Realistic Expectations Research Articles

Metrics to Increase Data Usage Understanding and Transparency

Data metrics are essential to assess the impact of data repositories' holdings and to understand the research practices of the community that they serve. These metrics are useful for reporting to funders, to inform community engagement strategies, and to direct and sustain repository services. In turn, communicating these metrics to the user community conveys transparency and elicits their trust in data sharing. However, because data metrics are time-sensitive and context-dependent, tracking, interpreting, and communicating them is challenging. In this work we introduce data usage analyses including benchmarking and grouping, developed to better assess the impact of the DesignSafe Data Depot, a natural hazards data repository. Make Data Count compliant metrics are analysed in relation to research methods, sub-disciplines, natural hazard types, and time, to learn what data is being used, what influences data usage, and to establish realistic usage expectations. Results are interpreted in relation to the research and publication practices of the community and to natural hazard events. In addition, we introduce strategies to clearly communicate dataset metrics to users.

Preparing Students for the Workplace: The Good, The Bad, and The Ugly

Curriculum for master’s level education in library and information science is an historically popular subject of discussion in the disciplinary literature. Specific topic areas are interrogated (Saunders & Bajjaly, 2022), opinions are solicited about courses or topics which ought to be required of all students (Saunders, 2019) or required of students in particular sub-areas of the profession (Davis & Saunders, 2020; Saunders, 2020; Williams & Saunders, 2020), changes over time are analyzed (EunKyung Chung, Schalk, & JungWon Yoon, 2022), and external standards are developed to articulate the breadth and depth of curricula which “should” be included (ALA, 2023). Similarly, the literature promotes a range of pedagogical approaches (Ely, 2023), and conference programs (such as the ALISE conference) and webinar series (such as those sponsored by ALISE, including the “LIS Pedagogy Chat” series) also address pedagogy. One aspect of professional practice that has received less consideration is the way students are prepared to hold realistic expectations for the workplace. Those expectations may relate to organizational cultures, practices, and challenges, all of which may be minimally addressed during students’ pre-professional education or ignored completely. The panel highlights specific aspects of workplace experience as revealed through research projects delving into the lived experiences of library workers. These research findings will be considered in terms of the ways in which they may inform the curricula of master’s programs in the field. The panel will open with a very short introduction by the moderator, Dr. Heidi Julien. Then each panelist will have 15 minutes to summarize results of their recent studies, and individually will suggest their implications for preparing master’s students for the realities of professional practice. The remaining 40 minutes will be devoted to audience discussion about possible ways students may be exposed to these realities. Prompting questions for the audience include: Are there other workplace realities not addressed by the panel that would be relevant to students? Who is best positioned to discuss these realities with students – e.g., practitioners? Adjunct instructors? Regular faculty members? Alumni? Are there existing opportunities in master’s curricula to include these discussions, or would extra-curricular opportunities be more effective? Ideas generated by the panelists and the audience will be captured and shared with attendees orally at the close of the session.

Understanding Information Literacy Instructional Practices: Implications for Preparing Pre-Service Librarians

The role of academic librarians in supporting people to navigate the changing information environment is fundamental to librarianship and is critical in the current information environment. This poster focuses on the implications for educating pre-service librarians about the realities and challenges associated with that role, drawn from a national survey of instructional librarians in the U.S. The project speaks directly to the conference theme, “The Ethics and Evolution of Truth and Information,” as the survey respondents engage directly on the frontline of these issues. Implications for shaping the expectations of future instructional librarians will be revealed from findings of a national online survey currently underway. The survey returns to a series of questions motivating longitudinal surveys of librarians’ instructional practices conducted in other countries, and most recently conducted in the U.S. in 2016 (Julien 1998, 2000, 2005; Julien, Gross, & Latham, 2018; Julien & Leckie, 1997; Julien, Tan, & Merillat, 2013; Polkinghorne & Julien, 2018). These data paint a detailed picture of the daily practices of these professionals and the challenges they face. Despite changing technology, introduction of the ACRL Framework (2015), and the explosion of artificial intelligence use, many of the instructional practices and the pressures associated with the instructional role have remained stable (although the recent pandemic moved instruction online, at least for a time). Developing realistic expectations for the workplace is as relevant as is developing conceptual understanding, skills, and attitudes. Thus, the survey data provide an excellent opportunity to inform the education of master’s students.

Optimizing Safety and Precision for Secondary Liposuctions: Integrating Intraoperative Ultrasound With VASER Technology.

Liposuction has gained significant popularity, leading to increased demand for secondary procedures due to complications such as scars and fibrosis that affect aesthetic outcomes. High-Definition Liposuction (HDL) has emerged as a preferred technique, but the presence of fibrosis from prior surgeries may limit its effectiveness. This study explores the application of ultrasound-assisted VASER (Vibration Amplification of Sound Energy at Resonance; VASER-Solta Medical, Bothell, WA) liposuction in secondary abdominal liposculpture to address these challenges. A prospective cohort study was conducted from May 2022 to May 2023, including patients undergoing secondary abdominal liposculpture with ultrasound-assisted VASER liposuction, at least 12 months post their initial procedure. Pre-operative ultrasound examinations were performed to identify and mark findings related to previous liposuction. Data on demographics, photographic results, and complications were collected and analyzed. Intraoperative ultrasound (I-US) significantly improved the detection of fibrotic lesions, leading to more precise, rapid, and atraumatic outcomes. The use of I-US optimized surgical procedures, reducing both costs and operation time. Clear communication with patients regarding potential limitations due to chronic damage was essential for setting realistic expectations. I-US has proven to be an invaluable tool in secondary liposculpture, enhancing surgical precision and outcomes. This methodology allows for better recognition of complications, promoting effective treatment strategies and ultimately improving patient satisfaction in the context of secondary abdominal liposculpture.

Assessing the ecological complexity and uncertainty of predicting forest ecosystem services under climate change

Climate change affects Central European forest ecosystems in different ways and, consequently, these changes result in different feedbacks on the provision of forest ecosystem services. Regarding the complexity and the variability in climate-forest interactions outcome, forest decision makers necessitate reliable information about changes in the forest ecosystem services for planning and adaptation purposes. However, forest productivity predictions incorporate multiple levels of uncertainty that have to be regarded to ensure building realistic expectations in forest decision-making. Besides the chosen forest simulation model, uncertainties come from the climate change data represented by a set of representative concentration pathways (RCP), within the underlying ensemble of global circulation and regional climate models (GCM-RCM), and further in the treatment of the CO2-fertilization effect. We considered the mentioned uncertainties in a framework on simulating forest growth and water services for two forest sites, a Sessile oak and a Scots pine stand in Rhineland-Palatine, Germany. The framework revealed a high variability in future forest ecosystem services. Particularly, the variability among the selected GCM-RCM models within the same Representative Concentration Pathway (RCP) was higher than the variability among different RCPs (RCP2.6 and RCP8.5 representing the low and high CO2-emission scenarios, respectively). Sessile oak productivity increased under all scenarios, whereas Scots pine growth declined in the lower end of the RCP8.5 scenario. Water services remained mostly stable at both sites. Moreover, we applied a panel data model to estimate what climate indices caused changes in the forest ecosystem services. We found that Scots pine is more sensitive to a multitude of climate indices, such as temperature changes and Sessile oak showed strong response to the CO2-fertilization. We propose applying this framework to evaluate forest management options under climate change.

Developing a foundation information and academic skills programme for potential Student Nursing Associates.

This article outlines the development of 'Prepare to Progress', a preapplication programme for potential Student Nursing Associate (SNA) applicants at Gloucestershire Hospitals NHS Foundation Trust. Created collaboratively by the Trust's Library and Knowledge Services and Professional Education teams, the programme aims to provide realistic course expectations, teach study skills and boost confidence in using library services. Evaluation results indicate increased understanding of the SNA course, improved application decision-making, and enhanced academic confidence among participants. The programme demonstrates the valuable role of library services in preparing healthcare support workers for further education and addressing library anxiety. The study suggests benefits for both participants and library services.

Digital transformation at what cost? A case study from Germany estimating the adoption potential of precision farming technologies under different scenarios

This study addresses the research gap in understanding the low adoption of Precision Agriculture Technologies (PATs) by extrapolating regional trends from in-depth farm-level analyses. Focusing on a smallholder region in Germany, it investigates the adoption limits of PATs, questioning whether the low rates are due to unknown economic thresholds and how these thresholds can be influenced. Six PATs are evaluated, along with the impact of six potential measures to increase adoption rates, using predictive economic modeling and scenario analysis. Findings confirm low adoption rates, peaking at 4.61 % for automatic guidance and 17.73 % for site-specific fertilization, highlighting that current strategies are only partially effective, especially for precision weeding, site-specific seeding, planting, and spraying. Fortunately, targeted interventions for less adopted PATs enhance average farm income, which may increase their broader acceptance. The study advocates for targeted, technology-specific strategies over broad measures like subsidies, emphasizing the effectiveness of private sector initiatives like machinery cooperatives and service providers in improving adoption. The study concludes that greater PAT uptake in agriculture is only possible if realistic expectations are set by all stakeholders and tailored strategies are developed to promote a comprehensive digital transformation of the sector.

Changes in Outcomes Expectations During the Cochlear Implant Evaluation Process.

Patient expectations are a critical factor in determining cochlear implant (CI) candidacy. However, minimal data are available on how potential CI recipients develop their expectations and if expectations can be modified by providers. In addition, there is little insight into the resources patients use to inform their decision to undergo implantation. This project aims to assess (1) the role of the CI evaluation (CIE) process on patients' expectations, (2) the extent to which patients' pre-CI outcome expectations can be modified, (3) the information patients use to inform their expectations, and patients' preferences for the discussion/display of potential CI outcomes. Prospective mixed methods study of 32 adult CI patients undergoing CIEs. Outcome measures included: pre-CI Cochlear Implant Quality of Life-35 Profile scores (CIQOL-35 Profile); pre-CIE/post-CIE/day of surgery CIQOL-Expectations scores; post-CIE/day of surgery Decisional Conflict Scale (DCS) scores; and pre-CI aided CNC-word and AzBio sentence scores. Thematic analyses of key informant interviews with 19 potential CI recipients were also performed. In aim 1, CI CIQOL-Expectation domain scores remained essentially unchanged following the CIE when averaged across all participants (d = 0.01 to 0.17). However, changes in expectations were observed for many participants at the individual level. Regarding the second aim, participants with higher pre-CIE expectations showed a decrease in expectations following the CIE for all CIQOL domains except emotional and social (d = -0.27 to -0.77). In contrast, the only significant change in participants with lower expectations was an increase in expectations in the environment score from pre-CIE to the day of surgery (d = 0.76). Expectations remained essentially unchanged or continued to change in the same direction between the post-CIE and the day of surgery, narrowing the gap between participants with higher and lower expectations. Overall, participants demonstrated low overall conflict related to their decision to proceed with cochlear implantation (mean DCS of 11.4 post-CIE and 14.2 at time of surgery out of 100) but DCS scores were higher for participants with lower pre-CIE expectations (d = 0.71). In aim 3, key informant interviews demonstrated no differences between the low- and high expectation cohorts regarding resources used to develop their perception of CI outcomes. Potential CI recipients placed high value in talking with patients who had previously received a CI, and preferred discussing CI functional abilities via clinical vignettes described in the CIQOL Functional Staging System rather than by discussing speech recognition or CIQOL-35 Profile scores. The results of the present study suggest that, although overall expectations averaged across the cohort remained essentially unchanged, individual participants' pre-CI expectations can be modified and there is value in measuring these expectations using the CIQOL-Expectations tool to determine if they are realistic. This information can then be utilized during personalized counseling to present a more accurate representation of likely CI outcomes for each patient. Discussions between potential CI recipients and current CI users may also provide valuable information to inform their expectations. In addition, communicating potential CI benefits using CIQOL functional stages and associated clinical vignettes may result in more realistic patient expectations and support shared decision-making related to CI surgery.

Practical Resources for Effective Postpartum Parenting (PREPP): a randomized controlled trial of a novel parent-infant dyadic intervention to reduce symptoms of postpartum depression: RCT of the PREPP intervention for postpartum depression

BackgroundThere is little known about the effectiveness of psychological interventions to prevent postpartum depression that focus on the birthing parent and infant dyad. Risk factors for PPD include depression during pregnancy, low parenting self-efficacy, and disrupted parental nocturnal sleep. The brief Practical Resources for Effective Postpartum Parenting (PREPP) intervention is designed for pregnant individuals at-risk for postpartum depression, providing them with 1) caregiving strategies aimed at reducing infant fuss and cry behavior and increasing infant sleep, 2) self-reflection and mindfulness skills and 3) psychoeducation about the postpartum period and infant behavior. The aims are to set more realistic postpartum expectations, enhance parenting confidence and sleep via supporting infant regulatory behavior, improve parental affect regulation and ultimately reduce the risk of postpartum depression. ObjectivesAssess the effectiveness of PREPP compared to enhanced treatment as usual in reducing symptoms of depression and anxiety and episodes of infant fuss and cry behavior and improving parental and infant sleep in the early postpartum. Study designA randomized controlled trial was conducted of 175 pregnant individuals. Inclusion criteria were standard prenatal care for a singleton pregnancy, aged 18 to 45 and at increased risk of PPD as determined by a score of ≥19 on the Predictive Index of Postnatal Depression or ≥7 on the Edinburgh Postnatal Depression Scale. Participants assigned to the PREPP group (n=88) received three coaching sessions and two phone check-ins. Participants assigned to the enhanced treatment as usual group (n=87) received three sessions which included psychoeducation, mood assessments, and clinical referral and follow-up as indicated. Assessments were conducted at 28 to 32 weeks and 34 to 39 weeks gestation, and at six, 12 and 16 weeks postpartum and included measures of parental depression, anxiety and sleep (Edinburgh Postnatal Depression Scale, Patient Health Questionnaire (PHQ-9), Hamilton Rating Scales of Depression and Anxiety and Pittsburgh Sleep Quality Index) and infant sleep and fuss and cry behavior (Baby Day Diary). ResultsCompared to enhanced treatment as usual, PREPP significantly reduced depressive symptoms at six, 12 and 16 weeks postpartum with medium to large effect sizes (d=0.7-0.98). Compared to enhanced treatment as usual, participants receiving PREPP reported less of a decline in sleep quality at six weeks postpartum (p=0.035) and the effect size was large (d=0.83). Moreover, parents receiving the PREPP intervention reported less infant fussing and crying, with the largest effect for morning crying (p<0.001; d=-1.48). ConclusionsThe results provide evidence that PREPP, initiated during pregnancy, reduced symptoms of parental depression and infant fuss and cry behavior in the early postpartum, compared to enhanced treatment as usual, in a sample at-risk for postpartum depression.

Chronic Widespread Pain

ABSTRACT OBJECTIVE This article reviews the potential etiologies of chronic widespread pain syndromes and outlines a practical approach to the management of patients with these disorders. LATEST DEVELOPMENTS Recent updates to diagnostic criteria for primary chronic widespread pain syndromes have allowed for more effective diagnosis. Fibromyalgia is the most common presentation of chronic widespread pain, and the concept of nociplastic pain has been used to describe pain that is related to altered processing of pain sensory pathways. Research studies have provided a better understanding of the pathophysiology of the central augmentation that occurs in patients with nociplastic pain and fibromyalgia. ESSENTIAL POINTS Primary chronic widespread pain and fibromyalgia have established diagnostic criteria in which chronic pain involves multiple defined regions and occurs for longer than 3 months. Evaluation of chronic widespread pain should be directed by the clinical presentation. Neurologic disease can present with chronic widespread pain but is accompanied by associated signs and symptoms. Patients with chronic widespread pain benefit from effective communication that validates concerns, provides an understandable explanation of the presenting symptoms, and sets realistic expectations in outcomes using a comprehensive multimodal care plan.

Does Primary School Teachers Resilience Have a Correlation With Students Reading Comprehension Skills

The psychological resilience of teachers refers to their capacity to cope with the challenges teachers face and their ability to prevent burnout. Teachers' psychological resilience can help them teach students more effectively and maintain their profession in the long term. To date, studies on teacher resilience have generally focused on teachers' characteristics, socialization, and behavior. However, very few studies investigate teacher resilience and its reflections on education through the relationship between teachers' resilience, students' transformation of educational behaviors into skills, and reading comprehension skills. Henderson and Milsteins’ study (2003) suggests that if teachers, who are the main source of role models in education, lack resilience, it is not a realistic expectation for students to be educationally resilient and indirectly demonstrate educational skills. So this study investigated the relationships between teachers' resilience and students' reading comprehension skills. This study was designed with the relational survey model, one of the quantitative research methods. The relationship between primary school students and their teachers was investigated. Numerical quantities representing the universe were calculated to question the existence of the relationship. In this regard, a total of 761 students and their teachers from the 2nd, 3rd, and 4th grades of primary school constitute the participants of the research. A total of 31 classes and their teachers from public and private primary schools were involved in the process. This study found a positive but low-level relationship between teachers' professional resilience and their students' reading comprehension skills. While teacher resilience contributes to students' reading comprehension, its impact is relatively limited, suggesting that other factors also play a significant role in students' academic success.

The Future of Regenerative Medicine: Stem Cell Research in Pakistan

The landscape of medicine is being revolutionized by the recent breakthroughs in stem cell research that offer new possibilities for treating diseases that were once deemed degenerative, incurable, or irreversible. In low and middle-income countries like Pakistan stem cell therapy holds promise for cost-effective solutions to non-communicable diseases. However, these advancements are hindered by ongoing debates, legal challenges, and public controversies. Stem cells can differentiate into various cell types and self-renew themselves, making them appealing for regenerative medicine. Unlike traditional therapies, regenerative medicine focuses on the restoration of optimal functioning of the damaged tissues and organs. Stem cells can be categorized as embryonic and adult stem cells. Adult stem cells such as mesenchymal stem cells can differentiate into various cell types. These can be obtained from bone marrow, adipose tissue, umbilical cord tissue, and amniotic fluid. Research shows that stem cells have the potential to treat cancers and advance regenerative medicine. Genetically modified stem cells can act as delivering systems for the treatment of genetic disorders and the development of therapeutic agents directly targeted to organs. Successful differentiation of stem cells into neurons, cardiomyocytes, insulin-producing cell clusters, hepatocytes, and hematopoietic precursors. These achievements are powerful tools that can help in combating human diseases. In Pakistan, while the potential of stem cell therapy has generated significant excitement, the progress is hindered by regulatory and infrastructure challenges. Addressing these concerns and fostering a supportive research environment is essential for advancing stem cell and regenerative medicine in the country. According to the WHO International Clinical Trials Registry, there are over 3000 trials on adult stem cells in progress [1]. These trials are essential in advancing the knowledge of stem cell therapies and for the establishment of realistic expectations for their outcomes. The transplantation of stem cells into non-native environments can pose risks, including tumor formation and other complications. These risks underscore the importance of rigorous evaluation and monitoring to ensure that these promising therapies are both safe and effective before they become widely available. In conclusion, stem cell research has great potential to revolutionize healthcare in Pakistan, but ethical, regulatory, and infrastructure challenges must be overcome before its benefits can be fully realized in regenerative medicine. An environment that is supportive and safe is imperative for clinical trials and research to ensure safe and effective therapies in the future.

Describing resident physician productivity in a Canadian academic emergency department.

This cohort study aimed to investigate resident physician productivity in an academic emergency department (ED) and assess the impact of longitudinal coaching relationships known as clinical coaching teams and co-learners (medical students) on resident productivity. Data from patient visits to two academic EDs in Ottawa, Canada between April 2022 and March 2023 were analyzed. The attending physician schedule, learner arrangements, and patient ED treatment team information were collected. The presence or absence of clinical coaching teams was also recorded. Mean productivity, measured as patients per hour, was calculated for different shifts and learner arrangements. Linear regression and paired t tests were performed for analysis across ambulatory and non-ambulatory settings, with a focus on productivity differences across residents' training programs and level of training. A total of 142,386 ED visits were included in the analysis across 8161 attending physician shifts. Resident productivity increased with each year of training, with Royal College of Physicians and Surgeons of Canada emergency medicine residents being the most productive by year 5. There was no significant difference in productivity between residents on clinical coaching team shifts compared to non-clinical coaching team shifts. Productivity decreased slightly when residents worked with medical students as co-learners. There was no significant relationship between the difference in productivity on shifts with and without a medical student and year of training. This study is the first of its kind to describe resident physician productivity in a Canadian emergency department. The results of this study demonstrate that resident physician productivity improves with seniority, and that co-learners and clinical coaching teams do not significantly impact productivity. This information will be useful to program directors and residents to help set realistic expectations around productivity and to ED physician leads in planning service delivery for patients in the context of a training program.

Comparison of voice quality in patients with oral cancer at both pre and post treatment stage

Background: Patients with oral cancer have very common complaints of change in voice. This research is designed to study the effect of oral cancer and its treatment on the various domains of voice like functional, physical, and emotional along with parameters of voice like pitch, loudness and quality. Method: This study included total 48 participants (34 males and 14 females) with oral cancer. The voice quality of the participants was analysed both before and after treatment using Dr. speech and the voice handicap index (VHI). First, the voice analysis done when the patient was diagnosed as a case of oral cancer by the head-neck oncosurgeon after completion of all required investigations. Patients were recalled for voice analysis after completion of treatment. Results: There was a significant difference observed in all three domains of the VHI at both before and after treatment. The difference in the functional domain was more prominent. The VHI was not linked to tumor or nodal staging. However, post treatment the voice parameters are greatly affected as compared to pre-treatment stage. Conclusions: The administration of the VHI should be made mandatory prior to treatment of oral cancer and the findings of the test should be discussed with the patient prior to start of any treatment modality and accordingly the realistic expectations can be set. Therefore, voice analysis using Dr speech will also help in timely assessment and rehabilitation of voice before and after treatment.

From Filters to Scalpels-Understanding Perceptions of Facial Asymmetry: An AAFPRS Survey.

Facial asymmetries can significantly affect patient satisfaction post-surgery. Social media can impact a patient's perception of their asymmetries. To gather insights into the practices, perceptions, and approaches concerning facial asymmetry among facial plastic surgeons. The aim of this study was to understand the impact of social media on perceptions of facial asymmetry. This is an American Academy of Facial Plastic and Reconstructive Surgeons (AAFPRS) survey consisting of 46 questions that sought to understand facial plastic surgeons' perceptions of facial asymmetry, their consultation process, their patients' perspectives on their own facial asymmetries, and patient satisfaction. The survey was distributed to 1,269 members of AAFPRS across community hospitals, private practices, and academic hospitals. Sixty-seven members completed the survey. The survey revealed that 31% (21) of surgeons face challenges in managing patient expectations regarding facial asymmetry. In addition, 12% (8) of surgeons felt that patients did not initially recognize their own asymmetries. Eighty-seven percent (58) of surgeons emphasize the natural occurrence of asymmetry during consultations to set realistic expectations. This study emphasizes the need for thorough patient education during initial consultations to align expectations with achievable outcomes. Surgeons should explain the natural occurrence of asymmetry clearly and use digital imaging to show patients realistic previews of surgical results.

Harvesting Costal Cartilage for Secondary Rhinoplasty: Techniques, Considerations, and Outcomes.

Secondary rhinoplasty is a surgical procedure aimed at reshaping the nose after the unsatisfactory results of primary rhinoplasty, which usually requires a reliable source of cartilage for grafting. Septal cartilage is usually the first option for rhinoplasty, but in cases where it is insufficient, rib cartilage might be used, which is the focus of the current study. The article details the surgical techniques for rib cartilage harvesting, highlighting the preference for the seventh rib done under general anaesthesia. The surgery requires a precise incision, harvesting of the cartilage, and careful closure while the cartilage is stored in a saline solution until use. It also introduces innovative approaches to minimize complications and improve patient satisfaction, including trans-umbilical endoscopic harvesting, the use of the 10th rib to reduce morbidity, and employing fresh frozen homologous rib cartilage as a grafting alternative. Based on various studies, most cases following rhinoplasty with rib cartilage showed a high satisfaction rate despite the complexity of the procedure. Patient consideration includes good communication with realistic expectations through imaging techniques. We also discuss complications, which can heavily impact the patient's quality of life. We hope that by providing this information, our paper will provide surgeons and researchers with the latest information on this topic.

Selective Transfection of a Transferrin Receptor-Expressing Cell Line with DNA-Lipid Nanoparticles.

Despite considerable progress in using lipid nanoparticle (LNP) vehicles for gene delivery, achieving selective transfection of specific cell types remains a significant challenge, hindering the advancement of new gene or gene-editing therapies. Although LNPs have been equipped with ligands aimed at targeting specific cellular receptors, achieving complete selectivity continues to be elusive. The exact reasons for this limited selectivity are not fully understood, as cell targeting involves a complex interplay of various cellular factors. Assessing how much ligand/receptor binding contributes to selectivity is challenging due to these additional influencing factors. Nonetheless, such data are important for developing new nanocarriers and setting realistic expectations for selectivity. Here, we have quantified the selective, targeted transfection using two uniquely engineered cell lines that eliminate unpredictable and interfering cellular influences. We have compared the targeted transfection of Chinese ovary hamster (CHO) cells engineered to express the human transferrin receptor 1 (hTfR1), CHO-TRVb-hTfR1, with CHO cells that completely lack any transferrin receptor, CHO-TRVb-neo cells (negative control). Thus, the two cell lines differ only in the presence/absence of hTfR1. The transfection was performed with pDNA-encapsulating LNPs equipped with the DT7 peptide ligand that specifically binds to hTfR1 and enables targeted transfection. The LNP's pDNA encoded for the monomeric GreenLantern (mGL) reporter protein, whose fluorescence was used to quantify transfection. We report a novel LNP composition designed to achieve an optimal particle size and ζ-potential, efficient pDNA encapsulation, hTfR1-targeting capability, and sufficient polyethylene glycol sheltering to minimize random cell targeting. The transfection efficiency was quantified in both cell lines separately through flow cytometry based on the expression of the fluorescent gene product. Our results demonstrated an LNP dose-dependent mGL expression, with a 5-fold preference for the CHO-TRVb-hTfR1 when compared to CHO-TRVb-neo. In another experiment, when both cell lines were mixed at a 1:1 ratio, the DT7-decorated LNP achieved a 3-fold higher transfection of the CHO-TRVb-hTfR1 over the CHO-TRVb-neo cells. Based on the low-level transfection of the CHO-TRVb-neo cells in both experiments, our results suggest that 17-25% of the transfection occurred in a nonspecific manner. The observed transfection selectivity for the CHO-TRVb-hTfR1 cells was based entirely on the hTfR1/DT7 interaction. This work showed that the platform of two engineered cell lines which differ only in the hTfR1 can greatly facilitate the development of LNPs with hTfR1-targeting ligands.

Does the coronal deformity angular ratio affect bracing outcome in adolescent idiopathic scoliosis?

To examine if coronal deformity angular ratio (C-DAR) serves as a predictor for progression to surgical magnitude in patients with Adolescent Idiopathic Scoliosis (AIS) treated with thoracolumbar sacral orthosis (TLSO). Patients with AIS, prescribed a full-time TLSO, Cobb angle 20-40°, Risser 0-2, who wore the brace ≥ 12.9 h and reached skeletal maturity/surgery were included retrospectively. C-DAR was defined as the Cobb angle divided by the number of vertebrae in the curve, yielding a larger value in short curves. The association between C-DAR and the risk of progression to surgical magnitude (> 45°) was assessed. Secondly, we evaluated the association between pre-treatment Cobb angle and in-brace correction on the risk of progression to > 45°. We included 165 patients with a mean Cobb angle of 30 ± 6°. Of these, 46/165 (28%) progressed ≥ 6° and 26/165 (16%) reached surgical magnitude at the end of treatment. C-DAR was a significant predictor for risk of progression to surgical magnitude with an OR of 1.9 (CI 1.2-2.9) per unit increase in C-DAR. A threshold value of 5.15 was established and demonstrated an OR 5.9 (CI 2.1-17.9) for curve progression to a surgical magnitude. Likewise, pre-treatment Cobb angle showed a significant OR 1.3(CI 1.2-1.4) per degree increase in Cobb, whereas in-brace % correction showed OR 0.96 (CI 0.93-0.98). C-DAR is an independent predictor for progression to a surgical magnitude in AIS patients treated with bracing. Patients with a higher C-DAR should be counseled to help set realistic expectations regarding the likelihood of curve progression despite compliance with brace wear.

REPRODUCTIVE HEALTH IN TRANS AND GENDER-DIVERSE PATIENTS: Psychosocial counseling of transgender and gender-diverse individuals in fertility and reproductive medicine: a narrative review.

Transgender and gender-diverse (TGD) people have similar desires for parenting as cisgender individuals but are likely to face greater barriers in accessing fertility treatment than their cisgender peers. Mental health professionals are well-positioned to advocate for and support TGD individuals seeking fertility care through pre-fertility treatment implications counseling regarding the psychosocial aspects of fertility treatment and family building. Transgender and gender-diverse (TGD) individuals experience significantly greater all-cause mortality and mental health disparities compared to their cisgender peers. Gender-affirming hormone therapy (GAHT) is a safe and effective treatment option for gender dysphoria that dramatically improves psychosocial health outcomes but may adversely impact fertility. Medical society guidelines recommend medical fertility preservation (FP) counseling and pre-fertility treatment psychoeducational implications consultation from qualified, reproductive mental health professionals (MHPs) for TGD individuals pursuing FP or third-party reproductive treatment. However, sparse literature exists specific to the structure of mental health psychoeducational consultation for TGD individuals pursuing FP. This narrative review highlights important areas for discussion in pre-fertility treatment mental health consultations. Results indicate that implications counseling should be conducted by an MHP with specialized training in reproductive mental health with TGD populations to reduce the risk of harm and promote successful emotional navigation of fertility treatment. Such counseling should be psychoeducational and not gatekeeping in nature and may include consideration of the psychosocial (e.g. emotional, relational, ethical, spiritual, social) risks and benefits of various family-building options. During these consultations, TGD individuals can explore their hopes and fears related to fertility and future family-building plans and discuss realistic treatment expectations, individual strengths, coping and communication strategies, and identify key support network members who may aid in navigating the fertility treatment process. MHPs can provide referrals to appropriate resources if necessary to help TGD individuals navigate treatment while coping with psychological symptoms and promoting behavior change.

Aetiology of patient dissatisfaction following primary total knee arthroplasty in the era of robotic-assisted technology.

Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction. This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups. Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023). Multivariate analysis revealed preoperative opioid use (p = 0.012), prior ACL reconstruction (p = 0.038), male sex (p = 0.006), and preoperative psychotropic medication use (p = 0.001) as independent predictive factors of patient dissatisfaction. The use of RA-TKA demonstrated a high rate of patient satisfaction (629 of 674, 93.3%). Demographics for patients not satisfied following RA-TKA included: male sex, chronic opioid use, chronic psychotropic medication use, and prior ACL reconstruction. Patients in these groups should be identified preoperatively and educated on realistic expectations given their comorbid conditions.