (Adam Sabir) Eidsvåg, Gunnar Magnus, The Old Greek Translation of Zechariah (Lena-Sofia Tiemeyer) Fredriksen, Paula, Paul: The Pagan’s Apostle (Lukas Hagel) Frevel, Christian, Gottesbilder und Menschenbilder: Studien zu Anthropologie und Theologie im Alten Testament, samt Wagner, Andreas, Menschenverständnis und Gottesverständnis im Alten Testament: Gesammelte Aufsätze 2 (Richard Pleijel) Gertz, Jan C., Bernhard M. Levinson, Dalit Rom-Shiloni och Konrad Schmid (red.), The Formation of the Pentateuch: Bridging the Academic Cultures of Europe, Israel, and North America (Josef Forsling) Graybill, Rhiannon, Are We Not Men? Unstable Masculinity in the Hebrew Prophets (Mikael Larsson) Gundry, Robert H., Peter – False Disciple and Apostate according to Saint Matthew (John-Christian Eurell) Hays, Richard B., Echoes of Scripture in the Gospels (James Starr) Heilig, Christoph, Paul’s Triumph: Reassessing 2 Corinthians 2:14 in Its Literary and Historical Context (Ludvig Svensson) Himmelfarb, Martha, Between Temple and Torah: Essays on Priests, Scribes, and Visionaries in the Second Temple Period and Beyond (Stefan Green) Hurtado, Larry W., Destroyer of the Gods: Early Christian Distinctiveness in the Roman World (Mikael Tellbe) Keener, Craig S., Spirit Hermeneutics: Reading Scripture in Light of Pentecost (Bo Krister Ljungberg) Keener, Craig S. and John H. Walton (gen. eds.), NIV Cultural Backgrounds Study Bible: Bringing to Life the Ancient World of Scripture (Bo Krister Ljungberg) Kok, Michael J., The Gospel on the Margins: The Reception of Mark in the Second Century (Joel Kuhlin) Licona, Michael R., Why Are There Differences in the Gospels? What We Can Learn from Ancient Biography (Tobias Ålöw) Lin, Yii-Jan, The Erotic Life of Manuscripts: New Testament Criticism and the Biological Sciences (Joel Kuhlin) Lied, Liv Ingeborg och Hugo Lundhaug (red.), Snapshots of Evolving Traditions: Jewish and Christian Manuscript Culture, Textual Fluidity and New Philology (Kamilla Skarström Hinojosa) Mermelstein, Ari and Shalom E. Holtz (eds.), The Divine Courtroom in Comparative Perspective (Lena-Sofia Tiemeyer) Miller, Stuart S., At the Intersection of Texts and Material Finds: Stepped Pools, Stone Vessels, and Ritual Purity Among Jews of Roman Galilee (Cecilia Wassén) Moxon, John R. L., Peter’s Halakhic Nightmare: The “Animal” Vision of Acts 10:9–16 in Jewish and Graeco-Roman Perspective (Carl Johan Berglund) Neudecker, Reinhard, Moses Interpreted by the Pharisees and Jesus: Matthew’s Antitheses in the Light of Early Rabbinic Literature (Tobias Ålöw) Penner, Todd and Davina C. Lopez, De-Introducing the New Testament: Texts, Worlds, Methods, Stories (Martin Wessbrandt) Schellenberg, Ryan S., Rethinking Paul’s Rhetorical Education: Comparative Rhetoric and 2 Corinthians 10–13 (Johannes Leckström) Schreiner, Patrick, The Body of Jesus: A Spatial Analysis of the Kingdom in Matthew (Tobias Ålöw) Sprinkle, Preston (red.), Two Views on Homosexuality, the Bible, and the Church (Bo Krister Ljungberg) Stökl, Jonathan and Caroline Waerzeggers (eds.), Exile and Return: The Babylonian Context (Karin Tillberg) Thurén, Lauri, Parables Unplugged: Reading the Lukan Parables in Their Rhetorical Context (Lennart Thörn) Thörn, Lennart, Ordets tillblivelse. Lukasevangeliet (Magnus Evertsson) Weima, Jeffrey A. D., Paul the Ancient Letter Writer: An Introduction to Epistolary Analysis (Adam Sabir) Winninge, Mikael (red.), Dödahavsrullarna – i svensk översättning (Søren Holst)

Introduction: Ultrasound-guided peripheral nerve blockade is a common pain management strategy to decrease perioperative pain and opioid/general anesthetic use. In this article our goal was to systematically review publications supporting upper extremity nerve blocks distal to the brachial plexus. We assessed the efficacy and safety of median, ulnar, radial, suprascapular, and axillary nerve blocks by reviewing previous studies. Methods: We searched MEDLINE and Embase databases to capture studies investigating these nerve blocks across all specialties. We screened titles and abstracts according to agreed-upon inclusion/exclusion criteria. We then conducted a hand search of references to identify studies not found in the initial search strategy. Results: We included 20 studies with 1,273 enrolled patients in qualitative analysis. Both anesthesiology (12, 60%) and emergency medicine (5, 25%) specialties have evidence of safe and effective use of radial, ulnar, median, suprascapular, and axillary blocks for numerous clinical applications. Recently, multiple randomized controlled trials show suprascapular nerve blocks may result in lower pain scores in patients with shoulder dislocations and rotator cuff injuries, as well as in patients undergoing anesthesia for shoulder surgery. Conclusion: Distal upper extremity nerve blocks under ultrasound guidance may be safe, practical strategies for both acute and chronic pain in perioperative, emergent, and outpatient settings. These blocks provide accessible, opioid-sparing pain management, and their use across multiple specialties may be expanded with increased procedural education of trainees.

Background:. Total knee arthroplasty (TKA) has long been considered the definitive treatment for knee osteoarthritis. Although tremendous improvements have been made in surgical techniques for conventional TKA, a substantial dissatisfaction rate among patients has persisted because of moderate-to-severe pain and stiffness following TKA. Robot-assisted TKA was developed as an alternative to conventional TKA with the goal of improving operative precision and producing better clinical outcomes with minimal postoperative complications. The aim of this study was to compare the radiographic outcomes, duration of surgery, and complication rate between robot-assisted TKA and conventional TKA. Methods:. We conducted relevant literature searches of Medline, Scopus, ClinicalTrials.gov, and the Cochrane Library databases with use of specific keywords. The outcomes for continuous variables were pooled into mean differences, whereas the outcomes for dichotomous variables were pooled into odds ratios with 95% confidence intervals with use of random-effects models. Results:. A total of 12 randomized clinical trials were included. Our pooled analysis revealed that robot-assisted TKA was associated with fewer outliers in the hip-knee-ankle (HKA) angle (p < 0.0001), femoral component (coronal) angle (p = 0.0006), femoral component (sagittal) angle (p = 0.009), tibial component (coronal) angle (p = 0.05), and tibial component (sagittal) angle (p = 0.01) when compared with conventional TKA. The postoperative HKA angle was also significantly more neutral in the robot-assisted TKA group (mean difference, −0.77°; p < 0.0001). However, the complication rate did not differ significantly between the 2 groups. Conclusions:. Robot-assisted TKA may produce more accurate placement of the prosthetic component and better joint alignment accuracy than conventional TKA as shown by fewer outliers in several joint angles. Level of Evidence:. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

BackgroundDehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava (IVC) to the aorta (Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama.MethodsThis was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration.ResultsA total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half (n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half (n=18) of these subjects also had an IVC/Ao ratio below the American threshold of 0.8.ConclusionOur study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.

Acknowledging that language barriers between the pharmacist as the health care provider and the deaf as the patient have been the most prominent limiting factor in providing accessible and quality pharmaceutical care services to the deaf, this study made use of a set of drug information instructional materials in integrating a lesson about providing patient counselling to the deaf in the course Dispensing and Medication Counselling I in the new BS Pharmacy Curriculum. The study assessed the effectiveness of the use of the said materials through a survey and through the scores obtained by BS Pharmacy student-respondents from a paired pre- and post-test, and a summative test. Findings showed that the instructional materials consist of a video and a reference guidebook were perceived by Pharmacy students as highly effective in serving its purpose. The materials were also found highly effective in improving the students’ awareness on deaf culture and communication and effective in developing their basic sign language skills used in communicating drug information. The study recommended the integration of the materials across different health education and continuing professional programs to help catalyze positive change by providing more inclusive health services to the Deaf.

Introduction Head and neck lymphedema is an omnipresent morbidity related to head and neck cancer therapies. Studies on therapy for these patients in the acute postsurgical population have not been published to date. Objective To assess changes in the measurements of lymphedema in surgical head and neck cancer patients during the hospital stay with implementation of modified decongestive therapy (MDT). Methods Patients aged > 18 years undergoing neck dissection with or without primary-site resection or laryngectomy between 2016 and 2019 were included. Facial measurements were obtained prior to beginning MDT and again prior to discharge. A total facial composite measurement was calculated and used to assess change over time. Rates ≥ 2% of change were considered significant. Results A total of 38 patients were included (subsites: larynx = 27; thyroid = 4; oral cavity = 3; and neck = 4). The mean number of days between surgery and the start of lymphedema therapy was 3.0 days. The mean number of days between measurements was 5.2 days. Reduction in the total composite score was observed in 37 (97%) patients, and 35 (92%) patients had a total composite reduction score > 2%. Tumor subsite and surgery type did not portend toward greater percent change, except for those patients treated with total laryngectomy, regional flap reconstruction, and neck dissection (p = 0.02). Conclusion Acute postsurgical inpatient MDT was associated with reduced total composite measurements in patients after head and neck surgery. As the first published study on lymphedema therapy in this acute postsurgical period, further prospective case-control studies are warranted to explore further benefits of acute therapy.

Patellar clunk crepitation is a well-known complication following knee replacement surgery and is associated with posterior stabilized knee replacement surgery and surgical technique. Currently, patellar clunk or crepitation management following knee replacement surgery with preserved patella remains unclear. The purpose of this case report is to discuss whether patellar clunk or crepitation management should include debridement with patellar resurfacing or debridement alone. This case describes a patellar crepitation after knee replacement surgery with the preserved patella. The surgery went uneventfully using the standard medial parapatellar approach. However, the patient was still unsatisfied with the chronic left knee pain (>3 months) and crepitation that developed following the surgery, and the patient was diagnosed with patellar clunk and crepitation (PCC). A patellar resurfacing procedure was performed with a satisfactory clinical outcome. Replicating the original joint line level and placing the tibial component posteriorly play a pivotal role in preventing PCC. Debridement and patellar resurfacing procedures are recommended in this type of case to overcome the valgus knee alignment and the placement of the tibial component.

The study on the Psychological Effects of Blended Learning among the Faculty of Sultan Kudarat State University was conducted to determine the blended learning and its psychological effects on the teachers. The result shows that modular learning is satisfactorily implemented while online learning is moderately implemented. When it comes to the psychological effects of blended learning in terms of teachers’ anxiety, the teachers are moderately experiencing it and in terms of teachers’ distress and boredom, the teachers are seldom experiencing it. The top 5 issues and concerns on blended learning are also asked.