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This paper underscores the significance of experiential learning, emphasising active engagement and practical application, particularly in the realm of online education. This research is focused on the National Open University of Nigeria (NOUN). The study employs a survey research design involving internal and external online facilitators. The research explores the perceptions, benefits, challenges, and potential strategies for integrating experiential learning into online facilitation. With a sample size of 276, data collection utilised a structured questionnaire, and analysis involved descriptive and inferential statistics. The study’s findings have practical implications, informing policy decisions, instructional design practices, and faculty development initiatives at NOUN, ultimately aiming to enhance the holistic and immersive learning experience for online learners. The conclusion emphasises the potential of integrating experiential learning to elevate the quality, effectiveness, and real-world preparedness of NOUN’s online programmes, fostering student engagement and critical thinking. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the impact of sidedness of colorectal cancer (CRC) in elderly patients on the prognosis. Methods: In a sub-analysis of a multicenter case–control study of CRC patients who underwent surgery at ≥ 80 years old conducted in Japan between 2003 and 2007, both short- and long-term outcomes were compared between right-sided colon cancers (RCCs) and left-sided colorectal cancers (LCCs). RCCs were defined as those located from the cecum to the transverse colon. Results: Among the 1680 patients who underwent curative surgery, 812 and 868 had RCCs and LCCs, respectively. RCCs were more frequent than LCCs in those who were female, had renal comorbidities, and had a history of abdominal surgery. Regarding tumor characteristics, RCCs were larger, invaded more deeply, and were diagnosed as either mucinous or signet ring-cell carcinoma more frequently than LCCs. Regarding the prognosis, patients with RCCs had a significantly longer cancer-specific survival (CS-S) and cancer-specific relapse-free survival (CS-RFS) than those with LCCs. Furthermore, sidedness was determined to be an independent prognostic factor for CS-S and CS-RFS. Conclusion: RCCs, which accounted for half of the cases in patients ≥ 80 years old, showed better long-term outcomes than LCCs. [ABSTRACT FROM AUTHOR]

The global pandemic has led to an explosion of open learning opportunities for academics to connect, share and develop ideas together. This paper presents a collaborative autoethnographic case study on the educational leadership approaches enacted and experienced in the voluntary Creativity for Learning in Higher Education (#creativeHE) community. The authors reflect, critically analyse and review the leadership of this open peer support community as it is experienced by them using visual metaphors and paired conversations. Insights gained through this inquiry seem to suggest that the leadership within this community is characterised by and experienced as communityship, a highly participatory and democratic way of leading that brings harmony, offers refuge and stretches the leadership team. Their humane and affective bonds as a collective provide a safe and calm working space in which everybody can flourish. [ABSTRACT FROM AUTHOR]

Introduction: The ultimate measure of successful abdominal wall reconstruction is a pain-free, complication-free, and durable hernia repair. Open techniques have generally lost favor, but they still have much to offer for patients with skin deficits and excess. The long-term complication rates for open hernia repairs is unknown. Electronic medical records now provide the ability to easily follow patients who have switched medical institutions. Using this tool, we followed a cohort of abdominal wall reconstruction patients who had an early high "success" rate. Methods: We performed a retrospective chart review of 101 patients who underwent open ventral hernia repair with a narrow well-fixed retrorectus uncoated polypropylene mesh by a single surgeon (GAD) between the years of 2010 and 2015. These patients were initially reported in a 2016 publication. Patients' post-operative follow-up by any medical provider assessing the abdominal region were studied up until August 2023. Patient demographics, operative reports, and postoperative course were re-reviewed. Results: A total of 101 patients underwent ventral hernia repair. Mean follow-up time was 7.68 years (range 1.8 – 13.0 years). There were no recurrent hernias across the studied time period and no instances of enterocutaneous fistulas. 15 patients (15%) had abdominal surgery after hernia repair unrelated to their original surgery and 5 patients (5%) reported chronic post-operative pain. 13 patients died in the follow-up period, all unrelated to the abdominal wall surgery. Conclusion: Open well-fixed narrow retrorectus mesh hernia repairs perform well in the long-term without fistulas, extrusions, and hernia recurrence. [ABSTRACT FROM AUTHOR]

Abstract Background This study was conducted to investigate the long-term outcomes of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) in patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NACT). Methods Patients with AGC who received NACT before surgery were enrolled in either the LTG or OTG group. Propensity score matching (PSM) (1:2) was performed between the two groups based on the propensity score using a 0.15 calliper width. Three-year overall survival (OS) and disease-free survival (DFS) were compared between these two groups before and after PSM. OS and DFS rates were calculated by the Kaplan‒Meier method, and any differences in survival were evaluated with a log-rank test. Univariate and multivariate Cox proportional hazards analyses were used to estimate the simultaneous effects of prognostic factors on survival and the hazard ratio (HR) between LTG and OTG patients. Results A total of 144 patients completed the follow-up, with 24 patients in the LTG group and 120 patients in the OTG group. After a mean follow-up of 64.40 months, there were no significant differences in the 3-year OS or DFS rates between the two groups before (P = 0.453 and P = 0.362, respectively) or after PSM (P = 0.972 and P = 0.884, respectively). Multivariate Cox proportional hazards analysis indicated that ypN stage was an independent risk factor for worse OS (P = 0.013). Conclusions This study showed that LTG with D2 lymphadenectomy performed by an experienced surgical team resulted in comparable 3-year OS and DFS compared with OTG in patients with AGC after NACT. Trial registration This study is not registered.

Background: Shoulder instability in pediatric and adolescent patients can be treated operatively via arthroscopic or open procedures, but there a paucity of evidence to support the incidence of these treatment modalities over time. It is hypothesized that the overall rate of arthroscopic shoulder stabilization procedures will increase over time. Given advances in open stabilization techniques, we also hypothesized that the rate of open procedures may be increasing. Methods: The Pediatric Health Information System database was queried for patients 19 years or younger who underwent arthroscopic or open surgery for shoulder instability and pediatric orthopedic surgeries between 2009 and 2019. Data from 37 of the 52 pediatric hospitals with Pediatric Health Information System data was included in the analysis. Annual and overall incidence rates were estimated for arthroscopic and open procedures, along with 95% confidence intervals. The yearly incidence for secondary (homolateral revisions) or primary contralateral arthroscopic and open procedures was also examined. Results: 4747 patients underwent primary arthroscopic procedures and 384 patients had primary open procedures. There were 8.2 primary open shoulder stabilization procedures per 10,000 orthopedic surgical patients in 2009, which decreased by 19% to 6.7 per 10,000 orthopedic surgical patients in 2019. There was an increase seen in both arthroscopic and open secondary stabilization procedures. In 2009, there were 0.97 secondary arthroscopic procedures per 10,000 orthopedic surgical patients. This increased by 672% to 7.5 per 10,000 orthopedic surgical patients in 2019. No secondary open procedures were recorded in 2009; however, an increase to 2.6 secondary open procedures per 10,000 orthopedic surgical patients was seen by 2019. Conclusion: This study shows a rise in primary arthroscopic pediatric shoulder stabilization surgeries across the U.S. over the last decade. There was a slight decrease in the rate of primary open shoulder stabilization surgeries and an increase in both arthroscopic and open secondary (homolateral revisions or primary contralateral) shoulder stabilization surgeries, implying an increasing revision burden in this population.

Background: Hernia surgery is one of the commonly done procedures in General surgery. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Aims and Objectives: Comparison of morbidity in terms of total analgesic usage, mean length of hospital stay, comparison among open and TEP repair of hernias in primary inguinal hernias among males. Material and Methods: This study was done on 80 patients with clinical diagnosis of primary inguinal hernia over a period of one year to compare the result of two surgeries, open lichenstein repair (n=40) and TEP repair (n=40). Results: Postoperative pain using VAS was found to be lower in patients having laparoscopic TEP hernia repair when compared to open lichenstein tension free repair (p

Objective To explore the perioperative situation of patients with hepatocellular carcinoma (HCC) treated with laparoscopic hepatectomy or open hepatectomy and their effects on liver function. Methods A retrospective analysis was conducted on 85 patients with HCC who visited the Department of Biliary and Pancreatic Surgery, Shanxi Bethune Hospital from January 2020 to December 2022. According to the surgical methods, the patients were divided into open group (open hepatectomy, n=53) and laparoscopic group (laparoscopic hepatectomy, n=32). Both groups of patients were followed up for one month after discharge. The general information, intraoperative conditions, postoperative complications, and liver function indicators were compared between two groups of patients. Results Compared with the open group, the laparoscopic group had shorter hospitalization time ［(14.19±3.02) d vs (16.36±3.30) d, t=3.03, P＜0.01］, as well as shorter time for the first postoperative anal evacuation ［(2.30±0.77) d vs (2.75±0.49) d, t=3.29, P＜0.01］ and less intraoperative bleeding ［(395.63±70.25) mL vs (440.38±62.42) mL, t=3.05, P＜0.01］. Serum total bilirubin, alanine aminotransferase, aspartate aminotransferase levels were lower in the laparoscopic group than those in the open group at 3 days postoperatively, and the difference was statistically significant (P＜0.05). In the 1-month postoperative period, the difference in the overall rate of postoperative complications between the two groups was not statistically significant (15.63% vs 16.98%, χ2=0.92, P=0.34). Conclusion For patients with HCC, the application of laparoscopic hepatectomy is safe and feasible, which can reduce the impact on liver function, shorten hospitalization time, and promote early recovery.

Background: This study was conducted to investigate the long-term outcomes of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) in patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NACT). Methods: Patients with AGC who received NACT before surgery were enrolled in either the LTG or OTG group. Propensity score matching (PSM) (1:2) was performed between the two groups based on the propensity score using a 0.15 calliper width. Three-year overall survival (OS) and disease-free survival (DFS) were compared between these two groups before and after PSM. OS and DFS rates were calculated by the Kaplan‒Meier method, and any differences in survival were evaluated with a log-rank test. Univariate and multivariate Cox proportional hazards analyses were used to estimate the simultaneous effects of prognostic factors on survival and the hazard ratio (HR) between LTG and OTG patients. Results: A total of 144 patients completed the follow-up, with 24 patients in the LTG group and 120 patients in the OTG group. After a mean follow-up of 64.40 months, there were no significant differences in the 3-year OS or DFS rates between the two groups before (P = 0.453 and P = 0.362, respectively) or after PSM (P = 0.972 and P = 0.884, respectively). Multivariate Cox proportional hazards analysis indicated that ypN stage was an independent risk factor for worse OS (P = 0.013). Conclusions: This study showed that LTG with D2 lymphadenectomy performed by an experienced surgical team resulted in comparable 3-year OS and DFS compared with OTG in patients with AGC after NACT. Trial registration: This study is not registered. [ABSTRACT FROM AUTHOR]

Showing results of open and percutaneous surgical management of traumatic AO type A3, A4 and B2 thoracic and lumbar fractures. Retrospective comparative analysis of traditional open fusion versus percutaneous navigated fixation of thoracic and lumbar spinal fractures. Minimum 24 months follow-up to collect ODI and VAS outcome scores for comparative analysis was required. Fifty-seven patients with a mean age of 39 years met the inclusion criteria. Twenty-six patients were in the open group (Group O) and 31 in the percutaneous group (Group P). The majority of fractures were either type A3 or A4; there were three type B chance fractures in Group O and one in Group P. VAS and ODI scores followed comparable trends in the two groups until the final follow-up. The main statistically significant result between the two groups was blood loss, which was lower in Group P (110 versus 270 ml in Group O on average), although this did not reflect into different clinical outcomes. Similar peri-operative measures of operating time and length of stay were found between the two groups. A significantly higher degree of loss of reduction was noted at follow-up in Group P (8° versus 5° in Group O on average). Open and percutaneous posterior fixation techniques of thoracic and lumbar fractures in this cohort were associated with different perioperative blood losses as well as radiological measurements, but not with clinically meaningful differences in patient reported outcome measures at 24 months' follow-up. [ABSTRACT FROM AUTHOR]

Background: Cervical radiculopathy is a spine ailment frequently requiring surgical decompression via anterior cervical discectomy and fusion (ACDF) or posterior foraminotomy/discectomy. While endoscopic posterior foraminotomy/discectomy is gaining popularity, its financial impact remains understudied despite equivalent randomized long-term outcomes to ACDF. In a cohort of patients undergoing ACDF vs endoscopic posterior cervical foraminotomy/discectomy, we sought to compare the total cost of the surgical episode while confirming an equivalent safety profile and perioperative outcomes. Methods: A single-center retrospective cohort study of patients with unilateral cervical radiculopathy undergoing ACDF or endoscopic cervical foraminotomy between 2018 and 2023 was undertaken. Primary outcomes included the total cost of care for the initial surgical episode (not charges or reimbursement). Perioperative variables and neurological recovery were recorded. Multivariable analysis tested age, body mass index, race, gender, insurance type, operative time, and length of stay. Results: A total of 38 ACDF and 17 endoscopic foraminotomy/discectomy operations were performed. All patients underwent single-level surgery except for 2 two-level endoscopic decompressions. No differences were found in baseline characteristics and symptom length except for younger age (46.8 ± 9.4 vs 57.6 ± 10.3, P = 0.002) and more smokers (18.4% vs 11.8%, P = 0.043) in the ACDF group. Actual hospital costs for the episode of surgical care were markedly higher in the ACDF cohort (mean ±95% CI; $27,782 ± $2011 vs $10,103 ± $720, P < 0.001) driven by the ACDF approach (β = $17,723, P < 0.001) on multivariable analysis. On sensitivity analysis, ACDF was never cost-efficient compared with endoscopic foraminotomy, and endoscopic failure rates of 64% were required for break-even cost. ACDF was associated with significantly longer operative time (167.7 ± 22.0 vs 142.7 ± 27.4 minutes, P < 0.001) and length of stay (1.1 ± 0.5 vs 0.1 ± 0.2 days, P < 0.001). No significant difference was found regarding 90-day neurological improvement, readmission, reoperation, or complications. Conclusion: Compared with patients treated with a single-level ACDF for unilateral cervical radiculopathy, endoscopic posterior cervical foraminotomy/discectomy can achieve a similar safety profile, pain relief, and neurological recovery at considerably less cost. These findings may help patients and surgeons revisit offering the posterior cervical foraminotomy/ discectomy utilizing endoscopic techniques. Clinical Relevance: Endoscopic posterior cervical foraminotomy/discectomy offers comparable safety, pain relief, and neurological recovery to traditional methods but at a significantly lower cost. [ABSTRACT FROM AUTHOR]

The International Lower Limb Collaborative (INTELLECT) study analyzed pediatric open fractures in the lower limbs, involving 163 patients from 43 centers in 13 countries. The study found that road traffic accidents were the most common cause of injury, followed by high-energy falls. The majority of injuries were open tibial/fibula fractures. The study examined outcomes such as soft tissue infection, deep infection, non-union, and amputation. It found that patients with Gustilo-Anderson IIIB and IIIC injuries had a higher risk of wound infection and deep infection. Delay in achieving soft tissue closure beyond 72 hours after injury was associated with a greater likelihood of infection. The study also emphasized the importance of a combined ortho-plastic approach for managing soft tissue injuries in pediatric trauma cases. However, the study has limitations due to its retrospective design and limited applicability to middle- and low-income settings. [Extracted from the article]

Objectives: To apply a new evidence‐gathering methodology, called reverse systematic review (RSR), to analyse the influence of different continence classification criteria on urinary continence rates among open retropubic radical prostatectomy (RRP), laparoscopic RP (LRP) and robot‐assisted RP (RARP). Materials and Methods: A search was carried out in eight databases between 2000 and 2020 through systematic reviews (SRs) studies referring to RRP, LRP or RARP (80 SRs). All references used in these SRs were captured referring to 910 papers in an overall database called the 'EVIDENCE Database'. A total of 422 studies related to post‐RP urinary continence were selected for the final analysis, totalling 782 reports referring to 193 618 patients. Results: Overall, 206 (26.4%) reports for RRP, 243 (31.0%) reports for LRP, and 333 (42.6%) reports for RARP were found. Mean overall continence rates, respectively for RRP, LRP and RARP, were: 42%, 34% and 42% at 1 month; 62%, 64% and 65% at 3 months; 73, 77 and 79% at 6 months; and 81%, 85% and 86% at 12 months. The most used criterion was 'No pad' (53.3%), followed by 'Safety pad' (19.3%), 'Not described' (10.6%), and 'No leak' (9.9%). 'No pad' showed the lowest discrepancy in continence rates in each period compared to the overall average for each technique, demonstrating less ability to influence the final results favouring any of the techniques. Conclusion: The RSR demonstrated that the 'No pad' criterion was the most used in the literature and showed the lowest bias capable of influencing the results and favouring any of the techniques and is the fairest option for future comparisons. [ABSTRACT FROM AUTHOR]

Intensive cultivation coupled with scrupulous use of fertilizers could be detrimental to soil health and quality of the produce in the long run. Therefore, this study aimed to assess the predominant protected/polyhouse and open field vegetable production on soil quality. The changes in soil quality in comparison to control (fallow) indicate, whether the management practices being adopted under both the systems are sustainable or not. Thus, a study was conducted to identify the most appropriate soil quality indicators and finally to know about the status of soil quality both under polyhouse and open field system of cultivation in mid hills of North western Himalayas. Principal component analysis (PCA), a data reduction tool was employed to get the minimum data set for the assessment of soil quality. Geo-referenced soil samples were collected from 25 progressive farmers' cultivating vegetables under polyhouse, as well as open field conditions and analyzed for various physical, chemical and biological indicators of soil quality. The PCA was performed which screened out the three principal components (PCs) with eigen value > 1. Average soil quality index (SQI) for different sites was observed to be on higher under polyhouse conditions (0.815) as compared to open field cultivation for vegetables (0.760) and control (0.703). Where, soil organic carbon contributed maximum to soil quality (75.6%) followed by pH (13.9%), water holding capacity (6.8%) and EC (3.6%). Conclusively, polyhouse cultivation system revealed high category of soil quality. Whereas, open field cultivation system revealed medium category of soil quality. [ABSTRACT FROM AUTHOR]

Baseball coaches often focus on the landing position of a pitcher's front foot as a key aspect of mechanics. Furthermore, controversy persists regarding positioning the rear foot on the first base or third base end of the rubber. The purpose of this study was to determine the effect of rear and front foot placement on pitching biomechanics. Our hypotheses were that there would be significant kinematic and kinetic differences associated with foot placement. This was a retrospective review including 144 healthy right-handed adult baseball pitchers divided into groups based on their rear and front foot placements: first base open (1B-Open), first base closed (1B-Closed), third base open (3B-Open), and third base closed (3B-Closed). Two-way ANOVAs detected no statistically significant main effects for kinetic variables but several for kinematic variables. Open pitchers had less shoulder abduction at the time of ball release and greater maximum shoulder internal rotation velocity in comparison with closed pitchers. They also had less forearm pronation at the time of ball release and greater maximum elbow extension velocity. Additional statistically significant results were found; however, low effect sizes may lessen the clinical significance of many of the results. [ABSTRACT FROM AUTHOR]

Background: Rhinoplasty is a surgical procedure used to reconstruct nasal structures for cosmetic and functional purposes. Modern rhinoplasty surgery can be performed by one of two different approaches, the open or the closed rhinoplasty. However, the preferred method is still a subject for debate. We aimed in this study to compare the outcomes of open versus closed rhinoplasty. Patients and Methods: This is a prospective study included 50 patients divided into two groups according to the approach of rhinoplasty performed. Group A (25 patients) underwent open rhinoplasty, while group B (25 patients) underwent closed rhinoplasty. The outcomes are studied for advantages and limitations of each. Cosmetic outcome was evaluated by the Rhinoplasty Outcome Evaluation (ROE) questionnaire. Results: No significant difference was noted in ROE scores when comparing between rhinoplasty groups (open vs. closed) at the same specific study visit, with p value = 0.872, 0.624 and 0.764 at preoperatively, one month postoperatively, and 6 months post-operatively respectively. Conclusion: Although the closed rhinoplasty group has less operative time, less amount of intraoperative bleeding and less periorbital edoema, there was significant improvement in the cosmetic state compared in both groups and no significant difference occurred in improvement between the two groups. [ABSTRACT FROM AUTHOR]

Background: Hernia surgery is one of the commonly done procedures in General surgery. A hernia is defined as an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. Aims and Objectives: Comparison of morbidity in terms of total analgesic usage, mean length of hospital stay, comparison among open and TEP repair of hernias in primary inguinal hernias among males. Material and Methods: This study was done on 80 patients with clinical diagnosis of primary inguinal hernia over a period of one year to compare the result of two surgeries, open lichenstein repair (n=40) and TEP repair (n=40). Results: Postoperative pain using VAS was found to be lower in patients having laparoscopic TEP hernia repair when compared to open lichenstein tension free repair (p <0.01). Operating time was observed to be more with TEP group with mean of 59 ± 17.02 minutes compared with open group which had mean of 44.92±12 minutes. Mean number of analgesic in open cases was 6.65 ± 1.81 whereas in case of TEP group it was 4.35±1.47 over a period of one month. Conclusion: Lichtenstein tension free mesh hernioplasty still remains the gold standard operation done for inguinal hernia. TEP repair has proven to be superior in terms of perioperative hemorrhage and post-operative analgesia requirement. Study concluded that laparoscopic TEP repair of inguinal repair have a considerable clinical advantage over open hernia repair in terms of postoperative pain and analgesia requirement, hospital stay and postoperative complications. [ABSTRACT FROM AUTHOR]

This article introduce a new idea in the field of topological space which is supra soft v- open set and this concept is another generalization of a soft open set as well as the concept of supra soft v- closure is studied. Furthermore, the notion of supra soft v- interior is introduced and some properties of this concept were discussed. Finally, the concept of supra soft v- exterior is introduced and basic properties of this concept are investigated. [ABSTRACT FROM AUTHOR]

Cubital tunnel syndrome (CUTS) is a common upper limb compression neuropathy with significant consequences when left untreated. Surgical decompression remains gold-standard treatment for moderate to severe disease, however the optimal operative technique remains unclear. This network meta-analysis (NMA) of Level I and II randomised prospective studies aims to discern superiority between open in-situ, endoscopic and anterior transposition (subcutaneous or submuscular techniques) with respect to the primary outcome of response-to-treatment and secondary outcomes which include complications, post-operative chronic pain VAS scale, return to work and re-operation. This NMA adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PubMed, Web of Science, Cochrane Central, Science direct and Embase were searched. The MESH database was further searched with the terms 'cubital tunnel' to improve sensitivity of the search. Data pertaining to the primary and secondary outcomes were pooled for NMA. Following abstract and full-text screening, 10 randomised prospective trials were included. There was no statistical difference in the response-to-treatment between the four studied techniques. Endoscopic decompression conferred a significantly higher complication rate compared to open decompression (Odds Ratio [OR], 4.21; 95% CI, 1.22–14.59). Endoscopic decompression had a statistically significant lower risk of post-operative chronic pain compared to open in-situ decompression (OR, 0.03, 95% CI, 0.00–0.32). There were no differences between techniques with respect to return to work or re-operation rates. Response-to-treatment was similar between the four operative techniques for CUTS. Endoscopic decompression was found to be more hazardous when compared to open-in situ decompression but conferred significantly less post-operative chronic pain. There was significant heterogeneity in reported outcomes between the included articles. The authors suggest conducting more high-quality research with standardised outcome reporting to facilitate comparison. Systematic Review and Meta-analysis of Randomised Prospective Trials- Therapeutic study. [ABSTRACT FROM AUTHOR]

To characterize patient risk profiles and outcomes associated with staged ultra-hybrid repair of extensive aortic disease, in which open thoracoabdominal completion was performed after thoracic stent grafting. From 1/2006 to 1/2021, 92 patients underwent open thoracoabdominal repair of chronic dissection (n=58, 63%), degenerative aneurysm (n=28, 30%), endoleak (n=4, 4.3%), or symptomatic acute type B dissection (n=2, 2.2%) after descending thoracic stent grafting (69, 75%), frozen elephant trunk (5, 5%), or both (18, 20%). The surgical graft was sewn to the distal endovascular device in situ, reducing the extent of the open procedure and eliminating the need for hypothermic circulatory arrest. Mean age was 58±13 years, 89 (97%) were hypertensive, 38 (43%) had chronic obstructive pulmonary disease, 63 (72%) were smokers, 20 (24%) had a prior stroke, and 33 (36%) had a suspected or confirmed heritable aortic condition. Hospital mortality was 7.6% (n=7). Complications included dialysis (16, 20%), tracheostomy (8, 8.7%), stroke (5, 5.7%), and permanent paralysis (6, 6.9%). Survival at 1, 3, and 5 years was 80%, 71%, and 66%, respectively. Mortality was associated with higher blood urea nitrogen and longer distance between the distal endograft edge and proximal patent visceral vessel (P=0.004 and .01, respectively). Patients with extensive aortic disease undergoing open aortic repair after thoracic stent grafting are often young with chronic dissection, multiple comorbidities, or a heritable aortic condition. Success of staged ultra-hybrid operations demonstrates open and endovascular repair strategies are complementary, even when performed in a high-risk patient population. [ABSTRACT FROM AUTHOR]

Technological advancement and the advent of the internet led higher education institutions to transform from open and distance learning (ODL) to ODeL. The University of South Africa was the first university in Africa to offer distance education since 1946. Its success inspired other African countries like Zimbabwe and Botswana to establish Open and Distance Learning universities. In Eswatini, the Ministry of Education and Training policy of 2018 calls for the introduction of ODL in all existing and new institutions of higher learning. The policy however does not have guidelines on ODL implementation. In the interim Eswatini does not have a fully-fledged open and distance learning university. The study was conducted to explore how teacher training institutions in Eswatini implemented ODeL under the prevailing circumstances. The findings revealed that ODeL was introduced in teacher training institutions as a reactive measure to mitigate the COVID-19 lockdown that restricted students and lecturers from accessing campuses. Institutions were not ready to deliver programmes through the ODeL model. It recommended that institutions should use a blended learning approach while building capacity to gradually introduce ODeL, and train their students and staff on e-learning knowledge and skills. The Ministry of Education and Training should enact a policy with guidelines and a framework for implementing ODeL, and the government should build an open and distance learning university to align with other countries.

AIM:To observe the clinical efficacy of vitrectomy at different times for open ocular trauma and explore the timing of stage Ⅱ vitrectomy.METHODS: Retrospective case series study. A total of 60 cases(60 eyes)with open ocular trauma who visited our ophthalmology department from June 2022 to February 2023 were included. They were divided into treatment group A(interval ≤14 d)and treatment group B(interval >14 d)based on the interval between the stage Ⅰ emergency treatment surgery and the stage Ⅱ vitreoretinal surgery. Among the 32 cases(32 eyes)in the treatment group A, 16 eyes(50%)had eyeball rupture, 13 eyes(41%)had penetrating injury, and 3 eyes(9%)had perforating injury. Among the 28 cases(28 eyes)in the treatment group B, 15 eyes(54%)had eyeball rupture, 12 eyes(43%)had penetrating injury, and one eye(4%)had perforating injury. The two groups of patients were followed-up for 6 mo after surgery, and the treatment effects were compared.RESULTS:There was no statistically significant difference in visual acuity between the two groups of patients before vitrectomy(P>0.05). In the treatment group A, 10 eyes(31%)had significantly improved visual acuity, 21 eyes(66%)had effectively enhanced visual acuity, and 1 eye(3%)had no improvement in visual acuity at 6 mo after surgery. Among the 28 eyes in the treatment group B, 5 eyes(18%)had significantly improved vision, 16 eyes(57%)had effectively enhanced vision, and 7 eyes(25%)had no change in vision, with statistically significant difference between the two groups(U=322.5, P=0.032). There was no significant difference between the treatment group A and the treatment group B in complications such as secondary glaucoma, silicone oil dependence, vitreous hemorrhage, and eyeball atrophy(P>0.05). There was no evidence of traumatic proliferative vitreoretinopathy(TPVR)in the treatment group A during postoperative follow-up, which was significantly lower than that of the treatment group B(P

Background: Existing literature indicates positive outcomes with the arthroscopic Broström-Gould technique as a viable alternative to the established open procedure in adults. Nevertheless, there exists a dearth of comparative studies focusing on adolescents.The objective of this study was to evaluate and contrast the clinical results of adolescents undergoing either arthroscopic or open Broström-Gould techniques over a 2-year follow-up. Methods: We conducted a retrospective comparative analysis on patients aged 18 years and below, who underwent either arthroscopic or open Broström-Gould procedures for chronic lateral ankle instability during the period spanning January 2014 to December 2016.The study included cases with at least 2-year follow-up. Key parameters such as age, sex, race, concomitant procedures, surgery duration, hospital stay length, and post-operative complications were documented. Additionally, the assessment of clinical outcomes involved the utilization of the Foot and Ankle Outcome Score (FAOS) at the 6-month post-operative follow-up. Results: Seven arthroscopic and 13 open procedures were conducted, and no statistical differences were observed in patient demographics and pain scores. The open group exhibited a notably reduced duration of surgical procedure (open: 77.8 ± 17.6 min; arthroscopic: 100.7 ± 24.1 min; p = 0.03). Hospital stays and FAOS scores at 6 months were similar between the groups. Two complications occurred in the open group, involving suboptimal pain control and deep infection requiring re-admission and repeated surgeries. No complications were reported in the arthroscopic group, and only one patient in this group had concomitant preoperative intra-articular abnormalities. Conclusions: The arthroscopic Broström-Gould technique yields clinical outcomes similar to the open technique in addressing chronic lateral ankle instability in adolescents, and it exhibits lower complication rates.

Higher education institutions are increasingly looking to implement online and distance learning (ODL) options for students. Professional development for the design of ODL is needed to support these strategies. This study explores how, in what ways, and to what extent, design for ODL approaches from a series of Learning Design & Course Creation (LDCC) Workshops were implemented. The LDCC Workshop is a mature and substantial professional development activity which adopts a constructivist and student-focused pedagogy and is based on design for ODL approaches embedded at the Open University (UK). Fourteen semi-structured interviews were conducted with participating staff from five Chinese Open Universities. Data was analysed using the Reflexive Thematic Analysis (RTA) approach. As a result, six "LDCC impact narratives" were identified and are discussed in terms of learning design being implemented in three orientations: product, practice, and process. The findings illustrate that design for ODL approaches were implemented in all three orientations, but the extent to which they were implemented was dependent on certain institutional enablers being present and/or staff being given opportunities to put into practice what they learnt. [ABSTRACT FROM AUTHOR]

Background: Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades. Methods: Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ). Results: From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001). Conclusions: ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training. [ABSTRACT FROM AUTHOR]

Background: Open fractures of the talar body and neck are uncommon. Previous reports of associated deep infection rates and resulting surgical requirements vary widely. The primary objective of this study is to report the incidence of deep infections for isolated open talar body and neck fractures, and secondarily the incidence and number of total surgeries performed (TSP), secondary salvage procedures (SSPs), and nonsalvage procedures (NSPs). Methods: Retrospective case-control study of 32 consecutive isolated open talus fracture patients (22 neck, 10 body) were followed for an average of 39.2 months. Results: Five (15.6%) fractures developed deep infections. Fifty percent of open body fractures became infected compared with 0% of neck fractures (P <.001). There was no difference between infected group (IG) and uninfected fracture group (UG) with respect to age, sex, body mass index, tobacco, diabetes, vascular disease, open fracture type, wound location, hours to irrigation and debridement, or definitive treatment. The majority (92.6%) of UG fractures used a dual incision with open wound extension. There were more single extensile approaches in the IG group (P =.04). The IG required 5.8 TSP per patient compared with 2.1 in the UG (P =.004). All (100%) of the IG required an SSP compared with 29.6% of the UG (P =.006). All (100%) of the IG required an NSP compared to 40.7% of the UG (P =.043). In the IG, 2.8 NSPs per patient were required after definitive surgery compared with 1.18 in the UG (P =.003). Of those followed 1 year, the incidence of SSP remained higher in the IG (P =.016). Conclusion: The incidence of deep infection following isolated open talar fractures is high and occurs disproportionally in body fractures. Infected fractures required nearly 6 surgeries, and all required SSP. Level of Evidence: Level IV, prognostic. [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopy in gallbladder cancer (GBC) has a possible role in staging, radical cure, and palliation in gallbladder cancer. However, a few studies have advocated the use of laparoscopic approach and concluded the safety of this approach. This present study was undertaken to determine the safety and feasibility between open and laparoscopic cholecystectomy in patients with the non-metastatic GBC. Materials and Methods: A systematic database search was performed in MEDLINE, Embase, and Google Scholar for relevant articles. As a result, a list of such studies, clinical trials, published in English up to May 2021, was obtained,14 studies were included and statistical analysis was conducted using RevMan software 5.3 (The Nordic Cochrane Centre). Results: The 5-year survival rate was reported in 13 out of 14 studies (1388 patients), and all compared laparoscopic and open approach. There was no significant heterogeneity in between the studies (chi-square, 10.66; df, 12; I2, 0%). There was significant higher overall survival in open group (389/850 vs 194/538 or 1.45, 95% CI (1.12–1.88), P value, 0.005). There was no significant difference in recurrence rate, operative time, blood loss, lymph node yield, and postoperative complication in between open and laparoscopic groups. Conclusions: Our present study demonstrates that overall survival is significantly increased with open approach when compared with laparoscopic approach. There is no difference in recurrence rate, operative time, blood loss, lymph node yield, and postoperative complications between the open and laparoscopic cholecystectomy groups. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMaterial and methodsResultsConclusionThe indication of laparoscopic liver resection (LLR) for treating large hepatocellular carcinoma (HCC) is controversial. In this study, we compared the short-term and long-term outcomes of LLR and open liver resection (OLR) for large HCC.We searched eligible articles about LLR versus OLR for large HCC in PubMed, Cochrane Library, and EMBASE and performed a meta-analysis.Eight publications involving 1,338 patients were included. Among them, 495 underwent LLR and 843 underwent OLR. The operation time was longer in the LLR group (MD: 22.23, 95% CI: 4.14–40.33, p = 0.02). but the postoperative hospital stay time was significantly shorter (MD : −4.88, CI: −5.55 to −4.23, p < 0.00001), and the incidence of total postoperative complications and major complications were significantly fewer (OR: 0.49, 95% CI:0.37–0.66, p < 0.00001; OR: 0.54, 95% CI:0.36 − 0.82, p = 0.003, respectively). Patients in the laparoscopic group had no significant difference in intraoperative blood loss, intraoperative transfusion rate, resection margin size, R0 resection rate, three-year overall survival (OS) and three-year disease-free survival (DFS).LLR for large HCC is safe and feasible. This surgical strategy will not affect the long-term outcomes of patients. [ABSTRACT FROM AUTHOR]

The cultivation of summer vegetables in open-air nutrient film technique (NFT) hydroponics is limited due to the elevated nutrient solution temperature (NST). In this regard, non-electric evaporative-cooling techniques were explored to maintain NST in open-air NFT hydroponics. Four cooling setups were employed by wrapping polyvinyl chloride (PVC) grow pipes with one and two layers of either wet or dry jute fabrics and attaching them with coiled aluminum pipe buried inside a) wet sand-filled brick tunnels (Cooling Setup I), b) two inverted and vertically stacked earthen pots (Cooling Setup II), c) two inverted and vertically stacked earthen pots externally wrapped with wet jute fabric (Wrapped Cooling Setup II), and d) an earthen pitcher wrapped with wet jute fabric (Cooling Setup III). Wrapping grow pipes with two layers of wet jute fabric reduced NST by 5°C as compared to exposed (naked) grow pipes. The doublelayer jute fabric-wrapped grow pipes produced 182% more reduction in NST in comparison to single layer-wrapped grow pipes. Additionally, the installation of Wrapped Cooling Setup II and Cooling Setup III outperformed Cooling Setup I and Cooling Setup II through NST reduction of approximately 4°C in comparison to control. Interestingly, Cooling Setup III showed its effectiveness through NST reductions of 193%, 88%, and 23% during 11 a.m.-12 p.m. as compared to Cooling Setup I, Cooling Setup II, and Wrapped Cooling Setup II, respectively. In contrast, Wrapped Cooling Setup II caused NST reductions of 168%, 191%, and 18% during 2-3 p.m. in comparison to Cooling Setup I, Cooling Setup II, and Cooling Setup III, respectively. Thus, the double-layer jute fabric-wrapped grow pipes linked with Wrapped Cooling Setup II can ensure summer vegetable cultivation in open-air NFT hydroponics as indicated by the survival of five out of 12 vegetable plants till harvest by maintaining NST between 26°C and 28°C. [ABSTRACT FROM AUTHOR]

Wilkie's syndrome is an unusual cause of upper intestinal obstruction due to mechanical compression of the superior mesenteric artery (SMA) to the duodenum, with nonspecific symptoms, whose diagnosis is confirmed by angiotomography. Initially, the treatment is conservative to regain weight and restore mesenteric adipose tissue, associated with postural changes of the patient. If this fails, surgical treatment is indicated, being laparoscopic duodenojejunostomy described as the gold standard. Robotics' assistance is feasible and safe to carry out the procedure. We present the case of a 21-year-old male patient who comes with stabbing abdominal pain and persistent postprandial vomiting that has caused weight loss of 11 kilograms in the last 2 years without apparent cause, associated with gastroesophageal reflux. During the procedure, we evidenced open diaphragmatic pillars and duodenal compression due to SMA, and robotic-assisted laparoscopic hyatoplasty + Nissen fundoplication + duodenojejunostomy were performed without complications, with excellent post-surgical results. [ABSTRACT FROM AUTHOR]

Objective: Open objects encourage interactivity and closed objects discourage it. Repeated experiences with open and closed objects are thought to give rise to spatial concepts that can be used to represent a variety of entities such as societies, others, and the self. The present investigation pursues the idea that preferring that which is open to that which is closed is more compatible with an agreeable mode of interacting with others. Method: Three studies (total N = 901) asked participants whether they preferred "open" or "closed" as spatial concepts. Such preferences were linked to variations in agreeableness, peer perceptions, and daily measures of pro‐social functioning. Results: Open‐preferring, relative to closed‐preferring, individuals scored higher in agreeableness (Study 1) and were rated by peers as interpersonally warmer (Study 2). Open preferences varied within and across persons in a daily diary protocol and, in both cases, higher levels of open preference were linked to higher levels of pro‐social feeling (Study 3). Conclusion: The findings point to a fundamental component of spatial orientation that plays a significant role in encouraging (open) or discouraging (closed) warm, interactive relations with others. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to estimate whether the potential short-term advantages of laparoscopic pancreaticoduodenectomy (LPD) could allow patients to recover in a more timely manner and achieve better long-term survival than with open pancreaticoduodenectomy (OPD) in patients with pancreatic or periampullary tumors. Background: LPD has been demonstrated to be feasible and may have several potential advantages over OPD in terms of shorter hospital stay and accelerated recovery than OPD. Methods: This noninferiority, open-label, randomized clinical trial was conducted in 14 centers in China. The initial trial included 656 eligible patients with pancreatic or periampullary tumors enrolled from May 18, 2018, to December 19, 2019. The participants were randomized preoperatively in a 1:1 ratio to undergo either LPD (n=328) or OPD (n=328). The 3-year overall survival (OS), quality of life, which was assessed using the 3-level version of the European Quality of Life—5 Dimensions, depression, and other outcomes were evaluated. Results: Data from 656 patients [328 men (69.9%); mean (SD) age: 56.2 (10.7) years] who underwent pancreaticoduodenectomy were analyzed. For malignancies, the 3-year OS rates were 59.1% and 54.3% in the LPD and OPD groups, respectively (P =0.33, hazard ratio: 1.16, 95% CI: 0.86–1.56). The 3-year OS rates for others were 81.3% and 85.6% in the LPD and OPD groups, respectively (P =0.40, hazard ratio: 0.70, 95% CI: 0.30–1.63). No significant differences were observed in quality of life, depression and other outcomes between the 2 groups. Conclusion: In patients with pancreatic or periampullary tumors, LPD performed by experienced surgeons resulted in a similar 3-year OS compared with OPD. Trial Registration: ClinicalTrials.gov Identifier: NCT03138213. [ABSTRACT FROM AUTHOR]

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The investigation of the role of preoperative conization in cervical cancer aiming to explore its potential clinical significance. Cochrane Library, Embase, PubMed, and Web of Science, up to April 28, 2023. (1) Observational cohort studies, (2) studies comparing radical hysterectomy with preoperative conization (CO) vs radical hysterectomy without preoperative conization (NCO) in patients with early-stage cervical cancer, and (3) studies comparing disease-free survival outcomes. Two reviewers independently extracted the data and assessed the quality of the studies. The meta-analysis used combined hazard ratios along with their corresponding 95% confidence intervals to compare CO and NCO. We conducted a Bayesian network meta-analysis using Markov chain Monte Carlo methods to compare minimally invasive CO, open CO, minimally invasive NCO, and open NCO. Our study included 15 retrospective trials, 10 of which were used to traditional pairwise meta-analysis and 8 for network meta-analysis. The NCO group exhibited a notably higher probability of cancer recurrence than the CO group (hazard ratio, 0.52; 95% confidence interval, 0.41–0.65). In the network meta-analysis, minimally invasive NCO showed the worst survival outcome. Preoperative conization seems to be a protective factor in decreasing recurrence risk, assisting clinicians in predicting survival outcomes for patients with early-stage cervical cancer. It may potentially aid in selecting suitable candidates for minimally invasive surgery in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to compare the clinical outcomes and safety of a novel hand-held retractor system-assisted Wiltse TLIF with that P-TLIF and assess whether this hand-held retractor system assisted Wiltse TLIF can yield less paraspinal muscle injury. Methods 56 patients (P-TLIF: 26, Wiltse TLIF: 30) were included in this one year prospective controlled study. The operation time, intraoperative blood loss, postoperative drainage, mobilization time, and discharge time were recorded. The clinical outcomes were evaluated by ODI, VAS, JOA, and SF-36 scores (7 days, 3, 6, and 12 months after surgery). Paraspinal muscle injury was assessed by postoperative MRI (6 months after surgery). CK and C-reaction protein were measured pre and postoperatively, and CT or X-ray (one year postoperatively) was used to assess bony union/non-union. Results The Wiltse (study) group was associated with significantly less estimated blood loss (79.67 ± 28.59 ml vs 192.31 ± 59.48 ml, P = 0.000*), postoperative drainage (43.33 ± 27.89 ml vs 285.57 ± 123.05 ml, P = 0.000*), and shorter mobilization (4.1 ± 1.2 d vs. 3.0 ± 0.9 d, P

Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.

Scaphoid dislocation represents a rare injury with only a few case reports and limited case series reported in the literature. The majority of scaphoid dislocations result from a high-energy trauma causing hyperextension and ulnar deviation of the wrist. The severity of a scaphoid dislocation depends on the degree of periscaphoid ligamentous injury as well as the presence of concomitant injuries, such as axial carpal dissociation. The most common complication after a scaphoid dislocation is scapholunate dissociation, which emphasizes the importance of scapholunate ligament repair/reconstruction in these cases. We report a case of an open scaphoid dislocation with the associated injuries of a hamate fracture and fourth metacarpal fracture treated with an open reduction of the scaphoid, open ligamentous repair and augmentation of the involved carpal ligaments, and open reduction internal fixation of both the hamate and the fourth metacarpal fractures.

Background. Open or wrist arthroscopic release of carpal tunnel is a relatively safe and reliable method. However, there is still some debate as to which of these various surgical methods is superior. Therefore, this study provides more clinical evidence by comparing the clinical efficacy of open and endoscopic single-channel bowl release in the treatment of carpal tunnel syndrome. Methods. The study conducted a retrospective analysis from January 2010 to January 2021. A total of 105 patients met the inclusion criteria, including 56 patients in the open carpal tunnel Release (OCTR) group and 49 patients in the single channel carpal tunnel release (SCCTR) group. The preoperative, intraoperative, and postoperative symptom improvement and functional recovery of the patients were compared. Results. The results of this study showed that the surgical incision healed well in all patients and complete remission of entrapment symptoms. Compared with the OCTR group, the SCCTR group had reduced surgical and hospital duration, intraoperative blood loss, postoperative scar pain score, and time required to return to normal lifestyle, and the SCCTR group had a lower incidence of sympathetic dystrophy and significantly improved clinical symptoms. Conclusion. Single Channel Carpal Tunnel Release under Carpal Arthroscopy in the treatment of carpal tunnel syndrome can achieve reliable clinical efficacy. It can relieve symptoms such as hand numbness and improve hand function. Postoperative pain and other complications are low, and worthy of clinical promotion.

With the increasing recognition of the significance of arachnid conservation, it is crucial to allocate greater efforts towards implementing targeted monitoring programmes. Despite recent studies, our understanding of arachnid populations in Portugal remains limited. This study serves as the initial inventory of arachnids (Araneae and Opiliones) within the Castro Verde Special Protection Area (SPA) located in Beja, southern Portugal. The surveys were conducted during the spring of 2012 across 80 open grasslands that were grazed by cattle and sheep.A total of 71 species of Araneae and two species of Opiliones have been identified. Notably, three spider species, namely Argenna subnigra, Civizelotes ibericus and Walckenaeria cucullata, are documented for the first time in Portugal. Additionally, two harvestmen species (Dasylobus ibericus and Homalenotus buchneri) and 14 spider species (Cheiracanthium pennatum, Haplodrassus rhodanicus, Marinarozelotes minutus, Tapinocyba algirica, Agraecina lineata, Tibellus macellus, Talavera petrensis, Tetragnatha intermedia, Dipoena umbratilis, Enoplognatha diversa, Neottiura uncinata, Ruborridion musivum, Theridion pinastri and Xysticus grallator) are recorded for the first time in the Beja District. The occurrence of each documented species within the SPA, including family and species details, is presented, underscoring the significance of the Castro Verde SPA for arachnid conservation. These findings contribute novel insights into the biodiversity of the Castro Verde SPA, emphasising the necessity of incorporating this area into arachnid diversity conservation efforts.

This case study describes the formation of Library Partnership Rating (LPR), a librarian-created rubric-based system to evaluate journal publisher practices. The LPR Rubric stems from the library profession’s values and helps identify practices that demonstrate shared values between libraries and values-driven journal publishers – the ‘partners’ in Library Partnership. The authors invited collaboration with university presses, learned societies, open access advocates, values-driven international publishers and publishing organizations, and other librarians. The resulting rubric is relevant and applicable as a decision-making tool for both libraries and publishers. In this case study, the authors describe the iterative process of creating the rubric, how they incorporated the value of community into the development process (including attention to equitability and solicitation of publisher feedback) and next steps.