Contemporary Assessment Research Articles

MP21-01 CONTEMPORARY COMORBIDITY PROFILE OF MEN WITH ERECTILE DYSFUNCTION

You have accessJournal of UrologyCME1 May 2022MP21-01 CONTEMPORARY COMORBIDITY PROFILE OF MEN WITH ERECTILE DYSFUNCTION Garrick Greear, Tristan Nicholson, Sarah Holt, Marah Hehemann, Hunter Wessells, and Thomas Walsh Garrick GreearGarrick Greear More articles by this author , Tristan NicholsonTristan Nicholson More articles by this author , Sarah HoltSarah Holt More articles by this author , Marah HehemannMarah Hehemann More articles by this author , Hunter WessellsHunter Wessells More articles by this author , and Thomas WalshThomas Walsh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002554.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The modern understanding of the comorbidities associated with erectile dysfunction (ED) was shaped by decades-old survey-based epidemiologic studies. The demographics and comorbidities of the United States population have since changed. A contemporary assessment of the comorbidity profile of men with ED is timely and indispensable for the efficient care of these men. METHODS: A cross-sectional analysis of the MarketScan® administrative claims database from 2008 to 2019 was performed. Inclusion criteria were men 18 to 64 years of age with a diagnosis of ED or phosphodiesterase type 5 inhibitor (PDE5i) prescription with ≥1 year of enrollment, as well as age-matched controls without an ED diagnosis or related prescription. Comorbidities were extracted by ICD-9/10 diagnosis codes and categorized by the Elixhauser Comorbidity Index. The trends in prevalence of comorbidities and odds of comorbidity diagnosis, overall and by age group, were analyzed. RESULTS: The prevalence of all comorbidities in men with and without ED increased over the study period. The five most prevalent comorbidities (and percentage increase) among men with ED were hypertension (108%), diabetes (78%), obesity (357%), chronic pulmonary disease (124%), and depression (164%). The association of ED with comorbidities such as complicated diabetes and paralysis was more pronounced among younger men (age 18-45 years vs 46-64 years). CONCLUSIONS: The comorbidity profile of men with ED has evolved since its initial characterization nearly 30 years ago. Increases in diseases associated with obesity and metabolic syndrome, as well as mental health disorders, are particularly notable. The findings illustrate the complex interplay of chronic health conditions in men with ED, and serve to justify the comprehensive evaluation of all men who present with ED. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e326 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrick Greear More articles by this author Tristan Nicholson More articles by this author Sarah Holt More articles by this author Marah Hehemann More articles by this author Hunter Wessells More articles by this author Thomas Walsh More articles by this author Expand All Advertisement PDF DownloadLoading ...

Sustainable practices of selected publiclylisted higher educational institutions in ensuring good health and well-being

Sustainable practices of selected publiclylisted higher educational institutions in ensuring good health and well-being

Doctor, I fractured my ankle. When can I return to play? An updated systematic review.

IntroductionAnkle fractures in sport are common. Their optimal management is unclear, as is when patients can return to their sports activities. This systematic review provides a contemporary assessment of the literature on return to sports following acute traumatic ankle fractures managed both operatively and non-operatively.Sources of dataWe systematically searched Pubmed, Google Scholar, the Cochrane Library, EMBASE and CINAHL using the terms ‘ankle fractures’, ‘ankle injuries’, ‘athletes’, ‘sports’, ‘return to sport’, ‘return to activity’, ‘operative management’, ‘non-operative management’.Areas of agreementThirteen retrospective studies fulfilled the inclusion criteria. The methodological quality of the studies was generally poor. The proportion of patients returning to sporting activity was high. In some studies, a quicker return to sporting activity was demonstrated in patients managed non-operatively.Areas of controversyThe time to return to sporting activity and level of performance post-treatment are not universally recorded, and the optimal time to return to sport remains to be confirmed.Growing pointsConservative management for stable or undisplaced fracture may result in a higher proportion of patients returning to sport more quickly.Areas timely for developing researchRandomized controlled trials should compare conservative to surgical treatment for appropriately chosen fracture patterns. Future studies should routinely report the timing of return to sport, the level of performance reached, and the time to achieve this.

Nonexercise Measurements as Predictors of Chronotropic Response to Exercise

ABSTRACT Background: Chronotropic response to exercise is a clinically important health indicator. Direct assessment of chronotropic response to exercise is problematic in many clinical settings because of lack of access to required exercise equipment. Also, abnormal chronotropic response to exercise is often asymptomatic, which hinders the ability to identify individuals who require exercise-based chronotropic response evaluation. The purpose of this study was to investigate a set of nonexercise, contemporary assessments as predictors of chronotropic response to exercise. Methods: This prospective, cross-sectional study investigated nonexercise predictors of chronotropic response to exercise. Forty participants (19 women, 21 men; mean age = 34.3 years, SD = 14.5) performed a graded exercise work rate protocol while heart rate was continuously monitored. Chronotropic response to exercise was recorded as the heart rate-work rate slope. Data on a variety of nonexercise measures were also collected. Results: Multivariable regression analysis indicated that sex, self-reported physical activity, body mass index, waist circumference, and isometric grip strength were independent predictors of chronotropic response to exercise and, as a subset, resulted in the strongest prediction model (R = 0.80, R2 = 0.64, P < 0.001). Conclusion: The results of this study suggest that a group of nonexercise measurements are predictive of chronotropic response to exercise. These findings provide a basis for future research to determine if these nonexercise predictors can be used to screen for chronotropic response to exercise abnormalities. Also, exercise interventions that target physical activity, body composition, and muscle strength may improve chronotropic response to exercise.

Inventer l’acteur. Émotions et spectacle dans l’Europe des lumières by Laurence Marie

Reviewed by: Inventer l’acteur. Émotions et spectacle dans l’Europe des lumières by Laurence Marie Jeffrey S. Ravel Laurence Marie, Inventer l’acteur. Émotions et spectacle dans l’Europe des lumières (Paris: Sorbonne université presses, 2019). Pp 477; 25 color illus. €26 paper. This admirable book provides a panoramic view of changes in acting theory in western and central Europe from the mid-eighteenth century into the early-nineteenth century. Laurence Marie focuses primarily on printed treatises on acting theory during this period, supplemented by contemporary assessments [End Page 406] of celebrity actors. The major strength of this work, particularly in the context of increasingly transnational approaches to Enlightenment Studies, is that it does not focus exclusively on one national context. English and French-language texts and English and French-speaking actors play the leads in the story Marie tells, but there is also important material from the German-speaking lands of the Holy Roman Empire, from the Italian peninsula, and, to a lesser extent, from Spain. Juxtaposing developments in these various areas over two generations suggests new perspectives on the stages of the Enlightenment and the Revolutionary period at the end of the century. Marie’s tale begins around 1750, when new assessments of acting styles began to appear in several European languages. These texts shared a common, innovative insight: critics and audiences were increasingly attentive to the physical aspects of stage representation, as opposed to the oratorical and declamatory styles of acting they had previously valued. In other words, pantomime, tableaux, and the embodiment of the dramatic text by stage performers were now appreciated as much or more than the recitation of printed theatrical texts. These issues famously led to debates among French theorists and critics about the nature of theatrical representation. Did actors truly experience the emotions they portrayed on stage, or did they coolly, rationally simulate them? In other words, were they faking it, and if so, was that desirable from a moral and technical point of view? Marie demonstrates that theorists in England and across the continent considered this issue, often drawing their examples from the performances of leading players in London, Paris, Berlin, Venice, and elsewhere. Furthermore, performers such as David Garrick, Henri Lekain, Michel Sticotti, and Conrad Eckhof traveled broadly during the period. They performed in many public, private, and courtly venues across the continent, engaging with authors, audiences, and critics in ways that led to evolution in acting styles. In a second phase of her story, beginning roughly in the 1780s and continuing into the first decades of the 1800s, theorists and performers moved beyond earlier questions of corporality on the stage to assess the ability of actors to evoke notions of beauty based in nature. Some critics advocated for the “beautiful,” or beau idéal, over a “truthful” replication of reality, while others looked to painting, sculpture, or music for representational techniques that might be adapted to the stage. Some even urged a return to the oratorical model of the pre-1750 period, wagering that words themselves were still sufficiently evocative to sustain the theatrical illusion. Throughout, Marie insists that there was no single, triumphant mode of theatrical representation that satisfied all audiences and critics, nor should there have been for an art form as closely allied with lived experience as the stage. Different modes emerged at different times and places in a dynamic, dialectical process that suited the most widespread form of public entertainment in the eighteenth century. In her conclusion, Marie sums up her investigation by reminding us of the general movement from theatrical imitation to artistic expression. It was a trend that increasingly shifted emphasis from the author to the player, and from the reader to the spectator. In this newly emerging performative space, players became celebrities, as Antoine Lilti has demonstrated elsewhere, and paying spectators with particular political, social, and cultural agendas became more important arbiters of nightly performances.1 In a coda, Marie provocatively asserts that modern debates about the merits of realism versus illusion in the theater, and about acting techniques, first took shape in the period she has studied. This book, as important as it is in advancing our transnational understanding...

Beneath the Backbone of the World: Blackfoot People and the North American Borderlands, 1720–1877 by Ryan Hall

Reviewed by: Beneath the Backbone of the World: Blackfoot People and the North American Borderlands, 1720–1877 by Ryan Hall L. James Dempsey (bio) Beneath the Backbone of the World: Blackfoot People and the North American Borderlands, 1720–1877 by Ryan Hall University of North Carolina Press, 2020 WHEN TAKING ON A HISTORY of one of the First Nations whose territory crossed the international boundary between the United States and Canada, one is confronted with how this First Nations tribe dealt with and reacted to the policies, actions, and most importantly the face-to-face interactions with members of non-Aboriginal populations. Ryan Hall takes on the task of detailing Blackfoot Confederacy's dealings with various fur trade companies, including the Hudson's Bay Company, the Northwest Company, and the American Fur Company. Hall's chronicle is an in-depth examination of a period when the Blackfoot Confederacy experienced immense change and evolution. Hall is mostly successful in his interpretation as he balances the different interactions the Blackfoot had with the Canadians and Americans; however, there is a stronger emphasis on the American side than the Canadian, which on occasion is overgeneralized. While the first chapter of the book covers Blackfoot culture and lifestyle, that content is not carried over into the rest of the book. Hall does not take into consideration the cultural life of the Confederacy, which may have been intentional on his part but would broaden the world's view of the Blackfoot and show that trade, while important, was not the center of their world nor always the main cause of the actions they took. A more extensive inclusion of the Blackfoot lifestyle would have clarified the issue of decision making. Hall asserts on a number of occasions that decisions were made on the Confederacy level, which does not take into consideration the tribal social structure. For example, political decisions were made at the band level, not the tribal or Confederacy level. An incident or action that took place in Montana may not have concerned the tribes on the Canadian side, and vice versa. As stated earlier, Hall traces the fur trade interactions of the Blackfoot Confederacy with the various fur trade companies. However, he implies that this trade was all important to the Blackfoot tribes, even concluding they were "dependent" on this trade. Hall never defines the term "dependent," [End Page 168] and much like fur trade historians of the pre-1970s, he bases many of his conclusions on statements made to traders at the posts by Blackfoot traders, rather than acknowledging the modern reinterpretation of these statements as "trade rhetoric." Trade rhetoric was a common form of bargaining in a barter system where one tries to gain the sympathy of the person they are dealing with in order to obtain a better deal. A closer look at Arthur Ray's work (in the bibliography) would reveal this contemporary assessment. It has to be noted, when writing about First Nations in today's climate, that tribal names have changed from what were used historically. This change has come about as First Nations restore the terms they used to refer to themselves, rather than use the terms that were more often than not placed upon them. Throughout the book the author makes use of different terms for the Blackfoot without any explanation why. Changes do make it difficult for authors to know which term to use, but this challenge should inspire them to provide a space to discuss and explain terms used in the book. Then the author should use terms consistently throughout the work. Using the Blackfoot as an example, historically they were known as the "Blackfeet" on the American side and the "Blackfoot" on the Canadian, but in reality the American Blackfeet were southern Piegans (a term they have been reintroducing) while the Blackfoot Confederacy on the Canadian side was made up of the northern Piegans, the Bloods, and the Blackfoot proper. Even here these tribes now refer to themselves by their Blackfoot language names. The book contains an extensive twenty-five-page bibliography. However, the footnote style is one that raises an issue about the sources. In many of the book's paragraphs...

Urban Scene Protection and Unconventional Practices—Contemporary Landscapes in World Heritage Cities of Spain

This paper theoretically examines the extent to which visual perception has excluded alternative forms of culture in World Heritage cities and towns in Spain. To do so, an initial review is carried out of the UNESCO framework and criteria which establishes the outstanding universal value of Spanish cities and towns. This is followed by a review of minor concepts such as informality and creativity, which are related to alternative conceptions of culture and heritage. Thirdly, a review of the literature provides an overview of the appraisal of the social value in the heritage realm. This is achieved through the Historic Urban Landscape approach, which is adapted to specific forms of local appraisal. An analysis of policy helps explain the need to review principles of protection in terms of ethical evaluations. The analysis shows that outdated policies clash with contemporary assessment and participatory methods of heritage-making.

F.A. Hayek on the political economy of endogenous preferences: An historical overview and contemporary assessment

In this paper, we analyse Hayek's views on endogenous preferences. Perhaps surprisingly in the light of his remarks that economists ought to take people's preferences as given, there are several places in Hayek's economics and political economy where preference endogeneity plays a significant role. We begin by documenting those cases, providing an historical overview of Hayek's views on preference endogeneity. We then go on to argue that in his work on theoretical psychology Hayek provides an account of the causal mechanisms through which people's preferences can change in response to their social context. Finally, we assess Hayek's views on preference endogeneity in the light of more recent work on the topic in behavioural economics, before going on to consider what Hayek's analysis can add to contemporary debates in political economy.

Risk assessment for marine ecosystem‐based management (EBM)

AbstractEcosystem‐based management (EBM) is a holistic way to manage the marine environment, involving partnerships between people and the recognition of ecological complexity. As we progress towards EBM, risk assessments must move beyond an evaluation of the direct impacts of a single stressor on a species or habitat. Here, we propose 12 risk assessment criteria that explicitly reflect the principles of EBM. These criteria include the need to assess risk to multiple ecosystem components and values, evaluate place and time‐specific ecological complexity, evaluate recovery, accommodate different knowledge types and communicate uncertainty. Contemporary risk assessment approaches rarely meet all 12 criteria and whilst many approaches could be adapted to do so, some are more easily modified than others. Risk assessment approaches that meet our criteria have the greatest potential to support decision‐making in an EBM context and thereby safeguard our marine environments and their values for future generations.

A contemporary assessment of resuscitative endovascular balloon occlusion of the aorta.

From the Department of Surgery, University of Texas McGovern Medical School (L.J.M.), Houston, Texas; and Department of Surgery (T.E.R.), Mayo Clinic, Rochester, Minnesota. Submitted: January 15, 2022, Revised: January 17, 2022, Accepted: January 18, 2022, Published online: January 31, 2022. Address for reprints: Todd E. Rasmussen, MD, Department of Surgery, Mayo Clinic, Rochester, MN 55905; email: [email protected].

Stroke Following Thoracic Endovascular Aortic Repair: Determinants, Short and Long Term Impact

We performed a contemporary assessment of clinical and radiographic factors of stroke after thoracic endovascular aortic repair (TEVAR). Patients undergoing TEVAR from 2006 to 2017 were identified. We assessed clinical and radiographic data, including preoperative head and neck computed tomography, Doppler ultrasonography, and intraoperative angiography. Our primary outcome was stroke after TEVAR. Four hundred seventy-nine patients underwent TEVAR, mean age 68.1 ± 19.5 years, 52.6% male. Indications for TEVAR included aneurysms (n = 238, 49.7%) or dissections (n = 152, 31.7%). Ishimaru landing zones were Zone 2 (n = 225, 47.0%), Zone 3 (n = 151, 31.5%), or Zone 4 (n = 103, 21.5%). Stroke occurred in 3.8% (n = 18) of patients, with 1.9% (8) major events (modified Rankin Scale >3). Pathophysiology was predominantly embolic (n = 14), and occurred in posterior (n = 6), anterior (n = 6), or combined circulation (n = 4), and in the left hemisphere (n = 10) or bilateral (n = 6). Univariate analysis suggested use of lumbar drain (33.3% versus 57.2%, P = 0.04), inability to revascularize the left subclavian artery (16.7% vs 5.2%, P = 0.04) and number of implanted components (2.5 ± 1.2 vs 2.0 ± 0.97, P = 0.03) were associated with stroke. Multivariable analysis identified number of implanted components (OR 1.7, 95%CI 1.17-2.67 P = 0.00) and inability to revascularize the left subclavian artery as independent predictors of stroke. Stroke was associated with a higher perioperative mortality (27.8% vs 3.9%, P < 0.01). Stroke after TEVAR is primarily embolic in nature and related to both anatomic and procedural factors. This may have important implications for device development in the era of endovascular arch repair.

Contemporary Assessment of Need for Palliative Bypass After Aborted Pancreatoduodenectomy Following Neoadjuvant Therapy

BackgroundPlanned pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) can be aborted due to intraoperative findings. There is little guidance regarding the need for prophylactic bypass following an aborted PD to prevent symptomatic biliary obstruction or gastric outlet obstruction (GOO) postoperatively. The aim of this study was to characterize postoperative interventions and postsurgical survival in patients following aborted PD. MethodsPatients with PDAC treated with neoadjuvant therapy and staging laparoscopy prior to planned PD between 2010 and 2015 were reviewed for aborted PDs. Data on postoperative biliary obstruction, GOO, procedural intervention, and postsurgical survival were analyzed. ResultsOf 271 planned PDs, 47 (17.3%) were aborted. Thirty-six patients had ≥ 2 months of follow-up data and were included. Six patients underwent hepaticojejunostomy and nine patients underwent gastrojejunostomy at the time of the aborted PD. Sixteen of 30 patients (53%) without a surgical biliary bypass required endoscopic intervention, but none required palliative surgery. Ten of 27 patients (37%) without an operative gastrojejunostomy required intervention, but none required palliative surgery. Endoscopic or percutaneous therapy was required to treat 13/16 (81%) patients who presented with postoperative biliary obstructions and 6/10 (60%) of GOOs. Median survival following aborted PD was 13.3 months (CI 8.9–17.7). There were no differences in survival when comparing patients who developed a biliary obstruction (p = 0.92) or GOO (p = 0.90) to asymptomatic patients. ConclusionsFollowing aborted PD, patients commonly develop obstructive symptoms. However, these symptoms can generally be managed without surgical intervention. In asymptomatic patients, preemptive surgical bypasses are not required at the time of aborted PD.

Incidence and Predictors of Infections and All-Cause Death in Patients with Cardiac Implantable Electronic Devices: The Italian Nationwide RI-AIAC Registry.

Background: The incidence of infections associated with cardiac implantable electronic devices (CIEDs) and patient outcomes are not fully known. Aim: To provide a contemporary assessment of the risk of CIEDs infection and associated clinical outcomes. Methods: In Italy, 18 centres enrolled all consecutive patients undergoing a CIED procedure and entered a 12-months follow-up. CIED infections, as well as a composite clinical event of infection or all-cause death were recorded. Results: A total of 2675 patients (64.3% male, age 78 (70–84)) were enrolled. During follow up 28 (1.1%) CIED infections and 132 (5%) deaths, with 152 (5.7%) composite clinical events were observed. At a multivariate analysis, the type of procedure (revision/upgrading/reimplantation) (OR: 4.08, 95% CI: 1.38–12.08) and diabetes (OR: 2.22, 95% CI: 1.02–4.84) were found as main clinical factors associated to CIED infection. Both the PADIT score and the RI-AIAC Infection score were significantly associated with CIED infections, with the RI-AIAC infection score showing the strongest association (OR: 2.38, 95% CI: 1.60–3.55 for each point), with a c-index = 0.64 (0.52–0.75), p = 0.015. Regarding the occurrence of composite clinical events, the Kolek score, the Shariff score and the RI-AIAC Event score all predicted the outcome, with an AUC for the RI-AIAC Event score equal to 0.67 (0.63−0.71) p < 0.001. Conclusions: In this Italian nationwide cohort of patients, while the incidence of CIED infections was substantially low, the rate of the composite clinical outcome of infection or all-cause death was quite high and associated with several clinical factors depicting a more impaired clinical status.

Outpatient treatment and clinical outcomes of bacteriuria in veterans: A retrospective cohort analysis.

To conduct a contemporary detailed assessment of outpatient antibiotic prescribing and outcomes for positive urine cultures in a mixed-sex cohort. Multicenter retrospective cohort review. The study was conducted using data from 31 Veterans' Affairs medical centers. Outpatient adults with positive urine cultures. From 2016 to 2019, data were extracted through a nationwide database and manual chart review. Positive urine cultures were reviewed at the chart, clinician, and aggregate levels. Cases were classified as cystitis, pyelonephritis, or asymptomatic bacteriuria (ASB) based upon documented signs and symptoms. Preferred therapy definitions were applied for subdiagnoses: ASB (no antibiotics), cystitis (trimethoprim-sulfamethoxazole, nitrofurantoin, β-lactams), and pyelonephritis (trimethoprim-sulfamethoxazole, fluoroquinolone). Outcomes included 30-day clinical failure or hospitalization. Odds ratios for outcomes between treatments were estimated using logistic regression. Of 3,255 cases reviewed, ASB was identified in 1,628 cases (50%), cystitis was identified in 1,156 cases (36%), and pyelonephritis was identified in 471 cases (15%). Of all 2,831 cases, 1,298 (46%) received preferred therapy selection and duration for cases where it could be defined. The most common antibiotic class prescribed was a fluoroquinolone (34%). Patients prescribed preferred therapy had lower odds of clinical failure: preferred (8%) versus nonpreferred (10%) (unadjusted OR, 0.74; 95% confidence interval [CI], 0.58-0.95; P = .018). They also had lower odds of 30-day hospitalization: preferred therapy (3%) versus nonpreferred therapy (5%) (unadjusted OR, 0.55; 95% CI, 0.37-0.81; P = .002). Odds of clinical treatment failure or hospitalization was higher for β-lactams relative to ciprofloxacin (unadjusted OR, 1.89; 95% CI, 1.23-2.90; P = .002). Clinicians prescribed preferred therapy 46% of the time. Those prescribed preferred therapy had lower odds of clinical failure and of being hospitalized.

Cardiovascular Disease in Patients With Breast Cancer Treated in the Modern Era

With improving cancer survivorship, cardiovascular disease (CVD) has become a leading cause of death in breast cancer (BC) survivors. There is no contemporary risk assessment tool specific to this patient cohort. Accordingly, we sought to investigate long-term cardiovascular outcomes in BC patients utilising a well characterised database at a quaternary referral centre. With the assembly of this cohort, we have derived a BC cardiovascular risk index titled the ‘CRIB (Cardiovascular Risk Index in Breast Cancer)’ to estimate the risk of a major adverse cardiovascular events (MACE) in women undergoing treatment for BC.

An Overview of the Structure of English Language Teaching Programs in the Netherlands, Austria, Denmark, Singapore, Norway, and Turkey: The Countries Ranking Among the Top Five in EF Proficiency Index

As English is widely accepted as a lingua franca in today's world, the importance of the language has been acknowledged globally in the present case. To rank the countries in terms of their English language proficiency, the EF Proficiency Index is prepared each year. In this study, five countries having the highest scores according to the Index (2021) were taken into account together with the English language curricula of the top five ranking EFL countries (Netherlands, Austria, Denmark, Singapore, and Norway). The English language teaching programs of these countries were analysed and compared in terms of the starting age, language assessment, and course content, adding to the comparison list a low-ranking country, Turkey. The data elicited through document analysis propounded the idea that overall, the objectives of English language curricula in these five countries have many common features and similarities. On the other hand, developing positive attitudes towards learning English is emphasised in the Turkish EFL context, and four basic language skills are treated separately in different grades. While other countries give prominence to communicative competence and communication skills together with the cognitive side of the language learning process, the affective components of the language learning process are emphasised in Turkey. Contemporary formative assessment techniques are also recommended in this continuum.

A Contemporary Assessment of Osteosarcoma: Lessons from a Comparative Approach

This review will describe more than two decades of comparative research on primary bone cancer (osteosarcoma). Osteosarcoma is a chaotic disease present in a complex and variable microenvironment composed of many different cell types which interact with each other and lead to high transcriptional heterogeneity. Despite this heterogeneity, common transcriptional patterns can be observed in the bulk transcriptomes of these tumors; additionally, these patterns are associated with outcome, indicating their importance to the molecular biology of the disease. Work from our group and others has led to our current understanding of osteosarcoma as a disease where multiple pathological processes appear to converge into a limited array of tissue organizations with distinct biology. Recurrent as well as distinct events can lead to these states of tissue organization, explaining the heterogeneity of osteosarcoma that is observed among and within species. Yet, despite their chaotic genomes, osteosarcomas seem to be (relatively) genetically stable, with persistent maintenance of essentially the same chromothriptic karyotype throughout the developmental lifetime of the tumor. Importantly, the transcriptional variance between tumors can highlight the underlying biology of the malignant cells themselves, as well as the composition of the osteosarcoma microenvironment and the host response, both of which are prognostically significant for this disease. Initial single cell RNA-seq reports provide further evidence of the importance of the osteosarcoma microenvironment for tumor characterization. Our data suggest that improving patient outcomes in immunologically barren or “cold” osteosarcomas, necessitates generating immune permissive or “warmer” microenvironments within the tumor. Furthermore, the aging bone microenvironment may create specific niches that predispose to cancer, and identification of the drivers that lead to these variable transcriptional patterns will be essential to identify personalized, effective genomic therapy for osteosarcoma.

‘Of course it is idealised’: Lindsay Anderson's Every Day Except Christmas

This article examines Lindsay Anderson's 1957 documentary, Every Day Except Christmas, as a distinct product of British post-war culture that also contributed significantly to the development of Anderson's own film aesthetic. It also sets Every Day Except Christmas against the background of Anderson's influential documentary made a year earlier, O Dreamland. The article combines formal and contextual analysis of Christmas with a review of contemporary assessments of the film as well as Anderson's own comments on it.

Gentlewomen of the Jury

This Article undertakes a contemporary assessment of the role of women on the jury. In 1946, at a time when few women served on U.S. juries, the all-male Supreme Court opined in Ballard v. United States: “The truth is that the two sexes are not fungible; a community made up exclusively of one is different from a community composed of both; the subtle interplay of influence of one on the other is among the imponderables.” Three-quarters of a century later, women’s legal and social status has changed dramatically, with increased participation in the labor force, expanded leadership roles, and the removal of legal and other barriers to their civic engagement, including jury service. Theoretical developments and research have produced new insights about how genderconforming individuals enact their gender roles. We combine these insights with a substantial body of jury research that has examined the effects of jurors’ gender on their decision-making processes and verdict preferences in criminal and civil cases. We also consider how nonbinary and gender-nonconforming individuals might bring distinctive perspectives and experiences to the jury. After a review of the historical record, describing shifts over time in women’s jury participation in the face of legal and societal barriers, we summarize evidence from decision-making research, gender scholarship, and jury studies to examine whether women bring a different voice to jury service. Our review, which demonstrates substantial commonalities as well as significant areas of divergence in jurors’ attitudes and verdicts as a function of their gender, altogether underscores the importance of full and equitable participation on the jury.

Targeting 3 Tiers of Psychiatric Problems in Patient-focused Psychiatric Practice: Diagnostic Signs, Symptoms, and Impairments; Specific Complex Subjective Complaints; and Contributing Meta-problems.

While contemporary psychiatric assessments ordinarily focus on signs, symptoms, and impairments comprising formal diagnoses, these assessments sometimes minimize or ignore specific complaints and other contributing problems that are the sources of patients' and families' greatest distress. Neglect of these problems may decrease patient satisfaction and reduce the quality of care. The author reviewed limitations of previous problem-oriented efforts in psychiatry and limitations of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. This review provided the basis for reconceptualizing how problems might be identified and framed in clinical assessments. A clinically practical 3-tier framework for psychiatric problems is suggested. The first tier encompasses diagnostic contents, including subjective symptoms, observable signs, and impairments. The second tier consists of additional specific complex subjective complaints in the patient's and family's own words, comprised of highly individualized distressing intrapsychic, interpersonal, and environmental situations and conflicts. The third tier consists of contributing meta-problems, comprised of significant additional patient-related or systems-related difficulties noted by clinicians that contribute substantially to complicated clinical problem sets. Diagnostic or not, specific problems expressed by patients and families and contributing meta-problems should be integrated into initial formulations and tracked during treatment. Whereas only some of these problems may fall within a clinician's scope of responsibilities, all should fall within the scope of concern, some to be referred to others, and some exceeding caregivers' capacities. Periodic review of problem lists for patients' and families' most distressing concerns can contribute to the therapeutic alliance, increase patient satisfaction, and perhaps improve outcomes.