Broad Expertise Research Articles

Facial Nerve Intraoperative Monitoring in Otologic Surgeries under Sedation and Local Anesthesia – A Case Series and Literature Review

Introduction Local anesthesia with sedation has been employed for an increasingly number of otolaryngology procedures, and might be associated with lower surgical morbidity and costs. Facial nerve monitoring is often advisable in otology to minimize the risks of injuries to this cranial nerve, but the principles, techniques and parameters involved have only been studied for procedures under general anesthesia. Objective To report the preliminary outcomes of intraoperative facial nerve monitoring during otologic procedures under sedation and local anesthesia. Methods A total of five procedures and their respective intraoperative electrophysiological main findings were described. Facial neuromonitoring was performed using the same device by an electrophysiologist. The monitor sensitivity was set at 100 mV, and a stimulating probe was used whenever needed. Results Progressively decreasing low-amplitude baseline values were usually obtained as the level of anesthesia increased, with isolated oscillations possibly related to some degree of voluntary muscular activity. These oscillations could be easily distinguished from those of the surgical manipulation or electrical stimulation of the nerve, which tended to be of much greater amplitude and shorter latency, occurring during specific surgical steps. Conclusion With a surgical team with proper procedural knowledge and broad expertise regarding the technique, intraoperative facial nerve monitoring under local anesthesia with sedation seemed both feasible and reliable. Thus, the need for intraoperative neuromonitoring should not be an obstacle for otologic procedures under less aggressive anesthetic management.

Languaging among Latinx siblings in immigrant homes: Implications for teaching literacy

ABSTRACTThis article synthesizes multiple studies that we have conducted on language and literacy practices among Latinx siblings at home, and identifies implications for teaching. Examples from micro-ethnographic discourse analyses provide rich vignettes of sibling interactions within Mexican and Central American immigrant households to illustrate how siblings engage in complex negotiations as they language together at home, in English and Spanish. Older siblings provided unique scaffolds for younger children’s learning and development in ways that demonstrated broad and flexible expertise, but these practices also reflected the complex social and linguistic circumstances in which immigrant-origin Latinx children live. Findings suggest that teachers can play active roles in supporting language and literacy development inside and outside classrooms.

Involving Industry Experts in the Selection of High-Impact Energy Research Projects

How can an impact-driven research program best select projects that will contribute to future technology cost reductions, given the inherent uncertainty of early-stage research efforts? Programs typically rely on peer review by academic experts, who are at the frontier of knowledge in their field, but may not be able to assess the potential impact of research on commercial technology. In order to achieve “step-out” ideas in energy research, i.e. novel ideas that could lead to technology breakthroughs, the Global Climate and Energy Project at Stanford University supplemented their proposal review process with an industry point of view. Program administrators solicited both the opinions of a panel of sponsor company representatives and an independent panel with broad energy expertise, and incorporated both of these opinions into their funding decisions. Incorporating sponsor opinions into the selection process did not result in the selection of proposals with measurably different characteristics beforehand, on the basis of mail- in reviews from subject matter experts. We find that the program may have produced fewer publications as a result of sponsor involvement in review, but we find no evidence that either panel was able to predict outputs closer to commercialization.

An integrated approach to knowledge management for internal consulting in healthcare

Mayo Clinic’s Management Engineering and Internal Consulting Department has a comprehensive and integrated approach to knowledge management (KM). This enables the department to provide consistent delivery of services, reduce project duration and innovate and build from the collective and diverse expertise of their team members, who are in multiple health system locations in the United States. The KM and sharing programme consists of tools to manage content and best-practice methodologies as well as informal and formal approaches to sharing broad knowledge and expertise via project design forums, social networks (eg community of practice groups) and knowledge sharing and project libraries. Staff are encouraged to contribute to the stored knowledge to support future project needs and to extract data for best practices and lessons learned (including successes and failures) to assist current project efforts.

Ex utero intrapartum treatment (EXIT) procedures

Ex Utero Intrapartum Treatment (EXIT) is a technique developed to safely and efficiently establish cardiopulmonary support at delivery while maintaining placental bypass. Indications for the EXIT approach are expanding and currently include EXIT-to-airway, EXIT-to-resection, EXIT-to-extracorporeal membrane oxygenation (ECMO), and EXIT-to-separation of conjoined twins. The EXIT technique involves planned partial delivery of the fetus via hysterotomy while maintaining uterine relaxation and placental support, allowing for the establishment of neonatal cardiopulmonary stability in a controlled manner. Fetal interventions performed during EXIT can include endotracheal intubation, tracheostomy, mass excision, removal of a temporary tracheal occlusive device, ECMO cannulation, and others. The most important aspect of an EXIT procedure is the formation of a multi-disciplinary team with broad expertise in fetal intervention to collaborate throughout the pre, intra, and post-partum periods. This chapter reviews the prenatal workup, decision making, surgical indications, and operative considerations associated with EXIT procedures.

Swiss Delphi study on iron deficiency

Iron deficiency (ID) and iron deficiency anaemia (IDA) are important conditions affecting a large proportion of the general population, causing the patients physical and psychosomatic symptoms, particularly fatigue, and significantly affecting their quality of life. General practitioners (GPs) are frequently consulted with nonspecific symptoms due to the ID. However, little evidence is available to guide iron treatment. The aim of the Swiss Delphi study was to generate a broad consensual Swiss expert opinion in various therapeutic areas on diagnosis and treatment of ID/IDA and their practical implications. Specific statements regarding clinical relevance, practical diagnostic and therapeutic approaches, and treatment were evaluated by Swiss experts in various therapeutic areas using the Delphi method. “Consensus” was defined as ≥80% agreement; the agreement of 50–79% was defined as “critical”, of <50% as “disagreement”. Consensus was reached for most statements. In patients without systemic inflammation, the threshold of 30 μg/l provide a good accuracy for the diagnosis of ID without anaemia. Ferritin levels within the range 30–50 μg/l with TSAT <20% can indicate ID without anaemia. Iron replacement therapy is accepted for treatment, not only of IDA, but also of symptomatic ID without anaemia. GPs play a central role in diagnosis and management of ID. This consensus study provides potential therapeutic strategies for management of iron deficiency and is based on opinions of a high number of contributing specialists, providing their views from a wide range of clinical perspectives. &nbsp.

Open collaborative writing with Manubot.

Open, collaborative research is a powerful paradigm that can immensely strengthen the scientific process by integrating broad and diverse expertise. However, traditional research and multi-author writing processes break down at scale. We present new software named Manubot, available at https://manubot.org, to address the challenges of open scholarly writing. Manubot adopts the contribution workflow used by many large-scale open source software projects to enable collaborative authoring of scholarly manuscripts. With Manubot, manuscripts are written in Markdown and stored in a Git repository to precisely track changes over time. By hosting manuscript repositories publicly, such as on GitHub, multiple authors can simultaneously propose and review changes. A cloud service automatically evaluates proposed changes to catch errors. Publication with Manubot is continuous: When a manuscript’s source changes, the rendered outputs are rebuilt and republished to a web page. Manubot automates bibliographic tasks by implementing citation by identifier, where users cite persistent identifiers (e.g. DOIs, PubMed IDs, ISBNs, URLs), whose metadata is then retrieved and converted to a user-specified style. Manubot modernizes publishing to align with the ideals of open science by making it transparent, reproducible, immediate, versioned, collaborative, and free of charge.

À la recherche d'une humanité durable by Michel Juffé

Reviewed by: À la recherche d'une humanité durable by Michel Juffé Abbey Carrico Juffé, Michel. À la recherche d'une humanité durable. L'Harmattan, 2018. ISBN 978-2-343-15719-1. Pp. 194. If Nature can be considered all-encompassing, self-creating, and self-sustaining, where does humanity fit? More precisely, how does humanity continue to fit and sustain itself when its influence on Nature, humans included, has proven so harmful? French philosopher Michel Juffé offers historical, scientific, and philosophical insight necessary to promote an ideological shift, "une réforme profonde de nos mœurs [...] et la nécessaire mesure de nos actions," that could ensure a future concerned not simply with existence but with quality of existence (138). As he claims, "Il ne suffit pas de proclamer que l'on veut préserver les générations futures, encore faut-il savoir dans quels buts et à quelles conditions" (13). Juffé challenges the reader with a deep knowledge [End Page 204] and breadth of subjects (astronomy, economics, ethology, climate change, etc.) as well as with certain controversial claims. For example, he reveals problems with the deep ecology movement of the 1990s whose language "continue à opposer l'homme au reste de la Nature" (71), and with Bruno Latour's popularized rhetoric of "human/non-human." Juffé suggests anti-tree-cruelty laws may need to be in place, and that as far as it concerns the "'persévérance dans l'être', les fabrications des fourmis sont aussi sophistiquées que les nôtres" (126). This work simultaneously reveals Juffé's broad expertise and the multifaceted nature of sustainability itself which concerns all aspects of life: socio-political, ecological, and economic, to name a few. Following evolutionary theory, cosmological argument, and a Spinozian philosophical grounding, Juffé rejects a teleological and hierarchical positioning of the human as the "end all be all" of Nature, claiming instead that humans—just like all other beings—are part of Nature and are primarily concerned with self-preservation, whatever the cost. He questions whether humans are the only ones capable of reflective communicative abilities, asserting "peut-être la croûte terrestre elle-même a-t-elle des capacités de réception d'information que nous ignorons" (105). He insists on the importance of perspective, adaptability, and the limitations of humans. However, the primary tension in his argument is the paradox of decentering, desacralizing, and de-hierarchizing the human while maintaining humans are different (and able to write and communicate the need for a sustainability plan, for instance). The primary strength and potential significance of this work is its comprehensive and critical analysis of humanity's current and past condition and relation to Nature. Juffé understands that for anything to motivate humans to change, certain fundamentals must be addressed, starting with, as he has set out to do in this book, "une description commune de la Nature et de ses diverses dynamiques" (176). With French ecocriticism on the rise and sustainability concerns spanning multiple, if not all, disciplinary modalities, sustainability research in French and Francophone studies is increasingly pertinent. Juffé's work will be important and influential to scholars desiring a nuanced philosophical foundation to the current human condition as well as ideas for how to pursue an "éthique pour une humanité durable" (176). Abbey Carrico Virginia Military Institute Copyright © 2019 American Association of Teachers of French

PARADOX HYBRIDNÍ VÁLKY: O příčinách a následcích pragmatismu v debatě

The aim of this article is to analyse current state of the debate about hybrid war concept, focusing on the paradox of its success despite broad expert critique. The article specifically discusses pragmatism in use of the concept by institutions and authors as an explanation of the current situation. Finally, it analyses its possible causes, with special attention to its development and conceptual quality, and its possible implications.

Introduction and Summary of the 2018 Dietary Glutamate Workshop

The 2018 Dietary Glutamate Workshop was organized and sponsored by the International Glutamate Technical Committee to provide a platform for a broad expert discussion on all relevant aspects of glutamate metabolism and safety in human nutrition. The participants reached a consensus with previous safety evaluations conducted by the global expert bodies, but contradicted the 2017 re-evaluation of dietary glutamates by the European Food Safety Authority, which proposed a group acceptable daily intake (ADI) of 30 mg/kg body weight per day. The participants of the Workshop concluded that the present knowledge on metabolism, kinetics, developmental and general toxicity of dietary glutamates did not warrant a change in the previous ADI of “not specified.”

The patient-centered dental home: A standardized definition for quality assessment, improvement, and integration.

To develop the first standardized definition of the patient-centered dental home (PCDH). Primary data from a 55-member national expert panel and public comments. We used a modified Delphi process with three rounds of surveys to collect panelists' ratings of PCDH characteristics and open-ended comments. The process was supplemented with a 1-month public comment period. We calculated median ratings, analyzed consensus using the interpercentile range adjusted for symmetry, and qualitatively evaluated comments. Forty-nine experts (89%) completed three rounds and identified eight essential PCDH characteristics, resulting in the following definition: "The patient-centered dental home is a model of care that is accessible, comprehensive, continuous, coordinated, patient- and family-centered, and focused on quality and safety as an integrated part of a health home for people throughout the life span." This PCDH definition provides the foundation for developing measures for research, care improvement, and accreditation and is aligned with the patient-centered medical home. Consensus among a broad national expert panel-including provider, payer, and accreditation stakeholder organizations and experts in medicine, dentistry, and quality measurement-supports the definition's usability and its potential to facilitate medical-dental primary care integration.

Peter Andreas Hochuli (1946–2018)

Peter Andreas Hochuli (1946–2018)

Putting the learner at the heart of student experience: The role of the University Library in a seven-year journey of superconvergence at Northumbria University, UK

Higher Education in the UK is experiencing a level of change unprecedented in the last twenty-five years. Coupled with global drivers and disruptors, from technology to generational differences, the new higher education landscape that is emerging is presenting academic libraries with a series of new and extreme strategic challenges and opportunities. Putting students at the heart of learning, by aligning with and influencing university strategy, creating new and more integrated learning environments, and designing support with student outcomes in mind, are rapidly becoming business critical.In this article, we describe the experience of the directorate of Student and Library Services at Northumbria University, in which the University Library has played a pivotal role driving a broad, deep, and sustainable superconvergence while transforming in its own right to deliver innovative new services and successful performance. In so doing, we discuss the evolution of the superconvergence portfolio, how structure and roles were arrived at, what phases of change and stages of convergence we passed through, and how we have adopted a new support framework to integrate distinct services, and physical and virtual spaces, while retaining the quality of our broad professional expertise. We provide several examples of how the new service is operating and specifically how the University Library works in this wider context. We conclude with a reflective discussion on the outcomes and impact our approach has afforded, and what may follow.

On the importance of a broad stakeholder network for developing a credible, salient and legitimate tiered approach for assessing ecosystem services

As the concept of ecosystem services is being operationalised and implemented in policies, a better guidance on the selection of suitable methods for ecosystem services mapping and assessment is needed to allow more sound, transparent and comparable processes. A vast range of assessments focusing on different sets of ecosystem services at various scales is existing and the applied methods cover different disciplines from ecology to economy and social sciences. This complicates the assessment of single or bundles of ecosystem services across spatio-temporal scales and requires a broad expertise. A tiered approach for ecosystem services assessment allows selecting the appropriate application of a certain method for tackling a specific question at a given scale. In this publication, we illustrate how the EU H2020 project ESMERALDA supported the development of such a tiered approach for assessing ecosystem services. The iterative exchanges between experienced researchers and practitioners in mapping and assessing ecosystem services in various contexts allowed the co-production of an approach to guide the choice of methods. Ultimately, the proposed tiered approach will not only support communication of the ecosystem services concept, but will also reduce the tendency for selecting an unsuitable approach for solving complex problems linked to ecosystem services-based resource management.

IFF will acquire Frutarom

Frutarom, the acquisitive Israeli flavor and fragrance firm, will soon be itself acquired by International Flavors & Fragrances in a $7.1 billion cash and stock transaction. The deal continues a rush among big ingredient suppliers to buy natural ingredient assets. Frutarom’s $1.6 billion in projected sales this year will bring IFF’s sales to about $5.3 billion when the deal is completed in the next six to nine months. IFF, now the fourth-largest flavor and fragrance maker, will vault ahead of Firmenich to occupy the number two spot just behind Givaudan, IFF says. IFF CEO Andreas Fibig calls Frutarom “extremely attractive” for its “broad expertise in naturals and diverse adjacencies, with capabilities beyond our core taste and scent business.” Among those adjacencies are fast-growing categories such as enzymes, antioxidants, and natural colors. For Frutarom, the acquisition is a final chapter for a company that started as a maker of extracts and

Erratum to "Methods": Canadian Journal of Diabetes 2018;42(S1):S6-S9.

In “Methods,” Canadian Journal of Diabetes 2018;42(S1):S6-S9, the author list should have read as follows: “Diana Sherifali RN, PhD, CDE, Doreen M. Rabi MD, MSc, FRCPC, Charlotte G. McDonald MD, MSc, FRCPC, Sonia Butalia MD, FRCPC, MSc, David J.T. Campbell MD, PhD, Dereck Hunt MD, MSc, FRCPC, Alexander A. Leung MD, MPH, FRCPC, MRCP(UK), FACP, Jeffrey Mahon MD, MSc, FRCPC, Kerry A. McBrien MD, MPH, Valerie A. Palda MD, MSc, FRCPC, Laura Banfield MLIS, MHSc, Stephanie Sanger MLIS, BA, Robyn L. Houlden MD, FRCPC.” The online version of the article has been updated. MethodsCanadian Journal of DiabetesVol. 42PreviewFollowing the process used to develop previous Diabetes Canada Clinical Practice Guidelines (1), an Executive Committee, Steering Committee and Expert Committee with broad expertise and geographic representation were assembled. In total, 135 volunteers, from diverse practice settings across the country, including professionals from family medicine, endocrinology, internal medicine, cardiology, neurology, nephrology, infectious disease, urology, psychiatry, psychology, obstetrics, ophthalmology, pediatrics, nursing, dietetics, pharmacy, chiropractic, exercise physiology, and others, participated in the guideline development process. Full-Text PDF

Technological Pedagogical Content Knowledge in the Literature: how TPCK is defined and implemented in initial Teacher Education

In recent decades, there has been increasing research interest in teachers’ competencesregarding the growing role of technologies in educational practices. These competences are grounded on a clear base of technological knowledge, along with the recognized dimensions of a broad pedagogical expertise and deep knowledge of the content. This paper analyses the most significant international literature on the topic, reporting the theoretical discussion about teachers’ knowledge as described by the Technological Pedagogical Content Knowledge framework (TPCK – Koehler & Mishra, 2005a) based on Shulman’s (1986, 1987) PCK. This framework will be analysed in its definition and main components, as well as in the different interpretations given by researchers in recent years. Finally, some of the main strategies documented in the literature to develop this type of teacher knowledge in pre-service education will be presented.

Methods.

Methods.

Sink or Collaborate: How the Immersive Model Has Helped Address Typical Adolescent and Young Adult Barriers at a Single Institution and Kept the Adolescent and Young Adult Program Afloat.

The unique needs of adolescent and young adult (AYA) oncology patients have been identified through research and well described in the literature.1–4 Defined as individuals aged 15–39 years, these patients benefit from age-appropriate multidisciplinary care with attention to psychosocial, fertility, financial, and physical effects of cancer, from diagnosis through survivorship. These are termed the pillars of AYA care. With the goal of improving outcomes for the 72,000 AYA patients diagnosed with cancer every year in the United States, AYA programs are being developed. Organizations such as Teen Cancer America (TCA, www.teencanceramerica.org) and Critical Mass (criticalmass.org) provide advocacy, collaboration, and resources for personnel, as well as physical space for AYA patients at major medical centers. Early reports of successful programs have been mitigated more recently by recognition of real barriers to successful program development, prompting an ongoing national dialogue. This article seeks to examine our institution's model and offer solutions to overcome real and perceived barriers to optimal AYA oncology care. Specifically, we examine our institution's model that involves a pediatric oncologist AYA champion employed within an adult cancer center, which we term the Immersive Model. This differs from other models that typically separate pediatric and adult oncology by building and department or medical group. Traditionally, AYA programs have been created to bridge the gap between pediatric and adult centers, often using acute lymphoblastic leukemia (ALL) care as a model. Pediatric oncologists would expand the age of patients seen upward, to provide direct care or participate in tumor boards with adult medicine colleagues. There is a data-driven consensus in the pediatric oncology community that so-called pediatric-inspired regimens improve outcomes for AYA patients compared with standard adult approaches for ALL and a perception that the medical oncology world has been slow to universally adopt these regimens with variation in levels of adoption across centers.5–8 Controversy regarding the optimal treatment for ALL continues at many centers, causing AYA program growth to be hindered. Moffitt Cancer Center (MCC) is a National Cancer Institute-designated Comprehensive Cancer Center based in Tampa, Florida that is uniquely organized by multidisciplinary disease teams rather than the more traditional model of departments of medicine, surgery, and other specialties. Thus, it is common for physicians to report to chairs with different, medical, or surgical, for example, board certifications and training than their own. The AYA program at MCC is led by a pediatric oncologist who reports directly to the chair of the Sarcoma Program, who is a surgical oncologist. MCC does not have a pediatric oncology practice and does not routinely care for patients under 15 years of age, although disease-specific expertise may be provided on a case-by-case basis, with administrative approval. MCC sees ∼16,000 new patients each year, with over 1500 of these new patients ranging from 15 to 39 years of age. This means that 100–125 unique AYA patients visit MCC each day, and 10% of inpatient beds are occupied by AYA patients. This volume prompted an administrative decision to contribute hospital resources to AYA patients, with coordinator support. Clinically, the Immersive Model began at MCC with a pediatric oncologist from All Children's Hospital providing care to sarcoma patients up to 40 years of age with select diagnoses. The program continues to collaborate with Johns Hopkins All Children's Hospital in a variety of ways, including several ongoing research collaborations and multiple physicians with clinical privileges at both facilities. Other groups, bringing broad and necessary expertise, began participating in the program (Fig. 1). MCC has grown to a multidisciplinary AYA Committee that is structured with five subcommittees that focus on: fertility, research, patient education, social events, and psychosocial issues. The entire group meets monthly in an open forum to share communication and discuss opportunities, provide updates on new and ongoing committee initiatives, and review factors that facilitate and obstruct local AYA care. Open in a separate window FIG. 1. AYA Program Organizational Chart: The AYA program incorporates many disciplines and areas of expertise together across traditional cancer center departments. AYA, adolescent and young adult.

In the Name of … Consultation-Liaison Psychiatry

In the Name of … Consultation-Liaison Psychiatry