University School Research Articles

Genetic Manifestations and Phenotype Spectrum in Infants With Feeding Difficulty.

Feeding difficulties frequently co-occur with multisystem disorders attributed to rare genetic diseases. In this study, we aimed to describe the genetic manifestations and phenotype spectrum in infants experiencing feeding difficulties. This case series included infants under 6 months old with feeding difficulties admitted to the neonatal department of Children's Hospital, Zhejiang University School of Medicine from October 2018 to May 2022. All infants underwent whole-exome sequencing (WES) during hospitalisation, and their clinical phenotypes and genetic results were analyzed. Among 28 infants studied, nine were preterm and 19 were full-term. Median admission age was 13.5 days (IQR 6.5, 35), with a median hospital stay of 16 days (IQR 10.5, 30). Overall, 12 (42.9%) cases were complicated with multiple malformations. Abnormal muscle tone (53.6%) and neurological issues (42.9%) were notable prevalent in these infants. Cranial MR abnormalities were noted in 96.2% of cases. Based on the combined analysis of WES results and clinical phenotypes, a total of 22 (78.3%) patients displayed disease-related genetic variation identified through WES; among them, 15 (53.6%) patients received genetic diagnoses, while 7 (25%) patients were suspected diagnoses. Positive findings were more frequent in full-term (89.5%) than preterm infants (55.6%). Ultimately, 24 (85.7%) patients were discharged alive, with 75% requiring post-discharge tube feeding. Following discharge, five patients developed new symptoms linked to genetic variants, and two patients died. Feeding difficulty may constitute a facet of the phenotypic spectrum of rare genetic diseases. Whole-exome sequencing can enhance molecular diagnosis accuracy for infants with feeding difficulties.

Clinical study on anterolateral femoral interregional flap with turbocharge technique in the repair of large limb wounds.

To compare the clinical outcomes of anterolateral femoral interregional flap with turbocharge technique and traditional anterolateral femoral flap in repair of large limb wounds. Clinical data of 38 patients with large limb surface wound (11 cm×39 cm-16 cm×65 cm) admitted to the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from May 2018 to May 2022 were retrospectively analyzed. Eighteen patients were treated by anterolateral thigh perforator flap combined with superficial circumflex iliac artery flap (ALTP-SCIAP) with turbocharge technique (interregional flap group); while 20 patients were treated with unilateral or bilateral anterolateral femoral flaps, combined with skin grafting if necessary (traditional anterolateral femoral flap group). The survival of skin flap, repair of donor area, complications and patient satisfaction were compared between the two groups. In interregional flap group, 18 flaps were harvested and transplanted, the flap width, length and the viable area were (9.9±2.0) cm, (44.2±3.5) cm and (343.2±79.9) cm2, respectively. In traditional anterolateral femoral flap group, 29 flaps were harvested and transplanted, the flap width, length and the viable area were (11.0±2.8) cm, (21.7±3.2) cm and (186.4±49.2) cm2, respectively. There were significant differences in the flap length and the viable area between the two groups (t=22.365 and 8.345, both P<0.05). In the interregional flap group, the donor site of flap was closed by direct suture in 11 flaps, by skin retractor assisted suture in 6 flaps, and by skin grafting in one flap. In traditional anterolateral femoral flap group, the donor site of flap was closed by direct suture in 12 flaps, by skin retractor assisted suture in 11 flaps, and by skin grafting in 6 flaps. The skin graft rates of the two groups were 5.6% (1/18) and 20.7% (6/29), respectively (χ2=2.007, P>0.05). The interregional flap group had lower postoperative complications rate (5.6% vs. 35.0%, χ2=4.942, P<0.05) and higher patient satisfaction rate (94.4% vs. 70.0%, χ2=4.448, P<0.05) than traditional anterolateral femoral flap group. Compared with the traditional anterolateral femoral flap, the anterolateral femoral interregional flap with turbocharge technique has a larger flap area, most of the donor areas of the flap can be sutured directly without skin grafting and with less complications and a higher patient satisfaction rate.

Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures.

To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament distal fascicle (ATiFL-DF) in patients with ankle fractures. Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed. Using arthroscopic results as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated, and Kappa consistency test was performed. The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0% and 92.3%, with the PPV of 92.6% and NPV of 100.0%. Ultrasonography findings exhibited excellent concordance with arthroscopic results (kappa=0.849). The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7% and 33.3%, with the PPV of 90.7% and NPV of 25.0%. However, the consistency between ultrasonography and arthroscopic results was poor (kappa=0.168). Ultrasonography is reliable in assessing injuries of ATFL in patients with ankle fractures, but its specificity in diagnosing ATiFL-DF is poor. Therefore, ankle arthroscopy remains necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.

Molecular mechanisms and clinical manifestations of hereditary hemorrhagic telangiectasia

IntroductionHereditary Hemorrhagic Telangiectasia (HHT) is charactered by telangiectasia and arteriovenous malformations (AVMs). Recurrent visceral and mucocutaneous bleeding is frequently reported among HHT patients, while data on the prevalence of thrombosis remains limited. This study aims to describe the clinical manifestations and molecular biological characteristics of HHT patients. MethodsWe conducted a retrospective study at Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine. A total of 24 HHT patients, observed between January 2019 and December 2023, were included. We recorded the biological, clinical, and therapeutic events, with particular attention to bleeding and thrombotic events. Gene mutation analysis and blood constituent measurements were performed. ResultsThe prevalence of bleeding among all HHT patients was 100 %, while thrombotic events were noted in 41.70 % of cases. Hepatic arteriovenous malformations (HAVMs) were identified in six patients, pulmonary arteriovenous malformations (PAVMs) in five patients, and cerebral arteriovenous malformations (CAVMs) in one patient. For patients with thrombosis, the discontinuation rates were 23.08 % for antiplatelet therapy and 33.33 % for anticoagulant therapy due to the increased risk of bleeding. Genetic mutations related to HHT were present in 16 patients, with ACVRL1 (activin A receptor-like type 1) mutations being the most frequent at 41.67 %, followed by ENG (endoglin) mutations at 20.83 %, and GDF2 (growth differentiation factor 2) mutations at 4.17 %. The incidence of PAVMs was 75.00 % in HHT1 patients with ENG mutations and 20 % in HHT2 patients with ACVRL1 mutations, while HAVMs occurred in 0 % and 40.00 % of these groups, respectively. Patients were divided into non-AVMs and AVMs groups. Compared to normal controls, von Willebrand factor (vWF) activity was significantly increased in all HHT patients (149.10 % vs. 90.65 %, P < 0.001). In the non-AVMs group, the median level of stromal cell-derived factor-1 (SDF-1) was significantly elevated (124.31 pg/mL vs. 2413.57 pg/mL, P < 0.05), while vWF antigen levels were markedly higher in the AVMs group (165.30 % vs. 130.60 %, P = 0.021). Further grouping of HHT patients based on bleeding and thrombosis phenotypes revealed that those with thrombosis had significantly higher median percentages of schistocytes (3.50 % vs. 0 %, P = 0.002), ferritin concentrations (318.50 μg/L vs. 115.50 μg/L, P = 0.001), and lactate dehydrogenase (LDH) levels (437 U/L vs. 105 U/L, P < 0.001). There were no significant differences in the activity of vWF, protein C (PC), protein S (PS), and factor VIII (FVIII) between the two groups. ConclusionThis study highlighted the complex relationship between arteriovenous malformations and genetic mutations in HHT patients. A comprehensive assessment of bleeding and thrombosis risks should be conducted for each HHT patient, additionally, further clinical studies are needed to explore the risk factors for thrombosis and anticoagulant-related bleeding in HHT.

Predictors of Response to Cognitive Behavioral Therapy in Patients With Tinnitus

Clinical guidelines recommend cognitive behavioral therapy (CBT) as a treatment for tinnitus. However, patient response to CBT is variable, and currently, there are no known predictors of response to CBT treatment for tinnitus. To identify the clinical predictors of patient response to CBT for treatment of tinnitus. This was a secondary cohort analysis of a single-arm clinical study including adults with chronic bothersome tinnitus recruited from Washington University School of Medicine in St Louis (Missouri) from September 2019 to February 2023. Participants completed an 8-week group CBT program with a licensed clinical psychologist. Each week consisted of 2.5 hours of CBT, amounting to 20 hours of total CBT participation, primarily delivered through a virtual platform. Conjunctive consolidation was used to create a predictive classification system for response to CBT based on tinnitus bother and anxiety levels. Response to CBT was predefined as a 13-point or greater decrease in the Tinnitus Functional Index (TFI) survey score. The study sample included 88 adult patients (median [IQR] age, 59 [49-66] years; 47 [53%] females and 41 [47%] males) with chronic bothersome tinnitus, of whom 53 (60%) had at least 13-point decrease in TFI and were considered to be responders. In univariable and multivariable logistic regression analyses, high to moderate anxiety level and severe tinnitus bother were associated with treatment response (adjusted odds ratio: anxiety, 3.33; 95% CI, 0.90-12.30; tinnitus bother, 12.08; 95% CI, 1.48-98.35). The clinical stratification system showed good predictive and discriminative ability (χ2 for linear trend = 20.0; C statistic = 0.75; 95% CI, 0.65-0.85). The findings of this study show that assessment of bother and anxiety levels in patients with tinnitus may be useful for identifying those who are more likely to respond to CBT. Before incorporation into clinical practice, future research should externally validate this finding in a separate population.

Histological Findings in Antigen E Positive and Negative in Chronic Hepatitis B.

To determine the histopathological findings in patients with HBeAg-positive chronic HBV infection (immunotolerant phase in old terminology) and HBeAg-negative chronic HBV infection (inactive carrier phase in old terminology). Observational study. Place and Duration of the Study: Department of Gastroenterology, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkiye and Diyarbakir and Mersin University School of Medicine, Diyarbakir, Turkiye, from May 2014 to August 2022. The difference between fibrosis and histological activity indices of 289 patients in the immunotolerant and inactive carrier phase who had liver biopsy was examined statistically. Additionally, the relationship of these data with age and gender was investigated. While 236 (81.7%) of the patients were in the inactive carrier phase, 53 (18.3%) patients were in the immunotolerant phase. The mean fibrosis score of patients in the immunotolerant stage was 2.0 ± 1.2, while it was 2.0 ± 1.0 in inactive carriers (p = 0.753). The number of patients with a fibrosis score of two and above was 21 (39.6%) in immunotolerant patients and 52 (22.0%) in inactive carrier patients (p = 0.004). In patients under 30 years of age, the mean fibrosis score was 1.7 ± 1.0. It was 2.0 ± 1.1 in those over 30 years of age (p = 0.016). Biochemical parameters or viral load cannot clearly reflect cellular damage in the liver. In the future, HBV DNA positivity alone may be the only criterion for the treatment. Chronic viral hepatitis B, Fibrosis, Immune tolerance phase, Inactive carrier phase.

Mature oocyte found during ovarian tissue cryopreservation in an early adolescent female.

A 15-year-old female with Hodgkin's lymphoma underwent ovarian tissue cryopreservation for preserving fertility in Reproductive Department of Sir Run Run Shaw Hospital, Zhejiang University School of Medical after receiving one course of chemotherapy. During the ovarian tissue cryopreservation, one MⅡmature oocyte and three germinal vesicle oocytes were found. The three immature oocytes underwent in vitro maturation but failed. Ultimately, one mature oocyte and 12 ovarian cortex slices were cryopreserved using vitrification. This case indicates that for patients with established gonadal axis feedback, ovarian tissue cryopreservation may not be the only method for fertility preservation. It is advisable to consider ovarian stimulation and oocyte retrieval for oocyte cryopreservation. Alternatively, for individuals in the ovulation phase of their menstrual cycle, attempting oocyte retrieval before ovarian tissue cryopreservation to obtain mature oocytes from the natural cycle, followed by oocyte cryopreservation, may enhance the likelihood of successful fertility preservation.

Chegg’s Growth, Response Rate, and Prevalence as a Cheating Tool: Insights From an Audit within an Australian Engineering School

AbstractOnline tools are increasingly being used by students to cheat. File-sharing and homework-helper websites offer to aid students in their studies, but are vulnerable to misuse, and are increasingly reported as a major source of academic misconduct. Chegg.com is the largest such website. Despite this, there is little public information about the use of Chegg as a cheating tool. This is a critical omission, as for institutions to effectively tackle this threat, they must have a sophisticated understanding of their use. To address this gap, this work reports on a comprehensive audit of Chegg usage conducted within an Australian university engineering school. We provide a detailed analysis of the growth of Chegg, its use within an Australian university engineering school, and the wait time to receive solutions. Alarmingly, we found over half of audit units had cheating content on Chegg is broadly used to cheat and 50% of questions asked on Chegg are answered within 1.5 h. This makes Chegg an appealing tool for academic misconduct in both assignment tasks and online exams. We further investigate the growth of Chegg and show its use is above pre-pandemic levels. This work provides valuable insights to educators and institutions looking to improve the integrity of their courses through assessment and policy development. Finally, to better understand and tackle this form of misconduct, we call on education institutions to be more transparent in reporting misconduct data and for homework-helper websites to improve defences against misuse.

Geriatrics Syndrome Research in Focus: A Bibliometric Overview

The bibliometric study provides an extensive summary of academic publications from 1990 to 2024 that are indexed in Web of Science (WoS) and Scopus. It highlights important research issues within geriatric syndromes, institutional contributions, regional distribution, and publication trends. 331 publications are listed in WoS, compared to 126 in Scopus. The yearly distribution patterns of the two databases are comparable, with noteworthy peaks occurring in 2000, 2010, and 2019. Strangely, there are no articles in 2024 according to both databases, which calls for more research. After Japan (35), Spain (28), and the United States (42) in terms of publications per country. Well-known establishments are Harvard Medical School and Johns Hopkins University. Two of the most often referenced studies, Inouye et al. (2007) and Tinetti et al. (1995), focus on important geriatric disorders, sarcopenia and frailty. With 25 publications, the Journal of the American Geriatrics Society takes first place. Six theme clusters, comprising fundamental concerns like disability, falls, and frailty, are revealed using keyword co-occurrence analysis. The results emphasize the necessity of ongoing financing for research on aging syndromes and draw attention to important research gaps and new trends. The sharp decline in 2024 publication numbers and dependence on two databases are acknowledged drawbacks that point to areas in need of greater research and thorough examinations in the future.

Enhancing undergraduate education and research in aging to eliminate health disparities (ENGAGED) – A pipeline program to advance diversity in aging research

ABSTRACT The Enhancing Undergraduate Education and Research in Aging to Eliminate Health Disparities (ENGAGED) program takes advantage of the broad, multidisciplinary research established in the area of aging at Wake Forest University School of Medicine and its partner institutions, Wake Forest University and Winston-Salem State University. The ENGAGED program is designed to provide undergraduate students who are underrepresented in the biomedical sciences an opportunity to participate in educational and research training in aging and health disparities. Funded since August 2019, ENGAGED has provided 73 academic year internships and 46 summer internships, with another 8 internships starting in Fall 2023. A total of 61 students (67% female, 64% African American, 21% Hispanic) have participated in the ENGAGED program, reflecting the fact that 49% participate in more than one session or program offering. To date, 38 of the ENGAGED trainees have graduated (100% with a science, technology, engineering, or math degree), 84% of whom are working or pursuing advanced degrees in the biomedical sciences. Given the unique strengths, existing infrastructure, and long-standing collaborations among the partner institutions, the ENGAGED program is helping advance diversity in aging and health disparities research by creating a pipeline for well-trained underrepresented students interested in biomedical research careers.

Thai Secondary EFL Teachers’ Use of Digital Literacy Tools in Post-COVID-19 Teaching

This study investigates the reasons behind pre-service and in-service teachers’ decisions to use digital literacy tools in their teaching following the COVID-19 pandemic. The objective is to understand the factors influencing their choices and to identify areas where support and training are needed. Semi-structured interviews were conducted with eight teachers from a university demonstration school in Thailand, evenly divided between pre-service and in-service teachers. The Technology Acceptance Model (TAM) framework guided the creation and adaptation of the interview questions. The findings indicate that pre-service teachers prefer digital tools that are easy to use, accessible, and affordable, with features such as templates, multimedia, and engaging functionalities. In contrast, in-service teachers prioritize familiar tools that save time and enhance the quality of teaching materials. Both groups value tools that facilitate collaboration and ensure privacy. The study highlights the significant generational differences in technology adoption, with younger teachers showing a greater inclination towards exploring a variety of digital tools, while more experienced teachers tending to stick with familiar technologies due to time constraints and comfort levels. These insights underscore the necessity for ongoing, tailored professional development programs that address the specific needs of both pre-service and in-service teachers. Such programs should focus on enhancing digital literacy, providing practical examples of new tools’ benefits, and fostering a supportive community for technology integration. By understanding these differences, educational institutions can better support teachers in integrating digital literacy tools effectively, thereby improving teaching practices and professional development opportunities. The implications of this study suggest that a one-size-fits-all approach to technology training may not be effective, and differentiated support is essential to cater to the diverse needs of educators.

Volume-Based Quantitative Measurement of [18F]AlF-NOTA-FAPI-04 PET/CT Uptake Reflects the Disease Activity of IgG4-Related Disease

BackgroundTo investigate the potential utility of quantitative parameters obtained by 18F-fibroblast activation protein inhibitor positron emission tomography/computed tomography ([18F]AlF-NOTA-FAPI-04 PET/CT) in the assessment of organ involvement and disease activity in IgG4-related disease (IgG4-RD).MethodsThis study enrolled patients who underwent [18F]AlF-NOTA-FAPI-04 PET/CT scans at the Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine from August 2021 to August 2022. The PET/CT images of the included patients were re-evaluated by PET center technicians, and the maximal standardized uptake value (SUVmax), metabolic lesion volume (MLV), and total lesion FAPI (TL-FAPI) were used to evaluate the involved organs and tissues that abnormally accumulated [18F]AlF-NOTA-FAPI-04. The clinical and laboratory data of patients are also systematically collected and analyzed.ResultsAmong the patients included in this study, 12 patients met the IgG4-RD classification criteria established by the American College of Rheumatology in 2019. Among them, 8 were males and 4 were females, with an average age of 59.3 ± 11.5 years. 50% of IgG4-RD patients were found with more organ involvement on PET/CT than physical examination, ultrasonography, and computed tomography. IgG4 levels (Rho = 0.594, p = 0.042) and IgG4-RI (Rho = 0.647, p = 0.023) were significantly positively correlated with TL-FAPI. After linear regression analysis, only TL-FAPI showed a predictive value of RI (R2 = 0.356, B = 0.008, p = 0.041).Conclusions[18F]AlF-NOTA-FAPI-04 PET/CT is a useful tool for identifying asymptomatic organ involvement and assessing disease activity. The TL-FAPI as an indicator was positively correlated with IgG4-RD disease activity.

Pathological complete response after conversion therapy in unresectable hepatocellular carcinoma: a retrospective study

BackgroundHepatocellular carcinoma is a highly lethal tumor worldwide, and China has a correspondingly high incidence and mortality rate. For patients with unresectable hepatocellular carcinoma, the prognosis is often poor. The objective of this retrospective study was to investigate the effects of conversion therapies on these patients.MethodsThe study included patients between the ages of 18 and 75 who were initially diagnosed with unresectable hepatocellular carcinoma and received conversion therapy. After completing surgery, the patients underwent pathological diagnosis, which showed complete necrosis. The study was conducted retrospectively at the First Affiliated Hospital, Zhejiang University School of Medicine, from January 2019 to December 2021. The main objectives of the study were to evaluate the overall survival and recurrence-free survival.ResultsA total of 60 patients who met the inclusion criteria were enrolled. The median age of the patients was 56.6 ± 9.5 years, and 85% of them were male. The one-year overall survival rate (OS) was 98.3%, and the three-year OS was 95.6%. The one-year recurrence-free survival rate (RFS) was 81.1%, and the three-year RFS was 71.4%. In subgroup analysis, there was no statistically significant difference in RFS between patients with BCLC stages 0-A and BCLC stages B-C (p = 0.296). Additionally, there was no statistically significant difference in RFS between patients who received postoperative new adjuvant therapy and those who did not (p = 0.324).ConclusionsConversion therapy followed by surgical resection could be a promising treatment for patients with initially unresectable hepatocellular carcinoma, and the prognosis is good with a pathological complete response.

Agency in negotiating partnerships in initial teacher education: shifting sands

ABSTRACT Despite over two decades of research, initial teacher education (ITE) partnerships remain problematic. Our study explores the development of a mandated ITE university–school partnership in Wales amidst significant educational reform. Through qualitative research, involving focus groups with 47 teacher educators from a university and 15 schools, we investigate their perceptions and experiences, focusing on shifts in professional roles and responsibilities. Our findings reveal disparities in the impact on the staff, including differences in changes to their roles and responsibilities, perceptions and experiences of agency and in the emotional effort required in the change process. We contend these findings have implications for all stakeholders involved in development of university–school ITE partnerships. In particular, the need for support for the development of individual and joint agency for all staff involved in partnership-building efforts. By shedding light on the complexities involved, we offer valuable insights for practitioners and researchers engaged in similar initiatives.

THE ROLE OF PERSON-ORGANIZATION FIT IN THE EFFECT OF INTRA-ORGANIZATIONAL POLITICAL BEHAVIOR ON WORK ALIENATION

The purpose of this research is to determine the role of person-organization fit in the effect of the perception of intra-organizational political behavior on work alienation of academics working in higher education institutions where tourism education is provided. In this regard, the research population consisted of academic staff working in faculties, colleges, and vocational schools of state and foundation universities in Turkey where tourism education is given. In this context, data were obtained from 385 academics by applying online and face-to-face questionnaires. AMOS program was used to test the measurement model, and PROCESS Macro was used to test the hypotheses. The study determined that intra-organizational political behavior had a significant and positive effect on work alienation. However, the moderating role of person-organization fit in this relationship is not significant.

Advancing Parent and Newborn Health Outcomes Through Community-Based Collaboration: A Somerville-Tufts University Partnership

This manuscript is based on Project INSPIRE: Improving New Somerville Parent &amp; Infant Resiliency &amp; Engagement, a healthcare and early childcare sector collaboration between: 1) the Center for Black Maternal Health and Reproductive Justice (CBMHRJ) at Tufts University School of Medicine in Boston, Massachusetts; 2) MARCH: Maternal Advocacy and Research for Community Health at Tufts University in Medford, Massachusetts; and 3) SomerBaby, an early childhood home-visiting and parental support program through Somerville Public Schools in Somerville, Massachusetts. To address Somerville immigrant parental health gaps in the literature, we convened a Parent Advisory Board (PAB), co-created a novel health needs assessment survey in English, Spanish, and Portuguese, and distributed this survey both through home visits by SomerBaby interpreters as well as online for all Somerville parents of children three years old or younger. In this manuscript, we focus on topics related to the overall methodology of this project, including study conceptualization, lessons learned in community-engaged parental health research, and recommendations for academic-community research partnerships in pursuit of Black and Brown maternal health equity.

Oral health care for individuals with intellectual and developmental disabilities: A statewide model.

Effective strategies and practices can assist in forming future initiatives and policies to improve oral health for individuals with intellectual and developmental disabilities (IDD). This manuscript aims to describe the Tufts Dental Facilities (TDF), a university-state collaboration providing sustained statewide access to comprehensive oral health care for individuals with IDD. The TDF program was established in 1976 as the result of a class action lawsuit to improve medical and dental care for individuals with IDD residing at state institutions in Massachusetts. TDF, A partnership, between Tufts University School of Dental Medicine (TUSDM) and the Commonwealth of Massachusetts, is a network of seven dental clinics strategically positioned across the state. These clinics are specifically designed to meet the oral health needs of individuals with IDD. TUSDM's oral health providers with expertise in special care dentistry deliver comprehensive oral health care for over 6500 individuals with IDD, incorporating supportive care services and access to general anesthesia. Additionally, the program provides training in special care dentistry for dental residents and pre-doctoral dental students. Leveraging state and university resources, TDF provides a model of a sustainable, long-term system for statewide access to oral health care for individuals with IDD.

Supporting early-career teachers with external mentoring: a scoping review

ABSTRACT This article presents a scoping review addressing the pressing issue of high attrition rates among early-areer teachers (ECTs), which poses a significant challenge to the development of a robust teacher workforce and student outcomes. Focusing on the role of external mentoring programmes, our study explores their potential in retaining ECTs within the teaching profession. Through a scoping review of the literature, we identified three central themes: (a) defining the role of external mentors, (b) elucidating the benefits of external mentoring and (c) examining the impact of external mentoring on ECT identity development. Our analysis revealed a scarcity of programmes emphasising university–school partnerships. Consequently, we propose the implementation of an ECT mentoring initiative involving university mentors collaborating with ECTs in their respective school environments. This study contributes significantly to the field of teacher education by shedding light on effective strategies for ECT induction and the transformative role of mentoring in cultivating ECTs as proficient educators capable of autonomous decision-making, networking, and enhancing overall teaching quality within schools.

Decision-making pathways for contraceptive use among refugee and host populations in Adjumani district, Uganda; an exploratory study

IntroductionContraceptive use is known to have a positive impact on maternal and child health outcomes; however, its use is still low in low-income countries, especially among people in humanitarian situations. This study explored decision-making processes towards the use of contraceptives by people in humanitarian situations to inform program design and uptake.MethodsA qualitative exploratory study was conducted among women of reproductive age (15–49 years) and men (15–60 years) living in three refugee settlements of Pagirinya, Nyumanzi, and Mirieyi and the surrounding host communities in Adjumani district, Uganda. Data were collected using 49 in-depth interviews (IDIs), 11 Key Informant Interviews (KIIs,) and 20 Focus Group Discussions (FGDs). Inductive thematic analysis was done with the aid of Atlas ti. Version 14.ResultsWe found that the decision-making processes entailed linear and nonlinear internalized cognitive and contextual processes involving four dynamic pathways. In the linear pathway, participants reported starting with 1) idea inception, 2) followed by cognitive processing, 3) consultation, and 4) decision-making for contraceptive use. The complex linear pathway happened when participants did not go through consultation but went straight to decision-making. However, participants who followed the non-linear pathway repeatedly went back to cognitive processing. Some women after consultation, or those already using and those not using contraceptives, decided to go back to cognitive processing to reconsider their current positions. This study found that some women who were not using contraceptives ended up using, while some who were using contraception ended up dropping out.ConclusionsThis study showed dynamic decision-making processes involving both internal and external environments as triggers to decision-making for contraceptive use. Interventions to increase contraceptive use should target both users and significant others who influence the decision to use particularly among refugees.Trial registrationThis study was registered by Makerere University School of Public Health Higher Degrees Research and Ethic Committee (HDREC) #188 and approved by Uganda National Council of Science and Technology on 15th/7/2021, Registration number—SS809ES.

Robot-assisted resection of choledochal cyst in neonates

ObjectiveLaparoscopic choledochectomy and hepatojejunostomy have been reported in children since 1995, but this procedure is technically demanding. Robotic surgical systems can simplify complex minimally invasive procedures. Currently, few reports have been made on neonates. We present the experience of 6 cases of neonatal CC(choledochal cysts).Study designBetween January 2022 and December 2023, 6 neonates underwent robotic resection of choledochal cyst and hepaticojejunostomy using the Da Vinci surgical system at Children’s Hospital, Zhejiang University School of Medicine, a high-volume hepatobiliary disease center. demographic data of the patients and surgical outcomes were collected and analyzed.ResultsAll 6 patients were successfully treated by robotic cystectomy and hepaticojejunostomy. The mean age was 17.3 days (range 4–25) and the mean weight was 3.6 kg (range 2.55–4.4). 5 cysts were type Ia and 1 was type Iva. The mean diameter of the cysts was 3.8 cm (range 1.25-5). The mean time to establish feeding was 4.83 days (range 4–6), and patients were discharged after a median time of 16.83 days (range 7–42) without postoperative complications.ConclusionsThis procedure is safe and effective for neonates. The authors found that the use of robot-assisted surgery has ergonomic advantages in this delicate, minimally invasive procedure.