One-half Years Research Articles

Direct resection is a safe and effective strategy to control seizures in patients with hypothalamic hamartoma

Achieving favorable seizure outcomes is challenging in patients with seizures resulting from hypothalamic hamartoma. Although minimally invasive and non-invasive surgical procedures are used to treat this population, these procedures have limitations. Therefore, we analyzed the outcomes of patients with hypothalamic hamartoma following direct resection. We included 159 patients with hypothalamic hamartoma who underwent direct resection using the transcallosal interforniceal approach between 2011 and 2018. The relationships between clinical parameters and seizure outcomes were analyzed. In total, 55.3% achieved gross total resection and 25.2% underwent near-total resection. Of all patients, 79.2% were overall seizure-free at one year, but this number dropped to 77.0% at more than five years. Moreover, 88.4% (129/146) reached gelastic seizure (GS)-free status at one year and this number increased to 89.0% (97/109) at more than five years. Seventy-one patients took antiseizure medication (ASM) long-term, 68 took it for one year, and 11 took it for one-half year. The duration of ASM consumption (p < 0.001) and extent of hypothalamic hamartoma resection (p = 0.016) were significant independent predictors of long-term overall seizure-free survival, while the duration of ASM consumption (p = 0.011) and extent of hypothalamic hamartoma resection (p = 0.026) were significant independent predictors of long-term GS-free survival. Most patients' behavior, school performance, and intelligence were not affected after surgery. Direct resection is effective and safe strategy for patients with hypothalamic hamartomas. Hypothalamic hamartomas should be removed as completely as possible, and patients should take ASM long-term following surgery to reach long-term overall seizure-free or GS-free status.

A hazard analysis of federal permitting under the national environmental policy act of 1970

The National Environmental Policy Act (NEPA) of 1970 requires federal agencies to assess the environmental impact of proposed federal actions. NEPA thus affects delivery of a wide range of infrastructure projects. NEPA requires the completion of an Environmental Impact Statement (EIS) for environmentally impactful federal actions. For infrastructure projects this can entail significant delays. A typical EIS now takes about four and one-half years and is over 600 pages long. Some EIS’s take over a decade to complete. We provide the first detailed analysis of project approval times under NEPA by examining 1269 EIS permitting processes. We analyze empirically the well-defined interval from Notice of Intent to file to Record of Decision (ROD). We use a Cox proportional hazard model to estimate the impact of several factors on EIS duration. Factors include permits featuring major construction, those including private investment, those for projects located in states with restrictive environmental laws, those using the federal permitting “dashboard,” and those publishing a Supplemental EIS prior to the ROD. We find that privately financed projects receive faster permitting, while projects involving major construction, those undertaken in restrictive states, and those utilizing the federal permitting dashboard, face slower permitting times. We also explore links between EIS page counts and permitting time. Greater EIS page counts are associated with longer permitting times. We conclude by examining EIS completion during economic stimulus programs such as the American Recovery and Reinvestment Act (ARRA), as well as the frequency of EIS completion by the federal government.

A Dynamic Model for Estimating the Retention Duration of Neutralizing Antibody Titers After Vaccination in a COVID-19 Convalescent Population.

We measured neutralizing antibodies (nAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a cohort of 235 convalescent patients (representing 384 analytic samples). They were followed for up to 588 days after the first report of onset in Taiwan. A proposed Bayesian approach was used to estimate nAb dynamics in patients postvaccination. This model revealed that the titer reached its peak (1819.70 IU/mL) by 161 days postvaccination and decreased to 154.18 IU/mL by day 360. Thus, the nAb titers declined in 6 months after vaccination. Protection, against variant B.1.1.529 (ie, Omicron) may only occur during the peak period.

Assessing Longitudinal Cognitive Change in Mild Cognitive Impairment Using Estimated Standardized Regression-Based Formulas.

Cognitive change in mild cognitive impairment (MCI), a likely prodrome to Alzheimer's disease, can be tracked with repeated neuropsychological assessments, but there has been little work quantifying these changes over time. Cognitive change can be statistically examined using standardized regression-based (SRB) formulas, which yield a z-score indicating amount of change compared to a normative group. To use SRB z-scores to quantify cognitive change in a sample of patients classified as MCI at baseline, and to compare cognitive change in those who remained MCI on follow-up (MCI-Stable) and those who progressed to dementia (MCI-Decline). Using 283 MCI patients from a cognitive disorders clinic who were re-assessed after approximately one- and one-half years, SRB z-scores were calculated for each test in a comprehensive neuropsychological battery for each participant. There was a significant decline between timepoints across all cognitive tests, with the greatest amount of decline on tests of learning and memory. Group differences were seen on nearly all cognitive tests, with the MCI-Decline group showing more decline (i.e., significantly larger and negative z-scores) than the MCI-Stable participants. Notable cognitive decline was also observed in the MCI-Stable group, with z-scores ranging from -0.01 - -2.24 compared to normative data. This study highlights the amount of cognitive decline that occurs in MCI, including for those who remain "stable" and those who progress to dementia. It also demonstrates the value of the SRB method in more clearly quantifying cognitive decline, which may help identify individuals most vulnerable to MCI progression.

Determination of Persistent Organic Pollutants (POPs) in Atmospheric Gases and Particles by Solid-Phase Extraction (SPE) and Gas Chromatography–Tandem Mass Spectrometry (GC–MS/MS)

Persistent organic pollutants (POPs) are harmful to the environment and human health. A simple method was developed for the determination of 58 POPs, including 16 polycyclic aromatic hydrocarbons (PAHs), 18 polychlorinated biphenyls (PCBs), and 24 organochlorine pesticides (OCPs), in atmospheric gaseous and particle-phase samples. Different extraction solvents, solid-phase extraction (SPE) cartridges and elution steps were used and compared to optimize the extraction efficiency. The POPs were isolated from the atmospheric samples by Soxhlet extraction using 1:1 acetone:n-hexane and separated using SPE cartridges. The fractions were collected by two-step elution with10 mL of n-hexane and 10 mL of 1:1 n-hexane:dichloromethane. The method validation showed that PAHs, PCBs and OCPs had good linearity, with the coefficients of determination higher than 0.995, from 2.5 to 800, 2.5 to 800, and 2.5 to 600 ng/mL, respectively. The average recoveries were 67–117%, 67–113%, and 73–114% for the PAHs, PCBs, and OCPs. The limits of detection for PAHs, PCBs, and OCPs were from 0.55 to 3.29, 0.09 to 2.00, and 0.57 to 4.86 pg/m3. The limits of quantification (LOQs) for PAHs, PCBs and OCPs were 1.80 to 10.48, 0.29 to 6.37, and 1.82 to 15.48 pg/m3. The applicability of the method was confirmed using an urban dust standard reference material. The method was employed for the analysis of atmospheric samples collected weekly for one-half year on the rooftop of a 14 m tall building in the downtown Mianyang, Sichuan, China. The developed method is demonstrated to accurately monitor persistent organic pollutants in the atmosphere.

Dosimetric implications of the potential radionuclidic impurities in 153Sm-DOTMP

Thehuman internal dosimetry of the radionuclidic impurities of samarium-153 in a new bone-seeking radiopharmaceutical, 153Sm-1,4,7,10tetraazacyclododecanetetramethylenephosponic acid (153Sm-DOTMP), has been estimated from preclinical data. The effective dose from the impurities in lower-specific-activity 153Sm is less than 17% of the effective dose from pure Sm-153. It has a background-equivalent radiation time for a dosage of 37 MBq/kg of less than one-half year.

Everything You Always to Know About Farid but Were Afraid to Ask

Younger readers might be interested to know that Everything You Always Wanted to Know About Sex but were Afraid to Ask was a 1972 Woody Allen film that took its title from a book of the same name by David Reuben, M.D. Unlike the film, the book was not comedic. Indeed, Dr. Reuben was not happy about the movie and told the L.A. Herald-Examiner, “I didn’t enjoy the movie because it impressed me as a sexual tragedy. Every episode in the picture was a chronicle of sexual failure, which was the converse of everything in the book.” Jeff Stafford, Everything You Always Wanted to Know About Sex . . . But Were Afraid to Ask, TURNER CLASSIC MOVIES, http://www.tcm.com/thismonth/article/?cid=12726&amp;rss=mrqe (last visited July 25, 2012). This Article suggests that the Farid story is more like Allen’s movie than Reuben’s book.Students engaged in the study of federal income taxation routinely examine the case of Farid-es-Sultaneh v. Commissioner, in which the Court of Appeals for the Second Circuit addressed a wife’s tax basis in stock she received under the terms of an antenuptial agreement. While the case invariably engenders a lively and engaging class discussion, the black letter law ultimately is straightforward: her basis equaled the fair market value of the shares on the date they were received because they were acquired for consideration (that being the release of marital rights in her future husband’s property). The government had argued that her basis was the same as her husband’s (a carryover basis) because she received the stock as a gift.Perhaps students’ enthusiasm for the case results from a sense that they simply do not know the full story. After all, why would an engaged woman accept stock worth $787,500 in exchange for the possibility of receiving over $33 million upon her husband’s death — particularly when her fiancé was twenty-five years her senior with a life expectancy of only sixteen and one-half years? The recital of facts in the court’s opinion reflects that the marriage was brief and, one might suspect, tumultuous. Students are also confused by the case name: how did an American citizen end up as Farid-Es-Sultaneh? Alas, neither the trial court nor the Court of Appeals betrayed even the slightest interest in the taxpayer’s motives or the details underlying what surely must have been a titillating tale

Nurse Executives Impacting the Human Experience in Health Care

The human experience in health care over the past 2 and one-half years has been unprecedented. Impacted by the COVID-19 pandemic, march on the United States Capitol, economic crisis, social injustice, and growing concerns regarding structural racism—our health system is under siege. Executive nurse leaders find themselves at the crossroads of motivating colleagues to provide excellence in nursing and patient care while confronting both a current and future shortage of registered nurses. Over 30 nurse leaders from around the globe meet and strategize on creating a preferred future for health care. The purpose of this article is to describe The Beryl Institute, the formation of the nurse executive council, the work of its members, and a collective call to action.

Implementation of the Addendum Guidelines for Peanut Allergy Prevention by US Allergists, A Survey Conducted by the NIAID, in Collaboration With the AAAAI

To assess peanut feeding guideline implementation by US allergists who manage infants with food allergies.US allergists within the American Academy of Allergy, Asthma, and Immunology database.This was a cross-sectional survey conducted electronically between September and October 2018. The survey consisted of 31 questions, of which 4 were used to screen out those who were not practicing, did not see infants ≤12 months old, did not manage food allergy, and were not board certified. The survey was performed ∼21 months after the guidelines were published and ∼3 and one-half years after publication of the Learning Early About Peanut Allergy (LEAP) study.Over 3200 surveys were delivered by e-mail. There was a return rate of 29% (n = 825), of which 789 were completed enough for analysis. Nearly all respondents (99%) advised parents on peanut allergy prevention and performed in vitro or in vivo testing for peanut-specific immunoglobulin E. Nearly all strongly agreed (69%) or agreed (28%) that early introduction was effective in preventing peanut allergy. A total of 97% were aware of the guidelines. Of those, 65% reported rare deviation from the guidelines, and 34% reported partial implementation. The deviations reported erred on the side of caution, not nonchalance. Three clinical scenarios of severe eczema and a positive skin-prick test (SPT) result to peanut were described and included in the survey. Respondents fully adhered to the guidelines when the diameter of the peanut SPT was small (0–2 mm; 75.4%) or large (≥8 mm; 78%). Somewhat fewer (68.6%) fully adhered when the peanut SPT was 3 to 7 mm diameter. Only 44% fully adhered to the guidelines in all 3 scenarios. As compared with older allergists (≥31 years since med school graduation), younger allergists (0–10 years since graduation) were more likely to use the guidelines as published (P = .012), perform graded oral peanut challenges (P < .0001), perform single dose in-office challenges (P = .0012), strongly agree that early peanut introduction conferred protection against the development of allergy (P = .0003), and have read the full guideline (P = .0008). Older respondents were more likely to desire more training on the guidelines (P = .001) and report that conducting graded challenges (P = .0008) and reimbursement (P < .0001) were barriers to implementation. Allergists in academic institutions were more aligned with the younger allergists but identified a lack of clinic time as a barrier to implementation (P < .0001). In contrast, nonacademically affiliated allergists were more likely to identify concern about allergic reactions (P < .0001) and legal liability (P < .0001) as barriers.Most allergists are aware of and implement guidelines regarding early introduction of peanut, but barriers to full implementation remain.One can look at these results as good news that so many allergists generally adhered to the guidelines ∼21 months after publication or as bad news that so many more did not. Because the LEAP study was published 2 years before the guidelines, many allergists had already started to adjust practices by the time the guidelines were published. I will say the glass is half full because implementation of these guidelines was much faster than implementation of guidelines for asthma care when the first expert panel report was published 30 years ago. One weakness of this study published in 2020 is that the survey was conducted 2 years before publication. The results might differ by now, but how? Guidelines are just that: advice based on scientific principles. They are not rules or laws, so they must be open to interpretation and adjustment as knowledge evolves and experience grows. Finally, as someone who graduated from medical school 38 years ago, I found it interesting that older allergists were less likely to follow the guidelines than those who were more recently trained. Might it be because their greater experience made them interpret the nuances of the guidelines differently? Or might it be that greater efforts should be made to target older and nonacademically affiliated allergists when new guidelines are published? If either of those or any other explanation is correct, I would not extrapolate from peanut allergy and allergists to other guidelines or specialties.

Contributors’ Notes

Contributors’ Notes

Child prodigies in Paris in the belle époque: Between child stars and psychological subjects.

This article considers the double role of child prodigies as child stars and psychological subjects in Paris in the Belle Époque. I argue that the celebrity status of child prodigies during this time contributed to their transformation into objects of scientific curiosity. The notions of innate talent and natural-born genius contributed heavily to stories of child prodigies within the public sphere; these stories also circulated in psychological accounts of such children. To illustrate this, I examine the case of Pepito Arriola, the so-called Spanish Mozart, in more detail. This musical prodigy toured Europe and America during the early 20th century, and when he was 3- and one-half years old, Charles Richet presented him at the Fourth International Psychology Congress (1900) in Paris. Arriola became the first virtuoso to be submitted to psychological examination, and he was subsequently examined in Berlin by the psychologist Carl Stumpf. This closer look at Pepito Arriola's case clarifies how popular culture and scientific research interacted in the making of a prodigy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Going the Distance: Technical Assistance to Community Prevention Coalitions and its impact on Prevention Coalitions Over Time.

Prevention Coordinators are the linking agents providing technical assistance between universities and communities in the PROSPER model to support the implementation and sustainability of youth and family programs that have reduced substance abuse in prior research. This study examines the outcomes and trajectory of the frequency of contact of technical assistance (i.e. dosage) with community collaborative prevention coalitions across the three stages of coalition development. After communities were randomized, members of PROSPER coalitions (n=12) provided information about the quality of their operations at five time points across four and one-half years; prevention coordinators reported on the frequency of contact with their community coalitions at 14 intervals across the same period of time. This study only utilizes the intervention communities. Results from correlational models show that levels of dosage relate to the quality of internal coalition processes over time, but that the direction of the relationship changes over time: high frequency of contact early on relates to lower coalition-rated functioning initially. In contrast, early frequency of contact relates to higher levels of coalition functioning at later time points. Furthermore, longitudinal mixed models show that levels of dosage were consistent over time. These results provide empirical support of the importance of a proactive technical assistance model and add further evidence that important distinctions exist among different coalition developmental phases.

The dendrogeomorphic spatio-temporal reconstruction of flow-like landslides activity in one of the most susceptible region of Central Europe (the Vsetínské vrchy Mts.)

Flow-like landslides are a dangerous landslide type. They often express gradual movement or seeming dormancy, but occasional reactivation can, in extreme cases, result in catastrophic events. To predict their future behaviour, knowledge of past spatio-temporal development and relationships with hydrometeorological triggers is crucial. Moreover, regional data are more robust than case studies. Dendrogeomorphic (tree-ring-based) methods are a very precise approach for reconstructing past landslide behaviour. Nevertheless, regional reconstructions are very rare, which is probably due to their time-consuming procedures. This paper presents the results of a regional tree-ring-based reconstruction of the spatio-temporal development of flow-like landslides in a selected region in the Outer Western Carpathians. Six selected landslides were studied via analysis of 614 increment cores that came from 307 disturbed trees. The reconstruction provided data for approximately 70 individual landslide reactivation phases that were distributed in 44 event years. Events with regional extension (at least half of the studied landslides were active) were detected in six years (1940, 1941, 1953, 1961, 1985, and 1997). Periods of increased (1950s, 1990s) as well as decreased (1940s, 1970s, 2010s) landslide activity were reconstructed. The use of tree-ring data enabled the construction of landslide probability maps. Based on this analysis, all studied landslides exhibit extremely high probabilities of reactivation during a temporal horizon of 100 years, but even over shorter periods (5 and 20 years), their probability of reactivation is very high. Finally, analysis of meteorological triggers suggests the positive effect of precipitation in May (and possibly in September) to activate landslides with regional extent. Extreme short-duration (1-day) precipitation events probably do not play a role in landslide triggering. Moreover, gradual increases in precipitation totals during periods of at least one-half year preceding the event years were detected.

Judas to the Garveyite Cause: A Review of Jeffrey Perry's Hubert Harrison: The Struggle for Equality, 1918–1927

In his second volume biography of Hubert Harrison's life entitled Hubert Harrison: The Struggle for Equality, 1917–1928, Jeffrey Perry accomplishes what his Introduction states it would do, which is to detail "the extraordinary last nine and one-half years of Harrison's life, which [was] lived at the edge of poverty in a United States shaped by capitalism, imperialism, and white supremacy". However, there are aspects of Harrison's life in this biography that are unable to clearly describe Harrison's work as both a US government informer and his work as an editor for the Negro World newspaper that promoted the principles of self-reliance and nationhood for members of the organization that Marcus Garvey co-founded, the UNIA (Universal Negro Improvement Association). These principles are at odds with those of the US government which, since 1919 was undermining the work of the UNIA.

Conversations with Galileo: A Fictional Dialogue Based on Biographical Facts

CONVERSATIONS WITH GALILEO: A Fictional Dialogue Based on Biographical Facts by William R. Shea. London, UK: Watkins Media, 2019. xi + 115 pages, including notes and further reading. Hardcover; $14.95. ISBN: 9781786782496. *Have you ever wanted to engage in an extended conversation with a famous person whose work and historical milieu you have studied carefully for many years? William R. Shea, one of the world's leading Galileo scholars, invites you to sit down, relax with a cup of coffee or a glass of wine, to engage in a conversation with Galileo. Conversations with Galileo: A Fictional Dialogue incorporates many of Galileo's own words taken from his works or letters. This slim book will allow you to experience how such a dialogue may have transpired. *Shea, a Canadian historian, was Galileo Professor of the History of Science at the University of Padua, Italy from 2003-2012, the very university where Galileo once taught. He has authored many books about Galileo and the Scientific Revolution. The latest, co-authored with Mariano Artigas, are Galileo in Rome: The Rise and Fall of a Troublesome Genius (2003) and Galileo Observed: Science and the Politics of Belief (2006). Conversations with Galileo is part of a series of books published by Watkins Media Ltd., offering conversations with luminaries such as JFK, Oscar Wilde, Casanova, Buddha, Charles Dickens and Isaac Newton. *First, a word about the format of Conversations with Galileo: A three-page introduction by Dava Sobel, author of Longitude (1995) and Galileo's Daughter (1999), is followed by a short (21-page) biography by Shea entitled "Galileo (1564-1642): His Life in Short." Then we are offered 13 chapters dealing with a vast range of topics. Each chapter then begins with Shea posing a leading personal question. These questions cover what, I suspect, most people would want to ask Galileo: questions about censorship, the earth as a planet, scientific failures, what do you take the Bible to say, relations with the Roman Catholic Church Congregation of the Holy Office, also known as the Roman Inquisition, and the Congregation of the Index, other church officials, and, perhaps a final question: what is your claim to fame? The Galileo I remember: the rebel, the seat-of-the-pants philosopher, the "heretic," the defender of the Copernican world-picture, and the creator of a "science of motion" (appearing in the last chapter, "His Claim to Fame") are all present. *So, what more would you want to ask? To me it was surprising to see what else Shea does in fact ask. There are conversations/chapters dealing with "Family Burdens," "Wine, Women and Song," "The Burdens of Teaching," "Moonlighting," "Mind your Horoscope," "The Plague," and "On Art and Literature." This is a Galileo with a human face, with human foibles, jealousies, amorous interests, financial pressures and responsibilities, work-load issues, social conventions, concerns about the plague and social distancing, and literary interests. These are subjects which are usually hidden or absent in many accounts of Galileo's exploits. For instance, we learn of Galileo the lutenist and of his musical family: his father Vincenzo, his brother Michelangelo (a court musician to the grand duke of Bavaria in Munich). We meet his children: his two daughters, Virginia and Livia, who both entered a convent, and his son Vincenzo who had no scientific interests. We also learn about Galileo's life as a student. At seventeen, Galileo attended the University of Pisa to study medicine and "natural philosophy" (science in our parlance). He attended lectures for four and one-half years without acquiring a degree (which was quite common at the time) but did develop his mathematical interests. These are only a few of the personal details in Galileo's life which Shea explores in this book. *All in all, this is a delightful and inviting book, carefully constructed, written in an engaging style, and easy to read. Don't let the poorly designed cover keep you from picking it up. This is a good read for anyone wanting to get a look behind the scenes and meet an illustrious natural philosopher as he lived his rich and complex life. *Reviewed by Arie Leegwater, Department of Chemistry and Biochemistry, Calvin University, Grand Rapids, MI 49456.

Pyogenic Liver Abscesses Caused by Acute Appendicitis: Frequency and Diagnostic and Therapeutic Recommendations.

Background: Pyogenic liver abscesses (PLA) are caused by biliary diseases or hematogenous spreading of mostly intra-abdominal infections. Liver abscesses resulted in hematogenous spreading of infections via the portal vein, such as abscesses caused by acute appendicitis. Pyogenic liver abscesses associated with appendicitis have rarely been described in the literature, especially in adults. The standard therapeutic procedures for liver abscesses are broad-spectrum antibiotic therapy and percutaneous drainage. Surgery for liver abscesses is required in cases of unsuccessful processes. Patients and Methods: A retrospective analysis of patients with liver abscesses between January 2005 and June 2013 was performed. Parameters investigated included demographics, etiologies of abscesses, treatment modalities, and germ spectrum including antibiotic profile. Five cases of PLA caused by appendicitis were reviewed in detail. Results: During the study period, 49 patients with PLA and 1,986 patients with acute appendicitis were treated in our hospital. Twenty-one patients with PLA were treated with antibiotic agents and computed tomography (CT)-guided drainage. Liver resections were necessary in 29 of the patients with PLA. In five patients with PLA, abscesses were caused by an acute appendicitis (9.4% of all PLA, 0.25% of all appendicitis operations). Diagnosis of appendicitis as cause of PLA was made during surgery for liver resections in three patients. Previous imaging was not clear in all cases of PLA caused by appendicitis. The most common pre-operative symptoms in patients with PLA caused by appendicitis were fever and right upper quadrant tenderness. Discussion: Pyogenic liver abscesses caused by acute appendicitis are rare. In the study period of eight and one-half years nearly 2,000 cases of acute appendicitis were treated and five of these patients developed liver abscesses (0.25%). Pyogenic liver abscesses should be considered in patients with unusual high infectious parameters, septic symptoms, and detection of unknown liver lesions.

Co-editors' notes

This issue covers numerous and diverse topics related to health professions education and policy development. Contributions are truly global as we are publishing papers of authors from Africa, Argentina, Canada, China, India, Saudi Arabia, Sweden, and the United States. Of interest in this issue is that the scope goes beyond medicine alone, and in the spirit of health professions as a whole brings in disciplines such as dentistry and physiotherapy, as well as focus on the community. In the article, “Is Emotional Intelligence Related to Objective Parameters of Academic Performance in Medical, Dental and Nursing Students: A Systematic Review,” Singh et al. present the results of a systematic review aimed to address the question of the influence of emotional intelligence (EI) on objective parameters of academic performance in undergraduates in three disciplines. Databases were systematically searched for empirical studies which measured the EI of medical, nursing, or dental undergraduate students and compared it with academic performance. Findings of the review showed that EI has a greater role in the academic success of clinical year medical and dental students. In the paper, “Assessing Perceptions of Professionalism in Medical Learners by the Level of Training and Sex,” Spiwak et al. looked at male and female perceptions of 16 vignettes related to such items as lapse in excellence, inappropriate dress, lack of altruism, disrespect, shirking duty, and abuse of power. They found significant differences on many items, with females more likely to rate items as more severe. The authors conclude that more work is needed in the area of professionalism and sex. This is especially important in light of changing conceptions of gender. Rashid et al. – “Doctor, Teacher, Translator: International Medical Students' Experiences of Clinical Teaching on an English-language Undergraduate Medical Course in China”– offer a description of student experiences related to participation in and completion of an English language program. Nonnative English-speaking students indicate that while English proficiency was variable in their clinical teachers, they were able to navigate the challenges of studying clinical medicine from teachers with limited English skills. The students felt that other attributes such as enthusiasm, interactivity, and a desire to teach superseded English proficiency of the clinical teacher. The authors call for future study of clinical teacher perceptions of working with non native English-speaking students and graduate outcomes of students participating in the course. In “Rural Stream: An Effective Alternative to the Longitudinal Integrated Clerkship Model for Small Rural Communities,” Carson et al. provide insight into a regionalized medical program where students spend the first two and one-half years of their undergraduate degree in district hospitals. The authors emphasize the importance of immersion and community engagement. While a challenge, Carson et al. show that effective medical education can occur locally, in small rural communities. There are four Letters to the Editor in this issue. Abu-Zaid (“Where do Medical Students Submit Their Work?”) replies to an Education for Health paper contending that main stream journals should encourage publication of student research work. Kuntz et al. (“Video Review with Sports Performance Software Improves Trainee Endotracheal Intubation Time, Performance, and Confidence”) where the researchers take success from one sector and apply it to another. Gali et al. (“Introducing a Communication Skills Course in an Indian Dental Institution: An Academic Experience”) where the educators share their experience in introducing a communication skills module to preclinical undergraduates. Finally, Paraskevopoulos and Papandreou (“Physiotherapy Clinical Placement during the COVID-19 Pandemic”) propose an alternative method of clinical education delivery through an online platform. Please feel free to submit a Letter to the Editor to Education for Health in response to any topics in this issue that spark your interest or attention.

Threaded Discussion

This article presents the results of two studies that focus on the role that threaded discussion plays in student learning. Over a period of three and one-half years, researchers conducted a series of surveys of graduate and undergraduate students at a private, nonprofit university in Southwestern Pennsylvania to determine how students viewed the value of threaded discussions in enhancing their ability to learn course material. Students were asked which types of threaded discussions they preferred; whether they found the threaded discussion to be a better tool for learning than a written assignment; and, which learning environment they felt was more conducive to learning, classroom or online. Results from the combined studies revealed some statistically significant differences based on enrollment status and gender. Upon comparing study results, researchers found statistically significant differences with regard to a preference for classroom versus online instruction and the usefulness of threaded discussions to learning.

Safety and efficacy of bariatric surgery in Mexico: A detailed analysis of 500 surgeries performed at a high-volume center.

Bariatric surgery is the best method for treating obesity and its comorbidities. Our aim was to provide a detailed analysis of the perioperative outcomes in Mexican patients that underwent surgery at a high-volume hospital center. A retrospective study was conducted on all the patients that underwent bariatric surgery at a single hospital center within a time frame of 4 and one-half years. Demographics, the perioperative variables, complications (early and late), weight loss, failure, and type 2 diabetes mellitus remission were all analyzed. Five hundred patients were included in the study, 83.2% of whom were women. Mean patient age was 38.8 years and BMI was 44.1kg/m2. The most common comorbidities were high blood pressure, dyslipidemia, and diabetes. Laparoscopic gastric bypass surgery was performed in 85.8% of the patients, sleeve gastrectomy in 13%, and revision surgeries in 1%. There were 9.8% early complications and 12.2% late ones, with no deaths. Overall weight loss as the excess weight loss percentage at 12 and 24 months was 76.9 and 77.6%. The greatest weight loss at 12 months was seen in the patients that underwent laparoscopic gastric bypass. A total of 11.4% of the patients had treatment failure. In the patients with type 2 diabetes mellitus, 68.7% presented with complete disease remission and 9.3% with partial remission. There was improvement in 21.8% of the cases. In our experience at a high-volume hospital center, bariatric surgery is safe and effective, based on the low number of adverse effects and consequent weight loss and type 2 diabetes mellitus control. Long-term studies with a larger number of patients are needed to determine the final impact of those procedures.

Analysis of a thermal generator’s participation in the Western Energy Imbalance Market and the resulting effects on overall performance and emissions

The inception of the Western Energy Imbalance Market (EIM) in November of 2014 has had significant impacts on participating balancing authorities (BAs) and individual generators. The EIM serves to balance available energy across a large geographical footprint. Since the market’s creation, the California Independent System Operator (CAISO) has reported that many benefits have been realized by participating BAs, including savings of $502 million and the avoided curtailment of an estimated 734,000 MWh of energy produced by variable renewable energy (VRE). Balancing energy across a larger geographic footprint, in conjunction with other factors (e.g., fluctuating fuel prices, new environmental policies), has also resulted in significant changes in the operation of some thermal generating stations which have traditionally operated as baseload units. The effects of these new operating practices on baseload units have not been characterized. This study analyzes the detailed operational history of a single coal-fired thermal generating station experiencing a large degree of load flexing located within the footprint of the EIM. A dataset comprised of hourly operational data from two and one-half years before and after beginning market participation was analyzed. Changes in operating practices, unit performance, and emission rates from this unit between the two periods were identified from this analysis. It was observed that the operational range of the unit has expanded by 65% and the unit has experienced ramping situations approximately 4.6 times more often since entering the EIM. Continual load changes have contributed to 18 times more turbine cycles, the impact of which on unit health and longevity cannot be fully characterized. The unit has demonstrated a strong adaptive ability in altering operational practices to meet the needs of the new market. Primarily due to lower average load operation, overall efficiency has decreased by 2.7%.