Great Debate Research Articles

Temporal Flaps in Head and Neck Reconstructive Surgery: A Systematic Review of Surgical Techniques.

The temporal region is a great source of vascularized flap, providing extremely variable and versatile options for reconstruction in head and neck surgery. Its popularity has led to the conception of a large variety of different flaps, in terms of contents and design. Temporal flaps are highly pliable and flexible, providing adequate bulk to obliterate dead spaces and improving engraftment, thus facilitating wound healing. The need to access different anatomical compartments, often far from the original flap anatomical site, has led surgeons to develop techniques to enlarge pedicles and bulk, by reverting and splitting flaps' contents, as well as through partial mandibular and zygomatic resection. To further increase versatility, a multilayered combination of different regional tissues and muscle segmentation techniques has been described. Historically, each flap has had its own proponents and opponents, but a pointy review systematizing techniques and comparatively analyzing different flaps was still missing in the literature. The field of use of some flaps has been progressively limited by the increasing relevance of free tissue transfers, which nowadays may provide success rates up to 95% with a constrained morbidity, thus offering an effective alternative, when available. Given the wide range of reconstructive strategies based on temporal flaps, there is still a great debate on nomenclature and surgical techniques. The present study systematizes the topic, classifying regional flaps according to contents and indications. Harvesting techniques are described stepwise and schematically illustrated, thus offering an indispensable tool to the armamentarium of reconstructive surgeons.

The Extraordinary Ethics of Self-Defence: Embodied Vulnerability and Gun Rights among Transgender Shooters in the United States

ABSTRACT Ethical ways of being form in response to bodily perceptions of vulnerability. Arguments that position firearms as defensive tools have become increasingly common in debates about gun legislation over the last two decades. This rhetoric has its origin in counter-hegemonic movements like the Black Panther Party for Self-Defence, which argued that African-Americans need guns to resist state-sanctioned violence from the police. For white men and women, as well as transgender gun rights activists in San Diego, California, vulnerability forms a key part of the argument for expanding access to guns as defensive weapons. This ‘vulnerability politics’ (Carlson [2014a]. From Gun Politics to Self-Defence Politics: A Feminist Critique of the Great Gun Debate. Violence Against Women, 20(3):369–377) represents both a lived experience and ideological lens that informs ethical behaviour. Firearms owners fashion an ethical self through a combination of the prescribed, normative politics of gun rights rhetoric and creatively innovate with these scripts through their embodied experiences of threat.

Understanding and Managing Severe Asthma in the Context of COVID-19.

Coronavirus disease 2019 (COVID-19) continues to spread across the world. Since the beginning of the pandemic, the question of whether asthma is a risk factor for getting the infection or for poor outcomes motivated a great debate. In the field of severe asthma and its treatment during COVID-19 pandemic, several issues are also pending. A literature review focused on the management of severe asthma patients in the context of COVID-19 is performed. The available evidence suggests that severe asthma patients do not have an increased risk of poor COVID-19 outcomes and that it is safe to treat asthmatic patients with inhaled corticosteroids (ICS) and biologics during the pandemic, even though some studies indicate that high doses of ICS may predispose to COVID-19. The chronic use of oral corticosteroid (OCS) might be associated with poor COVID-19 outcomes, although there is no complete agreement. There is very limited evidence concerning the use of triple therapy for asthma in the context of this pandemic. Ultimately, severe asthma patients should maintain their medication during the COVID-19 pandemic, including biologic agents. More studies are needed to address the role of asthma medications and asthma’s different phenotypes on the incidence and course of COVID-19.

Long-term survival of patients with stage II and III gastric cancer who underwent gastrectomy with inadequate nodal assessment.

BACKGROUNDGastric cancer is an aggressive disease with frequent lymph node (LN) involvement. The NCCN recommends a D2 lymphadenectomy and the harvesting of at least 16 LNs. This threshold has been the subject of great debate, not only for the extent of surgery but also for more appropriate staging. The reclassification of stage IIB through IIIC based on N3b nodal staging in the eighth edition of the American Joint Committee on Cancer (AJCC) staging system highlights the efforts to more accurately discriminate survival expectancy based on nodal number. Furthermore, studies have suggested that pathologic assessment of 30 or more LNs improve prognostic accuracy and is required for proper staging of gastric cancer.AIMTo evaluate the long-term survival of advanced gastric cancer patients who deviated from expected survival curves because of inadequate nodal evaluation.METHODSEligible patients were identified from the Surveillance, Epidemiology, and End Results database. Those with stage II–III gastric cancer were considered for inclusion. Three groups were compared based on the number of analyzed LNs. They were inadequate LN assessment (ILA, < 16 LNs), adequate LN assessment (ALA, 16-29 LNs), and optimal LN assessment (OLA, ≥ 30 LNs). The main outcomes were overall survival (OS) and cancer-specific survival. Data were analyzed by the Kaplan-Meier product-limit method, log-rank test, hazard risk, and Cox proportional univariate and multivariate models. Propensity score matching (PSM) was used to compare the ALA and OLA groups.RESULTSThe analysis included 11607 patients. Most had advanced T stages (T3 = 48%; T4 = 42%). The pathological AJCC stage distribution was IIA = 22%, IIB = 18%, IIIA = 26%, IIIB = 22%, and IIIC = 12%. The overall sample divided by the study objective included ILA (50%), ALA (35%), and OLA (15%). Median OS was 24 mo for the ILA group, 29 mo for the ALA group, and 34 mo for the OLA group (P < 0.001). Univariate analysis showed that the ALA and OLA groups had better OS than the ILA group [ALA hazard ratio (HR) = 0.84, 95% confidence interval (CI): 0.79–0.88, P < 0.001 and OLA HR = 0.73, 95%CI: 0.68–0.79, P < 0.001]. The OS outcome was confirmed by multivariate analysis (ALA HR = 0.68, 95%CI: 0.64–0.71, P < 0.001 and OLA: HR = 0.48, 95%CI: 0.44–0.52, P < 0.001). A 1:1 PSM analysis in 3428 patients found that the OLA group had better survival than the ALA group (OS: OLA median = 34 mo vs ALA median = 26 mo, P < 0.001, which was confirmed by univariate analysis (HR = 0.81, 95%CI: 0.75–0.89, P < 0.001) and multivariate analysis: (HR = 0.71, 95%CI: 0.65–0.78, P < 0.001).CONCLUSIONProper nodal staging is a critical issue in gastric cancer. Assessment of an inadequate number of LNs places patients at high risk of adverse long-term survival outcomes.

Global citizenship cultivation through COIL-PBL model: case study of the Great Debates course

The current global political, economic, and social challenges urge the need to cultivate global citizenship among students in their learning process. This paper presents the role of Collaboration Online International Learning (COIL) using theProject-Based Learning (PBL) approach in cultivating global citizenship among university students. The paper explains the different implementation challenges of a COIL course on the different levels and core design elements of the COIL-PBL model to overcome such challenges. Empirically, this paper presents a primary case study of the Great Debates course that was implemented in different forms by three partner universities, which are the University of Washington Bothell (UWB), the University of North Carolina Asheville (UNCA) in the USA, and the Future University in Egypt (FUE). The implementation showed a positive impact on cultivating global citizenship among participating students, which isclear from developments in students’ skills in the areas of cross-cultural communication and negotiation, cultural sensitivity and tolerance, teamwork and coordination across virtual global teams, analytical skills, and perception toward other cultures and society. Notably, the COIL-PBL model has started to gain further popularity after the COVID-19pandemic as an alternative for physical mobility, which encourages future research in this area using other implemented courses using the COIL-PBL model.

Infants Learn to Follow Gaze in Stages: Evidence Confirming a Robotic Prediction.

Gaze following is an early-emerging skill in infancy argued to be fundamental to joint attention and later language development. However, how gaze following emerges is a topic of great debate. Representational theories assume that in order to follow adults’ gaze, infants must have a rich sensitivity to adults’ communicative intention from birth. In contrast, learning-based theories hold that infants may learn to gaze follow based on low-level social reinforcement, without the need to understand others’ mental states. Nagai et al. (2006) successfully taught a robot to gaze follow through social reinforcement and found that the robot learned in stages: first in the horizontal plane, and later in the vertical plane—a prediction that does not follow from representational theories. In the current study, we tested this prediction in an eye-tracking paradigm. Six-month-olds did not follow gaze in either the horizontal or vertical plane, whereas 12-month-olds and 18-month-olds only followed gaze in the horizontal plane. These results confirm the core prediction of the robot model, suggesting that children may also learn to gaze follow through social reinforcement coupled with a structured learning environment.

A future triple entry accounting framework using blockchain technology

The study adopts a single case study approach to bring into conversation, ideas, and views of several scholars on triple entry accounting (TEA). The development of blockchain technology already drives the conscious move towards the TEA. The TEA is currently not being used in any significant way but is in a greater debate whether it is worth adopting such alternative accounting practices as the TEA. Shifting to the TEA system is challenging and at present, it is just a fascinating mental exercise. With these backdrops, the present study discusses the likelihood cases of future accounting practice namely: (I) Sophisticated Accounting Software based on the double entry accounting (DEA); (II) Combination of Blockchain and TEA; and (III) Combination of disruptive technologies in addition to Blockchain and TEA. Finally, the study concludes with describing the basic architecture of a potential system of triple-entry accounting that could support the TEA system to deliver real-time insights into business operations. Lastly, the study plotted a hype cycle for accounting technologies to help global organizations identify the relevant accounting technologies and applications.

Carbon emissions and firm performance: A matter of horizon, materiality and regional specificities

The relationship between environmental and financial performance has been a source of great debate. While some scholars have exerted that enhanced environmental performance should generate competitive advantages and thus greater profitability, others have argued that the cost burden would not be offset by corporations. In this study, I reexamined the impact of carbon emission performance (CEP) on corporate financial performance (CFP) by studying the moderating effect of CFP horizon, CEP materiality and regional attributes. Using an international sample of firms between 2015 and 2020, the results suggested that (1) short-term CFP was negatively affected by CEP and (2) solely high materiality firms would derive heightened CFP in the long run. While the former finding was exacerbated for high materiality firms and those operating in regions with more stringent regulations, the latter was driven mainly by North American corporations. Thus, materiality appeared to reconcile diverging expectations of scholars regarding the CEP-CFP relationship. The findings reported in this study were robust to firm-year effects as well as endogeneity issues.

Recurrent VTE in Pregnant Woman with Previous Personal History of VTE: A Systematic Review and Meta-Analysis

Introduction: Venous thromboembolism (VTE) is one of the leading causes of morbidity and mortality during pregnancy and the postpartum periods. Despite that, the prevention and management of VTEs in pregnant patients remains an area of great debate, particularly among those with a personal VTE history. There is no solid evidence behind the current practice guidelines on the prevention of VTE in pregnancy as most data comes from studies focusing on non-pregnant patients or from small studies. It has been suggested that without low molecular weight heparin (LMWH) thromboprophylaxis, women with a personal history of VTE may have a 2% to 10% absolute risk of developing recurrent VTE during a subsequent pregnancy. We conducted a systematic review to evaluate the risk of VTE recurrence during pregnancy for pregnant patients with prior personal history of VTE and the effect of LMWH on such risk.Materials and Methods: MEDLINE and EMBASE were searched between January 2000 to December 2020. We included studies that evaluated pregnant patients with previous personal VTE history (deep vein thrombosis (DVT) and pulmonary embolism (PE) only) that assessed venous thromboembolism recurrence and/or bleeding complication and/or pregnancy outcomes. Study selection and data extraction was conducted by 3 reviewers and discrepancies resolved by consensus. A meta-analysis of proportions was done through a Freeman-Tukey transformation using random effect models. Groups were analyzed according to prophylaxis strategy. Heterogeneity between studies was assessed by Cochrane Q and Higgins I 2 analyses. Publication bias was assessed using Eggers' tests and funnel plot.Results. Of 6934 potential studies, 27 were included in this systematic review. The studies included 3631 pregnant patients with a previous history of DVT or PE, regardless of the presence of thrombophilia. We found a wide variability in thromboprophylaxis practices which included mostly low molecular weight heparin using weight-based, risk category-based, anti-Xa based, fixed, or trimester-adjusted doses . In studies that categorized patients into provoked, estrogen associated and unprovoked, most patients had an estrogen-associated previous VTE.The estimated pooled proportions of VTE recurrence were 2.7% (95% CI 1.8-3.7; I 2 55.5%) in patients who were consistently on anticoagulation during pregnancy (pre- and post-partum), 2.6% (95% CI 0.6-5.9; I 2 not estimable) in patients who received anticoagulation in the postpartum period only, and 25.3% (95% CI 8.9-46.6; I 2 93.2%) in patients who were not on anticoagulation. No comparison could be done on the different dosage strategies due to the limited number of studies and wide variety of strategies. Due to limited data available, bleeding complications and pregnancy outcomes could not be assessed.Conclusion. In patients with a previous VTE history receiving prophylactic anticoagulation (either both pre- and post-partum or post-partum only), the estimates of VTE recurrence were significantly lower than that for patients who did not receive prophylaxis, however, a direct comparison was not possible. The optimal thromboprophylaxis strategy remains unknown. DisclosuresNo relevant conflicts of interest to declare.

Arguing Americanism: Franco Lobbyists, Roosevelt's Foreign Policy, and the Spanish Civil War

November 01 2021 Arguing Americanism: Franco Lobbyists, Roosevelt's Foreign Policy, and the Spanish Civil War Arguing Americanism: Franco Lobbyists, Roosevelt's Foreign Policy, and the Spanish Civil War. Stanley G. Payne Stanley G. Payne Search for other works by this author on: This Site Google Scholar Author and Article Information Stanley G. Payne Online Issn: 1531-3298 Print Issn: 1520-3972 © 2021 by the President and Fellows of Harvard College and the Massachusetts Institute of Technology2021by the President and Fellows of Harvard College and the Massachusetts Institute of Technology Journal of Cold War Studies (2021) 23 (4): 255–257. https://doi.org/10.1162/jcws_r_01050 Cite Icon Cite Permissions Share Icon Share Twitter LinkedIn Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Search Site Citation Stanley G. Payne; Arguing Americanism: Franco Lobbyists, Roosevelt's Foreign Policy, and the Spanish Civil War. Journal of Cold War Studies 2021; 23 (4): 255–257. doi: https://doi.org/10.1162/jcws_r_01050 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll JournalsJournal of Cold War Studies Search Advanced Search The escalating aggressiveness of Nazi Germany in the late 1930s has logically absorbed the attention of historians dealing with those years, obscuring the fact that from 1936 to 1938 the European issue that often generated the most discussion was the civil war in Spain. During that period, according to Michael Chapman's tabulation, The New York Times devoted one-third more headline space in column inches to the Spanish Civil War and the “Great Debate” raging over it than to reports about Nazi Germany. This finding roughly accords with the results of studies of the amount of attention given to Spain, compared with Germany, in the debates during the same years in the British House of Commons and the French Chamber... © 2021 by the President and Fellows of Harvard College and the Massachusetts Institute of Technology2021by the President and Fellows of Harvard College and the Massachusetts Institute of Technology You do not currently have access to this content.

Flashes of Creation: George Gamow, Fred Hoyle, and the Great Big Bang Debate

Flashes of Creation: George Gamow, Fred Hoyle, and the Great Big Bang Debate

Investigating Attitudes of EFL Learners Towards Standard English (SE) and Pakistani English (PE) at a Public Sector University, Sindh Jamshoro

This study deals with the attitudes of EFL learners towards accent of Standard English and Pakistani English at public sector University Jamshoro. There are not much studies have done in Pakistani context, in order to investigate the attitudes of EFL learners towards accent of Pakistani English and Standard English. University of Sindh was selected as site of the study. Quantitative research method was used for this study and the close ended questionnaire was adopted from Parveen and Mehmood (2013) was used as a tool of the study. The random selection of the participants was done. They participants were 200 in number and they were the students of Institute of English Language and Literature, University of Sindh, Jamshoro. The data was collected online through google form. The data was analyzed using statistical methods. SPSS version 22 was employed to carry out the statistical operations. Quantitative data was analyzed through SPSS to draw mean, median mode and percentages for each item in the questionnaire. It was found that EFL learners’ attitude towards the accent of Standard English and Pakistani English was positive. If one is acquiring a standard accent of English as an additional ingredient to one's linguistic knowledge that would be okay in multiple concerns. On the other hand if it is being given exaggerated significance and is learned discriminatively, that would be matter of great debate around the globe to cease language crisis. Keywords: Attitudes, Quantitative, EFL learners, Standard English, Pakistani English, Accent DOI: 10.7176/JLLL/83-04 Publication date: November 30 th 2021

Single-item measures of stress during work- and private time in healthcare workers.

While the psychosocial work environment within the hospital sector is a topic of great debate, surveys assessing stress often do not differentiate between stress related to work- and private life. Identifying risk factors associated with these domains of daily life would help improve policies as well as target relevant treatment options. Therefore, the aim of this study was to evaluate associations between stress during to work- and private time with Cohen's Perceived Stress Scale (CPSS). Perceived stress was assessed by the full version of CPSS (scores 0-40) as well as by two single-item questions related to stress related to work- and private life, respectively. Associations between these single-items and CPSS were modelled using general linear models controlling for lifestyle factors. Overall, stress due to both work- and private time was strongly associated with CPSS scores. In the full population (n = 3,600), "never experiencing stress" during both work- and private time was associated with low stress scores (6.0, 95%CI 5.1-6.9). "Never experiencing" work-related stress but experiencing private time stress "very often" was associated with high stress scores (22.4, CI 19.8-25.1). Likewise, experiencing work-related stress "very often" but "never experiencing" private time stress was also associated with high stress scores (22.2, CI 20.3-24.2). Lastly, Spearman's r between the full CPSS and the two single-item questions about work- and private time stress were 0.62 (p < 0.0001) and 0.52 (p < 0.0001), respectively, while the two items were only weakly correlated (r = 0.32). The present study shows that perceived stress due to both work and private time is strongly associated with Cohen's Perceived Stress Scale scores. The results illustrate the feasibility of using single-item questions related to work- and private time in identifying domain-specific risk factors for psychosocial stress.

Crystal Phase Control during Epitaxial Hybridization of III‐V Semiconductors with Silicon

AbstractThe formation and propagation of anti‐phase boundaries (APBs) in the epitaxial growth of III‐V semiconductors on Silicon is still the subject of great debate, despite the impressive number of studies focusing on this topic in the last past decades. The control of the layer phase is of major importance for the future realization of photonic integrated circuits that include efficient light sources or for new nano‐electronic devices, for example. Here, it is experimentally demonstrated that the main‐phase domain overgrows the anti‐phase domains (APDs) because it grows faster. A large‐scale analysis of the phase evolution based on reflection high‐energy electron diffraction and atomic force microscopy in the case of the molecular beam epitaxy of GaSb on Silicon (001) substrate is presented. The growth rate difference between the two domains is accurately measured and is shown to come from the atomic step distribution at the III‐V surface. The influence of the substrate preparation as well as of the growth condition on this distribution is also clarified.

Adjuvant therapy may be omitted for oral cavity cancer with only one positive lymph node.

ObjectiveWhether to administer adjuvant treatment is a matter of great debate for oral cavity cancer harboring a single positive node without extranodal extension and positive margin (defined as low/intermediate risk pN1new in this study).MethodsA total of 243 low/intermediate risk pN1new patients with oral cavity cancer who received curative surgery were included. Overall survival (OS), local recurrence‐free survival (LRFS), regional recurrence‐free survival (RRFS), and distant metastasis‐free survival (DMFS) were compared between patients receiving adjuvant treatment and observation alone.ResultsFor patients receiving adjuvant therapy vs observation, the differences in outcomes were not statistically significant in terms of 5‐year OS, LRFS, RRFS, and DMFS. For subgroup analysis, in low/intermediate pN1new patients with one or more minor risk factors, adjuvant therapy was not significantly associated with OS, LRFS, RRFS, or DMFS in pN1new patients.ConclusionFor low/intermediate risk pN1new patients with oral cavity cancer, adjuvant therapy might be omitted.Level of Evidence4.

La Conversation Transatlantique: Les échanges Franco-Américains en Poésie Depuis 1968

La Conversation Transatlantique: Les échanges Franco-Américains en Poésie Depuis 1968

The singing question: re-conceptualizing birdsong.

Birdsong has been the subject of broad research from a variety of sub-disciplines and has taught us much about the evolution, function, and mechanisms driving animal communication and cognition. Typically, birdsong refers to the specialized vocalizations produced by oscines. Historically, much of the research on birdsong was conducted in north temperate regions (specifically in Europe and North America) leading to multiple biases. Due to these historic biases these vocalizations are generally considered to be highly sexually dimorphic, heavily shaped by sexual selection and essential for courtship and territoriality. Song is also typically defined as a learned trait shaped by cultural evolution. Together, this framework focuses research specifically on males, particularly during the north temperate breeding season - reflecting and thereby reinforcing this framework. The physiological underpinnings of song often emphasize the role of the hypothalamic-pituitary-gonadal axis (associated with breeding changes) and the song control system (underlying vocal learning). Over the years there has been great debate over which features of song are essential to the definition of birdsong, which features apply broadly to contexts outside males in the north temperate region, and over the importance of having a definition at all. Importantly, the definitions we use can both guide and limit the progress of research. Here, we describe the history of these definitions, and how these definitions have directed and restricted research to focus on male song in sexually selected contexts. Additionally, we highlight the gaps in our scientific knowledge, especially with respect to the function and physiological mechanisms underlying song in females and in winter, as well as in non-seasonally breeding species. Furthermore, we highlight the problems with using complexity and learning as dichotomous variables to categorize songs and calls. Across species, no one characteristic of song - sexual dimorphism, seasonality, complexity, sexual selection, learning - consistently delineates song from other songbird vocal communication. We provide recommendations for next steps to build an inclusive information framework that will allow researchers to explore nuances in animal communication and promote comparative research. Specifically, we recommend that researchers should operationalize the axis of variation most relevant to their study/species by identifying their specific question and the variable(s) of focus (e.g. seasonality). Researchers should also identify the axis (axes) of variation (e.g. degree of control by testosterone) most relevant to their study and use language consistent with the question and axis (axes) of variation (e.g. control by testosterone in the seasonal vocal production of birds).

Analyzing Multi-Definitional Problems of Concepts in International Relations: Re-Conceptualizing Change

Endless debates within, between and among the theories have led to the emergence of numerous concepts, each with multiple meanings and definition(s) generating confusion and vagueness. The reason behind this is the intellectual plurality and differentiated perspectives. Accordingly, the aim of this article is to understand and explain the reasons behind the multiple definitions and meanings of the concepts within international relations and potentially in other areas of social studies. To achieve that end, the authors first tried to understand and explain “why” and “how,” the occurrence of change happens, with a belief that a clearer picture can be revealed. There were great debates that, most of the time cycles around the questions of “what has changed” and “how can we identify change,” giving us some idea about change but not really explaining the reasons behind the occurrence of the change. To understand change and the reasons behind the multiple meanings of concepts, we need a specific kind of understanding related to change. The author’s approach to the change and their attempt to establish a base for the reconceptualization of change will be the main contribution of the present study.

Introducing "The Great Debates".

Introducing "The Great Debates".

AUTHOR REPLY

We would like to thank Dr Haywood for his editorial comments, and we agree with all the points he mentioned. The impact of positive surgical margins (PSM) on oncological outcomes of partial nephrectomy has been controversial and a subject of a great debate. We believe that this may have resulted in a generalized complacency and misconception that positive surgical margins in renal cell carcinoma may not be important and do not warrant any intervention. In this systematic review/metanalysis, we were able to demonstrate that PSM was associated with increased risk of recurrence, metastasis, and mortality.